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Hung TY, Phuong LK, Grobler A, Tong SYC, Freeth P, Pelenda A, Gibney KB, Steer AC. Antibiotics to eradicate Streptococcus pyogenes pharyngeal carriage in asymptomatic children and adults: A systematic review. J Infect 2024; 88:106104. [PMID: 38360357 DOI: 10.1016/j.jinf.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/14/2024] [Indexed: 02/17/2024]
Abstract
Streptococcus pyogenes (S. pyogenes) is a Gram-positive bacteria which causes a spectrum of diseases ranging from asymptomatic infection to life-threatening sepsis. Studies report up to 2000 times greater risk of invasive S. pyogenes disease in close contacts of index cases within 30-days of symptom onset. Despite this, there is variability in the management of asymptomatic carriage of S. pyogenes and those at risk of secondary cases of invasive S. pyogenes infection. OBJECTIVE Our systematic review assessed the efficacy of different antibiotic regimens used for eradication of S. pyogenes from the pharynx in asymptomatic individuals. METHODS We searched Pubmed, EMBASE (1974-), OVID Medline (1948-) and the Cochrane CENTRAL registry. We included randomised controlled trials (RCTs) with asymptomatic participants with >50% with pharyngeal cultures positive with S. pyogenes at baseline. Only studies with microbiological methods including culture (+/- polymerase chain reaction, PCR) were included. We included studies published in English. Each included study was assessed by two independent reviewers for data extraction and risk of bias. RESULTS Of 1166 unique records identified, three RCTs were included in the review. Two of the three included RCTs found oral clindamycin for 10-days was the most efficacious regimen, compared to intramuscular benzathine penicillin G followed by 4 days of oral rifampicin, or monotherapy using benzathine penicillin, phenoxymethylpenicillin or erythromycin. Two RCTs were assessed as being at high risk of bias, with the third study demonstrating low/some risk of bias. CONCLUSIONS Current available evidence for the optimal antibiotic in eradicating pharyngeal S. pyogenes carriage is limited. Future RCTs should include penicillin, first-generation cephalosporins, rifampicin, macrolides (such as azithromycin) and clindamycin.
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Affiliation(s)
- Te-Yu Hung
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Paediatrics, Royal Darwin Hospital, Top End Health Service, Northern Territory, Australia.
| | - Linny K Phuong
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia; Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anneke Grobler
- Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Pippin Freeth
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Asika Pelenda
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Katherine B Gibney
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Andrew C Steer
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia; Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Hung TY, Wu SN, Huang CW. Safinamide, an inhibitor of monoamine oxidase, modulates the magnitude, gating, and hysteresis of sodium ion current. BMC Pharmacol Toxicol 2024; 25:17. [PMID: 38331833 PMCID: PMC10851555 DOI: 10.1186/s40360-024-00739-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Safinamide (SAF), an α-aminoamide derivative and a selective, reversible monoamine oxidase (MAO)-B inhibitor, has both dopaminergic and nondopaminergic (glutamatergic) properties. Several studies have explored the potential of SAF against various neurological disorders; however, to what extent SAF modulates the magnitude, gating, and voltage-dependent hysteresis [Hys(V)] of ionic currents remains unknown. METHODS With the aid of patch-clamp technology, we investigated the effects of SAF on voltage-gated sodium ion (NaV) channels in pituitary GH3 cells. RESULTS SAF concentration-dependently stimulated the transient (peak) and late (sustained) components of voltage-gated sodium ion current (INa) in pituitary GH3 cells. The conductance-voltage relationship of transient INa [INa(T)] was shifted to more negative potentials with the SAF presence; however, the steady-state inactivation curve of INa(T) was shifted in a rightward direction in its existence. SAF increased the decaying time constant of INa(T) induced by a train of depolarizing stimuli. Notably, subsequent addition of ranolazine or mirogabalin reversed the SAF-induced increase in the decaying time constant. SAF also increased the magnitude of window INa induced by an ascending ramp voltage Vramp. Furthermore, SAF enhanced the Hys(V) behavior of persistent INa induced by an upright isosceles-triangular Vramp. Single-channel cell-attached recordings indicated SAF effectively increased the open-state probability of NaV channels. Molecular docking revealed SAF interacts with both MAO and NaV channels. CONCLUSION SAF may interact directly with NaV channels in pituitary neuroendocrine cells, modulating membrane excitability.
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Sheng-Nan Wu
- Department of Physiology, National Cheng Kung University Medical College, Tainan, Taiwan.
- Institute of Basic Medical Sciences, National Cheng Kung University Medical College, Tainan, Taiwan.
- School of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Hung TY, Wu SN, Huang CW. Concerted suppressive effects of carisbamate, an anti-epileptic alkyl-carbamate drug, on voltage-gated Na + and hyperpolarization-activated cation currents. Front Cell Neurosci 2023; 17:1159067. [PMID: 37293624 PMCID: PMC10244622 DOI: 10.3389/fncel.2023.1159067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Carisbamate (CRS, RWJ-333369) is a new anti-seizure medication. It remains unclear whether and how CRS can perturb the magnitude and/or gating kinetics of membrane ionic currents, despite a few reports demonstrating its ability to suppress voltage-gated Na+ currents. In this study, we observed a set of whole-cell current recordings and found that CRS effectively suppressed the voltage-gated Na+ (INa) and hyperpolarization-activated cation currents (Ih) intrinsically in electrically excitable cells (GH3 cells). The effective IC50 values of CRS for the differential suppression of transient (INa(T)) and late INa (INa(L)) were 56.4 and 11.4 μM, respectively. However, CRS strongly decreased the strength (i.e., Δarea) of the nonlinear window component of INa (INa(W)), which was activated by a short ascending ramp voltage (Vramp); the subsequent addition of deltamethrin (DLT, 10 μM) counteracted the ability of CRS (100 μM, continuous exposure) to suppress INa(W). CRS strikingly decreased the decay time constant of INa(T) evoked during pulse train stimulation; however, the addition of telmisartan (10 μM) effectively attenuated the CRS (30 μM, continuous exposure)-mediated decrease in the decay time constant of the current. During continued exposure to deltamethrin (10 μM), known to be a pyrethroid insecticide, the addition of CRS resulted in differential suppression of the amplitudes of INa(T) and INa(L). The amplitude of Ih activated by a 2-s membrane hyperpolarization was diminished by CRS in a concentration-dependent manner, with an IC50 value of 38 μM. For Ih, CRS altered the steady-state I-V relationship and attenuated the strength of voltage-dependent hysteresis (Hys(V)) activated by an inverted isosceles-triangular Vramp. Moreover, the addition of oxaliplatin effectively reversed the CRS-mediated suppression of Hys(V). The predicted docking interaction between CRS and with a model of the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel or between CRS and the hNaV1.7 channel reflects the ability of CRS to bind to amino acid residues in HCN or hNaV1.7 channel via hydrogen bonds and hydrophobic interactions. These findings reveal the propensity of CRS to modify INa(T) and INa(L) differentially and to effectively suppress the magnitude of Ih. INa and Ih are thus potential targets of the actions of CRS in terms of modulating cellular excitability.
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Sheng-Nan Wu
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- College of Medicine, Institute of Basic Medical Sciences, National Cheng Kung University, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chong HYC, Hung TY, Hohls A, Francis JR, Chaturvedi S. Clinical characteristics of hospitalised children with acute post-streptococcal glomerulonephritis in the Top End of Australia. J Paediatr Child Health 2023; 59:735-742. [PMID: 36975716 DOI: 10.1111/jpc.16386] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 01/21/2023] [Accepted: 02/08/2023] [Indexed: 03/29/2023]
Abstract
AIMS Despite the declining incidence of acute post-streptococcal glomerulonephritis (APSGN) in Australia, there is still a significant burden of disease amongst Aboriginal and Torres Strait Islander people in the Northern Territory. Childhood APSGN has been highlighted as a predictor of chronic kidney disease in this population. We aimed to describe clinical characteristics and outcomes of hospitalised children with APSGN in the Northern Territory. METHODS Single-centre, retrospective cohort study of children (<18 years) with APSGN admitted to a tertiary hospital in the Top End of the Northern Territory between January 2012 and December 2017. Cases were confirmed using the Centre for Disease Control case definition guidelines. Data were extracted from the case notes and electronic medical records. RESULTS There were 96 cases of APSGN with median age of 7.1 years (interquartile range (IQR) 6.7-11.4). Majority were Aboriginal and Torres Strait Islander (90.6%) and from rural and remote areas (82.3%). Preceding skin infections were identified in 65.5% and sore throat in 27.1%. Severe complications included hypertensive emergencies (37.4%), acute kidney injury (43.8%) and nephrotic-range proteinuria (57.7%). All children improved from their acute illness with supportive medical therapy; however, only 55 out of 96 (57.3%) children were followed up within 12 months of their acute illness. CONCLUSIONS APSGN disproportionately affects Aboriginal and Torres Strait Islander children and highlights the need for continued and improved public health response. There is room for significant improvement in the medium- and long-term follow-up of affected children.
