Vaccine-induced immune thrombotic thrombocytopenia (VITT) with cerebral venous sinus thrombosis (CVST): a case report from Malaysia

Christopher Chin Keong Liam,Yu Jin Tee,Yang Liang Boo,Yee Ser Lim,Ahmad Razman Shamsuddin,Soo Min Lim 대한혈액학회 2022 Blood Research Vol.57 No.3

Transitional Percentage of Minute Volume as a Novel Predictor of Weaning from Mechanical Ventilation in Patients with Chronic Respiratory Failure

Ya-Ru Liang,Mei-Chen Yang,Yao-Kuang Wu,I-Shiang Tzeng,Pei-Yi Wu,Shiang-Yu Huang,Chou-Chin Lan,Chin-Pyng Wu 한국간호과학회 2020 Asian Nursing Research Vol.14 No.1

Purpose: Some patients with respiratory failure fail initial weaning attempts and need prolonged mechanical ventilation (MV). Prolonged MV is associated with many complications and consumption of heathcare resources. Objective weaning indices help staffs to identify high-potential patients for weaning from the MV. Traditional weaning indices are not reliable in clinical practice. Transitional percentage of minute volume (TMV%) is a new index of the work of breathing. This study aimed to investigate the utility of TMV% in the prediction of weaning potential. Methods: This study was prospectively performed including all patients with prolonged MV. Researchers recorded their demographics, TMV%, respiratory parameters, Acute Physiology and Chronic Health Evaluation II score, and laboratory data upon arrival at the respiratory care center. The factors associated with successful weaning were analyzed. Results: Out of the 120 patients included, 84 (70.0%) were successfully weaned from MV. Traditional weaning indices such as rapid shallow breathing index could not predict the weaning outcome. TMV% was a valuable parameter as patients with a lower TMV%, higher tidal volume, higher hemoglobin, lower blood urea nitrogen, and lower Acute Physiology and Chronic Health Evaluation II scores had a higher rate of successful weaning. TMV%, tidal volume, and HCO3- levels were independent predictors of successful weaning, and the area under the curve was .79 in the logistic regression model. Conclusion: TMV% is a novel and effective predictor of successful weaning. Patients with lower TMV% had a higher MV weaning outcome. Once patients with a high potential for successful weaning are identified, they should be aggressively weaned from MV as soon as possible.

Comparison of Models for the Prediction of Medical Costs of Spinal Fusion in Taiwan Diagnosis-Related Groups by Machine Learning Algorithms

Ching-Yen Kuo,Liang-Chin Yu,Hou-Chaung Chen,Chien-Lung Chan 대한의료정보학회 2018 Healthcare Informatics Research Vol.24 No.1

Objectives: The aims of this study were to compare the performance of machine learning methods for the prediction of themedical costs associated with spinal fusion in terms of profit or loss in Taiwan Diagnosis-Related Groups (Tw-DRGs) andto apply these methods to explore the important factors associated with the medical costs of spinal fusion. Methods: A dataset was obtained from a regional hospital in Taoyuan city in Taiwan, which contained data from 2010 to 2013 on patients ofTw-DRG49702 (posterior and other spinal fusion without complications or comorbidities). Naïve-Bayesian, support vectormachines, logistic regression, C4.5 decision tree, and random forest methods were employed for prediction using WEKA3.8.1. Results: Five hundred thirty-two cases were categorized as belonging to the Tw-DRG49702 group. The mean medicalcost was US $4,549.7, and the mean age of the patients was 62.4 years. The mean length of stay was 9.3 days. The lengthof stay was an important variable in terms of determining medical costs for patients undergoing spinal fusion. The randomforest method had the best predictive performance in comparison to the other methods, achieving an accuracy of 84.30%,a sensitivity of 71.4%, a specificity of 92.2%, and an AUC of 0.904. Conclusions: Our study demonstrated that the randomforest model can be employed to predict the medical costs of Tw-DRG49702, and could inform hospital strategy in terms ofincreasing the financial management efficiency of this operation.

