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Tai YC, Wang W, Wells MT. Progression-Free Survival Analysis With a Graphical Estimand Approach in the Phase 2 SAMCO-PRODIGE 54 Trial. JAMA Oncol 2024; 10:539-540. [PMID: 38421658 DOI: 10.1001/jamaoncol.2024.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Yi-Cheng Tai
- Institute of Statistics, National Yang Ming Chiao Tung University, Taiwan, Republic of China
| | - Weijing Wang
- Institute of Statistics, National Yang Ming Chiao Tung University, Taiwan, Republic of China
| | - Martin T Wells
- Department of Statistics and Data Science, Cornell University, Ithaca, New York
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Tai YC, Wang W, Wells MT. Two-sample inference procedures under nonproportional hazards. Pharm Stat 2023; 22:1016-1030. [PMID: 37429738 DOI: 10.1002/pst.2324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023]
Abstract
We introduce a new two-sample inference procedure to assess the relative performance of two groups over time. Our model-free method does not assume proportional hazards, making it suitable for scenarios where nonproportional hazards may exist. Our procedure includes a diagnostic tau plot to identify changes in hazard timing and a formal inference procedure. The tau-based measures we develop are clinically meaningful and provide interpretable estimands to summarize the treatment effect over time. Our proposed statistic is a U-statistic and exhibits a martingale structure, allowing us to construct confidence intervals and perform hypothesis testing. Our approach is robust with respect to the censoring distribution. We also demonstrate how our method can be applied for sensitivity analysis in scenarios with missing tail information due to insufficient follow-up. Without censoring, Kendall's tau estimator we propose reduces to the Wilcoxon-Mann-Whitney statistic. We evaluate our method using simulations to compare its performance with the restricted mean survival time and log-rank statistics. We also apply our approach to data from several published oncology clinical trials where nonproportional hazards may exist.
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Affiliation(s)
- Yi-Cheng Tai
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsin-Chu City, Taiwan, ROC
| | - Weijing Wang
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsin-Chu City, Taiwan, ROC
| | - Martin T Wells
- Department of Statistics and Data Science, Cornell University, Ithaca, New York, USA
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Tai YC, Liao PH, Leta V, Lin CH, Chaudhuri KR. Irritable bowel syndrome based on Rome IV diagnostic criteria associates with non-motor symptoms of Parkinson's disease. Parkinsonism Relat Disord 2023; 113:105496. [PMID: 37385160 DOI: 10.1016/j.parkreldis.2023.105496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Recent concepts suggest that the neuropathological hallmark of Parkinson's disease (PD) may in part originate from the enteric nervous system. We evaluated the frequency of functional gastrointestinal disorders in PD patients using Rome IV criteria and correlated the clinical severity of PD. METHODS PD patients and matched controls were recruited between January 2020 and December 2021. Rome IV criteria were used to diagnose constipation and irritable bowel syndrome (IBS). Severity of PD motor symptoms was evaluated using UPDRS part III scores and non-motor symptoms using Non-motor Symptoms Scale (NMSS). RESULTS A total of 99 PD patients and 64 controls were enrolled. The prevalence of constipation (65.7% vs. 34.3%, P < 0.001) and IBS (18.1% vs 5%, P = 0.02) were significantly higher in PD patients than controls. The prevalence of IBS was higher in early-stage PD than advanced-stage PD (14.43% vs. 8.25%, P = 0.02), whereas constipation was more common in advanced stages (71.43% vs. 18.56%, P < 0.001). PD patients with IBS had higher NMSS total scores (P < 0.01) than those without IBS. The severity of IBS correlated with NMSS scores (r = 0.71, P < 0.001), especially subscores in domain 3 assessing mood disorders (r = 0.83, P < 0.001), but not UPDRS part III scores (r = 0.06, P = 0.45). The severity of constipation correlated with the UPDRS part III scores (r = 0.59, P < 0.001) but not the domain 3 mood subscores (r = 0.15, P = 0.07). CONCLUSION The prevalence of IBS and constipation was higher in PD patients than controls and phenotypic correlation supported the occurrence of IBS with higher non-motor symptom burden, especially mood symptoms, in PD patients.
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Affiliation(s)
- Yi-Cheng Tai
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | | | - Valentina Leta
- Parkinson Foundation International Centre of Excellence, Kings College Hospital, Institute of Psychiatry, Psychology and Neurosciences, Kings College, London, UK
| | - Chin-Hsien Lin
- School of Medicine, National Taiwan University, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; Institute of Molecular Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, Kings College Hospital, Institute of Psychiatry, Psychology and Neurosciences, Kings College, London, UK
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Chuang CS, Chen YW, Zeng BY, Hung CM, Tu YK, Tai YC, Wu YC, Hsu CW, Lei WT, Wu SL, Stubbs B, Carvalho AF, Su KP, Chen TY, Tseng PT, Wu MK, Tsai CH. Effects of modern technology (exergame and virtual reality)-assisted rehabilitation vs conventional rehabilitation in patients with Parkinson’s disease: a network meta-analysis of randomised controlled trials. Physiotherapy 2022; 117:35-42. [DOI: 10.1016/j.physio.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 06/04/2022] [Accepted: 07/12/2022] [Indexed: 01/08/2023]
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Chung LYR, Lin YT, Liu C, Tai YC, Lin HY, Lin CH, Chen CC. Neuroinflammation Upregulated Neuronal Toll-Like Receptors 2 and 4 to Drive Synucleinopathy in Neurodegeneration. Front Pharmacol 2022; 13:845930. [PMID: 35401198 PMCID: PMC8987529 DOI: 10.3389/fphar.2022.845930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Parkinson’s disease (PD) is characterized by intraneuronal α-synuclein aggregation called Lewy bodies and progressive dopaminergic neurodegeneration. Toll-like receptor (TLR) signaling is a major pathway mediating inflammation. The molecular link on how neuroinflammation upregulates neuronal TLRs and induces accumulation of α-synuclein aggregates to drive synucleinopathy remains to be determined. Objective: Despite conditioned medium from microglia and TLR agonists were utilized to study their effects on neuronal cells, a Transwell coculture system, comprising lipopolysaccharide-activated microglia on top and retinoic acid-differentiated SH-SY5Y cells at the bottom more mimicking in vivo neuroinflammation, was employed to elucidate the mechanism of activated microglia on neuronal cells. Methods: Genetic variants of TLRs in PD patients were genotyped and the multiplex cytokines, sRAGE, and HMGB1were assessed. A coculture system was employed to measure α-synuclein aggregates and neurite shortening by confocal microscope. The expression of TLR2/4 and autophagy flux was detected by western blot and immunofluorescence. Results: PD patients showed higher plasma levels of proinflammatory cytokines and genetic TLR4 variant, c.896 A > G (p. D299G). Elevated proinflammatory cytokines in coculture medium was also seen. Phosphorylation and aggregation of α-synuclein, shortening of neurite, upregulation of TLR2/4 expression, activation of downstream p38 and JNK, and dampening of autophagic flux were seen in SH-SY5Y cells cocultured with activated microglia. Those were prevented by inhibiting TLR2/4 and p38/JNK signaling. Conclusion: Activated microglia-derived neuroinflammation induced neuronal TLR2/4-p38/JNK activation to perturb autophagy, causing accumulation of α-synuclein aggregates and neurite shortening. Targeting neuronal TLR2/4 pathway might be a mechanistic-based therapy for neurodegenerative disease, such as PD.
