Tzung-Hai Yen
Research interests
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InterestsRepeated chelation therapies, Kidney Transplantation
Publications
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2.87Impact points
Early Identification of Leptospirosis as an Ignored Cause of Multiple Organ Dysfunction Syndrome.
Shock (Augusta, Ga.). 05/2012;
ABSTRACT: Leptospirosis is the most common zoonosis in the world but remains underreported, owing to protean manifestations and ignorance about the disease among healthcare providers in Taiwan. From September 2000 to March 2006, surveillance of 455 multiple organ dysfunction syndrome patients with u... [more] ABSTRACT: Leptospirosis is the most common zoonosis in the world but remains underreported, owing to protean manifestations and ignorance about the disease among healthcare providers in Taiwan. From September 2000 to March 2006, surveillance of 455 multiple organ dysfunction syndrome patients with unclear cause or clinical suspicion of leptospirosis was performed. Diagnosis was further confirmed by microscopic agglutination test or isolation of leptospira. Cases were classified as excluded based on confirmed etiology other than leptospirosis or negative paired serologic test. Forty-two patients were confirmed as leptospirosis, which accounted for 9.2% of total patients with multiple organ dysfunction syndrome. Forty-nine excluded cases were identified for a case-control analysis for clinical distinction. The most common presentations of leptospirosis were fever (97.6%), acute kidney injury (85.7%), and jaundice (61.9%). The leptospirosis group showed lower urine specific gravity (cutoff value: 1.0145) and enlarged kidney size (cutoff value: 11.05 cm) as compared with the excluded cases by multivariate logistics regression. Delayed antibiotics administration prolongs the duration of hospitalization (R Square: .486, P< .01). No mortality has been found in the leptospirosis group after initiation in 2003 of rapid IgM serology assay that showed considerably high sensitivity and specificity. Leptospirosis accounts for a salient cause of multiple organ dysfunctions in Taiwan. Early awareness of leptospirosis by distinct presentations, followed by prompt antibiotics therapy can dramatically save the patients. The easy-performed rapid IgM serology assay is suitable as a rapid screening test for the diagnosis of leptospirosis.
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2.87Impact points
Early Identification of Leptospirosis as an Ignored Cause of Multiple Organ Dysfunction Syndrome.
Shock (Augusta, Ga.). 05/2012;
ABSTRACT: Leptospirosis is the most common zoonosis in the world but remains underreported, owing to protean manifestations and ignorance about the disease among healthcare providers in Taiwan. From September 2000 to March 2006, surveillance of 455 multiple organ dysfunction syndrome patients with u... [more] ABSTRACT: Leptospirosis is the most common zoonosis in the world but remains underreported, owing to protean manifestations and ignorance about the disease among healthcare providers in Taiwan. From September 2000 to March 2006, surveillance of 455 multiple organ dysfunction syndrome patients with unclear cause or clinical suspicion of leptospirosis was performed. Diagnosis was further confirmed by microscopic agglutination test or isolation of leptospira. Cases were classified as excluded based on confirmed etiology other than leptospirosis or negative paired serologic test. Forty-two patients were confirmed as leptospirosis, which accounted for 9.2% of total patients with multiple organ dysfunction syndrome. Forty-nine excluded cases were identified for a case-control analysis for clinical distinction. The most common presentations of leptospirosis were fever (97.6%), acute kidney injury (85.7%), and jaundice (61.9%). The leptospirosis group showed lower urine specific gravity (cutoff value: 1.0145) and enlarged kidney size (cutoff value: 11.05 cm) as compared with the excluded cases by multivariate logistics regression. Delayed antibiotics administration prolongs the duration of hospitalization (R Square: .486, P< .01). No mortality has been found in the leptospirosis group after initiation in 2003 of rapid IgM serology assay that showed considerably high sensitivity and specificity. Leptospirosis accounts for a salient cause of multiple organ dysfunctions in Taiwan. Early awareness of leptospirosis by distinct presentations, followed by prompt antibiotics therapy can dramatically save the patients. The easy-performed rapid IgM serology assay is suitable as a rapid screening test for the diagnosis of leptospirosis.
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1.04Impact points
Bacteremia in hemodialysis and peritoneal dialysis patients.