Increase in Plasma Glucose Lowering Action of Rosiglitazone by Electroacupuncture at Bilateral Zusanli Acupoints (ST.36) in Rats

Hui-Ching Pai,Chung-Yuh Tzeng,Yu-Chen Lee,Chin-Hsien Chang,Jaung-Geng Lin,Juei-Tang Cheng,Shih-Liang Chang 사단법인약침학회 2009 Journal of Acupuncture & Meridian Studies Vol.2 No.2

Objectives: Hypoglycemia induced by electroacupuncture (EA) is due to an increase of insulin secretion and/or mediation of β-endorphin. We applied EA at the Zusanli (ST.36) acupuncture point (acupoint) in combination with rosiglitazone (TZD) administration to evaluate their effect on plasma glucose and to explore possible mechanisms of action. Methods: Thirty six normal adult Wistar rats were randomly divided into four groups: the 0.1 mg/kg TZD group (0.1TZD), 0.1 mg/kg TZD and EA group (0.1TZD + EA), EA group, and control group. In other experiments, streptozotocin was used to induce type 2 diabetes mellitus in neonatal rats; these were then randomly divided into a 0.1TZD group, 0.1TZD + EA group, and EA group and changes in plasma glucose and insulin concentrations evaluated. Results: A marked hypoglycemic response was observed in the normal rat 0.1TZD, 0.1TZD + EA and EA groups, with the response more significant in the 0.1TZD + EA group than in the 0.1TZD group. Among the diabetic animals, the hypoglycemic responses in the 0.1TZD + EA and EA groups were greater than in the 0.1TZD group. In both the normal and diabetic rats, insulin secretion was increased by EA or 0.1TZD + EA treatment, but not by 0.1TZD. Conclusions: The plasma glucose lowering action of rosiglitazone was increased by EA in both normal and diabetic rats, indicating that the application of EA may enhance the hypoglycemic action of this insulin sensitizer. Objectives: Hypoglycemia induced by electroacupuncture (EA) is due to an increase of insulin secretion and/or mediation of β-endorphin. We applied EA at the Zusanli (ST.36) acupuncture point (acupoint) in combination with rosiglitazone (TZD) administration to evaluate their effect on plasma glucose and to explore possible mechanisms of action. Methods: Thirty six normal adult Wistar rats were randomly divided into four groups: the 0.1 mg/kg TZD group (0.1TZD), 0.1 mg/kg TZD and EA group (0.1TZD + EA), EA group, and control group. In other experiments, streptozotocin was used to induce type 2 diabetes mellitus in neonatal rats; these were then randomly divided into a 0.1TZD group, 0.1TZD + EA group, and EA group and changes in plasma glucose and insulin concentrations evaluated. Results: A marked hypoglycemic response was observed in the normal rat 0.1TZD, 0.1TZD + EA and EA groups, with the response more significant in the 0.1TZD + EA group than in the 0.1TZD group. Among the diabetic animals, the hypoglycemic responses in the 0.1TZD + EA and EA groups were greater than in the 0.1TZD group. In both the normal and diabetic rats, insulin secretion was increased by EA or 0.1TZD + EA treatment, but not by 0.1TZD. Conclusions: The plasma glucose lowering action of rosiglitazone was increased by EA in both normal and diabetic rats, indicating that the application of EA may enhance the hypoglycemic action of this insulin sensitizer.

Lack of Association between Pre-Operative Insulin-Like Growth Factor-1 and the Risk of Post-Operative Delirium in Elderly Chinese Patients

Che-Sheng Chu,Chih-Kuang Liang,Ming-Yueh Chou,Yu-Te Lin,Chien-Jen Hsu,Chin-Liang Chu,Po-Han Chou 대한신경정신의학회 2016 PSYCHIATRY INVESTIGATION Vol.13 No.3