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Affiliation(s)
- Hae-Young C Chong
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Anja Hohls
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Swasti Chaturvedi
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Mahony M, Hung TY, Cox V, Sufyan W, Wallis P, Nizzero D, Francis J, Yan J. Complicated Mycobacterium ulcerans infection in a child in the Northern Territory. J Paediatr Child Health 2023; 59:392-394. [PMID: 36422163 DOI: 10.1111/jpc.16288] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Michelle Mahony
- Department of Paediatrics, Division of Women, Child and Youth Health, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Division of Women, Child and Youth Health, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Victoria Cox
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Global Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Wajiha Sufyan
- Anatomical Pathology, Territory Pathology, Darwin, Northern Territory, Australia
| | - Peter Wallis
- Department of Paediatrics, Division of Women, Child and Youth Health, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Danielle Nizzero
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joshua Francis
- Department of Paediatrics, Division of Women, Child and Youth Health, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Global Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Jennifer Yan
- Department of Paediatrics, Division of Women, Child and Youth Health, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Global Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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Hung TY, Coates E, McAlpine A, Tam J, Goldfarb DM, McDonald PJ, Zelman M, Halverson M, Seaton C. Cephalohaematoma: Not always a benign bump. J Paediatr Child Health 2022; 58:1094-1096. [PMID: 34672403 DOI: 10.1111/jpc.15769] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Te-Yu Hung
- Division of Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin Coates
- Division of General Pediatrics, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alastair McAlpine
- Division of Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Tam
- Division of Infectious Diseases, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Patrick J McDonald
- Division of Neurosurgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mitchell Zelman
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Halverson
- Department of Radiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Claire Seaton
- Division of General Pediatrics, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Murad Y, Hung TY, Sadarangani M, Morris SK, Le Saux N, Vanderkooi OG, Kellner JD, Tyrrell GJ, Martin I, Demczuk W, Halperin SA, Bettinger JA. Clinical Presentations and Outcomes of Children in Canada With Recurrent Invasive Pneumococcal Disease From the IMPACT Surveillance Network. Pediatr Infect Dis J 2022; 41:e166-e171. [PMID: 35093996 PMCID: PMC8920017 DOI: 10.1097/inf.0000000000003454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasive pneumococcal disease due to Streptococcus pneumoniae can cause mortality and severe morbidity due to sepsis, meningitis and pneumonia, particularly in young children and the elderly. Recurrent invasive pneumococcal disease is rare yet serious sequelae of invasive pneumococcal disease that is associated with the immunocompromised and leads to a high mortality rate. METHOD This retrospective study reviewed recurrent invasive pneumococcal disease cases from the Canadian Immunization Monitoring Program, ACTive (IMPACT) between 1991 and 2019, an active network for surveillance of vaccine-preventable diseases and adverse events following immunization for children ages 0-16 years. Data were collected from 12 pediatric tertiary care hospitals across all 3 eras of public pneumococcal conjugate vaccine implementation in Canada. RESULTS The survival rate within our cohort of 180 recurrent invasive pneumococcal disease cases was 98.3%. A decrease of 26.4% in recurrent invasive pneumococcal disease due to vaccine serotypes was observed with pneumococcal vaccine introduction. There was also a 69.0% increase in the rate of vaccination in children with preexisting medical conditions compared with their healthy peers. CONCLUSION The decrease in recurrent invasive pneumococcal disease due to vaccine-covered serotypes has been offset by an increase of non-vaccine serotypes in this sample of Canadian children.
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Affiliation(s)
- Yousif Murad
- From the Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Te-Yu Hung
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Royal Darwin Hospital, Top End Health Service, Northern Territory, Australia
- Royal Melbourne Hospital, Doherty Institute for Infection Immunity, Victoria, Australia
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Nicole Le Saux
- Children’s Hospital of Eastern Ontario, Paediatric Infectious Disease, Ottawa, ON, Canada
| | - Otto G. Vanderkooi
- Departments of Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - James D. Kellner
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Gregory J. Tyrrell
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
- Alberta Precision Laboratories-Public Health, Edmonton, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - Scott A. Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, and Nova Scotia Health, Halifax, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Campbell AJ, Mowlaboccus S, Coombs GW, Daley DA, Al Yazidi LS, Phuong LK, Leung C, Best EJ, Webb RH, Voss L, Athan E, Britton PN, Bryant PA, Butters CT, Carapetis JR, Ching NS, Francis J, Hung TY, Nourse C, Ojaimi S, Tai A, Vasilunas N, McMullan B, Bowen AC, Blyth CC. Whole genome sequencing and molecular epidemiology of pediatric Staphylococcus aureus bacteremia. J Glob Antimicrob Resist 2022; 29:197-206. [PMID: 35342022 DOI: 10.1016/j.jgar.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The role Staphylococcus aureus antimicrobial resistance genes and toxins play in disease severity, management and outcome in childhood is an emerging field requiring further exploration. METHODS A prospective multi-site study of Australian and New Zealand children hospitalized with S. aureus bacteremia (SAB), occurred over 24-months (2017-2018). Whole genome sequencing (WGS) data was paired with clinical information from the ISAIAH cohort. RESULTS 353 SAB isolates were sequenced; 85% methicillin-susceptible S. aureus ([MSSA], 301/353); 15% methicillin-resistant S. aureus ([MRSA], 52/353). There were 92 sequence types (STs), most commonly; ST5 (18%) and ST30 (8%), grouped into 23 clonal complexes (CCs), most frequently CC5 (21%) and CC30 (12%). MSSA comprised the majority of healthcare-associated SAB (87%, 109/125), with principal clones CC15 (48%, 11/21) and CC8 (33%, 7/21). Panton Valentine Leukocidin (PVL)-positive SAB occurred in 22% (76/353); predominantly MSSA (59%, 45/76), community-onset (92%, 70/76) infections. For community-onset SAB, the only microbiological independent predictor of poor outcomes was PVL-positivity (aOR 2.6 [CI 1.0-6.2]). CONCLUSION From this WGS pediatric SAB data, we demonstrate the previously under-recognized role MSSA has in harboring genetic virulence and causing healthcare-associated infections. PVL-positivity was the only molecular independent predictor of poor outcomes in children. These findings underscore the need for further research to define the potential implications PVL-producing strains may have on approaches to S. aureus clinical management.
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Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute. Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
| | - Shakeel Mowlaboccus
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch; Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia; School of Biomedical Sciences, University of Western Australia, Nedlands
| | - Geoffrey W Coombs
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch; Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia
| | - Denise A Daley
- Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia; The Australian Group on Antimicrobial Resistance (AGAR)
| | - Laila S Al Yazidi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia; The Children's Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, NSW, Australia
| | - Linny K Phuong
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia; Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Leung
- Department of Paediatrics, Wagga Wagga Base Hospital, New South Wales, Australia
| | - Emma J Best
- Department of Paediatrics; Child and Youth Health, The University of Auckland; The National Immunisation Advisory Centre, The University of Auckland; Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Rachel H Webb
- Department of Paediatrics, Child and Youth Health, The University of Auckland; Department of Infectious Diseases Starship Children's Hospital, Auckland, New Zealand; Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand
| | - Lesley Voss
- Department of Paediatrics, Child and Youth Health, The University of Auckland; Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia
| | - Philip N Britton
- Sydney Medical School and Marie Bashir Institute, University of Sydney, NSW, Australia; Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Coen T Butters
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia; Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jonathan R Carapetis
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia; University of Western Australia. School of Medicine, Perth, Western Australia
| | - Natasha S Ching
- Infection and Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia; Department of General Paediatrics, Monash Children's Hospital, Monash Health, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Australia
| | - Joshua Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Clare Nourse
- Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Australia
| | - Samar Ojaimi
- Infection & Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Australia; Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Alex Tai
- Department of Infectious Disease, Barwon Health, Geelong, Australia
| | - Nan Vasilunas
- Infectious Diseases Department, Women's and Children's Hospital, Adelaide
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute; School of Medicine, University of Western Australia, Subiaco; Menzies School of Health Research, Charles Darwin Hospital, Darwin, NT
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia; Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia
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9
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Olijve L, Amarasena L, Best E, Blyth C, van den Boom M, Bowen A, Bryant PA, Buttery J, Dobinson HC, Davis J, Francis J, Goldsmith H, Griffiths E, Hung TY, Huynh J, Kesson A, Meehan A, McMullan B, Nourse C, Palasanthiran P, Penumarthy R, Pilkington K, Searle J, Stephenson A, Webb R, Williman J, Walls T. The role of Kingella kingae in pre-school aged children with bone and joint infections. J Infect 2021; 83:321-331. [PMID: 34265316 DOI: 10.1016/j.jinf.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections. METHODS Information about children 3-60 months of age who were hospitalized with an OAI to 11 different hospitals across Australia and New Zealand between January 2012 and December 2016 was collected retrospectively. RESULTS A total of 907 cases (73%) were included. Blood cultures grew a likely pathogen in only 18% (140/781). The peak age of presentation was 12 to 24 months (466/907, 51%) and Kingella kingae was the most frequently detected microorganism in this age group (60/466, 13%). In the majority of cases, no microorganism was detected (517/907, 57%). Addition of PCR to culture increased detection rates of K. kingae. However, PCR was performed infrequently (63/907, 7%). CONCLUSIONS This large multi-national study highlights the need for more widespread use of molecular diagnostic techniques for accurate microbiological diagnosis of OAI in pre-school aged children. The data from this study supports the hypothesis that a substantial proportion of pre-school aged children with OAI and no organism identified may in fact have undiagnosed K. kingae infection. Improved detection of Kingella cases is likely to reduce the average length of antimicrobial treatment.