Internal medicine (Tokyo, Japan). 01/2012; 51(9):1015-21.
Objective To analyze the incidence rates and risk factors for bacteremia in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Methods The records of 898 consecutive patients undergoing dialysis from January 2003 to December 2008 were reviewed retrospectively. Episodes of bacteremia... [more] Objective To analyze the incidence rates and risk factors for bacteremia in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Methods The records of 898 consecutive patients undergoing dialysis from January 2003 to December 2008 were reviewed retrospectively. Episodes of bacteremia were recorded. China Medical University (Taichung, Taiwan). Results The overall incidence rate of bacteremia was 7.63 per 100 patient-years in HD patients and 3.56 per 100 patient-years in PD patients and it was higher in HD patients each year from 2003 to 2008. S. aureus (27.53%) was the most common pathogen in HD patients, whereas Coagulase-negative Staphylococcus (21.3%) was the most common pathogen in PD patients. Vascular access infection was the most common etiology in HD patients, whereas peritonitis was the most common etiology in PD patients. Older age, shorter dialysis vintage, use of HD rather than PD, current smoker, use of a venous dialysis catheter, presence of diabetes mellitus, higher comorbidity score, and lower serum albumin were significant risk factors for bacteremia. Diabetes mellitus and lower serum albumin were significant risk factors for bacteremia-associated mortality. Conclusion Placement of a permanent access (fistula, graft, or PD catheter) prior to initiation of dialysis, smoking cessation, and better nutritional status (i.e. higher serum albumin) were associated with a reduced risk of bacteremia in dialysis patients. Higher serum albumin was also associated with a reduced bacteremia-associated mortality.
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4.41Impact points
Heart Rate-Corrected QT Interval Helps Predict Mortality after Intentional Organophosphate Poisoning.
PloS one. 01/2012; 7(5):e36576.
In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates. We ana... [more] In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates. We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal (<0.44 s) or prolonged (>0.44 s). Demographic, clinical, laboratory, and mortality data were obtained for analysis. The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P = 0.019). By the end of the study, 18 of 118 (15.2%) patients had died, including 3 of 75 (4.0%) patients with normal QTc intervals and 15 of 43 (34.9%) patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension (OR = 10.930, 95% CI = 2.961-40.345, P = 0.000), respiratory failure (OR = 4.867, 95% CI = 1.062-22.301, P = 0.042), coma (OR = 3.482, 95% CI = 1.184-10.238, P = 0.023), and QTc prolongation (OR = 7.459, 95% CI = 2.053-27.099, P = 0.002) were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval (503.00±41.56 versus 432.71±51.21 ms, P = 0.002), but also suffered higher incidences of hypotension (83.3 versus 12.0%, P = 0.000), shortness of breath (64 versus 94.4%, P = 0.010), bronchorrhea (55 versus 94.4%, P = 0.002), bronchospasm (50.0 versus 94.4%, P = 0.000), respiratory failure (94.4 versus 43.0%, P = 0.000) and coma (66.7 versus 11.0%, P = 0.000) than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc intervals than among those with normal QTc intervals (Log-rank test, Chi-square test = 20.36, P<0.001). QTc interval helps predict mortality after intentional organophosphate poisoning.
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Immunoglobulin G levels can predict non-diabetic renal disease in patients with type 2 diabetes mellitus.
Journal of diabetes. 12/2011; 4(1):37-40.