ObjectiveaaPostoperative delirium (POD) is a highly prevalent complex neuropsychiatric syndrome in elderly patients. However, its pathophysiology is currently unknown. Early detection and prevention of POD is important; therefore, the aim of this study was to investigate the link between preoperative insulin growth factor 1 (IGF-1) levels in the serum and POD in the Chinese elderly patients. MethodsaaOne hundred and three patients who were undergoing an orthopedic operation took part in the study. Preoperative serum IGF-1 levels were measured. POD was determined daily using the Confusion Assessment Method (CAM) and DSM-IV TR. Baseline serum IGF-1 levels were compared between patients who did and did not develop POD. Correlation coefficients were calculated to evaluate relationship between baseline characteristics and serum IGF-1 levels. The relationship between baseline biomarkers and delirium status was investigated using logistic regression analysis, adjusting for potential confounding variables. ResultsaaTwenty-three patients developed POD. The POD group had lower MMSE scores and higher CCI scores and proportions of acute admission. Preoperative serum IGF-1 levels were correlated with MMSE scores and age (MMSE: r=0.230, p<0.05; age: r=-0.419, p<0.001). Baseline serum IGF-1 levels did not differ between patients who did and did not develop POD, even after adjusting for potential confounding factors, MMSE score, and age. ConclusionaaNo association was found between preoperative IGF-1 levels and POD, suggesting that they are not direct biomarkers of the incidence of POD among the Chinese elderly population. Further research with larger sample sizes is warranted to clarify the relationship.

Preparation and characterization of superhydrophobic coatings

Hsing-I Hsiang,Ming-Tsai Liang,Yu-Lun Chang,Hung-Chin Huang,Fu-Su Yen 한양대학교 세라믹연구소 2010 Journal of Ceramic Processing Research Vol.11 No.3

To obtain a surface with water-repelling and self-cleaning abilities attracts much interest in the nanotechnology age. In this study, a perfluroalkyl surfactant (perflurodecanoic acid, PFDA) was coated on nano-sized boehmite surfaces to obtain hydrophobic nano-particles via surface modification. Then the hydrophobic boehmite was coated on a transparent plastic film using spin-coating to obtain a hydrophobic film. The effects of various amounts of hydrophobic polymer on the adsorption behavior and contact angle for hydrophobic properties were investigated using FTIR, and a contact-angle meter. The adsorption of PFDA onto the surface of boehmite takes place through ionic bonding. The contact angles of the thin film prepared by spin coating PFDA-modified-boehmite on glass substrates were above 150o as the adsorption of PFDA onto the surface of boehmite reached saturation.

Exendin-4 improves resistance to Listeria monocytogenes infection in diabetic db/db mice

Hsien Yueh Liu,Chih-Yao Chung,Wen-Chin Yang,Chih-Lung Liang,Chi-Young Wang,Chih-Yu Chang,Cicero Lee-Tian Chang 대한수의학회 2012 Journal of Veterinary Science Vol.13 No.3

The incidence of diabetes mellitus is increasing among companion animals. This disease has similar characteristics in both humans and animals. Diabetes is frequently identified as an independent risk factor for infections associated with increased mortality. In the present study, homozygous diabetic (db/db) mice were infected with Listeria (L.) monocytogenes and then treated with the anti-diabetic drug exendin-4, a glucagon-like peptide 1 analogue. In aged db/db mice, decreased CD11b+ macrophage populations with higher lipid content and lower phagocytic activity were observed. Exendin-4 lowered high lipid levels and enhanced phagocytosis in macrophages from db/db mice infected with L. monocytogenes. Exendin-4 also ameliorated obesity and hyperglycemia, and improved ex vivo bacteria clearance by macrophages in the animals. Liver histology examined during L. monocytogenes infection indicated that abscess formation was much milder in exendin-4-treated db/db mice than in the control animals. Moreover, mechanistic studies demonstrated that expression of ATP binding cassette transporter 1, a sterol transporter, was higher in macrophages isolated from the exendin-4-treated db/db mice. Overall, our results suggest that exendin-4 decreases the risk of infection in diabetic animals by modifying the interaction between intracellular lipids and phagocytic macrophages.