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Affiliation(s)
- Laudi Olijve
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand; Sheffield Teaching Hospitals, UK; Sydney Children's Hospital Randwick, 61 High Street, Randwick, NSW 2031, Australia
| | - Lahiru Amarasena
- Department of Paediatrics; Child and Youth Health, National Immunisation Advisory Centre, The University of Auckland, New Zealand
| | - Emma Best
- Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Australia
| | - Christopher Blyth
- School of Medicine, University of Western Australia, Australia; School of Medicine, University of Western Australia, Australia; Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Australia; Department of Paediatrics, Christchurch Hospital, Canterbury District Health Board, University of Otago, PO Box 4345, Christchurch Mail Centre, Christchurch 8140, New Zealand
| | - Mirjam van den Boom
- Starship Children's Hospital, Auckland, New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Asha Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; National Health and Medical Research Council, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Australia; Menzies School of Health Research, Charles Darwin University, Australia; Institute for Health Research, The University of Notre Dame Australia, Australia; Dept of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infection, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Infection and Immunity, Monash Children's Hospital, Australia
| | - Jim Buttery
- Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Wellington Regional Hospital, Capital and Coast District Health Board, Department of Paediatrics and Child Health, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Hazel C Dobinson
- Global Health Division, Menzies School of Health Research, Darwin, Australia
| | - Joshua Davis
- Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; John Hunter Children's Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Heidi Goldsmith
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Australia
| | - Elle Griffiths
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi 0810, Northern Territory, Australia
| | - Te-Yu Hung
- Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Australia
| | - Julie Huynh
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; Centre for tropical medicine, 764 Vo Van Kiet, District 5 Ho Chi Minh City, Viet Nam; Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Locked Bag 4001, Westmead 2145, Australia
| | - Alison Kesson
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; The Marie Bashir Institute of Infectious Diseases and Biosecurrity, University of Sydney, Australia; Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Andrea Meehan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, Randwick, NSW 2031, Australia
| | - Brendan McMullan
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Queensland Children's Hospital, Children's Health Queensland, Level 12, South Brisbane, QLD 4101, Australia
| | - Clare Nourse
- Faculty of Medicine, University of Queensland, Australia; Faculty of Medicine, University of Queensland, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Randwick, High Street, Randwick, NSW 2031, Australia
| | - Pamela Palasanthiran
- University of New South Wales, UNSW, Kensington, NSW, Australia; University of New South Wales, UNSW, Kensington, NSW, Australia; Counties manukau district health board, Middlemore Hospital, 100 hospital road, Otahuhu 2025, Auckland, New Zealand
| | - Rushi Penumarthy
- Monash Children's Hospital, Monash Health, 101/71 Abinger Street, Richmond, VIC 3121, Australia
| | - Katie Pilkington
- Department of Paediatrics, the University of Melbourne, Australia; Department of Paediatrics, the University of Melbourne, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, 50 Flemington Road, Melbourne 3052, Australia
| | - Janine Searle
- Starship Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Anya Stephenson
- University of Auckland, Middlemore Hospital, 100 hospital road, Otahuhu, 2025 Auckland, New Zealand
| | - Rachel Webb
- Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Biostatistics and Computation Biology Unit, University of Otago, 2 Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Jonathan Williman
- Department of Paediatrics, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand.
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10
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Campbell AJ, Al Yazidi LS, Phuong LK, Leung C, Best EJ, Webb RH, Voss L, Athan E, Britton PN, Bryant PA, Butters CT, Carapetis JR, Ching NS, Coombs GW, Daley D, Francis J, Hung TY, Mowlaboccus S, Nourse C, Ojaimi S, Tai A, Vasilunas N, McMullan B, Blyth CC, Bowen AC. Pediatric Staphylococcus aureus bacteremia: clinical spectrum and predictors of poor outcome. Clin Infect Dis 2021; 74:604-613. [PMID: 34089594 DOI: 10.1093/cid/ciab510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology, and predictors of poor outcome remain inadequately defined in childhood. METHODS ISAIAH is a prospective, cross-sectional study of S. aureus bacteremia (SAB), in children hospitalized in Australia and New Zealand, over 24-months (2017-2018). RESULTS Overall, 552 SABs were identified, (incidence 4.4/100,000/yr [95% confidence interval (CI) 2.2-8.8]), with methicillin-susceptible (84%), community onset (78%) infection predominating. Indigenous children (8.1/100,000/yr [CI 4.8-14.4]), those from lower-socioeconomic areas (5.5/100,000/yr [CI 2.8-10.2]) and neonates (6.6/100,000/yr (CI 3.4-11.7) were over-represented. Although 90-day mortality was infrequent, one-third experienced the composite of: length of stay >30 days (26%), ICU admission (20%), relapse (4%), or death (3%).Predictors of mortality included prematurity (aOR 16.8 [CI 1.6-296.9]), multifocal infection (aOR 22.6 [CI 1.4-498.5]), necrotizing pneumonia (aOR 38.9 [CI 1.7 - 1754.6]), multiorgan dysfunction (aOR 26.5 [CI 4.1-268.8]) and empiric-vancomycin (aOR 15.7 [CI 1.6-434.4]); whilst Infectious Diseases (ID) consultation (aOR 0.07 [CI 0.004-0.9]) was protective. Neither MRSA nor vancomycin trough-targets impacted survival; however, empiric-vancomycin was associated with significant nephrotoxicity (OR 3.1 [CI 1.3-8.1]). CONCLUSIONS High SAB incidence was demonstrated, with at-risk populations identified for future prioritized care. For the first time in a pediatric setting, necrotizing pneumonia and multifocal infection were predictors of mortality, whilst ID consultation was protective. The need to re-evaluate pediatric vancomycin trough-targets and limit unnecessary empiric-vancomycin exposure, to reduce poor outcomes and nephrotoxicity is highlighted. One in three children experienced considerable SAB morbidity, therefore pediatric inclusion in future SAB comparator trials is paramount to improve outcomes.
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Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Laila S Al Yazidi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,The Children's Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, NSW, Australia
| | - Linny K Phuong
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia.,Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Leung
- Department of Paediatrics, Wagga Wagga Base Hospital, New South Wales, Australia
| | - Emma J Best
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,The National Immunisation Advisory Centre, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Rachel H Webb
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand
| | - Lesley Voss
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Geelong, Australia
| | - Philip N Britton
- Sydney Medical School and Marie Bashir Institute, University of Sydney, NSW, Australia.,Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Coen T Butters
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jonathan R Carapetis
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia.,University of Western Australia. School of Medicine, Perth, Western, Australia
| | - Natasha S Ching
- Department of General Paediatrics, Monash Children's Hospital, Monash Health, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - Geoffrey W Coombs
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia.,Antimicrobial Resistance and Infectious Diseases Research (AMRID) Laboratory, Murdoch University, Perth, Western Australia
| | - Denise Daley
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia.,The Australian Group on Antimicrobial Resistance (AGAR)
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Doherty Institute of Infection and Immunity, The Royal Melbourne Hospital, The University of Melbourne
| | - Shakeel Mowlaboccus
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch.,School of Biomedical Sciences, University of Western Australia, Nedlands
| | - Clare Nourse
- Queensland Children's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Australia
| | - Samar Ojaimi
- Infection & Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.,Department of Pediatrics, Monash University, Clayton, Australia
| | - Alex Tai
- Department of Infectious Disease, Barwon Health, Geelong, Australia
| | - Nan Vasilunas
- Infectious Diseases Department, Women's and Children's Hospital, Adelaide
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia.,National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia.,Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute.,School of Medicine, University of Western Australia, Subiaco.,Menzies School of Health Research, Charles Darwin Hospital, Darwin, NT
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11
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Hung TY, Chan KC, Ma LJ. Overused laboratory test of haemoglobin A 1c at one medical centre in southern Taiwan. Int J Clin Pract 2021; 75:e14006. [PMID: 33400399 DOI: 10.1111/ijcp.14006] [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] [Received: 07/13/2020] [Accepted: 01/03/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS To investigate overused laboratory test of haemoglobin Ac1 (HbA1c) in one medicine centre in southern Taiwan. METHODS Data were extracted from the database of the Medical Center from March 2013 to March 2015. These patients were classified into five groups, including group A (diabetic patients with HbA1c value ≥7), group B (healthy people with HbA1c value ≥7), group C (diabetic patients with HbA1c test value <7), group D (healthy people with HbA1c value <6.5) and group E (prediabetic people with HbA1c value 6.5-7). The divisions requested for HbA1c test were divided into four categories, including endocrinology, internal medicine, surgery and the others. Repeat testing at the time of the second test was investigated using survival analysis. RESULTS The percentage of overall inappropriate repeat testing was as high as 34%. The percentages among the five patient groups were relatively different. Group C had the largest percentage of inappropriate repeat testing (48%) and group A had the second largest (30%), followed by groups D (25%), E (13%) and B (10%). The percentages of inappropriate repeat testing of the five patient groups were also relatively different among the four categories of division, with Kaplan-Meier curves showing significant differences. The time to repeat testing was the shortest for group A and was the second shortest for group C, followed by groups B, E and D. CONCLUSIONS The results provided detailed information about the percentages of inappropriate repeat testing of HbA1c of the five patient groups among the four categories of division.
