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Chen YT, Lin CC, Huang PH, Li SY. Comparative analysis of hemodialysis and peritoneal dialysis on the risk of new onset diabetes mellitus. J Formos Med Assoc 2024; 123:606-612. [PMID: 38220559 DOI: 10.1016/j.jfma.2024.01.013] [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: 08/28/2023] [Revised: 11/17/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Diabetes mellitus is a significant risk factor for cardiovascular events and mortality in dialysis patients. The impact of different dialysis modalities on the risk of new onset diabetes mellitus (NODM) remains a subject of debate. Previous studies did not adequately account for critical confounding factors such as pre-dialysis glycemic status, medication use, and nutritional status, which may influence the association between dialysis modality and NODM risk. METHODS We conducted a retrospective cohort study of 1426 non-diabetic end-stage renal disease (ESRD) patients who underwent either hemodialysis (HD) or peritoneal dialysis (PD) at a single medical center. We used different statistical methods, adjusting for potential confounding factors, and accounted for competing risk of death. RESULTS Over 12 years, 331 patients (23 %) developed NODM. After adjusting for potential confounding factors and mortality, PD patients had a significantly higher risk of NODM compared to HD patients (adjusted HR 1.52, p = 0.001). A propensity-matched cohort sensitivity analysis yielded similar results. Among patients with prediabetes, those receiving PD had a 2.93 times higher risk of developing NODM than those receiving HD (p for interaction <0.001), whereas no significant difference was observed among euglycemic patients. NODM was also associated with a 1.78 times increased risk of major cardiovascular events. CONCLUSION Our study provides evidence that PD treatment may increase the risk of NODM in ESRD patients, particularly among those with preexisting prediabetes. These findings highlight the importance of personalized treatment approaches, and nephrologists should consider prediabetes when choosing the dialysis modality for their patients.
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Affiliation(s)
- Yung-Tai Chen
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan; University of Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Depart of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsun Huang
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Depart of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Tsai MT, Tseng WC, Lee KH, Lin CC, Ou SM, Li SY. Associations of urinary fetuin-A with histopathology and kidney events in biopsy-proven kidney disease. Clin Kidney J 2024; 17:sfae065. [PMID: 38577269 PMCID: PMC10993056 DOI: 10.1093/ckj/sfae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Indexed: 04/06/2024] Open
Abstract
Background Fetuin-A is implicated in the pathogenesis of vascular calcification in chronic kidney disease (CKD); however, the relationship between fetuin-A, histopathologic lesions and long-term kidney outcomes in patients with various types of kidney disease remains unclear. Methods We measured urinary fetuin-A levels in 335 individuals undergoing clinically indicated native kidney biopsy. The expressions of fetuin-A mRNA and protein in the kidney were assessed using RNA sequencing and immunohistochemistry. The association of urinary fetuin-A with histopathologic lesions and major adverse kidney events (MAKE), defined as a decline in estimated glomerular filtration rate (eGFR) of at least 40%, kidney failure or death, was analyzed. Results Urinary fetuin-A levels showed a positive correlation with albuminuria (rs = 0.67, P < .001) and a negative correlation with eGFR (rs = -0.46, P < .001). After multivariate adjustment, higher urinary fetuin-A levels were associated with glomerular inflammation, mesangial expansion, interstitial fibrosis and tubular atrophy, and arteriolar sclerosis. Using a 1 transcript per million gene expression cutoff, we found kidney fetuin-A mRNA levels below the threshold in both individuals with normal kidney function and those with CKD. Additionally, immunohistochemistry revealed reduced fetuin-A staining in tubular cells of CKD patients compared with normal controls. During a median 21-month follow-up, 115 patients experienced MAKE, and Cox regression analysis confirmed a significant association between elevated urinary fetuin-A and MAKE. This association remained significant after adjusting for potential confounding factors. Conclusion Urinary fetuin-A is associated with chronic histological damage and adverse clinical outcomes across a spectrum of biopsy-proven kidney diseases.
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Affiliation(s)
- Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Cheng Tseng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuo-Ming Ou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Szu-yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Chen TH, Ho Y, Tai HL, Chu YC, Lin YP, Yang CY, Tseng WC, Ou SM, Tsai MT, Chen JY, Wu TH, Lee KH, Chen FY, Li SY, Lin CC, Tarng DC. Survival benefit of a third dose of the COVID-19 vaccine among hemodialysis patients: A prospective cohort study. J Microbiol Immunol Infect 2023; 56:1198-1206. [PMID: 37770324 DOI: 10.1016/j.jmii.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/19/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Hemodialysis (HD) patients are particularly vulnerable to severe coronavirus disease 2019 (COVID-19) due to their immunocompromised state and comorbid conditions. Timely vaccination could be the most effective strategy to reduce morbidity and mortality. However, data on the survival benefit of the COVID-19 vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and death among HD patients are limited, especially during the Omicron-dominant period. METHODS In this prospective hospital-based cohort study, we identified HD patients from July 1, 2021, to April 29, 2022. The patients were divided into fully vaccinated and partially vaccinated groups. We compared the humoral response, risk of developing SARS-CoV-2 infection, and all-cause mortality between the two groups. RESULTS Among the 440 HD patients included, 152 patients were fully vaccinated, and 288 patients were partially vaccinated. Patients in the fully vaccinated group exhibited higher anti-spike protein receptor-binding domain (S protein RBD) antibody levels and lower risks of all-cause mortality (adjusted hazard ratio, 0.35; 95% confidence interval, 0.17-0.73; p = 0.005) than the partially vaccinated group. However, the risk for SARS-CoV-2 infection did not significantly differ between the two groups. Irrespective of the number of vaccinations, the risk of all-cause mortality was lower in patients with anti-S protein RBD antibody levels in the higher tertile. CONCLUSION A third dose of the COVID-19 vaccine was associated with a decreased risk of all-cause mortality among HD patients during the Omicron-dominant period. A higher post-vaccination anti-S protein RBD antibody level was also associated with a lower risk of mortality.
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Affiliation(s)
- Tz-Heng Chen
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yang Ho
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Clinical Toxicology and Occupational Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Ling Tai
- Department of Business Administration, National Taiwan University of Science and Technology, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taiwan
| | - Yuan-Chia Chu
- Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan; Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yu Yang
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Cheng Tseng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuo-Ming Ou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsai-Hung Wu
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fan-Yu Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Jasuja S, Gallieni M, Jha V, Vachharajani T, Bhalla AK, Tan J, Tan CS, Basnet NB, Herath N, An HPH, Kim YS, Kim Y, SampathKumar K, Sahay M, Ramachandran R, Alexander S, Bhargava V, Balasubramaniam J, Voss D, Ogbac FE, Gunawan A, Goh BL, Lin CC, Khan J, Shiham I, Ayub H, Hein MA, Iqbal S, Srisawat N, Gao B, Sajiv C, Wilkinson C, Pichthida T, Rana DS, Sagar G, Bahl A, Tawakley S, Gaur M. Practice of dialysis access interventional nephrology procedures in the Asia-Pacific region: Getting lay of the land. Nephrology (Carlton) 2023; 28:672-681. [PMID: 37697492 PMCID: PMC7615839 DOI: 10.1111/nep.14236] [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: 04/27/2023] [Revised: 07/23/2023] [Accepted: 08/12/2023] [Indexed: 09/13/2023]
Abstract
AIM This cross-sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia-Pacific Region (APR), specifically related to dialysis access (DA). METHODS The Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia-Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey. RESULTS Twenty-one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access-related IN procedures, primarily the placement of non-tunnelled central catheters (n-TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico-legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel. CONCLUSION The practice of dialysis access-related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access-related IN is constrained by a lack of a skilled workforce and finances.
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Affiliation(s)
| | - Maurizio Gallieni
- DIBIC “L. Sacco”, Università degli Studi di Milano, Milano, Italy
- The Journal of VA, USA
| | | | - Tushar Vachharajani
- John D. Dingell Veterans Affair Medical Center, Detroit, Michigan, USA
- Wayne State University, Detroit, Michigan, USA
| | | | - Jackson Tan
- Rimba Dialysis Center, Simpang, Brunei Darussalam
- Univeristy of Brunei Darussalam, Bandar Seri Begawan, Brunei
- RIPAS Hospital, Bandar Seri Begawan, Brunei
| | | | | | | | | | - Yong Soo Kim
- College of Medicine, St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Yaeni Kim
- College of Medicine, St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | | | | | | | | | | | | | - David Voss
- Middlemore Hospital, Auckland, New Zealand
| | | | - Atma Gunawan
- St Luke’s Medical Center, Quezon City, Philippines
- Dr Saiful Anwar General Hospital, Malang, Indonesia
| | | | | | | | | | | | - Min Aung Hein
- Defence Services Medical Academy (DSMA), Yangon, Myanmar
| | - Sarwar Iqbal
- BIRDEM General Hospital, Dhaka, Bangladesh
- Ibrahim Medical College, Dhaka, Bangladesh
| | | | - Bihu Gao
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Cherian Sajiv
- Alice Springs Hospital, The Gap, Northern Territory, Australia
| | - Catherine Wilkinson
- Cairns and Hinterland Hospital and Health Service, Cairns North, Queensland, Australia
| | - Thim Pichthida
- School of Medicine, International University, Phnom Penh, Cambodia
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - D. S. Rana
- Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | | | - Anupam Bahl
- Indraprastha Apollo Hospital, New Delhi, India
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Tsai MT, Ou SM, Lee KH, Lin CC, Li SY. Circulating Activin A, Kidney Fibrosis, and Adverse Events. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00298. [PMID: 37983094 PMCID: PMC10861103 DOI: 10.2215/cjn.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Identification of reliable biomarkers to assess kidney fibrosis severity is necessary for patients with CKD. Activin A, a member of the TGF- β superfamily, has been suggested as a biomarker for kidney fibrosis. However, its precise utility in this regard remains to be established. METHODS We investigated the correlation between plasma activin A levels, kidney fibrosis severity, and the incidence of major adverse kidney events in patients who underwent native kidney biopsies at a tertiary medical center. We performed RNA sequencing and histological analyses on kidney biopsy specimens to assess activin A expression. In vitro experiments were also conducted to explore the potential attenuation of TGF- β -induced fibroblast activation through activin A inhibition. RESULTS A total of 339 patients with biopsy-confirmed kidney diseases were enrolled. Baseline eGFR was 36 ml/min per 1.73 m 2 , and the urine protein/creatinine ratio was 2.9 mg/mg. Multivariable logistic regression analysis revealed a significant association between plasma activin A levels and the extent of tubulointerstitial fibrosis. Our RNA sequencing data demonstrated a positive correlation between kidney INHBA expression and plasma activin A levels. Furthermore, the histological analysis showed that myofibroblasts were the primary activin A-positive interstitial cells in diseased kidneys. During a median follow-up of 22 months, 113 participants experienced major adverse kidney events. Cox proportional hazards analysis initially found a positive association between plasma activin A levels and kidney event risk, but it became insignificant after adjusting for confounders. In cultured fibroblasts, knockdown of activin A significantly attenuated TGF- β -induced fibroblast-myofibroblast conversion. CONCLUSIONS Plasma activin A levels correlate with kidney fibrosis severity and adverse outcomes in various kidney disorders.
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Affiliation(s)
- Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuo-Ming Ou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Szu-yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Yen CC, Hsu PC, Lin CC, Chen SC, Hsiao CY, Hwang SJ. Effect of far-infrared radiation therapy on von Willebrand factor in patients with chronic kidney disease. Front Med (Lausanne) 2023; 10:1268212. [PMID: 37746066 PMCID: PMC10514495 DOI: 10.3389/fmed.2023.1268212] [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: 07/27/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background Hemostatic abnormality has contributed to vascular access thrombosis in patients with chronic kidney disease (CKD). Previous studies have demonstrated that far-infrared radiation (FIR) therapy can maintain the patency and maturity of arteriovenous fistulas of patients undergoing hemodialysis (HD). However, prolonged access bleeding is observed once FIR is conducted at the end of dialysis. FIR can block the binding of platelet and von Willebrand factor (vWF), a predictor of hemostatic abnormality and vascular access thrombosis. However, clinical studies exploring FIR and vWF are sparse. Methods We recruited 20 HD patients, 21 CKD patients, and 20 controls to examine the alteration of vWF and a disintegrin and metalloproteinase with thrombospondin type 1 repeats 13 (ADAMTS13) following a single 40-min session of FIR therapy. In addition, the alteration of these factors in the HD group was examined following a 40-min FIR session thrice a week for 3 months. Results A decreasing trend in the vWF activity-antigen ratio of participants in all groups following a single FIR session was observed. In addition, the ratio in the HD group was significantly lower following 3 months of FIR therapy. The subgroup analysis revealed a consistent trend and multiple regression analysis showed that participants not taking hydroxymethylglutaryl-coenzyme A reductase inhibitor, diabetes mellitus, and higher hemoglobin levels were the significant factors. The alteration of the vWF activity-antigen ratio correlated moderately to that of ADAMTS13 antigen and activity. Conclusion FIR may alter the ratio of ultra-large vWF multimers through ADAMTS13, contributing to inhibiting platelet-endothelium interactions of CKD patients.