Learning Curve of ROSA ONE Spine System for Transpedicular Screw Placement

Bing-Hung Hsu,Heng-Wei Liu,Kha-Liang Lee,Ming-Chin Lin,Gao Chen,Jang Yu,Chiao-Ling Chen,I-Chang Su,Chien-Min Lin 대한척추신경외과학회 2022 Neurospine Vol.19 No.2

Objective: The study investigated our institutional learning curve for the ROSA ONE spine system (ROSA) based on ROSA usage time. Methods: ROSA was designed to provide high accuracy for spinal pedicle screw placement through a built-in tracking technique. This study was conducted from November 2018 to January 2021. The time taken to complete each step of the robotic workflow was recorded. Patient demographics, comorbidities, surgical indications, and number of screw placements were examined in subgroup analysis. The Curve Fitting-General package (a part of NCSS 2021 software) was used to fit a mathematical model to the learning curve. Patient demographics, imaging data, and surgical time were reviewed retrospectively. Results: A total of 167 patients who had undergone surgery were included. The mean total ROSA usage time was 107.1 ± 27.3 minutes. The estimated learning rate was 90.4%, and the largest slope change occurred close to the time of the 20th surgery. The observed overall learning trend in the 4-screw group could be attributed to screw planning. The presence of scoliosis (p = 0.73) or spondylolisthesis (p = 0.70) did not significantly influence the mean total time (TT) for all patients; however, the mean TT differed significantly (p < 0.01) among subgroups stratified by body mass index, screw number placement, and thoracic spine involvement. Conclusion: To the best of our knowledge, this is the first study to examine the learning curve for the various crucial steps of ROSA-guided pedicle screw placement. The indicative learning curve involved 20 patients who had undergone surgery.

The Clinical Outcomes of Different First-Line EGFR-TKIs Plus Bevacizumab in Advanced EGFR-Mutant Lung Adenocarcinoma

Yen-Hsiang Huang,Kuo-Hsuan Hsu,Chun-Shih Chin,Jeng-Sen Tseng,Tsung-Ying Yang,Kun-Chieh Chen,Kang-Yi Su,Sung-Liang Yu,Jeremy J.W. Chen,Gee-Chen Chang 대한암학회 2022 Cancer Research and Treatment Vol.54 No.2

Purpose The aim of this study was to investigate the efficacy of various epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitors (TKIs) plus bevacizumab in advanced EGFR-mutant lung adenocarcinoma patients. Materials and Methods From August 2016 to October 2020, we enrolled advanced lung adenocarcinoma patients harboring exon 19 deletion or L858R receiving gefitinib, erlotinib and afatinib plus bevacizumab as the first-line treatment for the purposes of analysis. Results A total of 36 patients were included in the final analysis. Three patients received gefitinib, 17 received erlotinib, and 16 received afatinib combined with bevacizumab as the first-line treatment. The objective response rate was 77.8%, and disease control rate was 94.4%. The overall median progression-free survival (PFS) was 16.4 months, while the median PFS was 17.1 months in patients with exon 19 deletion, and 16.2 months in patients with L858R mutation (p=0.311). Regarding the use of different EGFR-TKIs, the median PFS was 17.1 months in the erlotinib group and 21.6 months in the afatinib group (p=0.617). In patients with brain metastasis at baseline, the median PFS was 18.9 months in the erlotinib group and 16.4 months in the afatinib group (p=0.747). Amongst patients harboring exon 19 deletion, the median PFS was 16.2 months in the erlotinib group and not-reached in the afatinib group (p=0.141). In patients with L858R mutation, the median PFS was 18.9 months in the erlotinib group and 16.2 months in the afatinib group (p=0.481). Conclusion Our research demonstrates that not only erlotinib combined with bevacizumab, but also afatinib plus bevacizumab as first-line treatment, provides solid clinical efficacy in advanced EGFR-mutant lung adenocarcinoma patients. PurposeThe aim of this study was to investigate the efficacy of various epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitors (TKIs) plus bevacizumab in advanced <i>EGFR</i>-mutant lung adenocarcinoma patients.Materials and MethodsFrom August 2016 to October 2020, we enrolled advanced lung adenocarcinoma patients harboring exon 19 deletion or L858R receiving gefitinib, erlotinib and afatinib plus bevacizumab as the first-line treatment for the purposes of analysis.ResultsA total of 36 patients were included in the final analysis. Three patients received gefitinib, 17 received erlotinib, and 16 received afatinib combined with bevacizumab as the first-line treatment. The objective response rate was 77.8%, and disease control rate was 94.4%. The overall median progression-free survival (PFS) was 16.4 months, while the median PFS was 17.1 months in patients with exon 19 deletion, and 16.2 months in patients with L858R mutation (p=0.311). Regarding the use of different EGFR-TKIs, the median PFS was 17.1 months in the erlotinib group and 21.6 months in the afatinib group (p=0.617). In patients with brain metastasis at baseline, the median PFS was 18.9 months in the erlotinib group and 16.4 months in the afatinib group (p=0.747). Amongst patients harboring exon 19 deletion, the median PFS was 16.2 months in the erlotinib group and not-reached in the afatinib group (p=0.141). In patients with L858R mutation, the median PFS was 18.9 months in the erlotinib group and 16.2 months in the afatinib group (p=0.481).ConclusionOur research demonstrates that not only erlotinib combined with bevacizumab, but also afatinib plus bevacizumab as first-line treatment, provides solid clinical efficacy in advanced <i>EGFR</i>-mutant lung adenocarcinoma patients.