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Affiliation(s)
- Lucia Yi-Ru Chung
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi Liu
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Cheng Tai
- Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Yi Lin
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Ching-Chow Chen, ; Chin-Hsien Lin,
| | - Ching-Chow Chen
- Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
- *Correspondence: Ching-Chow Chen, ; Chin-Hsien Lin,
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Lin CH, Lin HY, Ho EP, Ke YC, Cheng MF, Shiue CY, Wu CH, Liao PH, Hsu AYH, Chu LA, Liu YD, Lin YH, Tai YC, Shun CT, Chiu HM, Wu MS. Reply to: "Letter to the Editor by Derkinderen and Colleagues". Mov Disord 2022; 37:665-666. [PMID: 35092086 PMCID: PMC9306538 DOI: 10.1002/mds.28947] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Yi Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - En-Pong Ho
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ci Ke
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chyng-Yann Shiue
- Department of Nuclear Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Han Wu
- Department of Nuclear Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | - Li-An Chu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan.,Brain Research Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Ya-Ding Liu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan.,Brain Research Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Ya-Hui Lin
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan.,Brain Research Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Yi-Cheng Tai
- Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Lin CH, Lin HY, Ho EP, Ke YC, Cheng MF, Shiue CY, Wu CH, Liao PH, Hsu AYH, Chu LA, Liu YD, Lin YH, Tai YC, Shun CT, Chiu HM, Wu MS. Mild Chronic Colitis Triggers Parkinsonism in LRRK2 Mutant Mice Through Activating TNF-α Pathway. Mov Disord 2021; 37:745-757. [PMID: 34918781 DOI: 10.1002/mds.28890] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Leucine-rich repeat kinase 2 (LRRK2) is a common risk gene for Parkinson's disease (PD) and inflammatory bowel disorders. However, the penetrance of the most prevalent LRRK2 mutation, G2019S, is <50%. Factors other than genetic mutations are needed in PD process. OBJECTIVES To examine whether and how gut inflammation may act as an environmental trigger to neurodegeneration in PD. METHODS A mild and chronic dextran sodium sulfate (DSS)-induced colitis mice model harboring LRRK2 G2019S mutation was established. The colitis severity, immune responses, locomotor function, dopaminergic neuron, and microglia integrity were compared between littermate controls, transgenic LRRK2 wild type (WT), and LRRK2 G2019S mice. RESULTS The LRRK2 G2019S mice are more vulnerable to DSS-induced colitis than littermate controls or LRRK2 WT animals with increased intestinal expressions of pattern-recognition receptors, including toll-like receptors (TLRs), nuclear factor (NF)-κB activation, and pro-inflammatory cytokines secretion, especially tumor necrosis factor (TNF)-α. Notably, the colonic expression of α-synuclein was significantly increased in LRRK2 G2019S colitis mice. We subsequently observed more aggravated locomotor defect, microglia activation, and dopaminergic neuron loss in LRRK2 G2019S colitis mice than control animals. Treatment with anti-TNF-α monoclonal antibody, adalimumab, abrogated both gut and neuroinflammation, mitigated neurodegeneration, and improved locomotor function in LRRK2 G2019S colitis mice. Finally, we validated increased colonic expressions of LRRK2, TLRs, and NF-κB pathway proteins and elevated plasma TNF-α level in PD patients compared to controls, especially in those with LRRK2 risk variants. CONCLUSIONS Our findings demonstrate that chronic colitis promotes parkinsonism in genetically susceptible mice and TNF-α plays a detrimental role in the gut-brain axis of PD. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Yi Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - En-Pong Ho
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ci Ke
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chyng-Yann Shiue
- Department of Nuclear Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Han Wu
- Department of Nuclear Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | - Li-An Chu
- Department of Biomedical Engineering and Environmental Science, National Tsing Hua University, Hsinchu, Taiwan.,National Center for High-Performance Computing, Hsinchu, Taiwan
| | - Ya-Ding Liu
- Department of Biomedical Engineering and Environmental Science, National Tsing Hua University, Hsinchu, Taiwan.,National Center for High-Performance Computing, Hsinchu, Taiwan
| | - Ya-Hui Lin
- Department of Biomedical Engineering and Environmental Science, National Tsing Hua University, Hsinchu, Taiwan.,National Center for High-Performance Computing, Hsinchu, Taiwan
| | - Yi-Cheng Tai
- Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Tai YC, Kuo HC, Wu Y, Hsu SP. Orthostatic myoclonus - A retrospective study of Asian patients. J Formos Med Assoc 2021; 121:1310-1316. [PMID: 34656403 DOI: 10.1016/j.jfma.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND/PURPOSE Orthostatic myoclonus (OM) is myoclonic jerks in both legs during standing. It may relate to gait unsteadiness and may be associated with various diagnoses, including neurodegenerative, systemic, and musculoskeletal diseases. Diagnosis is based on the surface electromyography (SEMG). METHODS From January 2016 to June 2020, we retrospectively reviewed 35 patients diagnosed with OM based on the SEMG criteria and analyzed the electrophysiological data. RESULTS The mean age was 75.3±8.9. Disease duration ranged from 2 days to several years. Genders were equally affected. The most common symptom was gait disturbance, and the next was leg tremulous sensation, followed by backward disequilibrium. 28.6% of our patients had falls. Electrophysiologically, bursting duration shorter than 100 ms supported the myoclonic origin from the cortex. The bursting activity occurred only on the upright and weight-bearing leg. The associated diagnoses included lumbosacral radiculopathy (28.6%), lumbosacral radiculopathy plus myasthenia gravis (2.9%), lumbosacral radiculopathy plus vascular parkinsonism (5.7%), diabetic polyneuropathy (5.7%), vascular parkinsonism (17.1%), Parkinson's disease (PD) (14.2%), normal pressure hydrocephalus (5.7%), medication-induced parkinsonism (2.9%), cervical myelopathy (2.9%), medication-related myoclonus (2.9%), and unknown (11.4%). In PD, OM was present before, along with, or after PD diagnosis. The myoclonic activity disrupted the parkinsonian tremor upon standing on SEMG. CONCLUSION OM is a syndrome instead of a diagnosis. It is more prevalent in the elderly with gait disturbance and patients will not necessarily fall. It is associated with central and peripheral nerve system disorders, systemic diseases, and medication use. We hypothesize that OM is a pathological disintegration of motor circuit.