Background: Proteinuria in patients with diabetes mellitus (DM) is sometimes caused by glomerular diseases other than diabetic nephropathy. In patients with type 2 DM (T2DM), specific predictors for non-diabetic renal disease (NDRD) are needed in addition to the traditional indicators for renal bio... [more] Background: Proteinuria in patients with diabetes mellitus (DM) is sometimes caused by glomerular diseases other than diabetic nephropathy. In patients with type 2 DM (T2DM), specific predictors for non-diabetic renal disease (NDRD) are needed in addition to the traditional indicators for renal biopsy. Methods: From 1 January 2000 to 31 March 2011, we retrospectively enrolled 54 T2DM patients with proteinuria who had undergone renal biopsies into the present study. Associations between NDRD and 20 potential biomarkers, including serum levels of Igs and proteins associated with kidney function, and urinary protein and red blood cell levels, and hepatitis virus carrier status, were analyzed by multivariate logistic regression. Results: Multivariate logistic regression showed that reduced serum IgG (odds ratio [OR] 0.997; P = 0.006; 95% confidence interval [CI] 0.94-0.998) and creatinine (Cr; OR 0.587; P = 0.014; 95% CI 0.348-0.897) were predictors of NDRD. The area under the receiver operating characteristic curve (AUC(ROC) ) confirmed the good discriminatory power of IgG (AUC(ROC) 0.857 ± 0.058; 95% CI 0.744-0.970; P < 0.001) and Cr (AUC(ROC) 0.838 ± 0.054; 95% CI 0.732-0.943; P < 0.001). The IgG level below which the risk for NDRD increased, as calculated by obtaining the best Youden index, was 919.5 mg/dL (sensitivity 91.7%; specificity 83.3%), and the corresponding Cr level was 4.1 mg/dL (sensitivity 58.3%; specificity 96.7%). Conclusion: Serum IgG levels <919.5 mg/dL and serum Cr levels <4.1 mg/dL are associated with NDRD in T2DM patients.
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0.66Impact points
Food safety involving ingestion of foods and beverages prepared with phthalate-plasticizer-containing clouding agents.
Journal of the Formosan Medical Association = Taiwan yi zhi. 11/2011; 110(11):671-84.
In May 2011, the illegal use of the phthalate plasticizer di(2-ethylhexyl) phthalate in clouding agents for use in foods and beverages was reported in Taiwan. This food scandal has caused shock and panic among the majority of Taiwanese people and has attracted international attention. Phthalate expo... [more] In May 2011, the illegal use of the phthalate plasticizer di(2-ethylhexyl) phthalate in clouding agents for use in foods and beverages was reported in Taiwan. This food scandal has caused shock and panic among the majority of Taiwanese people and has attracted international attention. Phthalate exposure is assessed by ambient monitoring or human biomonitoring. Ambient monitoring relies on measuring chemicals in environmental media, foodstuff and consumer products. Human biomonitoring determines body burden by measuring the chemicals, their metabolites or specific reaction products in human specimens. In mammalian development, the fetus is set to develop into a female. Because the female phenotype is the default, impairment of testosterone production or action before the late phase may lead to feminizing characteristics. Phthalates disrupt the development of androgen-dependent structures by inhibiting fetal testicular testosterone biosynthesis. The spectrum of effects obtained following perinatal exposure of male rats to phthalates has remarkable similarities with the human testicular dysgenesis syndrome. Epidemiological studies have suggested associations between phthalate exposure and shorter gestational age, shorter anogenital distance, shorter penis, incomplete testicular descent, sex hormone alteration, precocious puberty, pubertal gynecomastia, premature thelarche, rhinitis, eczema, asthma, low birth weight, attention deficit hyperactivity disorder, low intelligence quotient, thyroid hormone alteration, and hypospadias in infants and children. Furthermore, many studies have suggested associations between phthalate exposure and increased sperm DNA damage, decreased proportion of sperm with normal morphology, decreased sperm concentration, decreased sperm morphology, sex hormone alteration, decreased pulmonary function, endometriosis, uterine leiomyomas, breast cancer, obesity, hyperprolactinemia, and thyroid hormone alteration in adults. Finally, the number of phthalate-related scientific publications from Taiwan has increased greatly over the past 5 years, which may reflect the health effects from the illegal addition of phthalate plasticizer to clouding agent in foodstuff over the past two decades.
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1.31Impact points
Outcome of patients with lithium poisoning at a far-east poison center.
Human & experimental toxicology. 07/2011; 30(7):528-34.