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Affiliation(s)
- Cheng-Chieh Yen
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Szu-Chia Chen
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Shang-Jyh Hwang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
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Wang TY, Chang FP, Yang AH, Ka SM, Chen A, Hsieh JT, Chen FY, Lee TL, Tseng PY, Tsai MT, Li SY, Yang CY, Chen JY, Lin CC, Tarng DC. Key pathological features characterize minimal change disease-like IgA nephropathy. PLoS One 2023; 18:e0288384. [PMID: 37471324 PMCID: PMC10358932 DOI: 10.1371/journal.pone.0288384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 06/26/2023] [Indexed: 07/22/2023] Open
Abstract
AIMS A subset of IgA nephropathy (IgAN) patients exhibiting minimal change disease (MCD) like features present with nephrotic-range proteinuria and warrants immunosuppressive therapy (IST). However, the diagnosis of MCD-like IgAN varied by reports. We aimed to identify the key pathological features of MCD-like IgAN. METHODS In this cohort, 228 patients had biopsy-proven IgAN from 2009 to 2021, of which 44 without segmental sclerosis were enrolled. Patients were classified into segmental (< 50% glomerular capillary loop involvement) or global (> 50%) foot process effacement (FPE) groups. We further stratified them according to the usage of immunosuppressant therapy after biopsy. Clinical manifestations, treatment response, and renal outcome were compared. RESULTS 26 cases (59.1%) were classified as segmental FPE group and 18 cases (40.9%) as global FPE group. The global FPE group had more severe proteinuria (11.48 [2.60, 15.29] vs. 0.97 [0.14, 1.67] g/g, p = 0.001) and had a higher proportion of complete remission (81.8% vs. 20%, p = 0.018). In the global FPE group, patients without IST experienced more rapid downward eGFR change than the IST-treated population (-0.38 [-1.24, 0.06] vs. 1.26 [-0.17, 3.20]mL/min/1.73 m2/month, p = 0.004). CONCLUSIONS The absence of segmental sclerosis and the presence of global FPE are valuable pathological features that assist in identifying MCD-like IgAN.
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Affiliation(s)
- Tsung-Yueh Wang
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Pang Chang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Hang Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuk-Man Ka
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ann Chen
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jyh-Tong Hsieh
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
| | - Fan-Yu Chen
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
| | - Tsung-Lun Lee
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Yu Tseng
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Division of Nephrology, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Szu-Yuan Li
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Yu Yang
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan
- Stem Cell Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Division of Clinical Toxicology and Occupational Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jinn-Yang Chen
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Ching Lin
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Der-Cherng Tarng
- Department of Medicine, Division of NephrologyTaipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan
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Li SY, Chen CY, Tsai MT, Lin NC, Liu CS, Lin CC. Hybrid Method for Peritoneal Dialysis Catheter Insertion: A New Technique for Improved Outcomes and Reduced Costs. Am J Nephrol 2023; 54:349-358. [PMID: 37253336 DOI: 10.1159/000531162] [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: 04/19/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Peritoneal dialysis (PD) is a well-established treatment choice for end-stage kidney disease (ESKD). While there are several methods for PD catheter insertion, they each have limitations. In this study, we present a new hybrid method for PD catheter insertion and compare it to the conventional laparoscopic method. METHODS This retrospective study included 171 patients who were undergoing their first PD catheter insertion, and a total of 20% of the enrolled patients had a past medical history of abdominal surgery. Out of these, 101 patients underwent the laparoscopic method and 70 underwent a new invented hybrid method. The study aimed to compare the surgical outcomes, incidence of early and late complications, hospital stay, and medical expenses between the two groups. RESULTS There were no notable differences in basic demographic features and comorbid conditions between the two groups. The results of our data revealed that the hybrid group had a significantly shorter break-in period and did not require temporary hemodialysis. Additionally, length of hospital stay and medical costs were significantly lower in the hybrid group (all p < 0.05). The incidence of early complications was lower in the hybrid group, while the incidence of late complications was comparable between the two groups. CONCLUSION Our study demonstrates that the hybrid method of PD catheter insertion provides a safe and efficient alternative to the traditional laparoscopic method, enabling urgent-start PD and reducing hospital stays and medical expenses. Our findings support the use of the hybrid method as a new standard of care for ESKD patients undergoing PD catheter insertion.
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Affiliation(s)
- Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,
| | - Cheng-Yen Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Niang-Cheng Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Su Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Taipei Veterans General Hospital International Medical Service Center, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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9
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Kuo CW, Chen DH, Tsai MT, Lin CC, Cheng HW, Tsay YG, Wang HT. Pyruvate kinase M2 modification by a lipid peroxidation byproduct acrolein contributes to kidney fibrosis. Front Med (Lausanne) 2023; 10:1151359. [PMID: 37007793 PMCID: PMC10050374 DOI: 10.3389/fmed.2023.1151359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023] Open
Abstract
Renal fibrosis is a hallmark of diabetic nephropathy (DN) and is characterized by an epithelial-to-mesenchymal transition (EMT) program and aberrant glycolysis. The underlying mechanisms of renal fibrosis are still poorly understood, and existing treatments are only marginally effective. Therefore, it is crucial to comprehend the pathophysiological mechanisms behind the development of renal fibrosis and to generate novel therapeutic approaches. Acrolein, an α-,β-unsaturated aldehyde, is endogenously produced during lipid peroxidation. Acrolein shows high reactivity with proteins to form acrolein-protein conjugates (Acr-PCs), resulting in alterations in protein function. In previous research, we found elevated levels of Acr-PCs along with kidney injuries in high-fat diet-streptozotocin (HFD-STZ)-induced DN mice. This study used a proteomic approach with an anti-Acr-PC antibody followed by liquid chromatography–tandem mass spectrometry (LC–MS/MS) analysis to identify several acrolein-modified protein targets. Among these protein targets, pyruvate kinase M2 (PKM2) was found to be modified by acrolein at Cys358, leading to the inactivation of PKM2 contributing to the pathogenesis of renal fibrosis through HIF1α accumulation, aberrant glycolysis, and upregulation of EMT in HFD-STZ-induced DN mice. Finally, PKM2 activity and renal fibrosis in DN mice can be reduced by acrolein scavengers such as hydralazine and carnosine. These results imply that acrolein-modified PKM2 contributes to renal fibrosis in the pathogenesis of DN.
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Affiliation(s)
- Chin-Wei Kuo
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dong-Hao Chen
- Molecular Medicine Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Wei Cheng
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yeou-Guang Tsay
- Institute of Biochemistry and Molecular Biology, College of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiang-Tsui Wang
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Doctor Degree Program in Toxicology, Kaohsiung Medical University, Kaohsiung, Taiwan
- *Correspondence: Hsiang-Tsui Wang,
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10
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Liu WS, Lin CH, Tan AC, Lai YT, Liu TY, Chan HL, Li SY, Chen CF, Chen YT, Chen TH, Chen FY, Ho Y, Tsou HH, Lin CC. The Associations between Erythropoietic Response with Inflammation Markers and Perfluorinated Chemicals in Hemodialysis Patients. Healthcare (Basel) 2023; 11:healthcare11030442. [PMID: 36767017 PMCID: PMC9914349 DOI: 10.3390/healthcare11030442] [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: 12/02/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Erythropoiesis-stimulating agents (ESA) are used to treat anemia in hemodialysis (HD) patients. We investigated the role of inflammation and accumulation of environmental toxins (perfluorinated chemicals (PFCs), such as perfluorooctanoic acid and perfluorooctane sulfonate) in the erythropoietic response of HD patients who receive a fixed monthly continuous erythropoietin receptor activator (CERA) dosage. Forty-five patients underwent three successive phases of ESA treatment for two months each (phase one: 100 µg CERA once monthly; phase two: 50 µg CERA twice monthly; phase three: 100 µg CERA once monthly). Patient data were collected to determine the association of various factors with erythropoietic response (change in hematocrit). Liquid chromatography-tandem mass spectrometry was used to analyze perfluorinated chemicals. Twenty-eight patients exhibited a poor erythropoietic response that was significantly associated with: age > 80 years, initial hematocrit > 36%, glucose > 200 mg/dL, alanine aminotransferase > 21 U/L, c-reactive protein > 1 mg/dL, interleukin-6 > 10 ng/mL, lactate dehydrogenase ≤ 190 U/L, and chloride ≤ 93 mEq/L. There was also a borderline significant association between inflammation and PFCs, although PFCs failed to show any impact on ESA response. Age, glucose, chloride, liver function, and inflammation may be associated with cost-effective fixed CERA dosage administered at an increased frequency.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei 103, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Special Education, University of Taipei, Taipei 100, Taiwan
| | - Chien-Hung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yen-Ting Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
| | - Tsung-Yun Liu
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital and University, Taoyuan 333, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chun-Fan Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yilan 260, Taiwan
| | - Yung-Tai Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Department of Special Education, University of Taipei, Taipei 100, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei 100, Taiwan
| | - Tz-Heng Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans, General Hospital Yuli Branch, Hualien 981, Taiwan
| | - Fan-Yu Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yang Ho
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Han-Hsing Tsou
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Correspondence: (H.-H.T.); (C.-C.L.)
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Correspondence: (H.-H.T.); (C.-C.L.)