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Affiliation(s)
- Yi-Cheng Tai
- Department of Neurology, E-DA Hospital /I-Shou University, Kaohsiung, Taiwan
| | - Hung-Chang Kuo
- Department of Neurology, E-DA Cancer Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Yihui Wu
- Department of Infectious Diseases, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-DA Hospital /I-Shou University, Kaohsiung, Taiwan; School of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Chen KHS, Keng LT, Kuo YT, Tai YC, Chen R. Ultrasound-Guided Needle Electromyography for Assessing Diaphragmatic Myoclonus. Mov Disord Clin Pract 2020; 7:870-871. [PMID: 33043090 DOI: 10.1002/mdc3.13043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kai-Hsiang S Chen
- Department of Neurology National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Li-Ta Keng
- Department of Internal Medicine National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Yu-Ting Kuo
- Department of Neurology National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Yi-Cheng Tai
- Department of Neurology E-Da Hospital, I-Shou University Kaohsiung Taiwan
| | - Robert Chen
- Krembil Research Institute University Health Network Toronto Ontario Canada.,Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada.,Edmond J. Safra Program in Parkinson's Disease University Health Network Toronto Ontario Canada
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Abstract
Pain is a common non-motor symptom of Parkinson's disease (PD) and the prevalence of pain among PD patients varies because of the disease stage, co-morbidities, and evaluating tools. Risk factors for pain in PD include an early age of onset, long disease duration, motor complications, concomitant depressive symptoms, female gender, and associated medical conditions. In patients with PD, pain can be classified as musculoskeletal pain, chronic body pain (central or visceral), fluctuation-related pain, nocturnal pain, orofacial pain, pain with discolouration/oedema/swelling, and radicular/neuropathic pain; musculoskeletal pain as the most common type. Potential underlying mechanisms include a disruption of peripheral nociception and alterations in central pain threshold/processing. Genetic polymorphisms in genes that confer pain susceptibility might also play a role in the occurrence of pain in PD. In advanced stage of patients with PD, polyneuropathy could occur in patients using high dosage of levodopa. Pain often correlates to other non-motor symptoms of PD, including depression, sleep, and autonomic symptoms. Dopaminergic drugs, non-dopaminergic medications, botulinum toxin, deep brain stimulation, and physiotherapy have shown some benefits for certain types of PD-related pain. An increased awareness of pain as a common non-motor symptom of PD provides further insights into sensory system dysregulation in this disease. In this review, we aim to summarizes the clinical features of pain in patients with PD and emphasize the latest evidence of pain related to levodopa treatment.
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Affiliation(s)
- Yi-Cheng Tai
- Department of Neurology, E-DA Hospital, Kaohsiung, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University, College of Medicine, Taipei, Taiwan
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Lin CH, Chen CC, Chiang HL, Liou JM, Chang CM, Lu TP, Chuang EY, Tai YC, Cheng C, Lin HY, Wu MS. Altered gut microbiota and inflammatory cytokine responses in patients with Parkinson's disease. J Neuroinflammation 2019; 16:129. [PMID: 31248424 PMCID: PMC6598278 DOI: 10.1186/s12974-019-1528-y] [Citation(s) in RCA: 234] [Impact Index Per Article: 46.8] [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: 01/29/2019] [Accepted: 06/20/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Emerging evidence suggests that gut microbiome composition alterations affect neurodegeneration through neuroinflammation in the pathogenesis of Parkinson's disease (PD). Here, we evaluate gut microbiota alterations and host cytokine responses in a population of Taiwanese patients with PD. METHODS Fecal microbiota communities from 80 patients with PD and 77 age and gender-matched controls were assessed by sequencing the V3-V4 region of the 16S ribosomal RNA gene. Diet and comorbidities were controlled in the analyses. Plasma concentrations of IL-1β, IL-2, IL-4, IL-6, IL-13, IL-18, GM-CSF, IFNγ, and TNFα were measured by a multiplex immunoassay and relationships between microbiota, clinical characteristics, and cytokine levels were analyzed in the PD group. We further examined the cytokine changes associated with the altered gut microbiota seen in patients with PD in another independent cohort of 120 PD patients and 120 controls. RESULTS Microbiota from patients with PD was altered relative to controls and dominated by Verrucomicrobia, Mucispirillum, Porphyromonas, Lactobacillus, and Parabacteroides. In contrast, Prevotella was more abundant in controls. The abundances of Bacteroides were more increased in patients with non-tremor PD subtype than patients with tremor subtype. Bacteroides abundance was correlated with motor symptom severity defined by UPDRS part III motor scores (rho = 0.637 [95% confidence interval 0.474 to 0.758], P < 0.01). Altered microbiota was correlated with plasma concentrations of IFNγ and TNFα. There was a correlation between Bacteroides and plasma level of TNFα (rho = 0.638 [95% CI: 0.102-0.887], P = 0.02); and a correlation between Verrucomicrobia abundance and plasma concentrations of IFNγ (rho = 0.545 [95% CI - 0.043-0.852], P = 0.05). The elevated plasma cytokine responses were confirmed in an additional independent 120 patients with PD and 120 controls (TNFα: PD vs. control 8.51 ± 4.63 pg/ml vs. 4.82 ± 2.23 pg/ml, P < 0.01; and IFNγ: PD vs. control: 38.45 ± 7.12 pg/ml vs. 32.79 ± 8.03 pg/ml, P = 0.03). CONCLUSIONS This study reveals altered gut microbiota in PD and its correlation with clinical phenotypes and severity in our population. The altered plasma cytokine profiles associated with gut microbiome composition alterations suggest aberrant immune responses may contribute to inflammatory processes in PD.