Lithium is a popular medication for bipolar disorder, but very little work has been done to study Asian patients with lithium poisoning. A total of 21 out of 7140 poisoned patients were referred for management of lithium poisoning between 2000 and 2009. Patients were stratified according to blood li... [more] Lithium is a popular medication for bipolar disorder, but very little work has been done to study Asian patients with lithium poisoning. A total of 21 out of 7140 poisoned patients were referred for management of lithium poisoning between 2000 and 2009. Patients were stratified according to blood lithium level, that is mild-to-moderate (<2.5 mEq/L) or severe (≥2.5 mEq/L) poisoning. Demographic, clinical, and laboratory data were obtained for analysis. Mortality rates were also analyzed. There were no significant differences between both groups for the baseline variables such as poisoning patterns, age, sex, smoking habit, alcohol consumption, or medical history of diabetes mellitus or hypertension (p > 0.05). Patients with severe poisoning had a greater distribution of severe neurological symptoms (mild/moderate/ severe: 11.1%/44.4%/44.4% versus 58.35%/16.65%/8.3%, p < 0.05), cardiovascular symptoms (66.6% versus 16.6%, p < 0.05), and renal impairment (urea nitrogen/creatinine: 27.1 ± 17.8/ 1.9 ± 1.3 mg/dL versus 14.1 ± 7.1/ 1.3 ± 0.6 mg/dL, p < 0.05) than patients with mild-to-moderate poisoning. Most patients were treated with saline diuresis (9 patients [100%] with severe poisoning versus 9 patients [75.0%] with mild-to-moderate poisoning, p > 0.05). Hemodialysis was initiated in 2 (22.2%) of 9 and 1 (8.3%) of 12 patients with severe and mild-to-moderate poisoning, respectively (p > 0.05). The treatment was successful and all patients recovered without chronic sequelae. Thus, these favorable outcomes were comparable to the data from other international Poison Centers. Given the excellent outcomes of detoxification protocols, patients undergoing lithium therapy must be closely monitored for its toxicity and treated immediately in case of poisoning.
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2.01Impact points
Resveratrol retards progression of diabetic nephropathy through modulations of oxidative stress, proinflammatory cytokines, and AMP-activated protein kinase.
Journal of biomedical science. 06/2011; 18(1):47.
Diabetic nephropathy (DN) has been recognized as the leading cause of end-stage renal disease. Resveratrol (RSV), a polyphenolic compound, has been indicated to possess an insulin-like property in diabetes. In the present study, we aimed to investigate the renoprotective effects of RSV and delineate... [more] Diabetic nephropathy (DN) has been recognized as the leading cause of end-stage renal disease. Resveratrol (RSV), a polyphenolic compound, has been indicated to possess an insulin-like property in diabetes. In the present study, we aimed to investigate the renoprotective effects of RSV and delineate its underlying mechanism in early-stage DN. The protective effects of RSV on DN were evaluated in streptozotocin (STZ)-induced diabetic rats. The plasma glucose, creatinine, and blood urea nitrogen were significantly elevated in STZ-induced diabetic rats. RSV treatment markedly ameliorated hyperglycemia and renal dysfunction in STZ-induced diabetic rats. The diabetes-induced superoxide anion and protein carbonyl levels were also significantly attenuated in RSV-treated diabetic kidney. The AMPK protein phosphorylation and expression levels were remarkably reduced in diabetic renal tissues. In contrast, RSV treatment significantly rescued the AMPK protein expression and phosphorylation compared to non-treated diabetic group. Additionally, hyperglycemia markedly enhanced renal production of proinflammatory cytokine IL-1β. RSV reduced IL-1β but increased TNF-α and IL-6 levels in the diabetic kidneys. Our findings suggest that RSV protects against oxidative stress, exhibits concurrent proinflammation and anti-inflammation, and up-regulates AMPK expression and activation, which may contribute to its beneficial effects on the early stage of DN.
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2.09Impact points
Measuring anisotropic diffusion in kidney using MRI.
Academic radiology. 06/2011; 18(9):1168-74.