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11
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Liu WS, Lin CH, Tsai CY, Wang HT, Li SY, Liu TY, Tan AC, Tsou HH, Tseng KH, Lin CC. Double Filtration Plasmapheresis with Polyvinyl Alcohol-Based Membrane Lowers Serum Inflammation and Toxins in Patients with Hyperlipidemia. Bioengineering (Basel) 2023; 10:bioengineering10010089. [PMID: 36671661 PMCID: PMC9855020 DOI: 10.3390/bioengineering10010089] [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] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/13/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023]
Abstract
Hyperlipidemia is increasing in prevalence and is highly correlated with cardiovascular disease (CVD). Lipid-lowering medications prevent CVD but may not be suitable when the side effects are intolerable or hypercholesterolemia is too severe. Double-filtration plasmapheresis (DF) has shown its therapeutic effect on hyperlipidemia, but its side effects are not yet known. We enrolled 45 adults with hyperlipidemia in our study. The sera before and two weeks after DF were evaluated, and we also analyzed perfluorochemicals to see if DF could remove these lipophilic toxins. After DF, all lipid profile components (total cholesterol, triglycerides, high-density lipoprotein [HDL], and low-density lipoprotein [LDL]) had significantly decreased. Leukocyte counts increased while platelet levels decreased, which may have been caused by the puncture wound from DF and consumption of platelets during the process. As for uremic toxins and inflammation, levels of C-reactive protein, uric acid, and alanine transaminase (ALT) all decreased, which may be related to the removal of serum perfluorooctane sulfonate (PFOS) and improvement of renal function. The total cholesterol/HDL ratio and triglycerides were significantly higher in the diabetes mellitus (DM) group at baseline but did not significantly differ after DF. In conclusion, DF showed potential for improving inflammation and removing serum lipids and PFOS in adults with hyperlipidemia.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei 103, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Institute of Food Safety and Health Risk Assessment, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Department of Special Education, University of Taipei, Taipei 100, Taiwan
| | - Chien-Hung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Ching-Yao Tsai
- Institute of Public Health, Department of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Department of Ophthalmology, Taipei City Hospital, Zhongxing Branch, Taipei 103, Taiwan
- Department of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Hsiang-Tsui Wang
- Department of Pharmacology, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Tsung-Yun Liu
- Institute of Food Safety and Health Risk Assessment, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Han-Hsing Tsou
- Institute of Food Safety and Health Risk Assessment, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Kim Forest Enterprise Co., Ltd., New Taipei City 221, Taiwan
| | - Kuo-Hsien Tseng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Correspondence:
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12
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Lai YT, Huang HL, Hsieh CC, Lin CH, Yang JC, Tsou HH, Lin CC, Li SY, Chan HL, Liu WS. The Effects of Yoga Exercise on Blood Pressure and Hand Grip Strength in Chronic Stroke Patients: A Pilot Controlled Study. Int J Environ Res Public Health 2023; 20:1108. [PMID: 36673861 PMCID: PMC9859542 DOI: 10.3390/ijerph20021108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND We investigated the beneficial effect of add-on yoga with rehabilitation on blood pressure (BP) and hand grip strength in patients with chronic stroke (more than 90 days). METHODS The study included patients 30-80 years of age who could stand independently for 1 min. Patients with psychiatric diseases or undergoing other therapies (like acupuncture) were excluded. The yoga group received training (1 h session twice weekly) with standard rehabilitation for 8 weeks. The control group received standard rehabilitation only. There were no differences in age, gender, hand grip strength, or BP between the two groups (16 subjects in each group) at baseline. RESULTS The systolic BP (p = 0.01) decreased significantly, and the diastolic BP also decreased but not significantly in the yoga group (p = 0.11). For hand grip strength, both the unaffected hand (p = 0.00025) and the affected hand (p = 0.027) improved significantly. The control group showed no significant change in systolic or diastolic BP, nor did the grip strength change in both hands. Gender and age also affected the results of overall rehabilitation in that women benefited more from a decrease in BP, while men and young people (lower than the mean age of 60) benefited from hand grip strength improvement. CONCLUSIONS Combining yoga with rehabilitation in chronic stroke patients can improve hand grip strength and decrease systolic BP.
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Affiliation(s)
- Yen-Ting Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hsin-Chu Hospital, Hsinchu 300, Taiwan
| | - Hsiao-Ling Huang
- Department of Healthcare Management, Yuanpei University of Medical Technology, No. 306, Yuanpei Street, Hsinchu 300, Taiwan
| | - City C. Hsieh
- Department of Kinesiology, Research Center for Education and Mind Sciences, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Chien-Hung Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Jung-Cheng Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hsin-Chu Hospital, Hsinchu 300, Taiwan
| | - Han-Hsing Tsou
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 112, Taiwan
| | - Chih-Ching Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Szu-Yuan Li
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan 333, Taiwan
| | - Wen-Sheng Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 112, Taiwan
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei 103, Taiwan
- Department of Special Education, University of Taipei, Taipei 100, Taiwan
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13
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Ramachandran R, Bhargava V, Jasuja S, Gallieni M, Jha V, Sahay M, Alexender S, Mostafi M, Pisharam JK, Wai TSC, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Cuong NT, Akhtar SF, Alsahow A, Rana DS, Kher V, Rajapurkar MM, Jeyaseelan L, Puri S, Sagar G, Bahl A, Verma S, Sethi A, Vachharajani T. Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia. J Vasc Access 2022; 23:849-860. [PMID: 33934667 PMCID: PMC7615897 DOI: 10.1177/11297298211011375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries.
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Affiliation(s)
| | | | | | | | - Vivekanand Jha
- Executive Director, George Institute of Global Health, India
| | | | | | - Mamun Mostafi
- Department of Nephrology, Armed Forces Medical College, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nguyen The Cuong
- Department of Kidney diseases and Dialysis, Viet Duc University Hospital, Vietnam
| | | | | | | | | | | | | | - Sonika Puri
- Rutgers Robert Wood Johnson Medical School, USA
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14
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Tong ZJ, Kuo CW, Yen PC, Lin CC, Tsai MT, Lu SH, Chang YP, Liu WS, Tsou HH, Cheng HW, Wang HT. Acrolein plays a culprit role in the pathogenesis of diabetic nephropathy in vitro and in vivo. Eur J Endocrinol 2022; 187:579-592. [PMID: 36001357 DOI: 10.1530/eje-22-0493] [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: 06/01/2022] [Accepted: 08/24/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Diabetic nephropathy (DN), also known as diabetic kidney disease (DKD), is a major chronic complication of diabetes and is the most frequent cause of kidney failure globally. A better understanding of the pathophysiology of DN would lead to the development of novel therapeutic options. Acrolein, an α,β-unsaturated aldehyde, is a common dietary and environmental pollutant. DESIGN The role of acrolein and the potential protective action of acrolein scavengers in DN were investigated using high-fat diet/ streptozotocin-induced DN mice and in vitro DN cellular models. METHODS Acrolein-protein conjugates (Acr-PCs) in kidney tissues were examined using immunohistochemistry. Renin-angiotensin system (RAS) and downstream signaling pathways were analyzed using quantitative RT-PCR and Western blot analyses. Acr-PCs in DN patients were analyzed using an established Acr-PC ELISA system. RESULTS We found an increase in Acr-PCs in kidney cells using in vivo and in vitro DN models. Hyperglycemia activated the RAS and downstream MAPK pathways, increasing inflammatory cytokines and cellular apoptosis in two human kidney cell lines (HK2 and HEK293). A similar effect was induced by acrolein. Furthermore, acrolein scavengers such as N-acetylcysteine, hydralazine, and carnosine could ameliorate diabetes-induced kidney injury. Clinically, we also found increased Acr-PCs in serum samples or kidney tissues of DKD patients compared to normal volunteers, and the Acr-PCs were negatively correlated with kidney function. CONCLUSIONS These results together suggest that acrolein plays a role in the pathogenesis of DN and could be a diagnostic marker and effective therapeutic target to ameliorate the development of DN.
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Affiliation(s)
- Zhen-Jie Tong
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Wei Kuo
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Cheng Yen
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shing-Hwa Lu
- Department of Urology, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ping Chang
- Division of Nephrology, Taoyuan Branch of Taipei Veterans General Hospital, Taoyuan, Taiwan
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
- Department of Business Administration, Ming Chuan University, Taipei, Taiwan
| | - Wen-Sheng Liu
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Han-Hsing Tsou
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Kim Forest Enterprise Co., Ltd., Taipei, Taiwan
| | - Hsiao-Wei Cheng
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiang-Tsui Wang
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Toxicology, Kaohsiung Medical University, Kaohsiung, Taiwan
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15
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Niu CY, Yang SF, Ou SM, Wu CH, Huang PH, Hung CL, Lin CC, Li SY. Sacubitril/Valsartan in Patients With Heart Failure and Concomitant End-Stage Kidney Disease. J Am Heart Assoc 2022; 11:e026407. [PMID: 36062622 PMCID: PMC9683670 DOI: 10.1161/jaha.122.026407] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Heart failure with reduced ejection fraction (HFrEF) is a chronic disease with substantial mortality. Management of HFrEF has seen significant breakthrough after the launch of neprilysin inhibitor. The PARADIGM‐HF (Prospective Comparison of ARNI with ACEI to Determine Impacton Global Mortality and Morbidity in Heart Failure) trial showed that sacubitril/valsartan significantly reduces HFrEF mortality and the heart failure hospitalization rate. However, in patients with advanced kidney disease, who have the highest prevalence of heart failure, the efficacy and safety of sacubitril/valsartan remains uncertain. We aim to study the efficiency of sacubitril/valsartan in patients with end‐stage kidney disease. Methods and Results Heart function was screened by echocardiogram among all patients with end‐stage kidney disease in 2 hospitals. Patients with HFrEF received either sacubitril/valsartan or conventional treatment. Fifteen echocardiographic parameters were compared before and after treatment. After 1‐year sacubitril/valsartan treatment, parameters of systolic (left ventricular ejection fraction 31.3% to 45.1%, P<0.0001; left ventricular end‐systolic volume 95.7 to 70.1 mL, P=0.006; left ventricular internal diameter at end‐systole phase 47.2 to 40.1 mm, P=0.005), and diastolic (E/A ratio 1.3 to 0.8, P=0.009; E/Med e' ratio 25.3 to 18.8, P=0.010) function improved in patients with HFrEF and end‐stage kidney disease. These parameters were unchanged in the conventional treatment group. Serum potassium did not increase in the sacubitril/valsartan group. Conclusions Sacubitril/valsartan improves left ventricular systolic and diastolic function in patients with HFrEF and end‐stage kidney disease.
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Affiliation(s)
- Chih-Yuan Niu
- Division of Nephrology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Shang-Feng Yang
- School of Medicine National Yang-Ming Chiao-Tung University Taipei Taiwan.,Division of Nephrology, Department of Medicine Cheng Hsin General Hospital Taipei Taiwan
| | - Shuo-Ming Ou
- Division of Nephrology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,School of Medicine National Yang-Ming Chiao-Tung University Taipei Taiwan
| | - Cheng-Hsueh Wu
- School of Medicine National Yang-Ming Chiao-Tung University Taipei Taiwan.,Department of Critical Care Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Po-Hsun Huang
- Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University Taipei Taiwan.,Department of Critical Care Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine MacKay Memorial Hospital Taipei Taiwan.,Institute of Biomedical Sciences, Mackay Medical College New Taipei Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,School of Medicine National Yang-Ming Chiao-Tung University Taipei Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.,School of Medicine National Yang-Ming Chiao-Tung University Taipei Taiwan
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16
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Liu WS, Lin CH, Li SY, Lin CC, Liu TY, Tan AC, Tsou HH, Chan HL, Lai YT. Perfluorooctanesulfonate Can Cause Negative Bias in Creatinine Measurement in Hemodialysis Patients Using Polysulfone Dialysis Membranes. Membranes (Basel) 2022; 12:778. [PMID: 36005693 PMCID: PMC9413667 DOI: 10.3390/membranes12080778] [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] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Serum creatinine is an important clinical marker for renal clearance. However, two conventional methods (Jaffe and enzymatic) are prone to interferences with organic compounds as compared to the standard method (isotope dilution-liquid chromatography-mass spectrometry) and can cause a significant negative bias. Perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA) are two common perfluorochemicals (PFCs) that can easily be accumulated in humans. We aimed to verify whether this bias is the result of an accumulation of PFCs. The serum creatinine values of 124 hemodialysis patients were analyzed using the three methods. We also aimed to evaluate which biochemical parameters will influence the difference between the conventional methods and the standard method. We found that a significant underestimation occurred when using the conventional methods. Albumin is an independent factor associated with negative bias, but it loses this correlation after dialysis, likely due to the removal of protein-bound uremic toxins. PFOS can cause negative bias when using the enzymatic method. Furthermore, this linear correlation is more significant in patients who used polysulfone-based dialysis membranes, possibly due to the better clearance of other uremic toxins. The serum creatinine of uremic patients can be significantly underestimated when using conventional methods. PFCs, as well the type of dialysis membrane being used, can be influencing factors.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei City Hospital Zhongxing Branch, Taipei 103, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Department of Special Education, University of Taipei, Taipei 100, Taiwan
| | - Chien-Hung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Tsung-Yun Liu
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Han-Hsing Tsou
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Kim Forest Enterprise Co., Ltd., New Taipei City 221, Taiwan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan 333, Taiwan
| | - Yen-Ting Lai
- College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
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17
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Hsieh MY, Cheng CH, Chen CH, Liao MT, Lin CC, Yang TF, Chuang SY, Wu CC. The association of long-term blood pressure variability with hemodialysis access thrombosis. Front Cardiovasc Med 2022; 9:881454. [PMID: 35990946 PMCID: PMC9386040 DOI: 10.3389/fcvm.2022.881454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Blood pressure variability (BPV) is an important risk factor for cardiovascular events in hemodialysis patients. We sought to determine the impact of BPV on hemodialysis access thrombosis. Methods We enrolled 1,011 prevalent hemodialysis patients from 12 hemodialysis centers since January 2018 and followed them until December 2020. Predialysis blood pressure (BP) was assessed at 12-week intervals. The coefficient of variation derived from 36 consecutive BP measurements was used as the metric for variability. The primary outcome was incident hemodialysis access thrombosis. Linear regression models were used to assess factors associated with BPV at baseline. Kaplan-Meier curves of the time until vascular access events were drawn and log-rank tests were calculated. Cox proportional hazards models were performed to assess the association of BPV with incident vascular access events. Results The average coefficient of variance for systolic BPV was 10.9%. BPV was associated with age, body mass index, mean BP, diabetes, coronary and peripheral artery disease, history of access dysfunction, graft access, intradialytic hypotension, and use of antihypertensive medications. There were 194 access thrombosis events and 451 access stenosis events during a median follow-up period of 30 months. After adjustment of potential confounding factors, BPV was associated with increased risk of access thrombosis [hazard ratio = 1.27, 95% confidence interval (CI), 1.18–1.44, per 1 standard deviation increase in BPV]. The patients in the highest BPV quartile had 2.45 times the risk of thrombosis (CI, 1.62–3.70). The association was independent of average BP, intradialytic hypotension, and comorbidities. Similar trends of association were found in the subgroups analyzed. Comparative analysis using a time-varying variable model and different metrics of BPV showed consistent results. Conclusion Our findings underscored the impact of BP fluctuation on vascular access thrombosis.