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Affiliation(s)
- Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.
| | - Chieh-Chang Chen
- Department of Gastroenterology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Han-Lin Chiang
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jyh-Ming Liou
- Department of Gastroenterology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Chang
- Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Eric Y Chuang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.,Bioinformatics and Biostatistics Core, Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Cheng Tai
- Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan
| | - Chieh Cheng
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Han-Yi Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Ming-Shiang Wu
- Department of Gastroenterology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Huang CH, Lin CW, Lee YC, Huang CY, Huang RY, Tai YC, Wang KW, Yang SN, Sun YT, Wang HK. Is traumatic brain injury a risk factor for neurodegeneration? A meta-analysis of population-based studies. BMC Neurol 2018; 18:184. [PMID: 30396335 PMCID: PMC6217762 DOI: 10.1186/s12883-018-1187-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background To determine the association of prior traumatic brain injury (TBI) with subsequent diagnosis of neurodegeneration disease. Methods All studies from 1980 to 2016 reporting TBI as a risk factor for diagnoses of interest were identified by searching PubMed, Embase, study references, and review articles. The data and study design were assessed by 2 investigators independently. A meta-analysis was performed by RevMan 5.3. Results There were 18 studies comprising 3,263,207 patients. Meta-analysis revealed a significant association of prior TBI with subsequent dementia. The pooled odds ratio (OR) for TBI on development of dementia, FTD and TDP-43 associated disease were 1.93 (95% CI 1.47–2.55, p < 0.001), 4.44 (95% CI 3.86–5.10, p < 0.001), and 2.97 (95% CI 1.35–6.53, p < 0.001). However, analyses of individual diagnoses found no evidence that the risk of Alzheimer’s disease, and Parkinson’s disease in individuals with previous TBI compared to those without TBI. Conclusions History of TBI is not associated with the development of subsequent neurodegeneration disease. Care must be taken in extrapolating from these results because no suitable criteria define post TBI neurodegenerative processes. Therefore, further research in this area is needed to confirm these questions and uncover the link between TBI and neurodegeneration disease.
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Affiliation(s)
- Chi-Hsien Huang
- Department of Family Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Chi-Wei Lin
- Department of Family Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Che Lee
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.,Department of Nephrology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Yuan Huang
- Neurosurgical Service, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ru-Yi Huang
- Department of Family Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Cheng Tai
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Wei Wang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.,Department of Neurosurgery, E-Da Hospital, I-Shou University, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan
| | - San-Nan Yang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Kuang Wang
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan. .,Department of Neurosurgery, E-Da Hospital, I-Shou University, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan.
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13
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Wang IK, Liu CH, Yen TH, Jeng JS, Sung SF, Huang PH, Li JY, Sun Y, Wei CY, Lien LM, Tsai IJ, Sung FC, Hsu CY, Liu CH, Tsai CH, Huang WS, Lu CT, Tsai TC, Tseng CH, Lin KH, Shyu WC, Yang YW, Liu YL, Cho DY, Chen CC, Jeng JS, Tang SC, Tsai LK, Yeh SJ, Chen CH, Tsai HH, Li JY, Chen HJ, Lu K, Hsu SP, Kuo HC, Tsou JC, Wang YT, Tai YC, Hsieh MT, Liliang PC, Liang CL, Wang HK, Tsai YT, Wang KW, Chen JS, Chen PY, Wang YC, Chen CH, Sung PS, Hsieh HC, Su HC, Chiu HC, Lien LM, Chen WH, Bai CH, Huang TH, Lau CI, Wu YY, Yeh HL, Chang A, Lin CH, Yen CC, Lin RT, Chen CH, Khor GT, Chao AC, Lin HF, Huang P, Lin HJ, Ke DS, Chang CY, Yeh PS, Lin KC, Cheng TJ, Chou CH, Yang CM, Shen HC, Chen AC, Tsai SJ, Lu TM, Kung SL, Lee MJ, Chou HH, Chang WL, Chiu PY, Hsu MH, Chan PC, Pan CH, Shoung HM, Lo YC, Wang FH, Chang WC, Lai TC, Yin JH, Wang CJ, Wang KC, Chen LM, Denq JC, Sun Y, Lu CJ, Lin CH, Huang CC, Liu CH, Chan HF, Lee SP, Sun MH, Ke LY, Chen PL, Lee YS, Sung SF, Ong CT, Wu CS, Hsu YC, Su YH, Hung LC, Lee JT, Lin JC, Hsu YD, Denq JC, Peng GS, Hsu CH, Lin CC, Yen CH, Cheng CA, Sung YF, Chen YL, Lien MT, Chou CH, Liu CC, Yang FC, Wu YC, Tso AC, Lai YH, Chiang CI, Tsai CK, Liu MT, Lin YC, Hsu YC, Chiang TR, Huang PH, Liao PW, Lee MC, Chen JT, Lie SK, Sun MC, Hsiao PJ, Chen WL, Chen TC, Chang CS, Lai CH, Chuang CS, Chen YY, Lin SK, Su YC, Shiao JL, Yang FY, Liu CY, Chiang HL, Chen GC, Hsu PJ, Chang CY, Lin IS, Chien CH, Chang YC, Chen PK, Chiu PY, Hsiao YJ, Fang CW, Chen YW, Lee KY, Lin YY, Li CH, Tsai HF, Hsieh CF, Yang CD, Liaw SJ, Liao HC, Yeh SJ, Wu LL, Hsieh LP, Lee YH, Chen CW, Hsu CS, Jhih YJ, Zhuang HY, Pan YH, Shih SA, Chen CI, Sung JY, Weng HY, Teng HW, Lee JE, Huang CS, Chao SP, Yuan RY, Sheu JJ, Yu JM, Ho CS, Lin TC, Yu SC, Chen JR, Tsai SY, Wei CY, Hung CH, Lee CF, Yang SK, Chen CL, Lin W, Tseng HP, Liu CH, Lin CL, Lin HC, Chen PT, Hu CJ, Chan L, Chi NF, Chern CM, Lin CJ, Wang SJ, Hsu LC, Wong WJ, Lee IH, Yen DJ, Tsai CP, Kwan SY, Soong BW, Chen SP, Liao KK, Lin KP, Chen C, Shan DE, Fuh JL, Wang PN, Lee YC, Yu YH, Huang HC, Tsai JY, Wu MH, Chiang SY, Wang CY, Hsu MC, Chen CC, Yeh PY, Tsai YT, Wang KY, Chen TS, Hsieh CY, Chen WF, Yip PK, Wang V, Wang KC, Tsai CF, Chen CC, Chen CH, Liu YC, Chen SY, Zhao ZH, Wei ZP, Wu SL, Liu CK, Lin RH, Chu CH, Yan SH, Lin YC, Chen PY, Hsiao SH, Yip BS, Tsai PC, Chou PC, Kuo TM, Lee YC, Chiu YP, Tsai KC, Liao YS, Tsai MJ, Kao HY. Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke. Atherosclerosis 2018; 269:288-293. [PMID: 29254692 DOI: 10.1016/j.atherosclerosis.2017.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/26/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
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14
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Liliang PC, Liang CL, Lu K, Yang SN, Hsieh MT, Tai YC, Wang KW. Population-based study suggests an increased risk of Alzheimer'sdisease in Sjögren's syndrome. Clin Rheumatol 2017; 37:935-941. [PMID: 29243055 PMCID: PMC5880848 DOI: 10.1007/s10067-017-3940-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/08/2017] [Accepted: 11/29/2017] [Indexed: 11/29/2022]
Abstract
This population-based study was designed to estimate and compare the risk of Alzheimer’s disease (AD) between patients with primary Sjögren’s syndrome (SS) and non-SS patients during a 10-year follow-up period. This is a retrospective cohort study. Data were obtained from the Taiwan’s National Health Insurance Research Database. We identified 4463 primary SS patients and 22,315 non-SS patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied to identify the subsequent manifestation of AD. Cox proportional hazard regression was used to study the subsequent manifestation of AD, and Kaplan-Meier survival curves were used to compare survival probability. During the 10-year follow-up period, 7 primary SS and 13 non-SS patients developed AD. During the 10-year follow-up period, the risk of AD was 2.68-fold higher in the primary SS cohort with an overall adjusted hazard ratio (HR) of 2.69 (95% CI 1.07–6.76), after adjusting for demographics and comorbidities. Within the 10-year period, patients with primary SS showed a 2.69-fold increased risk of developing AD. This risk increases with time, and the relative risk of AD is higher in older patients with primary SS.
