Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis

( Po-yao Hsu ),( Yu-ju Wei ),( Jia-jung Lee ),( Sheng-wen Niu ),( Jiun-chi Huang ),( Cheng-ting Hsu ),( Tyng-yuan Jang ),( Ming-lun Yeh ),( Ching-i Huang ),( Po-cheng Liang ),( Yi-hung Lin ),( Ming-ye 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.1

Background/Aims: Direct-acting antivirals (DAAs) have been approved for hepatitis C virus (HCV) treatment in patients with end-stage renal disease (ESRD) on hemodialysis. Nevertheless, the complicated comedications and their potential drug-drug interactions (DDIs) with DAAs might limit clinical practice in this special population. Methods: The number, class, and characteristics of comedications and their potential DDIs with five DAA regimens were analyzed among HCV-viremic patients from 23 hemodialysis centers in Taiwan. Results: Of 2,015 hemodialysis patients screened in 2019, 169 patients seropositive for HCV RNA were enrolled (mean age, 65.6 years; median duration of hemodialysis, 5.8 years). All patients received at least one comedication (median number, 6; mean class number, 3.4). The most common comedication classes were ESRD-associated medications (94.1%), cardiovascular drugs (69.8%) and antidiabetic drugs (43.2%). ESRD-associated medications were excluded from DDI analysis. Sofosbuvir/velpatasvir/voxilaprevir had the highest frequency of potential contraindicated DDIs (red, 5.6%), followed by glecaprevir/pibrentasvir (4.0%), sofosbuvir/ledipasvir (1.3%), sofosbuvir/velpatasvir (1.3%), and elbasvir/grazoprevir (0.3%). For potentially significant DDIs (orange, requiring close monitoring or dose adjustments), sofosbuvir/velpatasvir/voxilaprevir had the highest frequency (19.9%), followed by sofosbuvir/ledipasvir (18.2%), glecaprevir/pibrentasvir (12.6%), sofosbuvir/velpatasvir (12.6%), and elbasvir/grazoprevir (7.3%). Overall, lipid-lowering agents were the most common comedication class with red-category DDIs to all DAA regimens (n=62), followed by cardiovascular agents (n=15), and central nervous system agents (n=10). Conclusions: HCV-viremic patients on hemodialysis had a very high prevalence of comedications with a broad spectrum, which had varied DDIs with currently available DAA regimens. Elbasvir/grazoprevir had the fewest potential DDIs, and sofosbuvir/velpatasvir/voxilaprevir had the most potential DDIs. (Clin Mol Hepatol 2021;27:186-196)

ALDH2 Gene: Its Effects on the Neuropsychological Functions in Patients with Opioid Use Disorder Undergoing Methadone Maintenance Treatment

Po-Wei Lee,Tzu-Yun Wang,Yun-Hsuan Chang,Sheng-Yu Lee,Shiou-Lan Chen,Ze-Cheng Wang,Po See Chen,Chun-Hsien Chu,San-Yuan Huang,Nian-Sheng Tzeng,I Hui Lee,Kao Chin Chen,Yen Kuang Yang,Jau-Shyong Hong,Ru-B 대한정신약물학회 2020 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.18 No.1

Objective: Patients with opioid use disorder (OUD) have impaired attention, inhibition control, and memory function. The aldehyde dehydrogenase 2 (ALDH2 ) gene has been associated with OUD and ALDH2 gene polymorphisms may affect aldehyde metabolism and cognitive function in other substance use disorder. Therefore, we aimed to investigate whether ALDH2 genotypes have significant effects on neuropsychological functions in OUD patients undergoing methadone maintenance therapy (MMT). Methods: OUD patients undergoing MMT were investigated and followed-up for 12 weeks. ALDH2 gene polymorphisms were genotyped. Connors’ Continuous Performance Test (CPT) and the Wechsler Memory Scale-Revised (WMS-R) were administered at baseline and after 12 weeks of MMT. Multivariate linear regressions and generalized estimating equations (GEEs) were used to examine the correlation between the ALDH2 genotypes and performance on the CPTs and WMS-R. Results: We enrolled 86 patients at baseline; 61 patients completed the end-of-study assessments. The GEE analysis showed that, after the 12 weeks of MMT, OUD patients with the ALDH2 *1/*2+*2/*2 (ALDH2 inactive) genotypes had significantly higher commission error T-scores (p = 0.03), significantly lower hit reaction time T-scores (p = 0.04), and significantly lower WMS-R visual memory index scores (p = 0.03) than did patients with the ALDH2 1 */*1 (ALDH2 active) genotype. Conclusion: OUD patients with the ALDH2 inactive genotypes performed worse in cognitive domains of attention, impulse control, and memory than did those with the ALDH2 active genotype. We conclude that the ALDH2 gene is important in OUD and is associated with neuropsychological performance after MMT.