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Affiliation(s)
- Mu-Yang Hsieh
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | | | - Chiu-Hui Chen
- Hemodialysis Center, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli County, Taiwan
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Center of Quality Management, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
- Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli County, Taiwan
- *Correspondence: Chih-Cheng Wu,
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18
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Chou YH, Chen YT, Chen JY, Tarng DC, Lin CC, Li SY. Baseline Peritoneal Membrane Transport Characteristics Are Associated with Peritonitis Risk in Incident Peritoneal Dialysis Patients. Membranes 2022; 12:membranes12030276. [PMID: 35323751 PMCID: PMC8954606 DOI: 10.3390/membranes12030276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022]
Abstract
The peritoneal equilibration test (PET) is a semi-quantitative measurement that characterizes the rate of transfer of solutes and the water transfer rate across the peritoneum in patients treated with peritoneal dialysis (PD). The results of the PET are used to maximize daily peritoneal ultrafiltration and solute clearances. Previous studies have shown that high transport status is associated with ultrafiltration failure, malnutrition, and reduced survival; however, the way in which peritoneum transport characteristics affect peritonitis risk is unknown. In the current cohort study, we recruited 898 incident-PD patients and used intention-to-treat analysis to test if baseline PET affected the subsequent 3-year peritonitis rate. Among all recruited PD patients, 308 (34.2%) developed peritonitis within three years. Multivariate Cox regression analysis showed that the high-transport group has the greatest peritonitis risk (HR 1.98, 95% CI: 1.08–3.62) even after an adjustment for demographics, comorbid diseases, and biochemical measurements. We concluded that a baseline high peritoneal membrane transport rate is an independent risk factor for peritonitis in incident PD patients.
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Affiliation(s)
- Yi-Hsin Chou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
| | - Yung-Tai Chen
- Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei 11217, Taiwan;
- Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
- Department and Institute of Physiology, National Yang-Ming University, Taipei 11217, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
- Correspondence:
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19
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Chen YA, Ou SM, Lin CC. Influence of Dialysis Membranes on Clinical Outcomes: From History to Innovation. Membranes 2022; 12:membranes12020152. [PMID: 35207074 PMCID: PMC8876340 DOI: 10.3390/membranes12020152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 12/18/2022]
Abstract
Dialysis membranes were traditionally classified according to their material compositions (i.e., as cellulosic or synthetic) and on the basis of the new concept of the sieving coefficient (determined by the molecular weight retention onset and molecular weight cut-off). The advantages of synthetic polymer membranes over cellulose membranes are also described on the basis of their physical, chemical, and structural properties. Innovations of dialysis membrane in recent years include the development of medium cutoff membranes; graphene oxide membranes; mixed-matrix membranes; bioartificial kidneys; and membranes modified with vitamin E, lipoic acid, and neutrophil elastase inhibitors. The current state of research on these membranes, their effects on clinical outcomes, the advantages and disadvantages of their use, and their potential for clinical use are outlined and described.
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Affiliation(s)
- Yee-An Chen
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Shuo-Ming Ou
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: (S.-M.O.); (C.-C.L.); Tel.: +886-2-2875-3103 (C.-C.L.); +886-2-2871-2121 (S.-M.O.); Fax: +886-2-2875-7858 (C.-C.L.)
| | - Chih-Ching Lin
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: (S.-M.O.); (C.-C.L.); Tel.: +886-2-2875-3103 (C.-C.L.); +886-2-2871-2121 (S.-M.O.); Fax: +886-2-2875-7858 (C.-C.L.)
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20
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Liao MT, Luo CM, Hsieh MC, Hsieh MY, Lin CC, Chie WC, Yang TF, Wu CC. Stent grafts improved patency of ruptured hemodialysis vascular accesses. Sci Rep 2022; 12:51. [PMID: 34996982 PMCID: PMC8741950 DOI: 10.1038/s41598-021-03933-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
This study aimed to compare stent graft with balloon tamponade for ruptured dialysis access during percutaneous transluminal angioplasty. Patients over an 8-year period (2010–2018) were identified from a database of 11,609 procedures. The primary endpoint was target lesion primary patency at 12 months. A total of 143 patients who had rupture dialysis access were enrolled, of whom 52 were salvaged by stent grafts and 91 were salvaged by balloon tamponade. The 6-month target lesion primary patency was greater in the stent graft group than in the balloon tamponade group (66.7% vs. 29.5%, P < 0.001). The benefit of stent grafts was sustained for 12 months (52.5% vs. 9.0%, P < 0.001). The stent grafts increased the median time from the index procedure to the next intervention in the ruptured area by 171 days (260 vs. 89 days) at 12 months. There was no significant difference in the access circuit patency rates at 6 months (25.5% vs. 19.8%, P = 0.203) and 12 months (12.0% vs. 5.8%, P = 0.052). The patency results of the stent grafts remained after the multivariable adjustment analysis. Compared to balloon tamponade alone, stent grafts provided superior target lesion primary patency at 6 and 12 months. The access circuit patency rates were similar.
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Affiliation(s)
- Min-Tsun Liao
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC.,College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Chien-Ming Luo
- College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.,Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Ming-Chien Hsieh
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Mu-Yang Hsieh
- Division of Cardiology, Department of Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC.,College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.,Institute of Biological Science and Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
| | - Wei-Chu Chie
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.,School of Public Health, National Taiwan University, Taipei, Taiwan, ROC
| | - Ten-Fang Yang
- Institute of Biological Science and Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Medical University and Hospital, Taipei, Taiwan, ROC
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan, ROC. .,Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan, ROC. .,Institute of Cellular and System Medicine, National Health Research Institute, Zhunan, Taiwan, ROC. .,Cardiovascular Center, National Taiwan University Hospital Hsinchu Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd, Hsinchu City, 300, Taiwan.
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21
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Bhargava V, Jasuja S, Wai TSC, Bhalla AK, Sagar G, Jha V, Ramachandran R, Sahay M, Alexander S, Vachharajani T, Lydia A, Mostafi M, Pisharam JK, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Akhtar SF, Alsahow A, Rana DS, Rajapurkar MM, Kher V, Verma S, Krishnaswamy S, Gupta A, Bahl A, Gupta A, Khanna UB, Varughese S, Gallieni M. Peritoneal dialysis: Status report in South and South East Asia. Nephrology (Carlton) 2021; 26:898-906. [PMID: 34313370 PMCID: PMC7615904 DOI: 10.1111/nep.13949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/05/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region. METHODS The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups. RESULTS Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI - US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization. CONCLUSION Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.
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Affiliation(s)
- Vinant Bhargava
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sanjiv Jasuja
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Tang Sydeny Chi Wai
- Department of Nephrology, Hong Kong Society of Nephrology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Anil K. Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Gaurav Sagar
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Vivekanand Jha
- Chair of global Kidney Health, George Institute of Global Health, New Delhi, India
| | | | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | | | | | - Aida Lydia
- Department of Nephrology&Hypertension, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mamun Mostafi
- Department of Nephrology, Armed Forces Medical College, Dhaka, Bangladesh
| | | | - Chakko Jacob
- Department of Nephrology, Bangalore Baptist Hospital, Bangalore, India
| | - Atma Gunawan
- Department of Nephrology, Brawijaya University, Malang city, Indonesia
| | - Goh Bak Leong
- Department of Nephrology, Serdang Hospital, Kajang, Malaysia
| | - Khin Thida Thwin
- Department of Nephrology, University Of Medicine, Yangon, Myanmar
| | | | | | | | - Lina Choong
- Department of Nephrology, Singapore General Hospital, Singapore, Singapore
| | - Chula Herath
- Department of Nephrology, Sri Jayewardenepura General Hospital, Kotte, Sri Lanka
| | - Chih-Ching Lin
- Department of Nephrology, Taipei Veterans General Hospital, Teipei city, Taiwan
| | - Syed Fazal Akhtar
- Department of Nephrology, Sindh Institute of Urology and Transplantation, karachi, Pakistan
| | - Ali Alsahow
- Department of Nephrology, Jahra Hospital, Al-Jahra, Kuwait
| | | | - Mohan M. Rajapurkar
- Department of Nephrology, Muljibhai Patel Urological Hospital, Gujrat, India
| | - Vijay Kher
- Department of Nephrology, Medanta Hospital, Gurugram, Haryana, India
| | - Shalini Verma
- Clinical Research, AVATAR foundation, New Delhi, India
| | | | - Amit Gupta
- Department of Nephrology, Apollo Medics Hospital, Kanpur–Lucknow, Uttar Pradesh, India
| | - Anupam Bahl
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Ashwani Gupta
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Umesh B. Khanna
- Department of Nephrology, Lancelot Kidney and GI Centre, Mumbai, India
| | | | - Maurizio Gallieni
- ’L. Sacco’ Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
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22
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Li SY, Chuang CL, Lin CC, Tsai SH, Chen JY. Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial. Membranes (Basel) 2021; 11:membranes11100768. [PMID: 34677534 PMCID: PMC8541348 DOI: 10.3390/membranes11100768] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (−1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD.
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Affiliation(s)
- Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
| | - Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan;
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
| | - Shin-Hung Tsai
- Division of Nephrology, Department of Medicine, Cheng Hsin General Hospital, Taipei 112201, Taiwan;
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
- Correspondence:
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23
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Chan SL, Lin CC, Chau PH, Takemura N, Fung JTC. Evaluating online learning engagement of nursing students. Nurse Educ Today 2021; 104:104985. [PMID: 34058645 DOI: 10.1016/j.nedt.2021.104985] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 11/03/2020] [Revised: 04/20/2021] [Accepted: 05/17/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Previous studies suggest that increased learning satisfaction may encourage learning engagement in an online learning environment. OBJECTIVES To evaluate the level of learning engagement and its relationship with students' perceived learning satisfaction in an online clinical nursing elective course. DESIGN A prospective interventional study. SETTINGS A nursing course was converted to an online format because of the coronavirus disease COVID pandemic. PARTICIPANTS Part-time post-registration nursing undergraduates enrolled in an elective online clinical course. METHODS Related teaching and learning strategies were deployed in the course using the Community of Inquiry framework. All students who completed the course were invited to complete an online survey that included a validated Online Student Engagement questionnaire (OSE). Pearson's correlations were used to determine the association between perceived learning satisfaction and learning engagement. A logistic regression model was used to explore the associations of gender, age, working experience and perceived learning satisfaction with higher learning engagement. RESULTS The questionnaires were completed by 56 of 68 students (82%). The Pearson's correlation coefficient between the mean perceived learning satisfaction and OSE scores was 0.75 (p < .001). Twenty-five students (45%) were identified as highly engaged, using a cut-off of ≥3.5 for the mean OSE score. The mean perceived learning satisfaction (SD) score differed significantly between highly engaged and not highly engaged students [4.02 (0.49) vs. 3.27 (0.62), p < .001]. The logistic regression model showed that a greater perceived learning satisfaction [adjusted odds ratio (OR): 17.2, 95% C.I.: 3.46-86.0, p = .001] was associated with an increased likelihood of higher learning engagement, and >1 year of working experience (adjusted OR: 0.11, 95% C.I.: 0.01-0.89, p = .0039) was associated with a decreased likelihood of higher learning engagement. CONCLUSIONS The study findings suggest that perceived learning satisfaction predicts learning engagement among nursing students in this online learning course.
