Pleotropic effects of hypoxia-inducible factor-prolyl hydroxylase domain inhibitors: are they clinically relevant?

Chou Yu-Hsiang,Pan Szu-Yu,Lin Shuei-Liong 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.1

Anemia is common in patients with chronic kidney disease (CKD) and is mainly caused by insufficient production of erythropoietinfrom fibrotic kidney. Because anemia impairs quality of life and overall prognosis, recombinant human erythropoietin-related products(erythropoiesis-stimulating agents, ESAs) have been developed to increase hemoglobin level for decades. However, many safety concernshave been announced regarding the use of ESAs, including an increased occurrence of cardiovascular events, vascular accessthrombosis, cancer progression, and recurrence. Hypoxia-inducible factor (HIF) is crucial to erythropoietin production, as a result, prolylhydroxylase domain (PHD) enzyme inhibitors have been new therapeutic agents for the treatment of anemia in CKD. They can beadministered orally, which is a preferred route for patients not undergoing hemodialysis. In clinical trials, PHD inhibitor could inducenoninferior effect on erythropoiesis and improve functional iron deficiency compared with ESAs. Although no serious adverse eventswere reported, safety is still a concern because HIF stabilization induced by PHD inhibitor has pleotropic effects, such as angiogenesis,metabolic change, and cell survival, which might lead to unwanted deleterious effects, including fibrosis, inflammation, cardiovascularrisk, and tumor growth. More molecular mechanisms of PHD inhibition and long-term clinical trials are needed to observe thesepleotropic effects for the confirmation of safety and efficacy of PHD inhibitors.

Clinical Features and Computed Tomography Characteristics of Non-Klebsiella pneumoniae Liver Abscesses in Elderly (>65 Years) and Nonelderly Patients

Chih-Weim Hsiang,Wei-Chou Chang,Chang-Hsien Liu,Hsiu-Lung Fan,Kai-Hsiung Ko,Chih-Yung Yu,Hong-Hau Wang,Wen-I Liao,Hsian-He Hsu 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.2

Purpose: To compare the clinical and computed tomography (CT) appearances of liver abscesses caused by non-Klebsiella pneumoniae bacterial pathogens in elderly and nonelderly patients. Materials and Methods: Eighty patients with confirmed non-Klebsiella pneumoniae liver abscesses (non-KPLAs) were enrolled and dividedinto two age groups: elderly (age ≥65 years, n=42) and nonelderly (age <65 years, n=38). Diagnosis of non-KPLA was established by pus and/or blood culture. We compared clinical presentations, outcomes, and CT characteristics of the two groups, and performed multivariate analysis for significant variables and receiver-operating-characteristic analysis to determine the cutoff value of abscess diameter for predicting non-KPLA. Results: Elderly patients with non-KPLA were associatedwith a longer hospital stay (p<0.01). Regarding etiology, biliary sources had a strong association in the elderly group (p<0.01), and chronic liver diseases were relatedto the nonelderly group (p<0.01). Non-KPLAs (52.5%) tended to show a large, multiloculated appearance in the elderly group and were associated with bile duct dilatation (p<0.01), compared with the nonelderly group. The abscess diameter (cutoff value, 5.2 cm; area under the curve, 0.78) between the two groups was predicted. In multivariate analysis, underlying biliary tract disease [odds ratio (OR), 3.58, p<0.05], abscess diameter (OR, 2.40, p<0.05), and multiloculated abscess (OR, 1.19, p<0.01) independently predicted elderly patients with non-KPLA. Conclusion:In the elderly patients with non-KPLA, a large, multiloculated abscess with a diameter greater than 5.2 cm was the predominant imaging feature.

Factors Related to Treatment Refusal in Taiwanese Cancer Patients

Chiang, Ting-Yu,Wang, Chao-Hui,Lin, Yu-Fen,Chou, Shu-Lan,Wang, Ching-Ting,Juang, Hsiao-Ting,Lin, Yung-Chang,Lin, Mei-Hsiang Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.8

Background: Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. Materials and Methods: This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). Results: A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001), changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which case manager contact patients (p<0.001) and the frequency that case managers contact patients (${\geq}10times$) (p=0.016). Conclusions: Cancer patients who refuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

Addressing the challenges of missed parathyroid glands in ultrasonography for secondary hyperparathyroidism: a retrospective observational study

Shen-En Chou,Cheng-Hsi Yeh,Shun-Yu Chi,Fong-Fu Chou,Yi-Ju Wu,Yen-Hsiang Chang,Yi-Chia Chan 대한외과학회 2024 Annals of Surgical Treatment and Research(ASRT) Vol.107 No.3