Predicting the surgical reparability of large-to-massive rotator cuff tears by B-mode ultrasonography: a cross-sectional study

Po-Cheng Chen,Kuan-Ting Wu,Yi-Cun Chen,Yu-Chi Huang,Ching-Di Chang,Wei-Che Lin,Wen-Yi Chou 대한초음파의학회 2022 ULTRASONOGRAPHY Vol.41 No.1

Purpose: This study aimed to compare the ability of B-mode ultrasonography and magnetic resonance imaging (MRI) to predict the repairability of large-to-massive rotator cuff tears (RCTs). Methods: This cross-sectional study included participants with large-to-massive RCTs who underwent arthroscopic repair. B-mode ultrasonography and MRI were conducted prior to arthroscopic repair. B-mode ultrasonography was used to evaluate the echogenicity of the rotator cuff muscle using the Heckmatt scale. Intra-rater and inter-rater reliabilities were examined for two independent physicians. MRI was used to evaluate the degrees of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, two experienced orthopedic surgeons performed surgery and decided whether the torn stump could be completely repaired intraoperatively. Results: Fifty participants were included, and 32 complete repairs and 18 partial repairs were performed. B-mode ultrasonography showed good intra-rater reliability and inter-rater reliability for assessment of the muscle echogenicity of the supraspinatus and infraspinatus muscles. The correlation coefficients between B-mode ultrasound findings and MRI findings showed medium to large effect sizes (r=0.4-0.8). The Goutallier classification of the infraspinatus muscles was the MRI predictor with the best discriminative power for surgical reparability (area under the curve [AUC], 0.89; 95% confidence interval [CI], 0.81 to 0.98), while the Heckmatt scale for infraspinatus muscles was the most accurate ultrasound predictor (AUC, 0.85; 95% CI, 0.74 to 0.96). No significant differences in AUCs among the MRI and ultrasound predictors were found. Conclusion: B-mode ultrasonography was a reliable examination tool and had a similar ability to predict surgical reparability to that of MRI among patients with large-to-massive RCTs. Purpose: This study aimed to compare the ability of B-mode ultrasonography and magnetic resonance imaging (MRI) to predict the repairability of large-to-massive rotator cuff tears (RCTs).Methods: This cross-sectional study included participants with large-to-massive RCTs who underwent arthroscopic repair. B-mode ultrasonography and MRI were conducted prior to arthroscopic repair. B-mode ultrasonography was used to evaluate the echogenicity of the rotator cuff muscle using the Heckmatt scale. Intra-rater and inter-rater reliabilities were examined for two independent physicians. MRI was used to evaluate the degrees of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, two experienced orthopedic surgeons performed surgery and decided whether the torn stump could be completely repaired intraoperatively.Results: Fifty participants were included, and 32 complete repairs and 18 partial repairs were performed. B-mode ultrasonography showed good intra-rater reliability and inter-rater reliability for assessment of the muscle echogenicity of the supraspinatus and infraspinatus muscles. The correlation coefficients between B-mode ultrasound findings and MRI findings showed medium to large effect sizes (r=0.4-0.8). The Goutallier classification of the infraspinatus muscles was the MRI predictor with the best discriminative power for surgical reparability (area under the curve [AUC], 0.89; 95% confidence interval [CI], 0.81 to 0.98), while the Heckmatt scale for infraspinatus muscles was the most accurate ultrasound predictor (AUC, 0.85; 95% CI, 0.74 to 0.96). No significant differences in AUCs among the MRI and ultrasound predictors were found.Conclusion: B-mode ultrasonography was a reliable examination tool and had a similar ability to predict surgical reparability to that of MRI among patients with large-to-massive RCTs.

Validation of a Palliative Prognostic Index to Predict Life Expectancy for Terminally Ill Cancer Patients in a Hospice Consultation Setting in Taiwan

Cheng, Wei-Hong,Kao, Chen-Yi,Hung, Yu-Shin,Su, Po-Jung,Hsieh, Chia-Hsun,Chen, Jen-Shi,Wang, Hung-Ming,Chou, Wen-Chi Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.6