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kun-Chen Chan
- Division of Clinical Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Li-Jung Ma
- Division of Clinical Pathology, Department of Pathology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
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12
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Hung TY, Wu SN, Huang CW. The Integrated Effects of Brivaracetam, a Selective Analog of Levetiracetam, on Ionic Currents and Neuronal Excitability. Biomedicines 2021; 9:biomedicines9040369. [PMID: 33916190 PMCID: PMC8067033 DOI: 10.3390/biomedicines9040369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 12/22/2022] Open
Abstract
Brivaracetam (BRV) is recognized as a novel third-generation antiepileptic drug approved for the treatment of epilepsy. Emerging evidence has demonstrated that it has potentially better efficacy and tolerability than its analog, Levetiracetam (LEV). This, however, cannot be explained by their common synaptic vesicle-binding mechanism. Whether BRV can affect different ionic currents and concert these effects to alter neuronal excitability remains unclear. With the aid of patch clamp technology, we found that BRV concentration dependently inhibited the depolarization-induced M-type K+ current (IK(M)), decreased the delayed-rectifier K+ current (IK(DR)), and decreased the hyperpolarization-activated cation current in GH3 neurons. However, it had a concentration-dependent inhibition on voltage-gated Na+ current (INa). Under an inside-out patch configuration, a bath application of BRV increased the open probability of large-conductance Ca2+-activated K+ channels. Furthermore, in mHippoE-14 hippocampal neurons, the whole-cell INa was effectively depressed by BRV. In simulated modeling of hippocampal neurons, BRV was observed to reduce the firing of the action potentials (APs) concurrently with decreases in the AP amplitude. In animal models, BRV ameliorated acute seizures in both OD-1 and lithium-pilocarpine epilepsy models. However, LEV had effects in the latter only. Collectively, our study demonstrated BRV’s multiple ionic mechanism in electrically excitable cells and a potential concerted effect on neuronal excitability and hyperexcitability disorders.
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Sheng-Nan Wu
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (S.-N.W.); (C.-W.H.)
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (S.-N.W.); (C.-W.H.)
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13
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Hung TY, Huang CW, Wu SN. High ability of zileuton ((±)-1-(1-benzo[b]thien-2-ylethyl)-1-hydroxyurea) to stimulate I K(Ca) but suppress I K(DR) and I K(M) independently of 5-lipoxygenase inhibition. Eur J Pharmacol 2020; 887:173482. [PMID: 32795513 DOI: 10.1016/j.ejphar.2020.173482] [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: 04/02/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/16/2022]
Abstract
Zileuton (Zyflo®) is regarded to be an inhibitor of 5-lipoxygenase. Although its effect on Ca2+-activated K+ currents has been reported, its overall ionic effects on neurons are uncertain. In whole-cell current recordings, zileuton increased the amplitude of Ca2+-activated K+ currents with an EC50 of 3.2 μM in pituitary GH3 lactotrophs. Furthermore, zileuton decreased the amplitudes of both delayed-rectifier K+ current (IK(DR)) and M-type K+ current (IK(M)). Conversely, no modification of hyperpolarization-activated cation current (Ih) was demonstrated in its presence of zileuton, although the subsequent addition of cilobradine effectively suppressed the current. In inside-out current recordings, the addition of zileuton to the bath increased the probability of large-conductance Ca2+-activated K+ (BKCa) channels; however, the subsequent addition of GAL-021 effectively reversed the stimulation of channel activity. The kinetic analyses showed an evident shortening in the slow component of mean closed time of BKCa channels in the presence of zileuton, with minimal change in mean open time or that in the fast component of mean closed time. The elevation of BKCa channels caused by zileuton was also observed in hippocampal mHippoE-14 neurons, without any modification of single-channel amplitude. In conclusion, except for its suppression of 5-lipoxygenase, our results indicate that zileuton does not exclusively act on BKCa channels, and its inhibitory effects on IK(DR) and IK(M) may combine to exert strong influence on the functional activities of electrically excitable cells in vivo.
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Sheng-Nan Wu
- Department of Physiology, National Cheng Kung University Medical College, Tainan, Taiwan; Institute of Basic Medical Sciences, National Cheng Kung University Medical College, Tainan, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City, Taiwan.
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14
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Hung TY, Taylor B, Lim A, Baird R, Francis JR, Lynar S. Skin and soft tissue infection caused by Basidiobolus spp. in Australia. IDCases 2020; 20:e00731. [PMID: 32215254 PMCID: PMC7090362 DOI: 10.1016/j.idcr.2020.e00731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/01/2019] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 11/30/2022] Open
Abstract
Fungi from the order Entomophthorales are rare but well recognized cause of tropical fungal infection, typically causing subcutaneous truncal or limb lesions in immunocompetent hosts. They may also mimic malignancy by causing intrabdominal mass, sometimes resulting in obstructive gastrointestinal or renal presentations. A 4-year-old female presented with a progressively growing abdominal wall lesion over several months, developing into acute inflammation of the abdominal wall with systemic symptoms. She underwent surgical debridement and fungal culture of subcutaneous tissue was positive for Basidiobolus spp with characteristic histopathological findings. Treatment with voriconazole followed by itraconazole over a total duration of 6 weeks led to complete resolution. Basidiobolus spp is an unusual cause of infection with characteristic mycological and histopathological findings. Infection can present in a number of ways ranging from a slow-growing mass in the subcutaneous soft tissue to an invasive mass in the gastrointestinal tract. Identification of its unique beak-like zygospore and Splendore-Hoeppli phenomenon on histopathological specimens can be pathognomonic and could provide the key to early diagnosis. Review of the literature found that timely diagnosis and commencement of antifungal therapy can be curative with or without surgical treatment. Considering the rarity of this tropical infection, this case provides the opportunity for revision of the typical presentations and diagnostic findings of Basidiobolus spp. With early recognition and suitable treatment, outcomes are generally favorable.
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Affiliation(s)
- Te-Yu Hung
- Department of Microbiology, Territory Pathology, Royal Darwin Hospital, 105 Rocklands Drive Tiwi, Northern Territory, 0810, Australia.,Department of Paediatrics, Royal Darwin Hospital, Northern Territory, 0810, Australia
| | - Brooke Taylor
- Department of Microbiology, Territory Pathology, Royal Darwin Hospital, 105 Rocklands Drive Tiwi, Northern Territory, 0810, Australia
| | - Aijye Lim
- Department of Anatomical Pathology, Territory Pathology, Royal Darwin Hospital, Tiwi, Northern Territory, 0810, Australia
| | - Robert Baird
- Department of Microbiology, Territory Pathology, Royal Darwin Hospital, 105 Rocklands Drive Tiwi, Northern Territory, 0810, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Northern Territory, 0810, Australia.,Menzies School of Health Research, Charles Darwin University, Northern Territory, 0810, Australia
| | - Sarah Lynar
- Department of Infectious Diseases, Royal Darwin Hospital, Northern Territory, 0810, Australia.,Menzies School of Health Research, Charles Darwin University, Northern Territory, 0810, Australia
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15
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Chen TS, Lai MC, Hung TY, Lin KM, Huang CW, Wu SN. Pioglitazone, a PPAR-γ Activator, Stimulates BK Ca but Suppresses IK M in Hippocampal Neurons. Front Pharmacol 2018; 9:977. [PMID: 30210346 PMCID: PMC6123368 DOI: 10.3389/fphar.2018.00977] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/14/2018] [Accepted: 08/08/2018] [Indexed: 12/29/2022] Open
Abstract
Pioglitazone (PIO), a thiazolidinedone, was reported to stimulate peroxisome proliferator-activated receptor-γ (PPAR-γ) with anti-inflammatory, anti-proliferative, anti-diabetic, and antidepressive activities. However, whether this compound exerts any perturbations on Ca2+-activated K+ and M-type K+ currents in central neurons remains largely unresolved. In this study, we investigated the effects of PIO on these potassium currents in hippocampal neurons (mHippoE-14). In whole-cell current recordings, the presence of PIO (10 μM) increased the amplitude of Ca2+-activated K+ current [IK(Ca)] in mHippoE-14 cells. PIO-induced stimulation of IK(Ca) observed in these cells was reversed by subsequent addition of paxilline, yet not by TRAM-39 or apamin. In inside-out current recordings, PIO applied to the bath concentration-dependently increased the activity of large-conductance Ca2+-activated K+ (BKCa) channels with an EC50 value of 7.6 μM. Its activation of BKCa channels in mHippoE-14 cells was voltage-dependent and accompanied by both a lengthening in mean open time and a shortening in slow component of mean closed time. The activation curve of BKCa channels after addition of PIO was shifted to less depolarized potential without any change in the gating charge. PIO also suppressed the amplitude of M-type K+ currents inherently in mHippoE-14 neurons. Taken together, in addition to its agonistic action on PPAR-γ, PIO-induced perturbation of these potassium channels may be responsible for its widely pharmacological actions on hippocampal neurons.
