J H Juang

Chang Gung Memorial Hospital, Taipei, Taipei, Taiwan

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Publications (36)88.88 Total impact

  • W-T Lu · B R S Hsu · J H Juang ·

    Transplantation Proceedings 03/2003; 35(1):490-1. DOI:10.1016/S0041-1345(02)03948-9 · 0.98 Impact Factor
  • K W Chen · J H Juang · J D Lin ·
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    ABSTRACT: Congenital extreme insulin resistance syndrome has rarely been reported in Taiwan. In 1982, a girl of a consanguineous marriage was noted to have increased body hair, an enlarged clitoris, and acanthosis nigricans at birth. Two months later, she received an operation for bilateral polycystic evaries. She was found to have diabetes at 8 years old and was treated with insulin. In March 1999, she was referred to our clinic with growth retardation and poor glycemic control. She had a characteristic face with a saddle nose, broad mouth, large low-set ears, absence of subcutaneous fat, and deformed nails. Although a very high dose of insulin (> 10 IU/kg/day) was used, her glycemic control was very poor (HbA1c 13.8%). Pediatricians should remain alert for the manifestations of extreme insulin resistance.
    Chang Gung medical journal 11/2001; 24(10):640-5.
  • W.-T Lu · W.-C Lee · B. R.-S Hsu · J.-H Juang · S.-H Fu · C.-H Kuo ·

    Transplantation Proceedings 02/2001; 33(1):713-714. DOI:10.1016/S0041-1345(00)02218-1 · 0.98 Impact Factor
  • J H Juang · B.R.-S Hsu · C H Kuo · S H Fu · W C Lee · N K Yao ·

    Transplantation Proceedings 02/2001; 33(1-2):757-8. DOI:10.1016/S0041-1345(00)02239-9 · 0.98 Impact Factor
  • J H Juang · B.R.-S. Hsu · C H Kuo · N K Yaot ·
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    ABSTRACT: Old donor age has been considered as a risk factor and relative contraindication for transplantation. This study was designed to investigate the influence of donor age on islet characteristics and transplantation. Islets isolated from 8 (I-A)-, 32 (I-B)-, or 64 (I-C)-week-old C57BL16 mice were studied for number, size, insulin content, and secretion. After syngeneically transplanting 300 islets under the kidney capsule of streptozotocin-diabetic mice (R-A. R-B, and R-C, respectively), we measured recipients' metabolic parameters as well as the beta-cell mass and insulin content of the graft. Eight-week-old donors had better glucose tolerance than 32- and 64-week-old donors. However, 64-week-old donors had more pancreatic insulin content than 8- and 32-week-old donors. I-B and I-C were greater in number, larger in size, and higher in insulin content than I-A. But perifusion study showed I-C secreted less insulin, albeit with a similar stimulation index compared with that of I-A and I-B. After transplantation, the fall of blood glucose in R-C was faster than that in R-A and R-B. At 12 weeks, the recipients' blood glucose, body weight, HbA1c, and the beta-cell mass and insulin content of the graft were comparable in all groups. However, R-C had better glucose tolerance than R-A. During follow-up, R-A and R-B maintained lifelong normoglycemia and their glucose tolerance did not deteriorate. These data indicate that islets isolated from donors with different ages have different characteristics and effects on transplantation. The islets isolated from aged donors are functioning well and can be a potential source for transplantation; however, because we transplanted a large islet mass from the aged donors, the role of the islet dose needs to be further clarified.
    Cell Transplantation 02/2001; 10(3):277-84. DOI:10.3727/000000001783986738 · 3.13 Impact Factor
  • W T Lu · W C Lee · B R Hsu · J H Juang · S H Fu · C H Kuo ·