Background: The aim of our study was to assess the practical utility of the palliative prognostic index (PPI) as a prognostic tool used by nurse specialists in a hospice consultation setting in Taiwan. Methods: In total, 623 terminal cancer patients under hospice consultation care from one medical center in northern Taiwan were enrolled between January 1 and June 30, 2011. PPI was assessed by a nurse specialist at first hospice consultation and patients categorized into groups by prognosis (good, intermediate, poor). Patient survival was analyzed retrospectively to determine significance of between-group differences. Results: By PPI sum score, 37.2% of patients were in the good prognosis group, 18% in the intermediate prognosis group and 44.8% in the poor prognosis group. The death rates were 56%, 81.2% and 89.6% and median survivals were 76, 18 and 7 days, respectively. The hazard ratio was 0.19 (95% confidence interval [CI] 0.10-0.24, p<0.001) for the poor versus good prognosis group and 0.54 (95% CI 0.43-0.69, p<0.001) for the poor versus intermediate prognosis group. The sensitivity and specificity for the poor prognosis group was 66% and 71%; the positive predictive value and negative predictive value were 81% and 52%, respectively, to predict patient death within 21 days (area under the curve of the receiver operating characteristic was 0.68). Conclusions: Assessment by PPI can accurately predict survival of terminal cancer patients receiving hospice consultation care. PPI is a simple tool and can be administered by nurse members of hospice consultation teams.

Uniaxial Compression Properties and Compression Fatigue Performance of Selective Laser Melted Ti–6Al–4V Cellular Structure

Ming‑Wei Wu,Jhewn‑Kuang Chen,Mo‑Kai Tsai,Pei Wang,Tien‑Lin Cheng,Bo‑Huan Lin,Po‑Hsing Chiang,Annadurai Dhinakar 대한금속·재료학회 2022 METALS AND MATERIALS International Vol.28 No.1

The selective laser melted (SLM) Ti–6Al–4V cellular solid is a promising material in biomedical and other applications. The mechanical properties of the SLM Ti–6Al–4V cellular material are predominantly controlled by the design of the cellular structure. The objective of this study was to investigate the uniaxial compressive properties and compressive fatigueperformance of the SLM Ti–6Al–4V cellular solid with a new cuboctahedron unit cell reinforced by four diagonal strutsand two horizontal struts along the X and Y axes. The infuences of hot isostatic pressing (HIP) on the various mechanicalproperties were also examined. The results showed a smoother stress–strain curve and fewer stress oscillations in the HIPspecimen than in the SLM specimen. The HIP process slightly decreased the yield strength of the SLM sample from 55 to52 MPa. Under uniaxial compressive stress, the SLM and HIP specimens exhibited layer-by-layer fracture and diagonalshear fracture, respectively. Furthermore, the HIP treatment signifcantly increased the fatigue performance and improved thefatigue endurance ratio at 106cycles from 0.15 to 0.35. The HIP treatment contributed to several positive efects, includingphase transformation from brittle α′ to α + β, the elimination of strut porosity and residual stress, an increase in lath size,and a better combination of strength and ductility, thereby improving the fatigue performance. The efects of stress mode onthe fracture mechanism were also clarifed using in situ observation in combination with digital image correlation.

Fabrication and applications of ultraflexible nanostructures using dielectric heating-assisted nanoimprint on PVC films

Tsung-Yeh Wu,Po-Cheng Tsai,Shu-Cheng Lo,Yi-Ru Li,Kuang-Li Lee,Sen-Yeu Yang,Pei-Kuen Wei 한국물리학회 2018 Current Applied Physics Vol.18 No.1

We developed dielectric heating-assisted nanoimprint method for rapid fabrication of ultraflexible nanostructures. Using spin-coating polyvinyl-chloride (PVC) film on the glass slide, the dielectric heating on PVC film helped the pattern transfer from the mold to PVC film in few seconds. Various kinds of nanostructures were successfully made on PVC films with about 20-mm thickness. We demonstrated the applications of ultraflexible metallic nanostructures for bending measurement using surface plasmon resonance (SPR) and surface enhanced Raman scattering (SERS) on the curved surfaces. For measuring bending angles using SPR on capped nanowire arrays, the minimum detection angle was 2.4 103 degree under 0.02 nm wavelength resolution. For SERS measurement, the nanorod arrays on a curved substrate can increase SERS signals for two times as compared to planar SERS substrate.

Evaluation of Malignancy Risk of Ampullary Tumors Detected by Endoscopy Using 2-[18F]FDG PET/CT

Chuang Pei-Ju,Wang Hsiu-Po,Tien Yu-Wen,Chin Wei-Shan,Hsieh Min-Shu,Chen Chieh-Chang,Hong Tzu-Chan,Ko Chi-Lun,Wu Yen-Wen,Cheng Mei-Fang 대한영상의학회 2024 Korean Journal of Radiology Vol.25 No.3

Objective: We aimed to investigate whether 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy. Materials and Methods: This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[18F]FDG PET/CT for endoscopy-detected ampullary tumors 5–87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test. Results: The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in earlyphase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13–36.18; P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80–13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41–19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00–14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16–21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874–0.956] vs. 0.815 [0.732–0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816–0.967) in candidates for endoscopic papillectomy. Conclusion: Adding 2-[18F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