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Affiliation(s)
- Po-Chou Liliang
- Department of Neurosurgery, E-Da Cancer Hospital, I-Shou University, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
| | - Cheng-Loong Liang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kang Lu
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - San-Nan Yang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Meng-Tsang Hsieh
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Cheng Tai
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Wei Wang
- Department of Neurosurgery, E-Da Cancer Hospital, I-Shou University, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan.
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15
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Chiang HL, Tai YC, McMaster J, Fung VS, Mahant N. Primary orthostatic tremor: is deep brain stimulation better than spinal cord stimulation? J Neurol Neurosurg Psychiatry 2017; 88:804-805. [PMID: 28607117 DOI: 10.1136/jnnp-2016-315188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/18/2016] [Accepted: 01/02/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Han-Lin Chiang
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Neurology, Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yi-Cheng Tai
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Neurology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | | | - Victor Sc Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Neil Mahant
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
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16
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Tai YC, Yin YWK, Ha AD, Adam R, Mahant N, Sue CM, Fung VSC. Neurophysiological Features Of Hemiballism. Mov Disord Clin Pract 2017; 4:116-120. [PMID: 30713956 DOI: 10.1002/mdc3.12356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 11/07/2022] Open
Abstract
Hemiballism is a rare hyperkinetic movement disorder. The pathophysiology of hemiballism is poorly understood, and there have been few reports of neurophysiological recordings. The authors report three cases of hemiballism with associated radiological and neurophysiological findings. In patients 1 and 2, who were studied in the acute phase 4 and 14 days after presentation, irregularly timed and predominantly long-duration electromyographic (EMG) bursts were observed typically ranging from 200 to 1500 milliseconds in duration and occurring asynchronously or alternating in antagonist muscles. In patient 3, who was studied 6 weeks after presentation when the involuntary movements had become choreiform, the EMG bursts were still from 200 to 1000 milliseconds in duration but were more synchronous or co-contracting. The flailing movements of hemiballism appear to occur as a result of prolonged bursts of EMG activity generated in individual muscles unopposed by EMG bursting in the antagonist. During the subacute phase when the movements become more choreiform, the results indicate that EMG activity becomes more synchronous or co-contracting.
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Affiliation(s)
- Yi-Cheng Tai
- Movement Disorders Unit Department of Neurology Westmead Hospital Sydney New South Wales Australia.,Department of Neurology E-Da Hospital/I-Shou University Kaohsiung Taiwan
| | - Yun Wo Katie Yin
- Movement Disorders Unit Department of Neurology Westmead Hospital Sydney New South Wales Australia
| | - Ainhi D Ha
- Movement Disorders Unit Department of Neurology Westmead Hospital Sydney New South Wales Australia.,Department of Neurology Royal North Shore Hospital Sydney New South Wales Australia
| | - Robert Adam
- Movement Disorders Unit Department of Neurology Westmead Hospital Sydney New South Wales Australia.,Sydney Medical School The University of Sydney Sydney New South Wales Australia
| | - Neil Mahant
- Movement Disorders Unit Department of Neurology Westmead Hospital Sydney New South Wales Australia.,Sydney Medical School The University of Sydney Sydney New South Wales Australia
| | - Carolyn M Sue
- Department of Neurology Royal North Shore Hospital Sydney New South Wales Australia.,Sydney Medical School The University of Sydney Sydney New South Wales Australia
| | - Victor S C Fung
- Movement Disorders Unit Department of Neurology Westmead Hospital Sydney New South Wales Australia.,Sydney Medical School The University of Sydney Sydney New South Wales Australia
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17
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Wang HK, Hung CM, Lin SH, Tai YC, Lu K, Liliang PC, Lin CW, Lee YC, Fang PH, Chang LC, Li YC. Increased risk of hip fractures in patients with dementia: a nationwide population-based study. BMC Neurol 2014; 14:175. [PMID: 25213690 PMCID: PMC4172891 DOI: 10.1186/s12883-014-0175-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia has been associated with an increased risk of hip fracture. However, little research has been conducted on the impact of dementia on wrist or vertebral fracture development. The aim of this study was to investigate whether dementia is a risk factor for different types of fracture in Taiwan. METHODS The study sample was drawn from Taiwan's National Health Insurance Research Database of reimbursement claims, and comprised 1408 patients who visited ambulatory care centers or were hospitalized with a diagnosis of dementia. The comparison group consisted of 7040 randomly selected individuals. Cox proportional hazard regression model was used to examine associations between dementia and the risk of different types of fracture. RESULTS During a 3-year follow-up period, 264 patients with dementia (18.75%) and 1098 patients without dementia (15.60%) developed fractures. Dementia was independently associated with increased risk of hip fracture [adjusted hazard ratio (HR) 1.92, 95% CI 1.48-2.49]. Patients with dementia and osteoporosis had the highest risk of developing hip fracture (adjusted HR 2.27, 95% CI 1.28-4.01). Dementia did not increase wrist fracture or vertebral fracture risk when compared to the control group, even in patients with osteoporosis. CONCLUSIONS Individuals with dementia are at greater risk of developing hip fracture, particularly if they also have osteoporosis. Early mental screening programs and health education should be initiated to decrease disability and dependence in patients with dementia.