    Transplantation Proceedings 01/2001; 33(1-2):713-4. · 0.98 Impact Factor
  • B.R.-S. Hsu · J H Juang · S H Fu · C H Kuo · W T Lu ·
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    ABSTRACT: To study the effectiveness of a lipoxygenase inhibitor, nordihydroguaiaretic acid (NDGA), in the reduction of primary nonfunction, an insufficient number of syngeneic islets were transplanted underneath the renal capsule with NDGA administered daily for 4 weeks. After transplantation of the 150 islets, the decrement of blood glucose levels was significantly faster in the mice that had received NDGA than in the mice that had received no drug at all or dimethyl sulfoxide (DMSO) (p < 0.005, p < 0.05). The mean duration of temporary posttransplant hyperglycemia was 22.3 +/- 3.2 (n = 10), 35.9 +/- 2.3 (n = 14), and 33.7 +/- 4.1 (n = 6) days for the respective groups. The diabetic mice that received 300 islets had their blood glucose levels decrease faster than those that received 150 islets (19.7 +/- 1.6 vs. 35.9 +/- 2.3 days, n = 14. p < 0.0001). There was no significant difference in the blood glucose reducing effect between the mice that received 150 islets with NDGA and the mice that received 300 islets [22.3 +/- 3.2 (n = 10) vs. 19.7 +/- 1.6 (n = 14) days, p > 0.05]. The insulin content of the graft from the mice treated with 150 islets and NDGA (3.02 +/- 0.24 microg, n = 4) was higher than that from the mice that received 150 islets but no treatment (1.10 +/- 0.26 microg, n = 15, p < 0.005) or that had been treated with DMSO (1.21 +/- 0.30 microg, n = 4, p <0.05). The insulin content of the pancreas remnant had no significant differences among the three groups. The net glucose-stimulated insulin secretion was 0.82 +/- 0.14 vs. 0.20 +/- 0.10 microIU/islet x 60 min (n = 8, p < 0.005) and 0.59 +/- 0.08 vs. 0.04 +/- 0.02 microIU/islet x 60 min (n = 8, p < 0.0001) for islets cultured without NDGA vs. with NDGA at 1 and 2 weeks, respectively. However, the insulin content of the cultured islets was similar between the two groups for up to 2 weeks of incubation (at 1 week: 0.71 +/- 0.01 vs. 0.67 +/- 0.04 ng/islet, n = 8, p > 0.05; at 2 weeks: 0.71 +/- 0.02 vs. 0.80 +/- 0.07 ng/islet, n = 8, p > 0.05). Serum leukotriene B4 (LTB4) concentrations before and between the fifth and seventh days after transplantation were determined. For diabetic mice that received 150 islets, serum LTB4 levels were 25,835 +/- 3,335 and 27,631 +/- 3,136 pg/ml (n = 4, p > 0.05). For diabetic mice that received 150 islets and NDGA, the corresponding figures were 22,401 +/- 2,706 pg/ml and 27,530 +/- 2,190 pg/ml (n = 8, p > 0.05). The graft histology revealed viable islet cells and networks of close vascular structures around the islets and did not reveal microscopic differences among the samples of all four groups. In conclusion, our data revealed that daily administration of NDGA for 4 weeks enhanced isoislet engraftment and preserved three times more mass of the islet beta cells in the isografts. This result indicates that NDGA reduces primary nonfunction of islet syngeneic grafts in diabetic mice.
    Cell Transplantation 01/2001; 10(3):255-62. DOI:10.3727/000000001783986747 · 3.13 Impact Factor
  • J H Juang · C H Kuo · B.R.-S Hsu ·

    Transplantation Proceedings 09/2000; 32(5):1073-5. DOI:10.1016/S0041-1345(00)01130-1 · 0.98 Impact Factor
  • B.R.S Hsu · J H Juang · S H Fu · C H Kuo · P Wan · S Hsu · AW Hsu ·

    Transplantation Proceedings 09/2000; 32(5):1079-80. DOI:10.1016/S0041-1345(00)01132-5 · 0.98 Impact Factor
  • J H Juang · C H Kuo · B.R.-S Hsu ·