Fabrication and Characterization of Dye-sensitized Solar Cells based on Anodic Titanium Oxide Nanotube Arrays Sensitized with Heteroleptic Ruthenium Dyes

Shen, Chien-Hung,Chang, Yu-Cheng,Wu, Po-Ting,Diau, Eric Wei-Guang Korean Society of Photoscience 2014 Rapid communication in photoscience Vol.3 No.1

Anodic self-organized titania nanotube (TNT) arrays have a great potential as efficient electron-transport materials for dye-sensitized solar cells (DSSC). Herewith we report the photovoltaic and kinetic investigations for a series of heteroleptic ruthenium complexes (RD16-RD18) sensitized on TNT films for DSSC applications. We found that the RD16 device had an enhanced short-circuit current density ($J_{SC}/mAcm^{-2}=15.0$) and an efficiency of power conversion (${\eta}=7.2%$) greater than that of a N719 device (${\eta}=7.1%$) due to the increasing light-harvesting and the broadened spectral features with thiophene-based ligands. However, the device made of RD17 (adding one more hexyl chain) showed smaller $J_{SC}(14.1mAcm^{-2})$ and poorer ${\eta}(6.8%)$ compare to those of RD16 due to smaller amount of dye-loading and less efficient electron injection for the RD17 device than for the RD16 device. For the RD18 dye (adding one more thiophene unit and one more hexyl chain), we found that the device showed even lower $J_{SC}(13.2mAcm^{-2}) $ that led to a poorest device performance (${\eta}=6.2%$) for the RD18 device. These results are against to those obtained from the same dyes sensitized on $TiO_2$ nanoparticle films and they can be rationalized according to the electron transport kinetics measured using the methods of charge extraction and transient photovoltage decays.

Semi-Lagrangian Reproducing Kernel Particle Method for Slope Stability Analysis and Post-Failure Simulation

On-Lei Annie Kwok,Pai-Chen Guan,Wei-Po Cheng,Chien-Ting Sun 대한토목학회 2015 KSCE JOURNAL OF CIVIL ENGINEERING Vol.19 No.1

Slope stability analyses are often performed using Limit Equilibrium Methods (LEMs) and Finite Element Method (FEM). However, these methods can only model the slope condition up to the point of failure. Meshfree methods, which do not require amesh or a grid in the simulation process, have the potential to model the post-failure slope behavior as mesh tangling would not occurto cause numerical instability and non-convergence. Hence, while retaining the benefits of conventional numerical schemes,meshfree method can be more advantageous when problems with large deformation are encountered. In this paper, Semi-LagrangianReproducing Kernel Particle Method (SLRKPM), which is a type of meshfree method, is extended to analyze geomechanicsproblems such as the stability of a slope and post failure slope behavior. The results from SLRKPM agree well with those fromconvention methods (LEMs and FEM) in terms of factor-of-safety and failure surface. In addition, SLRKPM is able to simulate theslope failure process and successfully capture the development of shear band. This proves that SLRKPM has a significant advantageover FEM when dealing with problems involving large deformation and failure of geomaterials.

Correlation Between Fiber Orientation and Geometrical Shrinkage of Injected Parts Under the Influence of Flow-Fiber Coupling Effect

Chao-Tsai Huang,Jun-Zheng Wang,Cheng-Hong Lai,Sheng-Jye Hwang,Po-Wei Huang,Hsin-Shu Peng 한국정밀공학회 2023 International Journal of Precision Engineering and Vol.10 No.4

Fiber reinforced thermoplastics (FRP) have been widely used in automotive industry. However, how does the flow-fiber coupling effect influence the micro fiber orientation and further affect the geometrical shrinkage of the final part that is not fully understood yet. In this study, a complex center-gated plate has been applied to study the influence of the flow-fiber coupling effect on the fiber orientation variation and the geometrical change through numerical simulation. Then the practical verification through the micro-computed tomography (micro-CT) and image processing technology was carried out. Results show that in the presence of the flow-fiber coupling the required spruce pressure will be higher compared to no coupling case. In addition, the melt flow front pattern will be changed from “convex-flat” to “convex-concave” under the influence of this coupling. Moreover, in the presence of the flow-fiber coupling effect, the wider core width for fiber orientation tensor in the flow direction (A11) can be obtained from upstream to downstream regions for the same model. However, in the downstream region (i.e. in the FR), the flow-fiber coupling effect is more significantly due to the action of less shear rate in that region. Finally, through the measurement of the left–right asymmetrical shape of the FR for Model I (or Model II), the reason is that the flow-fiber coupling effect will switch the fiber orientation from the flow direction (A11) dominate to the cross-flow direction (A22) dominate. This asymmetrical fiber orientation distribution will further create that asymmetrical shrinkage shape of final part. The correlation between fiber orientation and geometrical shrinkage can be achieved.