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Affiliation(s)
- Tsang-Shan Chen
- Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan
| | - Ming-Chi Lai
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kao-Min Lin
- Department of Pediatric Neurology, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Nan Wu
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Huang CW, Lin KM, Hung TY, Chuang YC, Wu SN. Multiple Actions of Rotenone, an Inhibitor of Mitochondrial Respiratory Chain, on Ionic Currents and Miniature End-Plate Potential in Mouse Hippocampal (mHippoE-14) Neurons. Cell Physiol Biochem 2018; 47:330-343. [PMID: 29768258 DOI: 10.1159/000489810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Rotenone (Rot) is known to suppress the activity of complex I in the mitochondrial chain reaction; however, whether this compound has effects on ion currents in neurons remains largely unexplored. METHODS With the aid of patch-clamp technology and simulation modeling, the effects of Rot on membrane ion currents present in mHippoE-14 cells were investigated. RESULTS Addition of Rot produced an inhibitory action on the peak amplitude of INa with an IC50 value of 39.3 µM; however, neither activation nor inactivation kinetics of INa was changed during cell exposure to this compound. Addition of Rot produced little or no modifications in the steady-state inactivation curve of INa. Rot increased the amplitude of Ca2+-activated Cl- current in response to membrane depolarization with an EC50 value of 35.4 µM; further addition of niflumic acid reversed Rot-mediated stimulation of this current. Moreover, when these cells were exposed to 10 µM Rot, a specific population of ATP-sensitive K+ channels with a single-channel conductance of 18.1 pS was measured, despite its inability to alter single-channel conductance. Under current clamp condition, the frequency of miniature end-plate potentials in mHippoE-14 cells was significantly raised in the presence of Rot (10 µM) with no changes in their amplitude and time course of rise and decay. In simulated model of hippocampal neurons incorporated with chemical autaptic connection, increased autaptic strength to mimic the action of Rot was noted to change the bursting pattern with emergence of subthreshold potentials. CONCLUSIONS The Rot effects presented herein might exert a significant action on functional activities of hippocampal neurons occurring in vivo.
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Affiliation(s)
- Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kao-Min Lin
- Department of Pediatric Neurology, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yao-Chung Chuang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Nan Wu
- Department of Physiology, National Cheng Kung University, College of Medicine, Tainan, Taiwan
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Lai MC, Hung TY, Lin KM, Sung PS, Wu SJ, Yang CS, Wu YJ, Tsai JJ, Wu SN, Huang CW. Sodium Metabisulfite: Effects on Ionic Currents and Excitotoxicity. Neurotox Res 2017; 34:1-15. [PMID: 29188487 DOI: 10.1007/s12640-017-9844-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/31/2022]
Abstract
How sodium metabisulfite (SMB; Na2S2O5), a popular food preservative and antioxidant, interacts with excitable membrane and induces excitotoxicity is incompletely understood. In this study, the patch-clamp technique was used to investigate and record the electrophysiological effect of SMB on electrically excitable HL-1 cardiomyocytes and NSC-34 neurons, as well as its relationship to pilocarpine-induced seizures and neuronal excitotoxicity in rats. We used Western blotting, to analyze sodium channel expression on hippocampi after chronic SMB treatment. It was found that voltage-gated Na+ current (I Na) was stimulated, and current inactivation and deactivation were slowed in SMB-treated (30 μM) HL-1 cardiomyocytes. SMB-induced increases of I Na were attenuated in cells treated with ranolazine (10 μM) or eugenol (30 μM). The current-voltage relationship of I Na shifted to slightly more negative potentials in SMB-treated cells, the peak I Na with an EC50 value of 18 μM increased, and the steady-state inactivation curve of I Na shifted to a more positive potential. However, the tail component of the rapidly activating delayed-rectifier K+ current (I Kr) was dose-dependently inhibited. Cell-attached voltage-clamp recordings in SMB-treated cells showed that the frequency of action currents and prolonged action potential were higher. In SMB-treated NSC-34 neurons, the peak I Na was higher; however, neither the time to peak nor the inactivation time constant (I Na) changed. Pilocarpine-induced seizures were exacerbated, and acute neuronal damage and chronic mossy fiber sprouting increased in SMB-treated rats. Western blotting showed higher expression of the sodium channel in cells after chronic SMB treatment. We conclude that SMB contributes to the sodium channel-activating mechanism through which it alters cellular excitability and excitotoxicity in wide-spectrum excitable cells.
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Affiliation(s)
- Ming-Chi Lai
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kao-Min Lin
- Department of Pediatric Neurology, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shyh-Jong Wu
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Sheng Yang
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Yi-Jen Wu
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Jane Tsai
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Nan Wu
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Hung TY, Kotecha RS, Blyth CC, Steed SK, Thornton RB, Ryan AL, Cole CH, Richmond PC. Immunogenicity and safety of single-dose, 13-valent pneumococcal conjugate vaccine in pediatric and adolescent oncology patients. Cancer 2017; 123:4215-4223. [PMID: 28696530 DOI: 10.1002/cncr.30764] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 09/11/2016] [Revised: 03/02/2017] [Accepted: 04/12/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Children receiving immunosuppressive treatment for cancer are at high risk for invasive pneumococcal disease. The 13-valent pneumococcal conjugate vaccine (PCV13) can prevent pneumococcal disease in healthy children; however, there is an absence of literature regarding the benefit of PCV13 in immunocompromised children with cancer. METHODS A prospective, open-label cohort study recruited children between ages 1 and 18 years who were receiving active immunosuppressive therapy (AIT) or were within 12 months after completing immunosuppressive therapy (CIT). Blood samples were taken before and 4 weeks after the administration of single-dose PCV13. Serotype-specific immunoglobulin G antibody titers were measured, and titers ≥0.35 μg/mL were considered protective. Solicited side effects were recorded in a 7-day diary after vaccination. RESULTS Eighty-five children were recruited. At baseline, ≤50% had protective antibody titers against Streptococcus pneumoniae for 10 serotypes in the AIT group and for 8 serotypes in the CIT group. Postvaccination, ≥70% had protective antibody titers for 9 and 11 serotypes in the AIT and CIT groups, respectively. Both groups had comparable responses to PCV7 serotypes, whereas a significantly higher proportion in the CIT group achieved protective antibody titers to PCV13 serotypes. There was a low rate of serious adverse events (3.5%). CONCLUSIONS A single-dose of PCV13 is safe and immunogenic in children diagnosed with cancer. All children who are receiving therapy for cancer should receive a single dose of PCV13 as soon as possible after diagnosis, regardless of prior PCV exposure. The current data support the recommendation for an additional dose of PCV13 after the completion of immunosuppressive therapy to provide additional protection against invasive pneumococcal disease. Cancer 2017;123:4215-4223. © 2017 American Cancer Society.