Purpose: Preoperative localization plays an important role in secondary hyperparathyroidism (SHPT) surgery. The advantages of neck ultrasound (US) include high availability and low cost. However, the reported sensitivity of US is 54%– 76%, and the reason for missed parathyroid glands (PGs) on US has been rarely addressed. Methods: Fifty-four patients who were diagnosed with renal SHPT from September 2020 to March 2022 were included in this retrospective study. Preoperative localization included surgeon-oriented US and technetium 99m-sestamibi single- photon emission CT (SPECT)/CT. Results: A total of 212 PGs were pathologically confirmed, resulting in a success rate of 96.2% (52 of 54). Using echo, 193 PGs (91.0%) were accurately localized, while 19 glands (9.0%) were not identified, including those in ectopic positions (n = 12, at thymus or intrathyroid or others), of small size (<1 cm, n = 6), or overlapping with an ipsilateral PG (n = 1). US accurately detected 4 PGs in 36 (66.7%) patients, while SPECT/CT localized 4 glands in 19 patients (35.2%). Although the number of US-detectable PGs was not associated with success rate, it showed a significant negative correlation with surgical time (rs = –0.459, P = 0.002). Conclusion: US detected 4 glands in 66% of SHPT patients with a sensitivity of 90% for localization. Ectopic position and small size were the most common reasons for the failure to detect PG on US. Complete preoperative echo localization might shorten operating time.

Kimura Disease Simulating Hodgkin’s Lymphoma on 18F FDG PET-CT: Report of a Case

Tsung-Han Yang,Yu-Hsiang Chou,Woei-Yau Kao,Shiou-Chi Cherng 대한핵의학회 2014 핵의학 분자영상 Vol.48 No.4

Abstract We report the case of a 16-year-old male patientpresenting with several mass lesions on the left side of hisneck that had been there for weeks. Whole-body 18Ffluorodeoxyglucosepositron emission tomography and computedtomography (18F FDGPET-CT) revealedmultiple focalareas of increased uptake of fluorodeoxyglucose (FDG) on theleft side of the neck, left supraclavicular fossa, left axilla, andmediastinum, simulating the imaging findings of Hodgkin’slymphoma. Subsequent incisional biopsy of lymph nodes inthe left supraclavicular fossa with histologic examination confirmedthe diagnosis of Kimura disease. The differential diagnosesshould include Kimura disease when evaluating regionalor generalized lymphadenopathy seen on 18F FDGPET-CTbecause it also may show prominent uptake of FDG.

Acute kidney disease: an overview of the epidemiology, pathophysiology, and management

Kung Chin-Wei,Chou Yu-Hsiang 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.6

Acute kidney injury (AKI) increases the risk of chronic kidney disease (CKD), and AKI and CKD are seen as interconnected syndromes. Acute kidney disease (AKD) is defined as subacute damage and/or loss of kidney function occurring 7 to 90 days after AKI, during which period key interventions may be initiated to hinder the development of CKD. While AKD is usually under-recognized, it is associated with high morbidity and mortality globally. This review article aims to summarize the current knowledge concerning the epidemiology, pathophysiology, and management of AKD with the aim to develop monitoring strategies and therapeutic agents of AKD. Generally, AKD tends to occur more frequently in the elderly and those with chronic diseases, such as hypertension, diabetes mellitus, and metabolic syndrome. In addition, the severity, duration, and frequency of AKI are independent risk factors for AKD. Investigations of several mechanisms of AKD, such as renal tubular epithelium cell-cycle arrest, epigenetic change, chronic inflammation, mitochondria dysfunction, failed regeneration of tubular cells, metabolic reprogramming, and renin-angiotensin system (RAS) activation, have identified additional potential pharmacotherapy targets. Management of AKD includes prevention of repeated AKI, early and regular follow-up by a nephrologist, resumption and adjustment of essential medication, optimization of blood pressure control and nutrition management, and development of new pharmaceutical agents including RAS inhibitors. Finally, we outline a care bundle for AKD patients based on important lessons learned from studies and registries and identify the need for clinical trials of RAS inhibitors or other novel agents to impede ensuing CKD development.