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Affiliation(s)
- S L Chan
- University of Hong Kong School of Nursing, Hong Kong.
| | - C C Lin
- University of Hong Kong School of Nursing, Hong Kong.
| | - P H Chau
- University of Hong Kong School of Nursing, Hong Kong.
| | - N Takemura
- University of Hong Kong School of Nursing, Hong Kong.
| | - J T C Fung
- University of Hong Kong School of Nursing, Hong Kong.
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24
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Abstract
Uremic pericarditis and pericardial effusion are possible complications among patients with end-stage renal disease. The accumulation of toxic metabolites may contribute to the pathogenesis of uremic pericarditis. Bleeding diathesis in peritoneal dialysis patients raises the risk of hemorrhagic pericardial tamponade, which is a fatal complication of peritoneal dialysis. We report a case of hemorrhagic pericardial tamponade who was nonadherent to peritoneal dialysis with initial presentation of hypotension and syncope. Transthoracic echocardiogram revealed septated, fibrinoid pericardial effusion and right ventricular diastolic compression. A massive bloody pericardial effusion was drained when he underwent the pericardial window procedure. There was a significant improvement both in his clinical condition and in the echocardiogram images after the procedure. Hemorrhagic pericardial tamponade occurs in uremic patients but is rarely seen in those undergoing peritoneal dialysis. Early diagnosis, immediate surgical drainage, and regular follow-up with echocardiography are crucial to achieve better prognoses in future similar clinical scenarios.
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Affiliation(s)
- Yi-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ting-Yu Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fan-Yu Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Chung Yu
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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25
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Lin CC, Lai CH, Lin WS, Lin CS. Severe myocardial bridge presenting as paroxysmal atrioventricular block. J Postgrad Med 2021; 67:171-173. [PMID: 33835057 PMCID: PMC8445129 DOI: 10.4103/jpgm.jpgm_1027_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/09/2020] [Accepted: 12/24/2020] [Indexed: 11/11/2022] Open
Abstract
Chest pain complicated with electrocardiographic changes is not an uncommon scenario in emergency departments, which should be examined cautiously. We describe a 51-years-old man with a myocardial bridge of coronary artery presenting with simultaneous Mobitz type I atrioventricular block on electrocardiography. Echocardiography excluded valvular abnormality and systolic/diastolic dysfunction. Coronary angiography confirmed the diagnosis of a myocardial bridge at the middle segment of the left anterior descending artery, involving the most dominant septal perforator branch with marked systolic compression. The patient underwent coronary artery bypass grafting surgery and was followed up uneventfully at the outpatient department with medical treatment of diltiazem and clopidogrel. The present case is being reported to highlight that clinicians should be alert to such a congenital abnormality as a potential cause of repeated myocardial infarction and conduction abnormality.
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Affiliation(s)
- CC Lin
- Division of Cardiology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
| | - CH Lai
- Division of Cardiology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung City, Taiwan
| | - WS Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - CS Lin
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
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26
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Chen FY, Chen CF, Tan AC, Chan CH, Chen FA, Liu WS, Chen TH, Ou SM, Li SY, Tsai MT, Chen YT, Lin CC. Long-term prognosis of vascular access in hemodialysis patients with systemic lupus erythematosus: a retrospective cohort study. Sci Rep 2021; 11:12519. [PMID: 34131224 PMCID: PMC8206131 DOI: 10.1038/s41598-021-92005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/27/2021] [Indexed: 11/09/2022] Open
Abstract
Patients with systemic lupus erythematosus (SLE) have a higher risk of vascular complications. This retrospective cohort study aimed to analyze the differences in the risk of arteriovenous fistula or graft (AVF/AVG) dysfunction in hemodialysis patients with and without SLE from Taiwan's National Health Insurance Database over a 10-year period. AVF/AVG dysfunction is defined as the occurrence of the first episode of intervention after vascular access creation. A total of 1366 HD patients with SLE had higher incidence rates of AVF/AVG dysfunction than 4098 non-SLE HD patients in the following 4 periods: (1) after 1 year (incidence rates = 15.21% and 13.01%, respectively; subdistribution hazard ratio (SHR) = 1.16; P = 0.007), (2) 1st-to-10th-year period (15.36% and 13.25%; SHR = 1.16; P = 0.007), (3) 5th-to-10th-year period (11.91% and 8.1%; SHR = 1.42; P = 0.003), and (4) overall period (23.53% and 21.66%; SHR = 1.09; P = 0.027). In conclusion, there were significantly higher incidence rates of AVF/AVG dysfunction in SLE patients during the long-term follow-up period. Vascular access function should be monitored regularly by clinical examinations, especially after 1 year and during 5 to 10 years, to improve AVF/AVG patency and dialysis adequacy in SLE patients undergoing maintenance hemodialysis.
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Affiliation(s)
- Fan-Yu Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan
| | - Chun-Fan Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan
| | - Chia-Hao Chan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan
| | - Fu-An Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Wen-Sheng Liu
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan.,Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Institute of Food Safety and Health Risk Assessment, National Yang-Ming University, Taipei, Taiwan.,College of Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan.,University of Taipei, Taipei, Taiwan
| | - Tz-Heng Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Fenglin Branch, Taipei Veterans General Hospital, Hualien, Taiwan
| | - Shuo-Ming Ou
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan
| | - Ming-Tsun Tsai
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan
| | - Yung-Tai Chen
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,University of Taipei, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Fuyou Branch, Taipei City Hospital Heping, Taipei, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei, 11217, Taiwan.
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27
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Chen CM, Shen PS, Lin CC, Wu CC. Semiparametric mixture cure model analysis with competing risks data: Application to vascular access thrombosis data. Stat Med 2021; 40:4034. [PMID: 34018621 DOI: 10.1002/sim.9036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Chyong-Mei Chen
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Pao-Sheng Shen
- Department of Statistics, Tunghai University, Taichung, Taiwan, R.O.C
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C.,Cardiovascular Center, National Taiwan University Hospital, Hsinchu, Taiwan, R.O.C
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28
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Lee YW, Chuang JY, Lin CC, Paul MC, Das S, Dhar A. High-efficiency picosecond mode-locked laser using a thulium-doped nanoengineered yttrium-alumina-silica fiber as the gain medium. Opt Express 2021; 29:14682-14693. [PMID: 33985185 DOI: 10.1364/oe.422947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
We report the theoretical and experimental investigation of a self-starting mode-locked fiber laser with a nanoengineered Tm3+-doped yttrium-alumina-silica (YAS) fiber as the gain medium. The YAS fiber exhibits a higher capability of Tm3+ cluster elimination than commercial silica fibers. The Tm3+ fluorescence properties and YAS dispersion are well characterized. As a result, an efficient picosecond mode-locked fiber laser is demonstrated with a slope efficiency of 14.14% and maximum pulse energy of 1.27 nJ. To the best of our knowledge, this is the first mode-locked fiber laser based on a Tm3+-doped YAS fiber. The experimental observation is also supported by the numerical analysis.
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29
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Sahay M, Jasuja S, Wai TSC, Alexander S, Jha V, Vachharajani T, Mostafi M, Pisharam JK, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Cuong NT, Haian HP, Akhtar SF, Alsahow A, Rana DS, Rajapurkar MM, Kher V, Verma S, Ramachandran R, Bhargava V, Puri S, Sagar G, Bahl A, Mandal S, Gupta A, Gallieni M. Aetiology, practice patterns and burden of end-stage kidney disease in South Asia and South-East Asia: A questionnaire-based survey. Nephrology (Carlton) 2021; 26:142-152. [PMID: 33169890 PMCID: PMC7615902 DOI: 10.1111/nep.13825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
AIM There is paucity of data on the epidemiology of end-stage kidney disease (ESKD) from South Asia and South-East Asia. The objective of this study was to assess the aetiology, practice patterns and disease burden and growth of ESKD in the region comparing the economies. METHODS The national nephrology societies of the region; responded to the questionnaire; based on latest registries, acceptable community-based studies and society perceptions. The countries in the region were classified into Group 1 (High|higher-middle-income) and Group 2 (lower|lowermiddle income). Student t-test, Mann-Whitney U test and Fisher's exact test were used for comparison. RESULTS Fifteen countries provided the data. The average incidence of ESKD was estimated at 226.7 per million population (pmp), (Group 1 vs. Group 2, 305.8 vs. 167.8 pmp) and average prevalence at 940.8 pmp (Group 1 vs. Group 2, 1306 vs. 321 pmp). Group 1 countries had a higher incidence and prevalence of ESKD. Diabetes, hypertension and chronic glomerulonephritis were most common causes. The mean age in Group 2 was lower by a decade (Group 1 vs. Group 2-59.45 vs 47.7 years). CONCLUSION Haemodialysis was the most common kidney replacement therapy in both groups and conservative management of ESKD was the second commonest available treatment option within Group 2. The disease burden was expected to grow >20% in 50% of Group 1 countries and 78% of Group 2 countries along with the parallel growth in haemodialysis and peritoneal dialysis.