Identification and Characterization of a Novel Terrabacter ginsenosidimutans sp. nov. β-Glucosidase That Transforms Ginsenoside Rb1 into the Rare Gypenosides XVII and LXXV

An, Dong-Shan,Cui, Chang-Hao,Lee, Hyung-Gwan,Wang, Liang,Kim, Sun Chang,Lee, Sung-Taik,Jin, Fengxie,Yu, Hongshan,Chin, Young-Won,Lee, Hyeong-Kyu,Im, Wan-Taek,Kim, Song-Gun American Society for Microbiology 2010 Applied and environmental microbiology Vol.76 No.17

<B>ABSTRACT</B><P>A new β-glucosidase from a novel strain of <I>Terrabacter ginsenosidimutans</I> (Gsoil 3082<SUP>T</SUP>) obtained from the soil of a ginseng farm was characterized, and the gene, <I>bgpA</I> (1,947 bp), was cloned in <I>Escherichia coli</I>. The enzyme catalyzed the conversion of ginsenoside Rb1 {3-<I>O</I>-[β-d-glucopyranosyl-(1-2)-β-d-glucopyranosyl]-20-<I>O</I>-[β-d-glucopyranosyl-(1-6)-β-d-glucopyranosyl]-20(<I>S</I>)-protopanaxadiol} to the more pharmacologically active rare ginsenosides gypenoside XVII {3-<I>O</I>-β-d-glucopyranosyl-20-<I>O</I>-[β-d-glucopyranosyl-(1-6)-β-d-glucopyranosyl]-20(<I>S</I>)-protopanaxadiol}, gypenoside LXXV {20-<I>O</I>-[β-d-glucopyranosyl-(1-6)-β-d-glucopyranosyl]-20(<I>S</I>)-protopanaxadiol}, and C-K [20-<I>O</I>-(β-d-glucopyranosyl)-20(<I>S</I>)-protopanaxadiol]. A BLAST search of the <I>bgpA</I> sequence revealed significant homology to family 3 glycoside hydrolases. Expressed in <I>E. coli</I>, β-glucosidase had apparent <I>Km</I> values of 4.2 ± 0.8 and 0.14 ± 0.05 mM and <I>V</I>max values of 100.6 ± 17.1 and 329 ± 31 μmol·min<SUP>−1</SUP>·mg of protein<SUP>−1</SUP> against <I>p</I>-nitrophenyl-β-d-glucopyranoside and Rb1, respectively. The enzyme catalyzed the hydrolysis of the two glucose moieties attached to the C-3 position of ginsenoside Rb1, and the outer glucose attached to the C-20 position at pH 7.0 and 37°C. These cleavages occurred in a defined order, with the outer glucose of C-3 cleaved first, followed by the inner glucose of C-3, and finally the outer glucose of C-20. These results indicated that BgpA selectively and sequentially converts ginsenoside Rb1 to the rare ginsenosides gypenoside XVII, gypenoside LXXV, and then C-K. Herein is the first report of the cloning and characterization of a novel ginsenoside-transforming β-glucosidase of the glycoside hydrolase family 3.</P>