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Affiliation(s)
- Te-Yu Hung
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Rishi S Kotecha
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher C Blyth
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine WA, Perth, Western Australia, Australia.,Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Sarah K Steed
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Ruth B Thornton
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Anne L Ryan
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Catherine H Cole
- Department of Haematology and Oncology, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Peter C Richmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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Lin HJ, Hung TY, Hsieh YJ, Tsai JJ, Huang CW. Spontaneous and stimulus-induced rhythmic periodic or ictal discharges (SIRPIDs) with rhythmic eye blinking and ocular dipping in a post-anoxic comatose patient: a case report. Neurol Sci 2016; 37:2027-2030. [PMID: 27450096 DOI: 10.1007/s10072-016-2677-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Huan-Jan Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Te-Yu Hung
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yi-Jung Hsieh
- Department of Pediatrics, Chen Tso Yen Obstetrics and Gynecology Hospital, Tainan, Taiwan
| | - Jing-Jane Tsai
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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20
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Yeh PS, Wu SJ, Hung TY, Huang YM, Hsu CW, Sze CI, Hsieh YJ, Huang CW, Wu SN. Evidence for the Inhibition by Temozolomide, an Imidazotetrazine Family Alkylator, of Intermediate-Conductance Ca2+-Activated K+ Channels in Glioma Cells. Cell Physiol Biochem 2016; 38:1727-42. [DOI: 10.1159/000443112] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/19/2022] Open
Abstract
Background: Temozolomide (TMZ), an oral alkylator of the imidazotetrazine family, is used to treat glioma. Whether this drug has any ionic effects in glioma cells remains largely unclear. Methods: With the aid of patch-clamp technology, we investigated the effects of TMZ on the ionic currents in U373 glioma cells. The mRNA expression of KCNN4 (KCa3.1) in U373 glioma cells and TMZ's effect on K+ currents in these KCNN4 siRNA-transfected U373 cells were investigated. Results: In whole-cell recordings, TMZ decreased the amplitude of voltage-dependent K+ currents (IK) in U373 cells. TMZ-induced IK inhibition was reversed by ionomycin or 1-ethyl-2-benzimidazolinone (1-EBIO). In cell-attached configuration, TMZ concentration-dependently reduced the activity of intermediate-conductance Ca2+-activated K+ (IKCa) channels with an IC50 value of 9.2 µM. Chlorzoxazone or 1-EBIO counteracted the TMZ-induced inhibition of IKCa channels. Although TMZ was unable to modify single-channel conductance, its inhibition of IKCa channels was weakly voltage-dependent and accompanied by a significant prolongation in the slow component of mean closed time. However, neitherlarge-conductance Ca2+-activated (BKCa) nor inwardly rectifying K+ (Kir) channels were affected by TMZ. In current-clamp mode, TMZ depolarized the cell membrane and 1-EBIO reversed TMZ-induced depolarization. TMZ had no effect on IK in KCNN4 siRNA-transfected U373 cells. Conclusion: In addition to the DNA damage it does, its inhibitory effect on IKCa channels accompanied by membrane depolarization could be an important mechanism underlying TMZ-induced antineoplastic actions.
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Hung TY, Su YC. Increased risk of ischemic stroke in patients with burn injury: a nationwide cohort study in Taiwan. Crit Care 2015. [PMCID: PMC4471087 DOI: 10.1186/cc14550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tsai WH, Hwang YS, Hung TY, Weng SF, Lin SJ, Chang WT. Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants. Res Dev Disabil 2014; 35:1544-1550. [PMID: 24769371 DOI: 10.1016/j.ridd.2014.03.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ≦2, 3-14, ≧15 days). After adjusting for demographic and medical factors, the infants in the ≧15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50-4.59; p<0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02-3.76; p<0.05), than did infants in the ≦2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ≧15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants.
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Affiliation(s)
- Wen-Hui Tsai
- Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan 701, Taiwan; Division of Neonatology, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Yea-Shwu Hwang
- Department of Occupational Therapy, National Cheng Kung University College of Medicine, Tainan 701, Taiwan
| | - Te-Yu Hung
- Department of Pediatrics, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Shio-Jean Lin
- Department of Pediatrics, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Wen-Tsan Chang
- Department of Biochemistry and Molecular Biology, National Cheng Kung University College of Medicine, Tainan 701, Taiwan; Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan 701, Taiwan.
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23
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Huang CW, Hung TY, Liao YK, Hsu MC, Wu SN. Underlying mechanism of regulatory actions of diclofenac, a nonsteroidal anti-inflammatory agent, on neuronal potassium channels and firing: an experimental and theoretical study. J Physiol Pharmacol 2013; 64:269-280. [PMID: 23959723] [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] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/27/2013] [Indexed: 06/02/2023]
Abstract
Diclofenac (DIC), a nonsteroidal anti-inflammatory drug, is known to exert anti-nociceptive and anti-convulsant actions; however, its effects on ion currents, in neurons remain debatable. We aimed to investigate (1) potential effects of diclofenac on membrane potential and potassium currents in differentiated NSC-34 neuronal cells and dorsal root ganglion (DRG) neurons with whole-cell patch-clamp technology, and (2) firing of action potentials (APs), using a simulation model from hippocampal CA1 pyramidal neurons based on diclofenac's effects on potassium currents. In the NSC-34 cells, diclofenac exerted an inhibitory effect on delayed-rectifier K⁺ current (I(KDR)) with an IC₅₀ value of 73 μM. Diclofenac not merely inhibited the I(KDR) amplitude in response to membrane depolarization, but also accelerated the process of current inactivation. The inhibition by diclofenac of IK(DR) was not reversed by subsequent application of either naloxone. Importantly, diclofenac (300 μM) increased the amplitude of M-type K⁺ current (I)(KM)), while flupirtine (10 μM) or meclofenamic acid (10 μM) enhanced it effectively. Consistently, diclofenac (100 μM) increased the amplitude of I(KM) and diminished the I(KDR) amplitude, with a shortening of inactivation time constant in DRG neurons. Furthermore, by using the simulation modeling, we demonstrated the potential electrophysiological mechanisms underlying changes in AP firing caused by diclofenac. During the exposure to diclofenac, the actions on both I(KM) and I(KDR) could be potential mechanism through which it influences the excitability of fast-spiking neurons. Caution needs to be made in attributing the effects of diclofenac primarily to those produced by the activation of I(KM).
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Affiliation(s)
- C W Huang
- Department of Neurology, National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan City, Taiwan
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Chen BX, Hung TY, Jian RS, Lu CJ. A multidimensional micro gas chromatograph employing a parallel separation multi-column chip and stop-flow μGC × μGCs configuration. Lab Chip 2013; 13:1333-1341. [PMID: 23381092 DOI: 10.1039/c2lc41179b] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A dual-chip, multidimensional micro gas chromatographic module was designed, built and evaluated. Column chips were fabricated on a silicon wafer with an etched rectangular channel 100 μm (width) × 250 μm (depth) using a deep reactive ion etching (DRIE) process. The column chip for the first GC dimension was 3 m long and was coated with polydimethylsiloxane (DB-1) as the stationary phase. The columns on the second dimensional chip were etched with the same width and depth as the first chip, but the flow channel was split into three parallel columns, 1 m long, on the same sized silicon chip (i.e., 3 cm × 3 cm). These three parallel columns on the second chip were coated with polyethylene oxide (DB-Wax), trifluoropropylpolymethylsilicone (OV-210) and cyanopropylmethylphenylmethylpolysilicone (OV-225), accordingly, in order to provide diversified chromatographic retention. These two chips were connected via a stop-flow configuration to simultaneously generate multiple two-dimensional gas chromatograms for every analysis. This stop-flow μGC × μGCs design allowed the first column to function as a pre-separator and as a sequencing injector for the second parallel-separation chip. Fifteen volatile organic compounds with boiling points that ranged from 80-131 °C with various functional groups were tested using this μGC × μGCs module. Three discrete 2-D chromatograms were generated simultaneously, which demonstrated the advantages of simultaneously combining GC × GC with parallel separation GCs in microchip chromatography. The total traveling length in the column was only 4 m for each eluted peak and fully resolved separation was achieved through the cross reference among triplet 2-D chromatograms.
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Affiliation(s)
- Bo-Xun Chen
- Chemistry Department, National Taiwan Normal University, Ting-Chow Rd., Taipei, Taiwan
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Hung TY, Seow VK, Chong CF, Wang TL, Chen CC. Gabapentin toxicity: an important cause of altered consciousness in patients with uraemia. BMJ Case Rep 2009; 2009:bcr11.2008.1268. [PMID: 21686382 DOI: 10.1136/bcr.11.2008.1268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gabapentin toxicity should be considered one of the differential diagnoses of altered consciousness in patients with compromised renal function, even after a single dose. We report a 57-year-old woman with diabetes mellitus and uraemia on regular haemodialysis who developed severe dizziness and lethargy after a single recommended dose of gabapentin for bilateral leg dysthesia. Because of progressive drowsiness and decreasing level of consciousness, one session of haemodialysis was performed and clinical recovery was dramatic. The adverse effects of gabapentin seem to vary from person to person and should be viewed with a high degree of suspicion, especially in patients taking this drug at the beginning.