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Affiliation(s)
- Manisha Sahay
- Department of Nephrology Osmania General Hospital, Hyderabad (+91) 9849097507
| | - Sanjiv Jasuja
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9711197981
| | - Tang Sydeny Chi Wai
- Department of Nephrology Queen Mary Hospital Hong Kong Society of Nephrology (+852) 92360037
| | | | - Vivekanand Jha
- Department of Nephrology George Institute of Global Health (+91) 85275 44733
| | - Tushar Vachharajani
- Department of Nephrology Cleveland Clinic, Ohio, United States (+1) 336 546 2713
| | - Mamun Mostafi
- Department of Nephrology Armed Forces Medical College, Bangladesh Representative from Bangladesh Renal Association (+880) 171 3035 346
| | - Jayakrishnan K Pisharam
- Department of Nephrology Ministry of Health, Brunei, Darussalam Medical Services, Brunei Representative from Brunei Society of Nephrology (+673) 817 8123
| | - Chakko Jacob
- Department of Nephrology Bangalore Baptist Hospital, India Representative from Indian Society of Nephrology (+91)9535236019
| | - Atma Gunawan
- Department of Nephrology Brawijaya University, Indonesia Representative from Society of Nephrology Indonesia (+62) 812 3300 543
| | - Goh Bak Leong
- Department of Nephrology Serdang Hospital, Malaysia Representative from Malaysian Nephrology Congress (+60) 1260 69119
| | - Khin Thida Thwin
- Department of Nephrology University Of Medicine, Myanmar Representative from Myanmar Nephro-Uro Society (+95) 95021764
| | - Rajendra Kumar Agrawal
- Department of Nephrology Bir Hospital, Nepal Nepal Society of Nephrology (+977)98 5102 3840
| | - Kriengsak Vareesangthip
- Department of Nephrology Siriraj Hospital, Mahidol University, Thailand Representative from Nephrology Society of Thailand (+66) 24198383
| | - Roberto Tanchanco
- Department of Nephrology The Medical City, Philippine Representative from Philippine Society of Nephrology (+63)9189173940
| | - Lina Choong
- Department of Nephrology Singapore General Hospital, Singapore Representative from Singapore Society of Nephrology (+65) 81253594
| | - Chula Herath
- Department of Nephrology Sri Jayewardenepura General Hospital, Srilanka Representative from Sri Lanka Society of Nephrology (+94) 773017025
| | - Chih-Ching Lin
- Department of Nephrology Taipei Veterans General Hospital, Taiwan Representative from Taiwan society of Nephrology (+886) 937024083
| | - Nguyen The Cuong
- Department of Nephrology Hochiminh City national University, Vietnam Representative from Society of Nephrology-Urology of Vietnam (+84) 912 323276
| | - Ha Phan Haian
- Department of Nephrology Viet Duc University Hospital, Vietnam Representative from- Society of Nephrology-Urology of Vietnam (+84) 913546992
| | - Syed Fazal Akhtar
- Department of Nephrology Sindh Institute of Urology and Transplantation, Pakistan Representative from Pakistan Society of Nephrology (+92)300 8249856
| | - Ali Alsahow
- Department of Nephrology Jahara Hospital, Kuwait Representative From Gulf Corporation Council (+96)599335599
| | - D S Rana
- Department of Nephrology Sir Gangaram Hospital, Delhi (+91)9811033984
| | - M M Rajapurkar
- Department of Nephrology Muljibhai Patel Urological Hospital, Gujrat (+91) 9824349500
| | - Vijay Kher
- Department of Nephrology Medanta Hospital Gurugram, Haryana (+91) 9811054118)
| | - Shalini Verma
- Clinical Research AVATAR foundation, New Delhi (+91)8586983027
| | | | - Vinant Bhargava
- Department of Nephrology Sir Ganga Ram Hospital, Delhi (+91) 9990610096
| | - Sonika Puri
- Department of Nephrology Rutgers Robert Wood Johnson Medical School, New Jersy United States +1 (732) 501 1737
| | - Gaurav Sagar
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9810995996
| | - Anupam Bahl
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9711311750
| | - Sandeep Mandal
- Department of Nephrology Columbia Asia Hospital, Gurugram (+91) 8130007368
| | - Ashwani Gupta
- Department of Nephrology Sir Ganga Ram Hospital, Delhi (+91) 9811049761
| | - Maurizio Gallieni
- Department of Nephrology ‘L. Sacco’ Department of Biomedical and Clinical Sciences University of Milano, Italy (+39) 347746 8832
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30
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Chen TH, Yu HT, Wu CH, Lin CC. Black hairy tongue in an end-stage renal disease patient. J Formos Med Assoc 2021; 120:1531-1532. [PMID: 33388236 DOI: 10.1016/j.jfma.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Tz-Heng Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital Fenglin Branch, Hualien, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Tzu Yu
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Hsing Wu
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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31
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Chen CM, Shen PS, Lin CC, Wu CC. Semiparametric mixture cure model analysis with competing risks data: Application to vascular access thrombosis data. Stat Med 2020; 39:4086-4099. [PMID: 32790100 DOI: 10.1002/sim.8711] [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: 12/06/2019] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/12/2022]
Abstract
The article is motivated by a nephrology study in Taiwan, which enrolled hemodialysis patients who suffered from vascular access thrombosis. After treatment, some patients were cured of thrombosis, while some may experience recurrence of either type (acute or nonacute) of vascular access thrombosis. Our major interest is to estimate the cumulative incidence probability of time to the first recurrence of acute thrombosis after therapy. Since the occurrence of one type of vascular access thrombosis precludes occurrence of the other type, patients are subject to competing risks. To account for the presence of competing risks and cured patients, we develop a mixture model approach to the regression analysis of competing-risks data with a cure fraction. We make inference about the effects of factors on both the cure rate and cumulative incidence function (CIF) for a failure of interest, which are separately specified in the logistic regression model and semiparametric regression model with time-varying and time-invariant effects. Based on two-stage method, we develop novel estimation equations using the inverse probability censoring weight techniques. The asymptotic properties of the estimators are rigorously studied and the plug-in variance estimators can be obtained for constructing interval estimators. We also propose a lack-of-fit test for assessing the adequacy of the proposed model and several tests for time-varying effects. The simulation studies and vascular access thrombosis data analysis are conducted to illustrate the proposed method.
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Affiliation(s)
- Chyong-Mei Chen
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Pao-Sheng Shen
- Department of Statistics, Tugman University, Taichung, Taiwan, R.O.C
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C.,Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan, R.O.C
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32
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Chen CF, Chen YT, Chen TH, Chen FY, Yang YP, Wang ML, Huo TI, Chang YL, Charis Tan A, Lin CC. Judicious use of sodium-glucose cotransporter 2 inhibitors in patients with diabetes on coronavirus-19 pandemic. J Chin Med Assoc 2020; 83:809-811. [PMID: 32433344 PMCID: PMC7434023 DOI: 10.1097/jcma.0000000000000354] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Sodium glucose cotransporter-2 inhibitors (SGLT2i), a novel antidiabetic drug blocks the reabsorption of glucose in proximal tubules of kidney, are demonstrated to have cardiovascular and renal benefits for people with diabetes. The benefits are associated with the significant increase of intrarenal angiotensin-converting enzyme II (ACE2) expression and blood volume contraction. However, the increased ACE2 may be detrimental to patients infected with the coronavirus infection 2019 (COVID-19), which is found to invade cells via the entry receptor of ACE2. Besides, an SGLT2i-induced natriuretic effect may also increase the risk of acute kidney injury and affect the hemodynamic stability during systemic infection disease. In this article, we explain the mechanisms why the use of SGLT2i in people with diabetes may lead to worse outcomes and suggest clinician to judiciously use it during COVID-19 pandemic.
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Affiliation(s)
- Chun-Fan Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
| | - Yung-Tai Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Internal Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan, ROC
| | - Tz-Heng Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital Fenglin Branch, Hualien, Taiwan, ROC
| | - Fan-Yu Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ping Yang
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Mong-Lien Wang
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Teh-Ia Huo
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yuh-Lih Chang
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Pharmacy, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Ching Lin
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address Correspondence. Dr. Chih-Ching Lin, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (C.-C. Lin)
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Abstract
The pandemic infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is widely increasing the patients affiliated with coronavirus disease 2019 (COVID-19) from last December of 2019. It is reported that the entry receptor of SARS-CoV-2 has been confirmed to be angiotensin-converting enzyme 2 (ACE2). Notably, whether the ACE-related inhibitors or drugs modulated ACE2 activity in affecting the viral activity and disease severity of SARS-CoV-2 is still an open question. Dipeptidyl peptidase-4 (DDP-4), a well-known anti-diabetic drug, has been widely used to control the glycemic condition in patients with diabetes. In this article, we are focusing on the impact of ACE inhibitors (ACEI) and DPP4 inhibitors used on SARS-CoV-2 activity and discussions about those drugs that may be related to infectious condition of COVID-19 diseases.
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Affiliation(s)
- Chun-Fan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
| | - Chian-Hsu Chien
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ping Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Jie Chou
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Mong-Lien Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - The-Ia Huo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chih-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address Correspondence. Dr. Chih-Ching Lin, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (C.-C. Lin)
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Chen TH, Wen YH, Chen CF, Tan AC, Chen YT, Chen FY, Lin CC. The advantages of peritoneal dialysis over hemodialysis during the COVID-19 pandemic. Semin Dial 2020; 33:369-371. [PMID: 32677120 PMCID: PMC7405464 DOI: 10.1111/sdi.12903] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Tz-Heng Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital Fenglin Branch, Hualien, Taiwan
| | - Yu-Hua Wen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Chun-Fan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,National Yang-Ming University Hospital, Yilan, Taiwan
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Tai Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
| | - Fan-Yu Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Kailasam S, Singh S, Liu MJ, Lin CC, Yeh KC. A HemK class glutamine-methyltransferase is involved in the termination of translation and essential for iron homeostasis in Arabidopsis. New Phytol 2020; 226:1361-1374. [PMID: 31968122 DOI: 10.1111/nph.16440] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
Iron (Fe) transport and utilization are controlled by Fe-dependent transcriptional cascades. Many genes participate in these processes, transcriptionally controlled by Fe-status. Thorough knowledge of the translational check-points is lacking. We identified a non-response to Fe-deficiency1-1 (nrf1-1) mutant of Arabidopsis thaliana, which displayed a hypersensitive phenotype under Fe-deficient conditions. By mapping nrf1-1, we found that the AT3G13440 locus encoding a HemK methyltransferase is responsible for the phenotype. Analyses of ProUBQ10:NRF1CDS overexpression nrf1-1 lines and a T-DNA insertion mutant nrf1-2, confirmed that loss-of-function of NRF1 results in enhanced Fe-starvation-sensitivity. NRF1 is required for the proper expression of the majority of Fe-deficiency-inducible (FDI) genes. The nrf1 mutants accumulated more polysomes in the roots, due to stalled ribosomes on several transcripts. Ribosome-footprint (RF) mapping revealed that ribosomes are stalled at a stop codon that amplified the stalling of trailing ribosomes. We detected higher RF levels in many FDI transcripts in nrf1-2. Our study demonstrates the requirement of NRF1 for an accurate termination of protein synthesis essential not only for a precise iron homeostasis, but also cellular ion balance. NRF1 is also important for normal growth and development. A check-point that fine-tunes peptide release in plants is uncovered.
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Affiliation(s)
- Sakthivel Kailasam
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, 11529, Taiwan
| | - Surjit Singh
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, 11529, Taiwan
- Molecular and Biological Agricultural Sciences Program, Taiwan International Graduate Program, Academia Sinica and National Chung Hsing University, Taipei, 11529, Taiwan
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Ming-Jung Liu
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, 11529, Taiwan
| | - Chih-Ching Lin
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, 11529, Taiwan
| | - Kuo-Chen Yeh
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, 11529, Taiwan
- Molecular and Biological Agricultural Sciences Program, Taiwan International Graduate Program, Academia Sinica and National Chung Hsing University, Taipei, 11529, Taiwan
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Liao MT, Chen MK, Hsieh MY, Yeh NL, Chien KL, Lin CC, Wu CC, Chie WC. Drug-coated balloon versus conventional balloon angioplasty of hemodialysis arteriovenous fistula or graft: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2020; 15:e0231463. [PMID: 32287283 PMCID: PMC7156061 DOI: 10.1371/journal.pone.0231463] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background Restenosis remains a significant problem in endovascular therapy for hemodialysis vascular access. Drug-coated balloon (DCB) angioplasty decreases restenosis in peripheral and coronary artery diseases. The aim of this systematic review and meta-analysis is to assess the patency outcomes following DCB angioplasty, as compared to conventional balloon (CB) angioplasty for the stenosis of hemodialysis vascular access. Methods A comprehensive search in the MEDLINE, EMBASE, and CENTRAL databases was conducted in order to identify eligible randomized controlled trials evaluating DCB angioplasty for hemodialysis vascular access dysfunction. The primary endpoint was the 6-month target lesion primary patency and the secondary endpoints were 12-month target lesion primary patency and procedure-related complications. Risk ratios (RR) were pooled and relevant subgroups were analyzed separately. Results Eleven randomized controlled trials comprised of 487 patients treated with DCB angioplasty and 489 patients treated with CB angioplasty were included. There were no significant differences in the target lesion primary patency at 6 months [RR, 0.75; 95% confidence interval (CI), 0.56, 1.01; p = 0.06] and at 12 months (RR 0.89; 95% CI, 0.79, 1.00; p = 0.06). The absence of benefit for the DCB group remained, even in the arteriovenous fistula subgroup or the subgroup of studies excluding central vein stenosis. The risk of procedure-related complication did not differ between the two groups (RR 1.00; 95% CI 0.98, 1.02; p = 0.95). Conclusion DCB angioplasty did not demonstrate significant patency benefit for the treatment of hemodialysis vascular access dysfunction. Wide variations in patency outcomes across studies were noted. Further studies focusing on specific types of access or lesions are warranted to clarify the value of DCB for hemodialysis vascular access. (PROSPERO Number CRD42019119938)
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Affiliation(s)
- Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Meng-Kan Chen
- Department of Family Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Mu-Yang Hsieh
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nai-Lun Yeh
- Department of Family Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Kuo-Liong Chien
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan
- Cardiovascular Center, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- Institute of Cellular and System Medicine, National Health Research Institute, Zhunan, Taiwan
- * E-mail: (CCW); (WCC)
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (CCW); (WCC)
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Chang CF, Chen TL, Chen TW, Yang WC, Lin CC. Recurrent Dialysis-Associated Aeromonas hydrophila Peritonitis: Reports of Two Cases and Review of the Literature. Perit Dial Int 2020. [DOI: 10.1177/089686080502500516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chao-Fu Chang
- Division of Nephrology, Yang-Ming University Taipei, Taiwan
- Department of Medicine Taipei Veterans General Hospital School of Medicine, Yang-Ming University Taipei, Taiwan
| | - Te-Li Chen
- Division of Infectious Diseases, Yang-Ming University Taipei, Taiwan
- Department of Medicine Taipei Veterans General Hospital School of Medicine, Yang-Ming University Taipei, Taiwan
| | - Tzen-Wen Chen
- Division of Nephrology, Yang-Ming University Taipei, Taiwan
- Department of Medicine Taipei Veterans General Hospital School of Medicine, Yang-Ming University Taipei, Taiwan
| | - Wu-Chang Yang
- Division of Nephrology, Yang-Ming University Taipei, Taiwan
- Department of Medicine Taipei Veterans General Hospital School of Medicine, Yang-Ming University Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Yang-Ming University Taipei, Taiwan
- Department of Medicine Taipei Veterans General Hospital School of Medicine, Yang-Ming University Taipei, Taiwan
- Institute of Clinical Medicine National Yang-Ming University Taipei, Taiwan
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Affiliation(s)
- Szu-Yuan Li
- Division of Nephrology Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
- Department of Pathology & Laboratory Medicine Taipei Veterans General Hospital National Yang-Ming University School of Medicine Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
| | - Kwok-Woon Yu
- Department of Medicine Division of Clinical Microbiology Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
- Department of Pathology & Laboratory Medicine Taipei Veterans General Hospital National Yang-Ming University School of Medicine Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
| | - Wu-Chang Yang
- Division of Nephrology Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
- Department of Pathology & Laboratory Medicine Taipei Veterans General Hospital National Yang-Ming University School of Medicine Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
| | - Tzen-Wen Chen
- Division of Nephrology, Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
| | - Chih-Ching Lin
- Division of Nephrology Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
- Department of Pathology & Laboratory Medicine Taipei Veterans General Hospital National Yang-Ming University School of Medicine Department of Internal Medicine Taipei Medical University and Hospital Taipei, Taiwan, R.O. China
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Lee TL, Chen CF, Tan AC, Chan CH, Ou SM, Chen FY, Yu KW, Chen YT, Lin CC. Prognosis of Vascular Access in Haemodialysis Patients with Autosomal Dominant Polycystic Kidney Disease. Sci Rep 2020; 10:1985. [PMID: 32029758 PMCID: PMC7004976 DOI: 10.1038/s41598-020-58441-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 01/14/2020] [Indexed: 12/24/2022] Open
Abstract
Vascular diseases are commonly observed in patients with autosomal dominant polycystic kidney disease (ADPKD). We aim to investigate the differences in the risk for arteriovenous fistula or graft (AVF/AVG) dysfunction in haemodialysis (HD) patients with and without ADPKD. 557 ADPKD and 1671 non-ADPKD patients were enrolled in the study after propensity score matching. The primary outcome measure is the incidence rate of AVF/AVG dysfunction. The incidence rates and risks of AVF/AVG dysfunction (per 100 person-years) for ADPKD and non-ADPKD patients were (1) 38.83 and 48.99 [SHR = 0.79, P = 0.137], respectively, for within 90 days, (2) 45.85 and 51.31 [SHR = 0.90, P = 0.300], respectively, for within 180 days, (3) 44.42 and 41.40 [SHR = 1.08, P = 0.361], respectively, for within the first year, (4) 27.38 and 24.69 [SHR = 1.09, P = 0.168], respectively, for within 5 years, (5) 17.35 and 13.80 [SHR = 1.19, P = 0.045], respectively, for between the 1st and 10th year, and (6) 25.40 and 21.22 [SHR = 1.14, P = 0.031], respectively, for all periods. ADPKD patients had lower incidence rates of AVF/AVG dysfunction within the first 180 days than non-ADPKD patients, but presented a higher incidence rate after 1 year of AVF/AVG creation and onwards.