The effect of different colored light emitting diode illumination on egg laying performance, egg qualities, blood hormone levels and behavior patterns in Brown Tsaiya duck

Su, Chin-Hui,Cheng, Chih-Hsiang,Lin, Jung-Hsin,Liu, Hsiu-Chou,Yu, Yen-Ting,Lin, Chai-Ching,Chen, Wei-Jung Asian Australasian Association of Animal Productio 2021 Animal Bioscience Vol.34 No.11

Objective: The objective of this experiment was to investigate the effects of different colors produced by light emitting diode (LED) on Brown Tsaiya ducks. Methods: A total of 144 female Brown Tsaiya ducks were randomly allocated into three individual cage rearing chambers with different LED illumination colors as treatments. Three different treatments were: i) white color, ii) blue color, and iii) red color. The experiment periods were from ducks 21 to 49 weeks of age, determined traits included i) egg laying performance, ii) feed intake, iii) egg shell breaking strength, iv) egg shell thickness, v) egg Haugh unit, vi) egg weight, vii) serum Estradiol and Progesterone concentration, and viii) behavior pattern. Results: The results indicated that when compared with white and blue color, red color could stimulate ducks sexual maturation and raised the egg laying performance. The red light group was also observed to have the highest feed intake among three treatments. The blue treatment had the lowest egg shell breaking strength and the highest egg weight among three treatments, nevertheless, no significant difference was observed among three treatments on egg shell thickness and egg Haugh unit. The red light group had higher serum estradiol concentration than the white and blue groups, but no significant difference among treatments on the serum Progesterone concentration was found. The results of behavior pattern indicated that red light group showed more feeding and less resting behavior compared to the blue light group. Conclusion: We found a potential of applying red light illumination in the indoor laying duck raising system with positive results on egg laying performance and acceptable egg weight, equivalent egg qualities compared to white and blue light.

Analysis of the Interdecadal and Interannual Variability of Autumn Extreme Rainfall in Taiwan Using a Deep-Learning-Based Weather Typing Approach

Li‑Huan Hsu,Yi‑chao Wu,Chou‑Chun Chiang,Jung‑Lien Chu,Yi‑Chiang Yu,An‑Hsiang Wang,Ben Jong‑Dao Jou 한국기상학회 2023 Asia-Pacific Journal of Atmospheric Sciences Vol.59 No.2

This study sought to assess the interdecadal and interannual variability of autumn extreme rainfall (ER) in Taiwan from 1979to 2019. Three types of ER events were identified based on a clustering analysis augmented by a deep autoencoder-basedneural network model. This method outperforms other methods in obtaining the optimal number of clusters by extractingthe synoptic features in advance. The patterns associated with these three types include a tropical cyclone covering Taiwan(TC), a TC-like circulation in the South China Sea (SCS) accompanied by northeasterly near northern Taiwan (TC-NE), andnortheasterly near northern Taiwan (NE). The differences in the rainfall pattern caused by the three types were discernableover Taiwan. How the PDO or ENSO modulates the regional large-scale environment to favor the occurrence of these ERevents was investigated. The occurrence of TC-NE events was simultaneously correlated with the negative phases of PDO/ENSO in the interdecadal/interannual scale. In the negative phases of PDO/ENSO, a low-level anomalous cyclone overSCS accompanied by background northeasterly favored the regional TC activities and may cause more TC-NE events. Theoccurrence of NE events is simultaneously correlated with the cold phase of ENSO. An anomalous low-level anticyclone inNortheast Asia strengthened the northeasterly toward northern Taiwan, and with the seasonal background moisture, providedfavorable conditions for the occurrence of the NE events. Overall, the occurrence of the TC events did not correlate with thePDO or ENSO signals; the reasons for the lack of correlation were discussed herein.

2022 Taiwan clinical multicenter expert consensus and recommendations for thyroid radiofrequency ablation

Wei-Che Lin,Wen-Chieh Chen,Pei-Wen Wang,Yi-Chia Chan,Yen-Hsiang Chang,Harn-Shen Chen,Szu-Tah Chen,Wei-Chih Chen,Kai-Lun Cheng,Shun-Yu Chi,Pi-Ling Chiang,Chen-Kai Chou,Feng-Fu Chou,Shun-Chen Huang,Feng 대한초음파의학회 2023 ULTRASONOGRAPHY Vol.42 No.3

Radiofrequency ablation (RFA) is a minimally invasive management strategy that has been widely applied for benign and recurrent malignant thyroid lesions as an alternative to surgery in Taiwan. Members of academic societies for specialists in interventional radiology, endocrinology, and endocrine surgery collaborated to develop the first consensus regarding thyroid RFA in Taiwan. The modified Delphi method was used to reach a consensus. Based on a comprehensive review of recent and valuable literature and expert opinions, the recommendations included indications, pre-procedural evaluations, procedural techniques, post-procedural monitoring, efficacy, and safety, providing a comprehensive review of the application of RFA. The consensus effectively consolidates advice regarding thyroid RFA in clinical practice for local experts.