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Affiliation(s)
- T Y Hung
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Hung TY, Lin CC, Hwang YS, Lin SJ, Chou YY, Tsai WH. Relationship between umbilical cord blood insulin-like growth factors and anthropometry in term newborns. Acta Paediatr Taiwan 2008; 49:19-23. [PMID: 18581724] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Birth size is associated with long-term morbidity. Insulin-like growth factor (IGF) system is the most important endocrine factor influencing fetal growth. During rapid somatic growth, free-to-total IGF-I ratio is increased, resulting in higher IGF-I bioavailability. The purpose of this study was to investigate the association of free-to-total IGF-I ratios, IGF-II, and IGF-binding protein (IGFBP)-3 umbilical cord levels with anthropometric data of term neonates. METHODS Umbilical venous plasma samples were obtained from 95 term neonates and analyzed by enzyme-linked immunosorbent assay. RESULTS The large-for-gestational age (LGA) neonates had higher free IGF-I, total IGF-I, and IGFBP-3 levels than small-for-gestational age (SGA) neonates (P < 0.01, 0.001, 0.01, respectively) and higher total IGF-I and IGFBP-3 levels than appropriate-for-gestational age (AGA) neonates (P < 0.05, 0.01, respectively). The free-to-total IGF-I ratios and IGF-II levels were not different among SGA, AGA, and LGA neonates. Free IGF-I, total IGF-I, and IGFBP-3 levels were positively correlated with birth weight (r = 0.34, P < 0.001; r = 0.41, P < 0.001; r = 0.25, P < 0.05, respectively). Multiple linear regression analyses revealed that only total IGF-I levels was the independent predictive variable for birth weight. CONCLUSIONS Our data suggest total IGF-I is the most important factor in the IGF system for determining fetal growth, at least near term gestation. Free-to-total IGF-I ratios may mostly be determined by total IGF-I. If birth size is associated with adult chronic metabolic diseases, total IGF-I may be involved in the pathogenesis.
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi Mei Foundation Medical Center, Tainan County, Taiwan
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi-Mei Foundation Medical Center, Tainan, Taiwan
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Abstract
Undifferentiated (embryonal) sarcoma of the liver (UESL) is a rare hepatic tumor and mainly occurs in children. It usually has cystic changes on computed tomography scan, which represents areas of necrosis and hemorrhages. UESL is a rapidly growing tumor and tumor rupture does occur. We reported a girl with a large multicystic hepatic tumor who died of tumor rupture shortly after the diagnosis of UESL. It is mandatory to be aware of this potentially fatal complication especially in patients with UESL of large tumor volume.
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Affiliation(s)
- Te-Yu Hung
- Department of Pediatrics, Chi-Mei Foundation Medical Center, Liouying no. 201, Taikang Village, Liouying Township, Tainan County 736, Taiwan
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Hung TY, Wang LY, Chen CT, Chen TJ. Streptococcal toxic shock syndrome with initial manifestation of abdominal pain and cholecystitis. Acta Paediatr Taiwan 2005; 46:106-10. [PMID: 16302590] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Streptococcal toxic shock syndrome with the initial manifestation of abdominal pain and cholecystitis is rare. We report the case of a 10-year-old boy who presented with abdominal pain, cholecystitis and shock initially. Acute respiratory distress syndrome, renal and hepatic insufficiency and disseminated intravascular coagulation developed soon after admission. Skin rash and desquamation were found subsequently during the recovery phase. The blood and sputum cultures were sterile. Acute and convalescent plasma from the patient showed increased anti-streptolysin O titer (ASLO titer). Measurement of the ASLO titer on Day 11 after the onset of disease had an ASLO titer of 242 IU/ml (N Latex ASL, Dade Behring Marburg GmbH, USA), and the ASLO titer on Day 21 after the onset of disease showed an increase to 875 IU/ml. These clinical findings and the plasma analysis were consistent with streptococcal toxic shock syndrome.
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Affiliation(s)
- Te-Yu Hung
- Chi-Mei Foundation Medical Center, Department of Pediatrics, Yung-Kang City, Taiwan
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Abstract
Piperaquine is a bisquinoline antimalarial drug that was first synthesised in the 1960s, and used extensively in China and Indochina as prophylaxis and treatment during the next 20 years. A number of Chinese research groups documented that it was at least as effective as, and better tolerated than, chloroquine against falciparum and vivax malaria, but no pharmacokinetic characterisation was undertaken. With the development of piperaquine-resistant strains of Plasmodium falciparum and the emergence of the artemisinin derivatives, its use declined during the 1980s. However, during the next decade, piperaquine was rediscovered by Chinese scientists as one of a number of compounds suitable for combination with an artemisinin derivative. The rationale for such artemisinin combination therapies (ACTs) was to provide an inexpensive, short-course treatment regimen with a high cure rate and good tolerability that would reduce transmission and protect against the development of parasite resistance. This approach has now been endorsed by the WHO. Piperaquine-based ACT began as China-Vietnam 4 (CV4): dihydroartemisinin [DHA], trimethoprim, piperaquine phosphate and primaquine phosphate), which was followed by CV8 (the same components as CV4 but in increased quantities), Artecom (in which primaquine was omitted) and Artekin or Duo-Cotecxin (DHA and piperaquine phosphate only). Recent Indochinese studies have confirmed the excellent clinical efficacy of piperaquine-DHA combinations (28-day cure rates >95%), and have demonstrated that currently recommended regimens are not associated with significant cardiotoxicity or other adverse effects. The pharmacokinetic properties of piperaquine have also been characterised recently, revealing that it is a highly lipid-soluble drug with a large volume of distribution at steady state/bioavailability, long elimination half-life and a clearance that is markedly higher in children than in adults. The tolerability, efficacy, pharmacokinetic profile and low cost of piperaquine make it a promising partner drug for use as part of an ACT.
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Affiliation(s)
- Timothy M E Davis
- Medicine Unit Fremantle and Pharmacology Unit Nedlands, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
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Hung TY, Davis TME, Ilett KF, Karunajeewa H, Hewitt S, Denis MB, Lim C, Socheat D. Population pharmacokinetics of piperaquine in adults and children with uncomplicated falciparum or vivax malaria. Br J Clin Pharmacol 2004; 57:253-62. [PMID: 14998421 PMCID: PMC1884452 DOI: 10.1046/j.1365-2125.2003.02004.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.2] [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: 04/22/2003] [Accepted: 08/28/2003] [Indexed: 11/20/2022] Open
Abstract
AIMS To study the population pharmacokinetics of piperaquine after co-administration with dihydroartemisinin in uncomplicated malaria. METHODS The disposition of piperaquine was studied in 85 Cambodian patients with uncomplicated falciparum or vivax malaria treated with the piperaquine-dihydroartemisinin coformulation Artekin. All patients were given Artekin orally at 0, 6, 24 and 32 h with a total piperaquine dose of 32-35 mg base kg-1. Adults were given tablets while children received either tablets or a dispersible granule formulation. Patients underwent either intensive (17-19 samples) or sparse (2-5 samples) blood sampling schedules over 35 days and clinical/parasitological follow-up over > 28 days. Piperaquine in plasma was quantified by high performance liquid chromatography. RESULTS All patients achieved fever clearance within 24 h and parasite clearance within 72 h. The 28-day cure rate was 97% in adults and 98% in children. A covariate-free two-compartment population model with first-order absorption and elimination gave the most robust representation of the plasma concentration-time data in both adults and children. In adults (n = 38), the median (interquartile range) derived pharmacokinetic descriptors CL/F, Vss/F and t1/2,z were 0.9 l h-1 kg-1 (0.79-1.02 l h-1 kg-1), 574 l kg-1(371-711 l kg-1) and 23 days (19-28 days), respectively. In children (n = 47), corresponding values were 1.8 l h-1 kg-1 (1.29-2.3 l h-1 kg-1), 614 l kg-1 (332-1205 l kg-1) and 14 days (10-18 days), respectively. CONCLUSIONS Piperaquine is a highly lipid-soluble drug with a large Vss/F, long t1/2,z and a clearance that is markedly higher in children than in adults.
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Affiliation(s)
- Te-Yu Hung
- Medicine Unit (Fremantle Hospital) and Pharmacology Unit (Queen Elizabeth 2 Medical Centre), School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
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Karunajeewa H, Lim C, Hung TY, Ilett KF, Denis MB, Socheat D, Davis TME. Safety evaluation of fixed combination piperaquine plus dihydroartemisinin (Artekin) in Cambodian children and adults with malaria. Br J Clin Pharmacol 2004; 57:93-9. [PMID: 14678346 PMCID: PMC1884411 DOI: 10.1046/j.1365-2125.2003.01962.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [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: 04/25/2003] [Accepted: 07/29/2003] [Indexed: 01/27/2023] Open
Abstract
AIMS To assess the haemodynamic, electrocardiographic and glycaemic effects of piperaquine-dihydroartemisinin (Artekin) fixed combination therapy in uncomplicated malaria. METHODS Sixty-two Cambodians (32 children and 30 adults) with falciparum or vivax malaria were given Artekin given as four age-based oral doses over 32 h. Supine and erect blood pressure, the electrocardiographic QT interval and plasma glucose were measured before treatment and then at regular intervals during a 4-day admission period as part of efficacy and safety monitoring. QT intervals were rate-corrected (QTc) using Bazett's formula. RESULTS Artekin therapy was well tolerated and all patients responded to treatment. Average parasite and fever clearance times were 19 and 12 h, respectively. The pretreatment mean fall in systolic blood pressure on standing was 8 +/- 6 mmHg and 6-hourly measurements over 72 h showed no significant change (P = 0.48). There was a significant lengthening of the mean QTc to a maximum of 11 ms(0.5) (95% confidence interval 4-18 ms(0.5)) relative to baseline at 24 h (P = 0.003). The maximal QTc prolongation observed in any patient was 53 ms(0.5). There was a mean 0.4 mmol l(-1) reduction in the post-absorptive plasma glucose during the first 48 h but no episodes of hypoglycaemia (plasma glucose < 3.0 mmol l(-1)) were observed at any time. CONCLUSIONS Artekin is safe and effective combination therapy for uncomplicated malaria in children and adults. Although piperaquine is a long half-life drug related to other quinoline compounds including chloroquine and quinine, no clinically significant cardiovascular or metabolic effects were observed.