To measure the anisotropic diffusion in kidney and to demonstrate the feasibility of renal tractography. Diffusion tensor imaging was acquired in kidney from 10 healthy volunteers and 5 patients with chronic kidney disease. Diffusion indices were calculated from the tensor, including fractional anis... [more] To measure the anisotropic diffusion in kidney and to demonstrate the feasibility of renal tractography. Diffusion tensor imaging was acquired in kidney from 10 healthy volunteers and 5 patients with chronic kidney disease. Diffusion indices were calculated from the tensor, including fractional anisotropy, intervoxel diffusion coherence, and mean/axial/radial diffusivity. Acquisitions with respiratory triggering could provide improved image quality in all diffusion indices, as compared to that by breathhold. It is sufficient to use five to seven scan averages when the measured diffusion indices converge to a steady state in medulla, which reduced the acquisition time in a triggered measurement down to a clinically tolerable limit. Second, the measured diffusion indices can be affected by the diffusion weighting. An increased diffusion weighting will lead to an underestimation in all diffusion indices. Finally the direction of water diffusion is consistent in the kidney cortex, which was properly reflected in intervoxel diffusion coherence. In a feasibility study in healthy volunteers and patients, renal tractography was performed that visualized the organized renal structure and as it declined with the progress of chronic kidney disease. When compared to conventional breath hold technique, the significant improvement in image quality compensated for the prolonged acquisition time. Therefore, triggered acquisition is preferred in a clinical setting because it required less from patient cooperation.
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4.47Impact points
Association of blood lead levels with mortality in patients on maintenance hemodialysis.
The American journal of medicine. 04/2011; 124(4):350-8.
The association between blood lead levels and mortality in patients on maintenance hemodialysis remains unclear. A cross-sectional and 18-month prospective study included 927 patients on maintenance hemodialysis. Baseline variables and blood lead levels were measured before hemodialysis and categori... [more] The association between blood lead levels and mortality in patients on maintenance hemodialysis remains unclear. A cross-sectional and 18-month prospective study included 927 patients on maintenance hemodialysis. Baseline variables and blood lead levels were measured before hemodialysis and categorized as 3 equal groups: high (>12.64 μg/dL), middle (8.51-12.64 μg/dL), and low (<8.51 μg/dL). Mortality and cause of death were recoded for longitudinal analyses. At baseline, after related variables were adjusted, logarithmic transformation of blood lead level was negatively related to log ferritin and positively related to the vintage of hemodialysis and the percentage of urban area patients. By the end of the follow-up, 59 patients had died. Kaplan-Meier survival analysis showed that the high blood lead level group had greater mortality than the low blood lead level group (log-rank test, P<.001). After adjustment for potential variables, Cox multivariate analysis demonstrated that by using the low blood lead level as the reference, high blood lead levels were associated with increased hazard ratios (HRs) for all-cause (HR 4.70; 95% confidence interval [CI], 1.92-11.49; P=.003), cardiovascular-cause (HR 9.71; 95% CI, 2.11-23.26; P=.005), and infection-cause (HR 5.35; 95% CI, 1.38-20.83; P=.046) 18-month mortality in patients on maintenance hemodialysis. Moreover, there was a significant trend (P=.032) of HRs for all-cause mortality among the 3 study groups. High blood lead level is associated with increased HRs for all-cause, cardiovascular-cause, and infection-cause 18-month mortality in patients on maintenance hemodialysis.
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6.19Impact points
Chronic renal failure induced by lead.
Kidney international. 03/2011; 79(6):688; author reply 688-9.
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1.31Impact points
Human poisoning with spinosad and flonicamid insecticides.
Human & experimental toxicology. 03/2011; 30(11):1878-81.
This report describes the first known case in the literature of acute exposure to a mixture of spinosad and flonicamid that resulted in a substantial clinical toxicities. An 80-year-old depressed female attempted suicide by drinking a mixture of 80-mL Conserve (Dow AgroSciences, Taipei, Taiwan) and ... [more] This report describes the first known case in the literature of acute exposure to a mixture of spinosad and flonicamid that resulted in a substantial clinical toxicities. An 80-year-old depressed female attempted suicide by drinking a mixture of 80-mL Conserve (Dow AgroSciences, Taipei, Taiwan) and 2-3 gram powder of flonicamid (Ishihara Sangyo Kaisha, Taipei, Taiwan). Spinosad was the main compound ingested. The clinical manifestations were mostly neurological, i.e. consciousness disturbance, shock, respiratory failure, pneumonitis and urinary retention. Endoscopic examination found grade 2a corrosive esophageal injury. After resuscitation, detoxification procedures and intensive care, the patient recovered fully without leaving any chronic sequels. An emerging question arising from this report is, why are the clinical symptoms so severe, given that both compounds were claimed safe in laboratory animals? The answer is unclear. One possible explanation is, the amount of spinosad ingested was far beyond the physiological safety dose that can be handled by human body. Other potential contributors to the clinical toxicities in this patient are the solvent compositions that were found in the Conserve insecticide formulation.