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Affiliation(s)
- Tsung-Lun Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Nephrology, Fooyin University Hospital, Pingtung, Taiwan
| | - Chun-Fan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Hao Chan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuo-Ming Ou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fan-Yu Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ko-Wen Yu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Tai Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Internal Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
| | - Chih-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Wu CC, Hsieh MY, Lee CK, Chuang SY, Chung MY, Lin CC. Dimethylarginine Dimethylaminohydrolase 1 Polymorphisms and Venous Intimal Hyperplasia in Hemodialysis Patients. Am J Nephrol 2019; 50:454-464. [PMID: 31639806 DOI: 10.1159/000503949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/05/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND After angioplasty, veins are more prone to intimal hyperplasia than arteries. Veins tend to produce less nitric oxide (NO), which could lead to endothelial dysfunction. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthase and contributes to cardiovascular disease. In humans, dimethylarginine dimethylaminohydrolase 1 (DDAH1) is the major enzyme for ADMA degradation. In this study, we aim to determine whether venous intimal hyperplasia in hemodialysis (HD) vascular access is influenced by common polymorphisms in the DDAH1 genes. METHODS This is a prospective observational cohort study. A total of 473 HD patients referred for the angioplasty of vascular access were enrolled. There were 190 arteriovenous grafts (AVG) and 283 arteriovenous fistulas (AVF). The follow-up lasted for 2 years after the interventions. Seven single nucleotide polymorphisms (SNPs) in DDAH1 were genotyped and ADMA were measured at baseline. The primary outcome was restenosis after angioplasty. RESULTS Among the 7 SNPs, plasma ADMA levels were significantly different in DDAH1 rs233112 (GA + GG vs. AA, 0.86 ± 0.23 vs. 0.82 ± 0.19 μM, p = 0.03) and rs1498373 (CT + TT vs. CC, 0.87 ± 0.23 vs. 0.82 ± 0.20 μM, p = 0.02) genotypes. The AVF group with GG + GA genotype of rs233112 and CT + TT genotype of rs1498373 had higher risks of early restenosis at 3 months. In the AVG group, only GG + GA genotype of rs233112 was associated with early restenosis. A combined analysis of AVG and AVF groups showed that patients with rs233112 GA + GG genotype and rs1498373 CT + TT genotype had higher risks of early restenosis (both p < 0.001). The multivariate analysis results showed that the association of these genotypes with early restenosis is independent of clinical, access, or biochemical factors. CONCLUSIONS Our findings suggest that certain DDAH1 polymorphisms modulate circulating ADMA levels and are associated with venous intimal hyperplasia.
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Affiliation(s)
- Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
- Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan
- Institute of Cellular and System Medicine, National Health Research Institute, Miaoli, Taiwan
| | - Mu-Yang Hsieh
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chih-Kuo Lee
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Shao-Yuan Chuang
- Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ming-Yi Chung
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan,
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Hsieh YC, Liao YC, Li CH, Lin JC, Weng CJ, Lin CC, Lo CP, Huang KC, Huang JL, Lin CH, Wu TJ, Sheu WH. P5644Hypoglycemic episodes increase the risk of ventricular arrhythmias and sudden cardiac arrest in patients with type 2 diabetes - a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypoglycemic episode (HE) increases the risk of cardiovascular mortality. The impact of HE on the risk of sudden death remains unclear. We hypothesized that HE increases the risks of ventricular arrhythmia (VA) and sudden cardiac arrest (SCA), and that anti-diabetic agents (ADAs) causing hypoglycemia also increase the risks of VA and SCA.
Methods
Patients aged ≥20 years with newly diagnosed diabetes were identified from the Taiwan National Insurance Database. HE was defined as the presentation of hypoglycemic coma or specified/unspecified hypoglycemia. For control group, we included diabetic patients without HE, and they were frequency-matched to the HE group at a 4:1 ratio. The primary outcome was the occurrence of any event of VA (including ventricular tachycardia and fibrillation) and SCA during the defined follow-up periods. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for VA or SCA.
Results
A total of 54,303 diabetic patients were screened with 1,037 of them in the HE group, and 4,148 in the control group. During a mean follow-up period of 3.3±2.5 years, 29 VA/SCA events had occurred. Compared to the control group, the HE group had a higher incidence of VA/SCA (adjusted HR: 2.42, p=0.04). Diabetic patients medicated with insulin for glycemic control increased the risk of VA/SCA compared to those without insulin (adjusted HR: 3.05, p=0.01).
Kaplan-Meier survival curves
Conclusions
HEs in patients with diabetes increased the risks of VA and SCA compared to those without. Their use of insulin also independently increased the risk of VA/SCA.
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Affiliation(s)
- Y C Hsieh
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Y C Liao
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C H Li
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - J C Lin
- Chiayi Branch, Taichung Veterans General Hospital, Department of Internal Medicine, Chiayi, Taiwan
| | - C J Weng
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C C Lin
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - C P Lo
- Providence University, Department of Financial Engineering, Taichung, Taiwan
| | - K C Huang
- Providence University, Department of Financial Engineering, Taichung, Taiwan
| | - J L Huang
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - C H Lin
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - T J Wu
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - W H Sheu
- Taichung Veterans General Hospital, Division of Endocrinology and Metabolism, Department of Medicine, Taichung, Taiwan
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Chen MN, Ho KY, Hung YN, Su CC, Kuan CH, Tai HC, Cheng NC, Lin CC. Pre-treatment quality of life as a predictor of distant metastasis-free survival and overall survival in patients with head and neck cancer who underwent free flap reconstruction. Eur J Oncol Nurs 2019; 41:1-6. [PMID: 31358241 DOI: 10.1016/j.ejon.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/04/2018] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE This study examined the prognostic associations of pre-treatment quality of life (QoL) with overall survival (OS) and distant metastasis-free survival (DFMS) among patients with head and neck cancer (HNC) who underwent free flap reconstruction. METHODS A cohort of 127 HNC patients who received free flap reconstruction between November 2010 and June 2014 at a hospital were recruited. Pre-treatment QoL was measured by the University of Washington Quality of Life Questionnaire, which contains six physical domains, including speech, swallowing, appearance, saliva, taste and chewing, as well as the six social-emotional domains of pain, activity, recreation, shoulder, mood, and anxiety. Cox regression analyses were performed. RESULTS Results showed that pre-treatment QoL was predictive of OS and DMFS. Of the domains, swallowing, chewing, speech, taste, saliva, pain and shoulder were demonstrated to be significant predictors of OS. Additionally, swallowing, chewing, speech, pain and activity were demonstrated making significant contributions to DMFS. CONCLUSION Our data supported that physical domains of pre-treatment QoL were predictors for OS and DFMS in HNC patients with free-flap reconstruction. Longitudinal studies are warranted to clarify the prognostic abilities of social-emotional domains. Information on pre-treatment QoL should be taken into account to individualize care plan for these patients, and hence prolong their survival.
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Affiliation(s)
- M N Chen
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - K Y Ho
- School of Nursing, The University of Hong Kong, HKSAR, China.
| | - Y N Hung
- School of Gerontology and Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - C C Su
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - C H Kuan
- Graduate Institute of Clinical Research, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - H C Tai
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - N C Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - C C Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, The University of Hong Kong, HKSAR, China; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Hao S, Lu CH, Lin CC, Chen HY, Li L, Wang YB, Feng MX, He Y. [The role and mechanism of 2-deoxyglucose in reversing osimertinib-acquired resistance of non-small cell lung cancer cell line]. Zhonghua Jie He He Hu Xi Za Zhi 2019; 42:198-205. [PMID: 30845397 DOI: 10.3760/cma.j.issn.1001-0939.2019.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the role and mechanism of 2-deoxyglucose (2-dg) in reversing osimertinib- acquired resistance of non-small cell lung cancer(NSCLC)cell line. Methods: The NSCLC line H1975 (purchased from the American Type Culture Collection) was conducted by induction method in vitro to construct the osimertinib-resistance NSCLC cell line H1975-OR. The osimertinib-resistance of H1975-OR cell line was examined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, colony-formation assay, Ki67 incorporation assay and the expression of apoptosis-related protein. The glycolysis level was assayed by the lactic acid production measured in the culture medium supernatant of H1975 and H1975-OR. The expression of glycolysis key enzymes (HK2, GLUT1, P-PKM2) and apoptosis-related protein (BIM, Bcl-2) were detected by Western blot. The cells were divided into control group, 2-deoxyglucose (4 mmol/L) monotherapy group, osimertinib (3 μmol/L) monotherapy group and 2-deoxyglucose (4 mmol/L)+ osimertinib (3 μmol/L) combination therapy group, then the apoptosis rate of cells was measured by flow cytometry to evaluate the pro-apoptotic ability of drugs. Date were analyzed by Independent-Samples t-test using SPSS 16.0 statistical software. Results: The glycolysis level of osimertinib-sensitive cell line H1975 was lower than that of osimertinib-resistance cell line H1975-OR [the yield of lactic acid, respectively, was (21.0±0.9) and (26.5±2.8) mmol·L(-1)·10(4)cells(-1), P<0.05]. The osimertinib- acquired resistance of H1975-OR could be reversed by 4 mmol/L 2-deoxyglucose(the IC(50) value of osimertinib in H1975-OR cell line decreased from (7.0±1.9) μmol/L to (1.4±0.1) μmol/L, which was close to the IC(50) value of osimertinib in H1975 cell line (1.0±0.2) μmol/L. The apoptosis rate of H1975-OR was significantly higher in 2-deoxyglucose + osimertinib combination therapy group (26.7±2.4)%, compared to control group (5.1±0.7)%, 2-deoxyglucose monotherapy group (6.1±2.5)% and osimertinib monotherapy group (11.4±2.7)%(all P<0.05). The expression of pro-apoptotic protein BIM in H1975-OR was significantly higher in 2-deoxyglucose+ osimertinib combination therapy group (177.8±28.1)% and the expression of anti-apoptotic protein Bcl-2 in H1975-OR was significantly lower in 2-deoxyglucose+ osimertinib combination therapy group (24.6±5.2)%, compared to control group (100±0)%, all P<0.05. Conclusion: 2-deoxyglucose can reverse the acquired resistance of NSCLC cell line to osimertinib, which may be related to the inhibition of cell glycolysis and the induction of apoptosis.