    Transplantation Proceedings 09/2000; 32(5):1076-8. DOI:10.1016/S0041-1345(00)01131-3 · 0.98 Impact Factor
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    J D Lin · M J Huang · J H Juang · T C Chao · B Y Huang · K W Chen · J Y Chen · K L Li · J F Chen · Y.S. Ho ·
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    ABSTRACT: There is limited clinical information comparing presentations and results of treatment of papillary and follicular thyroid carcinoma patients with distant metastases. We retrospectively analyzed data of 1,257 thyroid cancer patients who received their treatment and follow-up at Chang Gung Memorial Hospital. We found 992 patients with papillary carcinoma and 205 patients with follicular thyroid carcinoma. Of these, 68 patients with papillary thyroid carcinoma (6.9%) had distant metastases at the time of diagnosis or during the follow-up period. Of the follicular thyroid carcinoma patients, 69 (33.7%) had distant metastases. Of the 68 patients with papillary carcinoma, only 33 were categorized as stage IV at the time of diagnosis. Nine of the patients were categorized as clinical stage I carcinoma, 10 as stage II, and 16 as stage III. Sixteen patients (23.5%) died during the study period, all but 2 of thyroid cancer. Twelve of the 68 patients were disease-free after treatment. Of the 69 patients with follicular thyroid carcinoma, 58 were categorized as stage IV at the time of diagnosis. Six of the patients were categorized as clinical stage I carcinoma, 2 as stage II, and 3 as stage III at the time of diagnosis; all of these patients deteriorated to stage IV during the follow-up period. Of the 42 patients with follicular thyroid carcinoma involving bone, 24 presented with bone metastases during the initial diagnosis. After treatment, 25 of 69 patients with follicular carcinoma died of follicular carcinoma. Only 3 patients were disease-free after the treatment. In patients with follicular carcinoma, only tumor size was an important prognostic factor. In this study, 8 patients categorized as clinical stages I to III at the time of operation had thyroglobulin (Tg) levels less than 5 ng/mL and developed distant metastases during the follow-up period. In conclusion, at diagnosis a large group of Asian patients with metastatic well-differentiated thyroid cancer was more likely to have follicular than papillary histology, and that, as expected, metastases from follicular cancer were present earlier and more frequently, were more likely to involve bone, were more likely to be associated with mortality, and were linked to tumor size but not gender. Also unlike some other reports, treatment producing a low Tg did not always produce a good outcome. More aggressive surgical procedures may be able to improve outcomes.
    Thyroid 01/2000; 9(12):1227-35. DOI:10.1089/thy.1999.9.1227 · 4.49 Impact Factor
  • B R Hsu · F H Chang · J H Juang · Y Y Huang · S H Fu ·
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    ABSTRACT: Because the development of surface neogrowth composed mainly of macrophages and fibroblasts precedes the recurrence of hyperglycemia in treated diabetic animals, the pericapsular macrophages may adversely affect the graft function of i.p. alginate-poly-L-lysine-alginate (A-P-A) microencapsulated islets. In order to clarify the role of pericapsular macrophages on late islet xenograft dysfunction, we investigated whether 15-deoxyspergualin (15-DSG), a macrophage inhibitor, has a rescue effect on the recurrent hyperglycemia in streptozotocin-induced diabetic mice that had been treated with i.p. transplantation of A-P-A microencapsulated rat islets. The mean duration of normoglycemia (whole blood glucose level below 8.3 mmol/l) in streptozotocin-induced diabetic mice treated with implantation of about 2200-2400 of A-P-A microencapsulated rat islets was 75 days. When the blood glucose levels were higher than 11.1 mmol/l for two consecutive determinations, 15-DSG at a dose of 0.625 mg/kg body weight or isotonic sodium chloride solution (control group) was given daily s.c.. The blood glucose levels decreased significantly from 13.9 +/- 0.5 mmol/l to 11.0 +/- 1.3 mmol/l (n = 18, p < 0.05) at the fourth day and to 7.6 +/- 1.0 mmol/l (n = 18) at the 14th day of 15-DSG administration. That was not significantly different from the mean glycemic level during the normoglycemic period (7.6 +/- 1.0 vs. 7.0 +/- 1.7 mmol/l, n = 18, p = NS). Isotonic sodium chloride solution injections did not reduce glycemic levels of mice in the control group. As another control, 10 streptozotocin-induced diabetic mice were given the same daily doses of 15-DSG for 14 days. 15-DSG did not decrease the blood glucose levels of diabetic mice in the control group. We further studied the effect of 15-DSG on the expression of interleukin-1beta (IL-1beta) in peritoneal exudate mononuclear cells (PEMCs) using reverse transcription-polymerase chain reaction. It was found that the mRNA of IL-1beta was undetectable in PEMCs of 15-DSG-treated diabetic mice even after those cells were stimulated by lipopolysaccharides in vitro. Administration of 15-DSG at a daily dose of 0.625 mg/kg body weight from the 22nd to the 28th day after transplantation and 7 consecutive days every 3 weeks thereafter did not prolong graft survival of i.p. microencapsulated rat islets. Our data suggest that 15-DSG has a rescue effect when A-P-A microencapsulated islets have induced cellular overgrowth that threatens the survival of the graft. It is possible that the surface overgrowth composed of macrophages is involved in the pathophysiology of late failure of A-P-A microencapsulated xenogeneic islets.
    Cell Transplantation 05/1999; 8(3):307-15. · 3.13 Impact Factor
  • K D Lin · J D Lin · J H Juang ·