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Affiliation(s)
- Harin Karunajeewa
- Medicine Unit (Fremantle Hospital), School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia
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Hung TY, Davis TME, Ilett KF. Measurement of piperaquine in plasma by liquid chromatography with ultraviolet absorbance detection. J Chromatogr B Analyt Technol Biomed Life Sci 2003; 791:93-101. [PMID: 12798169 DOI: 10.1016/s1570-0232(03)00209-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Piperaquine (PQ) is an antimalarial drug enjoying a resurgence of use in combination with an artemisinin derivative because of parasite resistance to standard treatments. Its pharmacokinetic properties have not been characterised. An assay for PQ in plasma was developed using solvent extraction and liquid chromatographic separation on a Waters XTerra RP(18) column, with a mobile phase of 7% acetonitrile in water (containing 0.025% trifluoroacetic acid, 0.1% NaCl and 0.008% triethylamine) and UV detection at 340 nm. The assay was linear up to 1000 microg/l. Intra- and inter-day relative standard deviations were <10% (5-500 microg/l) and <21% (5-500 microg/l), respectively. Inter-day limits of quantitation and detection were 5 microg/l and 3 microg/l, respectively. A preliminary pharmacokinetic study in a patient who received 2.56 g of PQ phosphate orally with dihydroartemisinin as four doses over 32 h found an apparent steady-state volume of distribution of 447 l/kg, an apparent oral clearance 0.93 l/h/kg and a terminal half-life of 17.3 days.
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Affiliation(s)
- Te-Yu Hung
- School of Medicine and Pharmacology, The University of Western Australia, Crawley 6009, Australia
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Liu MC, Chen CM, Cheng HY, Chen HY, Su YC, Hung TY. Toxicity of different industrial effluents in Taiwan: a comparison of the sensitivity of Daphnia similis and Microtox. Environ Toxicol 2002; 17:93-97. [PMID: 11979586 DOI: 10.1002/tox.10036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Industrial effluents are known to exhibit toxicity toward different aquatic organisms. In Taiwan management of these discharges still relies on chemical and physical and physical characteristics of water, although various standard method for assessing aquatic toxicity have been proposed by the Taiwan Environmental Protection Administration. In this study we examined the toxicity and compared the sensitivity of different types of industrial effluents using two proposed toxicity tests: the Daphnia similis acute toxicity test and the Microtox acute assay (Vibrio fischeri). Results showed that electroplating effluents were the most toxic of all the effluents tested, followed by acrylonitrile manufacturing, pulp/paper, and tannery effluents. The EC50 of an electroplating effluent for D. similis and V. fischeri (15 min) was as low as, respectively, 2.9% and 3.9% of the whole effluent. The other effluents were not acutely toxic to either organism tested. However, the tests exhibited different sensitivity toward various discharges. Only the electroplating and acrylonitrile manufacturing effluents had effects on both organisms. These results indicate the importance of the incorporation of aquatic toxicity tests into the management scheme for treated wastewaters.
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Affiliation(s)
- M C Liu
- Department of Environmental Engineering and Health, Chia-Nan University of Pharmacy and Science, 60 Section 1, Er-Jen Road, Jen-Der, Tainan, Taiwan, Republic of China
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Abstract
Previous studies have shown that osteoclasts are derived from mononuclear cells of hemopoietic bone marrow and peripheral blood. The purpose of this study was to demonstrate the presence of multinucleated osteoclasts after adding alveolar mononuclear cells to new-born rat calvaria osteoblasts in vitro. To utilize osteoclast-free bone, fetal calvariae were obtained from newborn Wistar-rats and cultured in DMEM medium for 14 days. On the day of osteoblast culture, alveolar mononuclear cells were isolated from newborn Wistar rats with a serial washing method and then co-cultured with the calvarial osteoblasts. Bone resorption characteristics were observed both with light and scanning electron microscopy. When alveolar mononuclear cells were cultured for 14 days on the calvarial osteoblasts in response to 1 alpha, 25-dihydroxyvitamin D3, they formed tartrate-resistant acid phosphatase (TRAP)-positive mononuclear and multinucleated cells. Resorption pits were seen in the 7-14 days long-term cultures. These results indicate that osteoclasts can be derived from alveolar mononuclear cells in vitro when a suitable microenvironment is provided by calvarial osteoblasts and vitamin D(3).
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Affiliation(s)
- J S Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
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Abstract
Aseptic loosening after total joint arthroplasty is a major problem in orthopedic surgery. Small particles from material wear have been reported as the main cause of implant failure. For this reason, investigation into possible wear particles from the materials used in the implant may lead to longevity after arthroplasty. Hydroxyapatite (HA) has been extensively investigated and reported as an excellent biomaterial with excellent biocompatibility. In this study, we used an in vitro osteoblast/osteoclast model to test the biocompatibility of various-sized HA particles. Primary osteoclasts/osteoblasts were co-cultured with different-sized HA particles (0.5-3.0 microm, 37-53 microm, 177-205 microm, and 420-841 microm) for 3 h, 1 day, 3 days, and 7 days. Cellular responses to the HA particles were evaluated by changes in cell counts and the secretion of transforming growth factor (TGF-beta1), alkaline phosphatase (ALP), tumor necrosis factor (TNF-alpha), prostaglandin (PGE2), and lactate dehydrogenase (LDH) in the supernatant of the culture media. The results showed that osteoblasts/osteoclasts co-cultured with HA particles smaller than 53 microm undergo the most significant changes. Cellular counts significantly decreased, and the changes were more obvious in the osteoblast population. There also was a significant decrease in TGF-beta1 concentration and a significant increase in PGE2 and LDH concentration, but there were no changes in the TNF-alpha or ALP titer. It can be concluded that larger HA particles may be quite compatible with bone cells while smaller-sized HA particles can both activate the osteoclasts and decrease the cell population of the osteoblasts. Justification for the additional expense incurred with the use of hydroxyapatite in primary total hip arthroplasty should be further evaluated.
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Affiliation(s)
- J S Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Republic of China
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Hung TY, Litofsky NS, Smith TW, Megerian CA. Ganglionic hamartoma of the intracanalicular acoustic nerve causing sensorineural hearing loss. Am J Otol 1997; 18:498-500. [PMID: 9233492] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This article highlights the clinical presentation and treatment issues of ganglionic hamartoma of the internal auditory canal and emphasizes the similarity of this lesion to acoustic neuroma regarding its audiologic and radiographic characteristics. STUDY DESIGN This article is composed of case reports and a literature review. SETTING The study was performed at a university hospital/tertiary referral center. PATIENT A patient with biopsy-proven ganglionic hamartoma of the acoustic nerve was studied. INTERVENTION Intervention consisted of surgical therapy. MAIN OUTCOME MEASURE The main outcome measure was clinical evaluation. RESULTS The result was successful removal of lesions with facial nerve preservation. CONCLUSIONS An intracanalicular ganglionic hamartoma resulted in progressive sensorineural hearing loss and magnetic resonance imaging findings suggestive of small acoustic neuroma. This lesion, composed of an admixture of ganglion cells, fibroadipose-tissue, and normal myelinated axons, although rare, should be added to the differential diagnosis of internal auditory canal lesions.
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Affiliation(s)
- T Y Hung
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Medical School, Worcester, USA
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Hung TY, Su CS. Fused-silica focusing lens for deep UV laser processing. Appl Opt 1992; 31:4397-4404. [PMID: 20725434 DOI: 10.1364/ao.31.004397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A simple four-element fused-silica lens is presented that has a focal length of 31.2 mm and a relative aperture of f/1 for use as a focusing lens for deep UV laser processing. The curvature of the lens is designed with a practical design method to match the curvature of existing optical tools. By applying an 8.5-mm beam diameter Nd:YAG laser at a wavelength of 266 nm through the lens, we can easily achieve the percussion drilled into samples of 25-microm-thick tantalum foil with a hole diameter of <6 microm. When the lens and/or the sample is tilted, the shape of the drilled hole is in agreement with the Gaussian beam spot simulation.
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