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18
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Lin CH, Chen ML, Tai YC, Yu CY, Wu RM. Reaffirmation of GAK, but not HLA-DRA, as a Parkinson's disease susceptibility gene in a Taiwanese population. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:841-6. [PMID: 24039160 DOI: 10.1002/ajmg.b.32188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/26/2013] [Indexed: 12/22/2022]
Abstract
Recent genome-wide association studies of Parkinson's disease (PD) in Caucasian populations have identified two new susceptibility loci, GAK and HLA-DRA; however, only limited information exists regarding the involvement of these genes in PD risk in other ethnic groups. Here, we examined whether these genetic effects were consistent in a Taiwanese PD population. In a total 900 participants, including 448 PD patients and 452 control subjects, we genotyped the rs11248051 and rs1564282 variants of GAK, and the rs3129882 variant of HLA-DRA. Logistic regression analysis was used to test for associations between genotype and PD under an additive model, adjusting for age and gender. Subjects with CT/TT genotypes of GAK rs11248051 had a modestly increased association with PD compared to those with CC genotype (OR = 1.37; 95% CI = 1.09, 1.87; P = 0.03). Carriers and non-carriers exhibited indistinguishable phenotypes in regards to clinical presentation and onset age. We observed no association between PD risk and GAK rs1564282 or HLA-DRA rs3129882 variant. The different genetic effects between Taiwanese and Caucasian populations may come from differences in population structure and geographic region-specific genetic-environmental interactions. In conclusion, our results supported the association between the rs11248051 variant in GAK and PD risk in a Taiwanese population. Future functional studies of GAK in neuronal degeneration are warranted to unravel its role in the pathogenetic mechanism of PD.
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Affiliation(s)
- Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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19
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Affiliation(s)
- Yi-Cheng Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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20
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Tai YC, Tsai LK. Vascular territories of MCA branches by computerized tomography. Acta Neurol Taiwan 2013; 22:49-50. [PMID: 23479247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Yi-Cheng Tai
- Department of Neurology, National Taiwan University College of Medicine, Taipei, Taiwan
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21
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Fong AJ, Roy RR, Ichiyama RM, Lavrov I, Courtine G, Gerasimenko Y, Tai YC, Burdick J, Edgerton VR. Recovery of control of posture and locomotion after a spinal cord injury: solutions staring us in the face. Prog Brain Res 2009; 175:393-418. [PMID: 19660669 DOI: 10.1016/s0079-6123(09)17526-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the past 20 years, tremendous advances have been made in the field of spinal cord injury research. Yet, consumed with individual pieces of the puzzle, we have failed as a community to grasp the magnitude of the sum of our findings. Our current knowledge should allow us to improve the lives of patients suffering from spinal cord injury. Advances in multiple areas have provided tools for pursuing effective combination of strategies for recovering stepping and standing after a severe spinal cord injury. Muscle physiology research has provided insight into how to maintain functional muscle properties after a spinal cord injury. Understanding the role of the spinal networks in processing sensory information that is important for the generation of motor functions has focused research on developing treatments that sharpen the sensitivity of the locomotor circuitry and that carefully manage the presentation of proprioceptive and cutaneous stimuli to favor recovery. Pharmacological facilitation or inhibition of neurotransmitter systems, spinal cord stimulation, and rehabilitative motor training, which all function by modulating the physiological state of the spinal circuitry, have emerged as promising approaches. Early technological developments, such as robotic training systems and high-density electrode arrays for stimulating the spinal cord, can significantly enhance the precision and minimize the invasiveness of treatment after an injury. Strategies that seek out the complementary effects of combination treatments and that efficiently integrate relevant technical advances in bioengineering represent an untapped potential and are likely to have an immediate impact. Herein, we review key findings in each of these areas of research and present a unified vision for moving forward. Much work remains, but we already have the capability, and more importantly, the responsibility, to help spinal cord injury patients now.
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Affiliation(s)
- Andy J Fong
- Division of Engineering, Bioengineering, California Institute of Technology, Pasadena, CA, USA
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22
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Andersen RA, Burdick JW, Musallam S, Scherberger H, Pesaran B, Meeker D, Corneil BD, Fineman I, Nenadic Z, Branchaud E, Cham JG, Greger B, Tai YC, Mojarradi MM. Recording advances for neural prosthetics. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:5352-5. [PMID: 17271551 DOI: 10.1109/iembs.2004.1404494] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An important challenge for neural prosthetics research is to record from populations of neurons over long periods of time, ideally for the lifetime of the patient. Two new advances toward this goal are described, the use of local field potentials (LFPs) and autonomously positioned recording electrodes. LFPs are the composite extracellular potential field from several hundreds of neurons around the electrode tip. LFP recordings can be maintained for longer periods of time than single cell recordings. We find that similar information can be decoded from LFP and spike recordings, with better performance for state decodes with LFPs and, depending on the area, equivalent or slightly less than equivalent performance for signaling the direction of planned movements. Movable electrodes in microdrives can be adjusted in the tissue to optimize recordings, but their movements must be automated to be a practical benefit to patients. We have developed automation algorithms and a meso-scale autonomous electrode testbed, and demonstrated that this system can autonomously isolate and maintain the recorded signal quality of single cells in the cortex of awake, behaving monkeys. These two advances show promise for developing very long term recording for neural prosthetic applications.
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Affiliation(s)
- R A Andersen
- Division of Biology, California Institute of Technology, Pasadena, CA, USA
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Kazemi M, Basham E, Sivaprakasam M, Wang G, Rodger D, Weiland J, Tai YC, Liu W, Humayun M. A test microchip for evaluation of hermetic packaging technology for biomedical prosthetic implants. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:4093-5. [PMID: 17271200 DOI: 10.1109/iembs.2004.1404142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The development of a test chip that will be used to evaluate a hermetic and biocompatible package for the driving CMOS circuitry of a retinal prosthesis is described. The package design is estimated to be about 2 x 2 x 0.3 mm(3) and will be formed by conformal layers of parylene and a metal (e.g. titanium) as inner and outer protections, respectively. The test chip has been specifically designed for evaluation of the packaging technology. It consists of many blocks of analog and digital components as well as relative humidity and temperature sensors. The test chip has more probe points than a typical chip, allowing a more thorough evaluation of circuit behavior during the testing. This chip will first be coated in a layer of parylene C and soaked in heated isotonic saline for an extended period of time. Every block in the chip will then be tested for functionality using the surface probe points. The next step is to coat the surface of another test chip with parylene and a metal and repeat these soak tests. The results will then be analyzed and mean time-to-failure for the different samples will then be computed. Using the accelerated testing paradigm, these results will then be extrapolated to mean time-to-failure in the operating intraocular environment. Parylene test structures have already undergone an accelerated lifetime test and results have been analyzed.