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3.31Impact points
Blood cadmium level's association with 18-month mortality in diabetic patients with maintenance haemodialysis.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 03/2011; 26(3):998-1005.
Cadmium exposure is related to severity of diabetes and diabetes-related organ damage in diabetic patients. Elevated blood cadmium levels (BCLs) are well known in maintenance haemodialysis (MHD) patients but the clinical significance in diabetic MHD patients remains unknown. A total of 212 diabetic ... [more] Cadmium exposure is related to severity of diabetes and diabetes-related organ damage in diabetic patients. Elevated blood cadmium levels (BCLs) are well known in maintenance haemodialysis (MHD) patients but the clinical significance in diabetic MHD patients remains unknown. A total of 212 diabetic MHD patients were enrolled in this 18-month prospective study and were categorized into three equal groups according to the basal BCL: high (> 0.889 μg/L; n = 71), middle (0.373-0.889 μg/L; n = 70) and low (< 0.373 μg/L; n = 71) BCL groups. The mortality and cause of death were recorded and analysed longitudinally. Patients with high BCL had trends of higher white blood cell counts, glycosylated haemoglobin, phosphate and blood lead levels than other group patients. At the end of the follow-up, 31 patients had died. Kaplan-Meier analysis showed that the high BCL group patients had a higher mortality than other group patients (log-rank test, P = 0.036). Cox multivariate analysis demonstrated that logarithmic BCL was associated with increased hazard ratios (HR) for the all-cause mortality (HR = 2.336, 95% confidence intervals [CI] = 1.099-4.964, P = 0.027) in diabetic MHD patients. Similarly, if the low BCL group was the reference, the high BCL was associated with increased HR for all-cause mortality (HR = 2.865, 95% CI = 1.117-7.353, P = 0.043) in these patients. The study results first demonstrated that BCL is associated with increased HR for 18-month all-cause mortality in diabetic MHD patients. Avoiding smoking and high cadmium-containing food may be important in these patients.
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4.21Impact points
Leptospira santorosai Serovar Shermani detergent extract induces an increase in fibronectin production through a Toll-like receptor 2-mediated pathway.
Infection and immunity. 03/2011; 79(3):1134-42.
Leptospirosis can activate inflammatory responses through Toll-like receptors (TLRs) and may cause renal tubulointerstitial fibrosis characterized by the accumulation of extracellular matrix (ECM). We have previously demonstrated that Leptospira santorosai serovar Shermani detergent extract stimulat... [more] Leptospirosis can activate inflammatory responses through Toll-like receptors (TLRs) and may cause renal tubulointerstitial fibrosis characterized by the accumulation of extracellular matrix (ECM). We have previously demonstrated that Leptospira santorosai serovar Shermani detergent extract stimulates ECM accumulation in vitro. The aim of this study was to examine the mechanistic basis of these previous observations and, in particular, to examine the potential involvement of TLRs. The addition of serovar Shermani detergent extract led to an increase in fibronectin gene expression and production. Inhibition of TLR2 but not TLR4 expression abrogated serovar Shermani detergent extract-mediated increases in fibronectin production. This response was also blocked by the knockdown of the gene expression of the TLR2 downstream transducers myeloid differentiation factor 88 (MyD88) and tumor necrosis factor receptor-associated factor 6 (TRAF6). Serovar Shermani detergent extract also activated nuclear factor-κB, and its inhibition by curcumin-attenuated serovar Shermani detergent extract induced increases in fibronectin production. These effects were also mimicked by the specific TLR2 agonist, Pam(3)CsK(4), a response that was also abrogated by the knockdown of MyD88 and TRAF6. Similarly, the administration of live leptospires to cells also induced fibronectin production that was blocked by inhibition of TLR2 and MyD88 expression. In conclusion, serovar Shermani detergent extract can induce fibronectin production through the TLR2-associated cascade, providing evidence of an association between TLRs and leptospirosis-mediated ECM deposition.