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Affiliation(s)
- S Hao
- Department of Respiratory Disease, Daping Hospital, Army Military Medical University, Chongqing 400042, China
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Lin HH, King YC, Li YC, Lin CC, Chen YC, Lin JS, Jeng ST. The p38-like MAP kinase modulated H 2O 2 accumulation in wounding signaling pathways of sweet potato. Plant Sci 2019; 280:305-313. [PMID: 30824008 DOI: 10.1016/j.plantsci.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 06/09/2023]
Abstract
In sweet potato (Ipomoea batatas cv Tainung 57), MAPK cascades are involved in the regulation of Ipomoelin (IPO) expression upon wounding. p38 MAPK plays an important role in plant's responses to various environmental stresses. However, the role of p38-like MAPK in wounding response is still unknown. In this study, the levels of phosphorylated-p38-like MAPK (pp38-like MAPK) in sweet potato were noticeably reduced after wounding. In addition, SB203580 (SB), a specific inhibitor blocking p38 MAPK phosphorylation, considerably decreased the accumulation of pp38-like MAPK. Expression of a wound-inducible gene IPO was elevated by SB. Moreover, it stimulated hydrogen peroxide (H2O2) production rather than cytosolic Ca2+ elevation in sweet potato leaves. However, NADPH oxidase (NOX) inhibitor diphenyleneiodonium could not inhibit IPO induction stimulated by SB. These results indicated a p38-like MAPK mechanism was involved in the regulation of IPO expression through NOX-independent H2O2 generation. In addition, the presence of the protein phosphatase inhibitor okadaic acid or the MEK1/ERK inhibitor PD98059 repressed the H2O2- or SB-induced IPO expression, demonstrating phosphatase(s) and MEK1/ERK functioning in the downstream of H2O2 and pp38-like MAPK in the signal transduction pathway stimulating IPO. Conclusively, wounding decreased the amount of pp38-like MAPK, stimulated H2O2 production, and then induced IPO expression.
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Affiliation(s)
- Hsin-Hung Lin
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan; Department of Horticulture and Biotechnology, Chinese Culture University, Taipei, 11114, Taiwan
| | - Yu-Chi King
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - Yu-Chi Li
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - Chih-Ching Lin
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan; Institute of Plant and Microbial Biology, Academia Sinica, Taipei, 11529, Taiwan
| | - Yu-Chi Chen
- Department of Biotechnology, National Kaohsiung Normal University, Kaohsiung, 82444, Taiwan
| | - Jeng-Shane Lin
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan; Department of life sciences, National Chung Hsing University, Taichung, 40227, Taiwan.
| | - Shih-Tong Jeng
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan.
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Kang SC, Lin CC, Chen YC, Wang WS. The Impact of Hemodialysis on Terminal Cancer Patients in Hospices: A Nationwide Retrospective Study in Taiwan. J Palliat Med 2019; 22:188-192. [PMID: 30601079 DOI: 10.1089/jpm.2018.0299] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Hemodialysis (HD) is the most common renal replacement therapy for patients with end-stage renal disease in Taiwan. The use of HD in hospice care and its impact on terminal cancer patients remains unclear. METHODS Using claim data from the Taiwan National Health Insurance Research Database, all patients who died from cancer and claim data of their terminal admissions in hospice from 2007 to 2010. Those with a comorbid diagnosis of renal failure or who had health insurance claims data for HD were enrolled. RESULTS A total of 5482 subjects were identified, of whom 4484 received HD and 998 did not. The HD group was significantly correlated with a younger age and high costs of terminal hospice admission. After adjusting for age and gender, the HD group was positively associated with a long hospice stay, in-hospice death, bone/connective tissue/breast cancers, and secondary/metastatic cancers, but negatively associated with genitourinary cancer. Compared with Department of Health/municipal hospitals, patients at both national and private university-affiliated hospitals were less likely to undergo HD. CONCLUSIONS For terminal cancer patients under hospice care, HD was associated with a younger age, long terminal hospice stay, and high medical costs. Some types of cancers were associated with HD. University-affiliated hospitals played significant roles in non-HD renal supportive care. In-hospice HD is still common in Taiwan. Dialysis withdrawal and alternative care have space to promoting in hospice care.
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Affiliation(s)
- Shih-Chao Kang
- 1 Division of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.,2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Ching Lin
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,3 Department of Nephrology, Taipei Veterans Hospital, Taipei, Taiwan
| | - Yu-Chun Chen
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,4 Department of Family Medicine, Taipei Veterans Hospital, Taipei, Taiwan
| | - Wei-Shu Wang
- 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Department of Medical Teaching and Research, National Yang-Ming University Hospital, Yilan, Taiwan
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Liu WS, Chan HL, Lai YT, Lin CC, Li SY, Liu CK, Tsou HH, Liu TY. Dialysis Membranes Influence Perfluorochemical Concentrations and Liver Function in Patients on Hemodialysis. Int J Environ Res Public Health 2018; 15:ijerph15112574. [PMID: 30453629 PMCID: PMC6265901 DOI: 10.3390/ijerph15112574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
Abstract
Introduction: Perfluoro-octanesulfonate (PFOS) and perfluoro-octanoic acid (PFOA) are two toxic perfluorochemicals (PFCs) commonly used as surfactants. PFCs are difficult to be eliminated from the body. We investigated the influence of different dialysis membranes on the concentrations of PFCs in patients under hemodialysis. Method: We enrolled 98 patients. Of these, 58 patients used hydrophobic polysulfone (PS) dialysis membranes, and the other 40 had hydrophilic membranes made by poly-methyl methacrylate (PMMA) or cellulose triacetate (CTA). Liquid chromatography tandem mass spectrometry coupled was used with isotope dilution to quantify PFOA and PFOS. Results: The predialysis concentrations of PFOA and PFOS in patients with hydrophobic PS dialysis membranes were 0.50 and 15.77 ng/mL, respectively, lower than the concentrations of 0.81 and 22.70 ng/mL, respectively, in those who used hydrophilic membranes (such as CTA or PMMA). Older patients have higher PFOS and poorer body function, with lower Karnofsky Performance Status Scale (KPSS) scores. The demographic data of the two groups were similar. However, patients with hydrophobic PS dialysis membranes had lower predialysis aspartate transaminase (AST) (p = 0.036), lower glucose levels (p = 0.017), and better body function (nonsignificantly higher KPSS scores, p = 0.091) compared with patients who used other membranes. These differences may be associated with the effects of different membranes, because PFOA positively correlated with AST, while PFOS negatively correlated with body function. Conclusions: This is the first study comparing PFC levels in uremic patients with different dialysis membrane. PS membrane may provide better clearance of PFCs and may, therefore, be beneficial for patients.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei 10466, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 10466, Taiwan.
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei 10466, Taiwan.
- College of Science and Engineering, Fu Jen Catholic University, New Taipei city 24451, Taiwan.
| | - Hsiang Lin Chan
- Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan 33043, Taiwan.
| | - Yen-Ting Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 30041, Taiwan.
- Department of Nursing, Yuanpei University, Hsinchu 30041, Taiwan.
| | - Chih-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei 10466, Taiwan.
- Division of Nephrology and Department of Medicine, Taipei Veterans General Hospital, Taipei 10466, Taiwan.
| | - Szu-Yuan Li
- School of Medicine, National Yang-Ming University, Taipei 10466, Taiwan.
- Division of Nephrology and Department of Medicine, Taipei Veterans General Hospital, Taipei 10466, Taiwan.
| | - Chih-Kuang Liu
- College of Medicine and Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 24451, Taiwan.
| | - Han-Hsing Tsou
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei 10466, Taiwan.
| | - Tsung-Yun Liu
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei 10466, Taiwan.
- Institute of Food Safety and Health Risk Assessment, National Yang-Ming University, Taipei 10466, Taiwan.
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Chen CF, Chen FA, Lee TL, Liao LF, Chen CY, Tan AC, Chan CH, Lin CC. Current status of dialysis and vascular access in Taiwan. J Vasc Access 2018; 20:368-373. [DOI: 10.1177/1129729818807336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Chun-Fan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Fu-An Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Tsung-Lun Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Feng Liao
- Organ Transplantation Team and Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Yen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Hao Chan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Chen FY, Chen CH, Lin CC. Hypertensive Crisis and Refractory Hypertension Caused by Atypical Hemolytic Uremic Syndrome and Effect of Eculizumab. Acta Cardiol Sin 2018; 34:446-449. [PMID: 30271097 PMCID: PMC6160511 DOI: 10.6515/acs.201809_34(5).20180326d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/26/2018] [Indexed: 12/26/2022]
Affiliation(s)
| | - Chen-Huan Chen
- Department of Medicine
- Department of Medical Education, Taipei Veterans General Hospital
- Institute of Public Health
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Ching Lin
- Department of Medicine
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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Liu WS, Lai YT, Chan HL, Li SY, Lin CC, Liu CK, Tsou HH, Liu TY. Associations between perfluorinated chemicals and serum biochemical markers and performance status in uremic patients under hemodialysis. PLoS One 2018; 13:e0200271. [PMID: 30016344 PMCID: PMC6049900 DOI: 10.1371/journal.pone.0200271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/23/2018] [Indexed: 01/09/2023] Open
Abstract
Perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA) are commonly used perfluorinated chemicals (PFCs). PFCs are mainly excreted by urine. Uremic patients tend to accumulate toxins in their body and have poor functional status. We investigated the associations between PFCs and the clinical profile of uremic patients under hemodialysis (HD). Liquid chromatography tandem mass spectrometry coupled with isotope dilution was used to quantify PFOA and PFOS. We enrolled 126 patients under regular HD. Compared with previous research, the concentration of PFOA was lower, but that of PFOS was higher in uremic patients than in the general population. The levels of PFOA and PFOS in uremic patients before dialysis were 0.52 (ng/ml) and 21.84 (ng/ml) respectively. The PFOA level remained unchanged but that of PFOS decreased to1.85 ng/mL after dialysis. PFOS can be removed by HD. Patients using hypertensive medication had a lower PFOS then those who did not. The PFOS level was negatively correlated with the duration of the HD session and patient performance status, but positively correlated with levels of cholesterol, chloride (an indicator of acidemia), ferritin, and total protein. (p<0.05). The association with serum protein may explain the long half-life of PFCs in humans. This is the first study which investigated PFCs in uremic patients and showed PFCs are associated with adverse effects in this population.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Ting Lai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Nursing, Yuanpei University, Hsinchu, Taiwan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Nephrology, and Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Kuang Liu
- College of Medicine & Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Han-Hsing Tsou
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Yun Liu
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Lin CC. SP544FAR INFRARED THERAPY IMPROVES ANKLE BRACHIAL INDEX IN HEMODIALYSIS PATIENTS WITH PERIPHERAL ARTERY DISEASE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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