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Affiliation(s)
- Mohammad Kazemi
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
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Abstract
AIMS Follicular lymphoma is frequently associated with t(14;18)(q32;q21) translocation. This study was undertaken to determine the pattern of Bcl-2, CD10 and Bcl-6 expression in relation to t(14;18) translocation in follicular lymphoma from a cohort of a multi-ethnic Asian population. METHODS AND RESULTS Sixty-two cases of follicular lymphoma were retrieved for immunohistochemistry, and t(14;18) translocation analysis by polymerase chain reaction and fluorescent in-situ hybridization techniques. Bcl-2 expression was present in 74% of the cases. CD10 expression was also relatively low (61%), with decreasing frequency of expression in high-grade tumours. Bcl-6 protein was expressed in most of the tumours (88%) regardless of the tumour grade. The t(14;18) translocation was detected in 46 cases (74%) with an extremely high rate of t(14;18) translocation in ethnic Indian cases (100%). CONCLUSION The frequency of t(14;18) translocation in this series of follicular lymphomas was higher when compared with previous Asian reports, but in accordance with European and North American findings. CD10 expression is strongly associated with a t(14;18) translocation event, but the overall CD10 expression was relatively low, possibly due to the high proportion of high-grade tumours in the series. t(14;18) translocation was not associated with Bcl-2 or Bcl-6 expression.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Asia
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Lymphoma, Follicular/classification
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/metabolism
- Male
- Middle Aged
- Neprilysin/genetics
- Neprilysin/metabolism
- Polymerase Chain Reaction
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/metabolism
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Proto-Oncogene Proteins c-bcl-6
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Translocation, Genetic
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Affiliation(s)
- S C Peh
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Tai YC, Peh SC. Feasibility of T-cell receptor gamma (TCRgamma) gene rearrangement on formalin-fixed, paraffin-embedded tissues by PCR assays. Singapore Med J 2003; 44:250-5. [PMID: 13677361] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
INTRODUCTION T- and B-lymphocytes are involved in recognition of foreign antigen by the specificity of their surface T-cell receptor and immunoglobulin, generated by gene rearrangement. Each T- and B-lymphocyte carries unique rearranged TCR or immunoglobulin gene, which has been applied to detect clonal from non-clonal T- and B-cell proliferation. METHODS Paraffin-embedded biopsy tissues of 85 T-, 24 B-cell non-Hodgkin's lymphomas (NHL) of various subtypes, and seven reactive lymphoid hyperplasia were retrieved from the archives for determining the feasibility of TCRgamma gene rearrangement analysis by PCR assays in our laboratory. DNA was extracted by Proteinase K digestion. The analyses were performed by five PCR assays, and analysed on polyacrylamide gel. RESULTS Clonal TCRgamma gene rearrangement was demonstrated in 69/85 (81.2%) of the cases. Selective rearrangement of specific Vgamma segment was observed, especially in peripheral T-cell lymphoma-unspecified and nasal NK/T-cell lymphoma. Clonal TCRgamma rearranged band was also demonstrated in 4/24 (16.7%) and 2/7 (28.6%) of B-NHL and reactive lymphoid tissues respectively. CONCLUSION PCR assays were able to demonstrate clonal TCRgamma gene rearrangement in a high proportion of T-NHL. However, the PCR results should be interpreted carefully. A neoplasm should only be considered as T-cell type if it does not express any B-cell marker because TCRgamma is not lineage specific as shown by the presence of clonal TCRgamma gene rearrangement in B-NHL. Hence, the results for TCR gene rearrangement should always be interpreted in conjunction with histology and immunophenotyping.
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MESH Headings
- B-Lymphocytes/pathology
- Cell Lineage/genetics
- DNA, Neoplasm/analysis
- Electrophoresis, Polyacrylamide Gel
- Feasibility Studies
- Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor
- Genes, Immunoglobulin
- Humans
- Immunoenzyme Techniques
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/pathology
- Paraffin Embedding
- Polymerase Chain Reaction/methods
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Sensitivity and Specificity
- T-Lymphocytes/immunology
- T-Lymphocytes/pathology
- Tissue Fixation
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Affiliation(s)
- Y C Tai
- Department of Pathology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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26
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Abstract
We describe a method for normalization in 3D PET for use with maximum a posteriori (MAP) or other iterative model-based image reconstruction methods. This approach is an extension of previous factored normalization methods in which we include separate factors for detector sensitivity, geometric response, block effects and deadtime. Since our MAP reconstruction approach already models some of the geometric factors in the forward projection, the normalization factors must be modified to account only for effects not already included in the model. We describe a maximum likelihood approach to joint estimation of the count-rate independent normalization factors, which we apply to data from a uniform cylindrical source. We then compute block-wise and block-profile deadtime correction factors using singles and coincidence data, respectively, from a multiframe cylindrical source. We have applied this method for reconstruction of data from the Concorde microPET P4 scanner. Quantitative evaluation of this method using well-counter measurements of activity in a multicompartment phantom compares favourably with normalization based directly on cylindrical source measurements.
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Affiliation(s)
- B Bai
- Signal and Image Processing Institute, 3740 McClintock Avenue EEB400, University of Southern California, Los Angeles, CA 90089, USA
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27
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Abstract
We are currently developing a small animal positron emission tomography (PET) scanner with a design goal of 1 microlitre (1 mm3) image resolution. The detectors consist of a 12 x 12 array of 1 x 1 x 10 mm lutetium oxyorthosilicate (LSO) scintillator crystals coupled to a 64-channel photomultiplier tube (PMT) via 5 cm long optical fibre bundles. The optical fibre connection allows a high detector packing fraction despite the dead space surrounding the active region of the PMT. Optical fibre bundles made from different types of glass were tested for light transmission, and also their effects on crystal identification and energy resolution, and compared to direct coupling of the LSO arrays to the PMTs. We also investigated the effects of extramural absorber (EMA) in the fibre bundles. Based on these results, fibre bundles manufactured from F2 glass were selected. We built three pairs of prototype detectors (directly coupled LSO array, fibre bundle without EMA and fibre bundle with EMA) and measured flood histograms, energy resolution, intrinsic spatial resolution and timing resolution. The results demonstrated an intrinsic spatial resolution (FWHM) of 1.12 mm (directly coupled), 1.23 mm (fibre bundle without EMA coupling) and 1.27 mm (fibre bundle with EMA coupling) using an approximately 500 microm diameter Na-22 point source. Using a 330 microm outer diameter steel needle line source filled with F-18, spatial resolution for the detector with the EMA optical fibre bundle improved to 1.05 mm. The respective timing and energy FWHM values were 1.96 ns, 21% (directly coupled), 2.20 ns, 23% (fibre bundle without EMA) and 2.99 ns, 30% (fibre bundle with EMA). The peak-to-valley ratio in the flood histograms was better with EMA (5:1) compared to the optical fibre bundle without EMA (2.5:1), due to the decreased optical cross-talk. In comparison to the detectors used in our current generation microPET scanner, these detectors substantially improve on the spatial resolution, preserve the timing resolution and provide adequate energy resolution for a modern high-resolution animal PET tomograph.