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1.22Impact points
High incidence and recurrence of transitional cell carcinoma in Taiwanese patients with end-stage renal disease.
Nephrology (Carlton, Vic.). 02/2011; 16(2):225-31.
Aim: This study examines the epidemiology of transitional cell carcinoma (TCC) in end-stage renal disease (ESRD) population from Taiwan, the area with the highest incidence and prevalence of ESRD. A total of 98 out of 10,890 ESRD patients were referred for management of TCC between 2000 and 2008. De... [more] Aim: This study examines the epidemiology of transitional cell carcinoma (TCC) in end-stage renal disease (ESRD) population from Taiwan, the area with the highest incidence and prevalence of ESRD. A total of 98 out of 10,890 ESRD patients were referred for management of TCC between 2000 and 2008. Demographic, clinical and laboratory data were collected and patient mortality and tumour recurrence rates were analyzed. TCC patients were aged 61.4 ± 10.2 years and 66.3% were female. The average time from initiation of dialysis to tumour detection was 51.2 ± 36.4 months. Hypertensive nephrosclerosis, diabetes mellitus, chronic glomerulonephritis and unknown aetiology accounted for 25.5%, 20.4%, 22.4% and 31.6% of the causes of renal failure, respectively. The aetiology of renal failure for the 31.6% of patients was unclear, but chronic tubulointerstitial nephritis following long-term consumption of Chinese herbs (19.4%) or analgesic compounds (3.1%) was considered in some patients. Almost all (98.0%) patients presented with gross haematuria. Most TCC were in early stage (stage 0, 3.1%; stage I, 56.1%) during diagnosis. At the end of this study, 17 of 98 (17.3%) patients died. Multivariate Cox regression analysis found that age (odds ratio =1.140, 95% confidence interval = 1.049-1.239, P = 0.002) and tumour pain (odds ratio = 0.234, 95% confidence interval = 0.057-0.961, P = 0.044) were significant risk factors for all-cause mortality. Furthermore, 35.7% of TCC recurred during follow up. The 5 year patient and tumour-free survival rates were 72.4% and 14.4%, respectively. The data shows that Taiwanese patients with ESRD had high incidence (0.9%) and recurrence (35.7%) of TCC.
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1.20Impact points
Impaired fasting glucose association with mortality in nondiabetic patients on maintenance peritoneal dialysis.
The American journal of the medical sciences. 02/2011; 341(4):312-7.
The aim of this study was to investigate clinical significance of impaired fasting glucose (IFG) in nondiabetic patients on maintenance peritoneal dialysis (PD). In total, 362 maintenance PD patients were enrolled and followed up for 2-years. According to 1997 definitions, patients were divided into... [more] The aim of this study was to investigate clinical significance of impaired fasting glucose (IFG) in nondiabetic patients on maintenance peritoneal dialysis (PD). In total, 362 maintenance PD patients were enrolled and followed up for 2-years. According to 1997 definitions, patients were divided into 3 groups: diabetic (n = 85), nondiabetic with IFG (n = 62) and nondiabetic with normal fasting glucose levels (n = 215). After basal data were collected for cross-sectional analyses, mortality and cause of death were recorded for longitudinal analyses. After adjusting for related variables by multivariate logistic regression analysis, IFG was found to be positively associated with age but negatively associated with normalized protein nitrogen appearance and transferrin saturation in nondiabetic maintenance PD patients. Thirty nondiabetic patients had died after the 2-year follow-up. Cox multivariate analysis showed that age (hazard ratio: 1.037; 95% confidence interval: 1.002-1.073; P = 0.036) and presence of IFG (hazard ratio: 2.719; 95% confidence interval: 1.082-6.833; P = 0.033) were significant risk factors for all-cause 2-year mortality in nondiabetic maintenance PD patients. IFG, a preventable and treatable condition, was associated with all-cause 2-year mortality in nondiabetic maintenance PD patients.
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5.17Impact points
Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids.
Intensive care medicine. 02/2011; 37(6):1006-13.