    New England Journal of Medicine 01/1999; 339(25):1860-1. DOI:10.1056/NEJM199812173392517 · 55.87 Impact Factor
  • F H Liu · S S Yarng · J D Lin · J H Juang ·
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    ABSTRACT: Despite recent improvements in the care of diabetic patients, diabetic retinopathy remains the most common cause of blindness among the diabetic population. The aim of this study is to identify the incidence and severity of diabetic retinopathy among diabetic patients followed-up at the metabolic clinics of the Chang Gung Memorial Hospital in Taoyuan, Taiwan. We investigated the retinas of diabetic patients who were followed-up at the metabolic clinics and received non-mydriatic fundus photograph from April 1994 through June 1994. There were 694 patients with type 2 diabetes enrolled in this study. Their mean age was 56.2 +/- 11.1 years and the mean number of years since diagnosis was 5.9 +/- 5.7 years. Among them, 171 (25%) patients had diabetic retinopathy, including 109 (15.7%) background, 45 (6.5%) preproliferative and 17 (2.4%) proliferative cases. The presence of diabetic retinopathy correlated with the number of years since diagnosis of these diabetic patients (odds ratio: 1.03; p = 0.0024). Non-mydriatic fundus photography is a good screening method for diabetic retinopathy detection. Twenty-five percent of type 2 diabetic patients followed-up at our metabolic clinics had diabetic retinopathy with background retinopathy being the most predominant. The most significant risk factor of diabetic retinopathy is the number of years since the patient was diagnosed with diabetes.
  • K D Lin · J D Lin · H H Hsu · J H Juang · M J Huang · H S Huang ·
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    ABSTRACT: Langerhans cell histiocytosis (LCH) is a rare disorder and may be complicated with hypopituitarism and diabetes insipidus (DI) due to invasion of the hypothalamic-pituitary area. In this study, 10 patients with complete (4) and partial (6) type central DI were found among 125 LCH patients in our hospital records. The water deprivation test, followed by the pitressin test, was performed to confirm DI. Hypothalamic-pituitary endocrine function tests were carried out on these 10 patients at the initial diagnosis and during follow-up. All patients revealed growth hormone insufficiency in the insulin hypoglycemic tolerance test. Four patients had impairment of cortisol secretion, demonstrated by insulin hypoglycemic stimulating test results. Two patients had poor response in the thyrotropin releasing hormone stimulating test. Two patients had only partial responses in the luteinizing hormone releasing hormone test. Four patients had hyperprolactinemia. All patients underwent surgical treatment followed by chemotherapy and/or radiotherapy. One patient completely recovered from the endocrine disorder, 3 patients required smaller doses of desmopressin, and one patient had normal adrenal, thyroid, and gonadal function. Hypothalamic-pituitary disorders in LCH should not be neglected. Treatment of LCH can partially or completely reverse associated endocrine disorders. Therefore, endocrine studies and hormone replacement should be mandatory for patients with LCH.
    Journal of endocrinological investigation 07/1998; 21(7):428-33. DOI:10.1007/BF03347321 · 1.45 Impact Factor
  • J H Juang · B.R.-S. Hsu · C H Kuo · H S Huang ·

    Transplantation Proceedings 03/1998; 30(2):565-6. DOI:10.1016/S0041-1345(97)01405-X · 0.98 Impact Factor
  • J H Juang · B.R.-S Hsu · C H Kuo · H S Huang ·

    Transplantation Proceedings 03/1998; 30(2):576-7. DOI:10.1016/S0041-1345(97)01410-3 · 0.98 Impact Factor
  • W T Lu · J H Juang · B. Ray-Sea Hsu · H S Huang ·

    Transplantation Proceedings 03/1998; 30(2):609-10. DOI:10.1016/S0041-1345(97)01425-5 · 0.98 Impact Factor
  • W.-T Lu · J.-H Juang · B. Ray-Sea Hsu · H.-S Huang ·

  • J.-H Juang · B. R.-S Hsu · C.-H Kuo · H.-S Huang ·