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Affiliation(s)
- A Chatziioannou
- Department of Molecular and Medical Pharmacology, Crump Institute for Molecular Imaging, UCLA School of Medicine, Los Angeles, CA 90095-1770, USA.
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28
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Abstract
Several types of silicon fluidic coupler have been designed, fabricated, and tested to facilitate external connections to MEMS (microelectromechanical systems) fluidic devices. By using both bulk micromachining and DRIE (deep reactive ion-etching) techniques, couplers of different geometry have been produced for use with any standard MEMS fluidic port. In addition, couplers are easily modified to accommodate any arbitrary fluidic port geometry. For ease of use, these couplers interface with PEEK (polyetheretherketone) and fused-silica capillary tubing, both of which are commonly used in HPLC (high-performance liquid chromatography) systems and are supported by a wide range of plumbing products. Coupler performance was evaluated and an operating range of at least 0-8,963 kPa (0-1,300 psig) is attainable.
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Affiliation(s)
- E Meng
- Caltech Micromachining Laboratory, California Institute of Technology, Pasadena, CA, 91126, USA.
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29
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Farquhar TH, Llacer J, Sayre J, Tai YC, Hoffman EJ. ROC and LROC analyses of the effects of lesion contrast, size, and signal-to-noise ratio on detectability in PET images. J Nucl Med 2000; 41:745-54. [PMID: 10768578] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
UNLABELLED Image quality in PET is typically assessed using measures such as contrast recovery, noise variation, and signal-to-noise ratio (SNR). However, these criteria do not directly reflect performance in the clinical use of the images. Lesion detection is a critical task in the clinical interpretation of many PET studies. A receiver operating characteristic (ROC) study is an accepted method for quantitatively evaluating detection performance with respect to factors that influence image quality. ROC and localization ROC (LROC) analyses were conducted to investigate the effects of lesion contrast, SNR, and size on detectability of hot lesions in PET images. METHODS A thorax phantom was imaged with spheres of 3 sizes simulating lesions (0.45, 1.0, and 1.9 mL). The relative activity in the lesions and the total number of counts acquired were each varied by factors of 2 to ascertain the effects of contrast and SNR, respectively. Measured attenuation correction and a standard reconstruction protocol were used. Three nuclear medicine physicians and 6 medical physicists participated as readers, rating each image and indicating the suspected lesion location. The area under the calculated ROC and LROC curves (Az and Az,LROC) were used as measures of detection performance. RESULTS Detection performance was shown to increase from virtually random (Az approximately 0.5, Az,LROC approximately 0.2) to superior (Az > 0.9, Az,LROC > 0.9) as lesion contrast was increased by 50% and as lesion SNR was doubled. Detection performance was not seen to vary when comparison was made using image-based measures alone. CONCLUSION This study quantitatively shows that moderate increases in the image-based measures of lesion contrast and SNR give a relatively large increase in the task-based measure of lesion detection as measured by ROC and LROC analyses. Thus, techniques that give modest increases in lesion contrast or SNR are expected to improve detection. Results will be useful in evaluating improvement in detection for various reconstruction, acquisition, and data analysis methods that enhance contrast or noise performance.
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Affiliation(s)
- T H Farquhar
- Department of Molecular and Medical Pharmacology, School of Medicine, University of California, Los Angeles 90095-6948, USA
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30
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Abstract
A micromachining process is described for fabricating a mass spectrometry electrospray source on a silicon chip. The process utilizes polymer (parylene) layers to form a system of chambers, filters, channels, and hollow needle structures (electrospray emitters) that extend more than a millimeter beyond the edge of the silicon substrate. The use of photoresist as the sacrificial layer facilitates the creation of long channels. Access to the channel structures on the chip is through a port etched through the silicon substrate that also serves as a sample reservoir. A reusable chip holder consisting of two plastic plates and an elastomer gasket provides the means to mount the chip in front of the mass spectrometer inlet and make electrical and gas connections. The electrospray emitters have tapered tips with 5 microns x 10 microns rectangular openings. The shape of the tip can be varied depending on the shape of the mask used to protect the parylene structures during the final plasma etch. The parylene emitters are physically robust and require only a high electric field to achieve stable electrospray operation over a period of a few hours. Direct comparisons with conventional glass or fused silica emitters indicated very similar performance with respect to signal strength and stability, spectral quality, and endurance. The automated MS/MS analysis of a mixture of tryptic peptides was no more difficult and yielded nearly identical results as the analysis of the same sample using a conventional nanospray device. This work demonstrates that an efficient electrospray interface to mass spectrometry can be integrated with other on-chip structures and mass-produced using a batch process.
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Affiliation(s)
- L Licklider
- Division of Immunology, Beckman Research Institute of the City of Hope, Duarte, California 91010, USA
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31
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Abstract
The neurochip is a silicon micromachined device upon which cultured mammalian neurons can be continuously and individually monitored and stimulated. The neurochip is based upon a 4 x 4 array of metal electrodes, each of which has a caged well structure designed to hold a single mature cell body while permitting normal outgrowth of neural processes. We demonstrate that this device is capable of maintaining cell survival, and that the electrodes can both record and stimulate electrical activity in individual cells with no crosstalk between channels.
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Affiliation(s)
- M P Maher
- Division of Biology, California Institute of Technology, Pasadena 91125, USA
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32
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Abstract
A description is given of a functional silicon micromachined device that permits non-invasive, bidirectional, highly specific communication with cultured mammalian neurons. The heart of the system is a well structure that holds the cell in close proximity to a metal extracellular electrode while permitting normal outgrowth of axons and dendrites. An iterative approach is used to create a design that allows normal growth of the neurons while preventing their escape. An array of 16 such neurowells makes it possible to perform studies of biological neural network development and function with unprecedented detail.
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Affiliation(s)
- M P Maher
- Division of Biology, California Institute of Technology, Pasadena 91125, USA.
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33
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Tai YC. The Aviation Medical Association, Republic of China. Aviat Space Environ Med 1979; 50:520-1. [PMID: 375920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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