To clarify the efficacy of repeated methylprednisolone (MP) and cyclophosphamide (CP) pulse therapy and daily dexamethasone (DEX) therapy in patients with severe paraquat (PQ) poisoning. A total of 111 patients with severe PQ poisoning and dark-blue color in urine tests within 24 h of intoxication w... [more] To clarify the efficacy of repeated methylprednisolone (MP) and cyclophosphamide (CP) pulse therapy and daily dexamethasone (DEX) therapy in patients with severe paraquat (PQ) poisoning. A total of 111 patients with severe PQ poisoning and dark-blue color in urine tests within 24 h of intoxication were included prospectively. The control group consisted of 52 patients who were admitted between 1998 and 2001 and who received high doses of CP (2 mg/kg per day) and DEX (5 mg every 6 h) for 14 days. The study group consisted of 59 patients who were admitted from 2002 to 2007 and who received initial MP (1 g) for 3 days and CP (15 mg/kg per day) for 2 days, followed by DEX (5 mg every 6 h) until a PaO(2) of >80 mmHg had been achieved, or treated with repeated 1 g MP for 3 days and 1 g CP for 1 day if the PaO(2) was <60 mmHg. There were no differences between the two groups with regard to baseline data and plasma PQ levels. The study group patients had a lower mortality rate (39/59, 66%) than the control group patients (48/52, 92%; P=0.003, log-rank test). Multivariate Cox regression analysis revealed that the repeated pulse therapy was correlated with decreased hazard ratios (HR) for all-cause mortality (HR=0.50, 95% CI 0.31-0.80; P=0.004) and death from lung fibrosis-related hypoxemia (HR=0.10, 95% CI 0.04-0.25; P<0.001) in severely PQ-intoxicated patients. Repeated pulses of CP and MP, rather than high doses of CP and DEX, may result in a lower mortality rate in patients with severe PQ poisoning.
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1.04Impact points
Respiratory failure and coma in an international traveler.
Internal medicine (Tokyo, Japan). 01/2011; 50(21):2691.
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1.04Impact points
Massive brain calcifications associated with vitamin D deficiency.
Internal medicine (Tokyo, Japan). 01/2011; 50(21):2693.
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1.14Impact points
White blood cell count predicts all-cause, cardiovascular disease-cause and infection-cause one-year mortality of maintenance hemodialysis patients.
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 12/2010; 14(6):552-9.
Elevated white blood cell (WBC) counts predict coronary heart disease and all-cause mortality in the general population. Chronic inflammation and malnutrition are associated with increased risk of cardiovascular death in individuals with chronic kidney disease. In this study, we investigated the ass... [more] Elevated white blood cell (WBC) counts predict coronary heart disease and all-cause mortality in the general population. Chronic inflammation and malnutrition are associated with increased risk of cardiovascular death in individuals with chronic kidney disease. In this study, we investigated the association between WBC count with inflammation, malnutrition, and mortality in maintenance hemodialysis (MHD) patients. A total of 959 MHD patients were stratified into four equal sized groups based on WBC count. Demographic, hematological, nutritional and inflammatory markers, and biochemical and dialysis-related data were obtained for cross-sectional analysis. All patients were followed for one year to investigate the risks for mortality. The mean WBC count was 6.4 ± 1.8 × 10(3)/µL (range: 2.3-16.3 × 10(3)/µL). Stepwise multiple linear regression analysis indicated a positive correlation between WBC count and inflammation (high-sensitivity C-reactive protein > 3 mg/L). Forty-five patients (4.7%) died within the 1-year study period. Cox multivariate regression analysis demonstrated that total WBC count significantly predicts 1-year mortality due to all-cause (hazard ratio (HR): 1.228, 95% confidence interval (CI): 1.095-1.378; P < 0.001), due to cardiovascular disease (HR: 1.242, 95% CI: 1.046-1.475; P = 0.013) and due to infection (HR: 1.252, 95% CI: 1.066-1.470; P = 0.006). These findings suggest that total WBC count should be measured in future studies that evaluate the clinical outcome of MHD patients and that dialysis patients with elevated WBC counts require further medical attention to reduce risks of mortality.
Following (3)
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Mai-Szu Wu
Chang Gung Memorial Hospital -
Chiz-Tzung Chang
China Medical University -
Danik M Martirosyan
Functional Foods Center
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