99 results on '"Chih-Yu Yang"'
Search Results
2. Far-Infrared Therapy Improves Arteriovenous Fistula Patency and Decreases Plasma Asymmetric Dimethylarginine in Patients with Advanced Diabetic Kidney Disease: A Prospective Randomized Controlled Trial
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Chun-Fan Chen, Chiu-Yang Lee, Fu-An Chen, Chih-Yu Yang, Tz-Heng Chen, Shuo-Ming Ou, Kuo-Hua Lee, Ching-Po Li, Chia-Hao Chan, Pui-Ching Lee, Yung-Tai Chen, Tsung-Lun Lee, Yang Ho, Fan-Yu Chen, Hao-Wei Ma, Jinn-Yang Chen, Ann Charis Tan, Szu-Yuan Li, and Chih-Ching Lin
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access blood flow ,Asymmetric dimethylarginine ,arteriovenous fistula ,chronic kidney disease ,diabetic kidney disease ,far-infrared therapy ,Medicine - Abstract
Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and plays a significant role in the pathogenesis of arteriovenous fistula (AVF) dysfunction. The aim of this study is to evaluate the effect of far-infrared (FIR) therapy on the maturation and patency of newly-created AVFs in patients with advanced diabetic kidney disease (DKD) as well as the concurrent change in plasma ADMA. The study enrolled 144 participants with advanced DKD where 101 patients were randomly allocated to the FIR therapy group (N = 50) and control group (N = 51). Patients receiving FIR therapy had a decreased AVF failure rate within 12 months (16% versus 35.3%; p = 0.027); decreased incremental change of ADMA concentration at the 3rd and 12th month; increased AVF blood flow at the 1st, 3rd, and 12th month; increased 3-month physiologic maturation rate (88% versus 68.6%; p = 0.034); increased 1-year unassisted AVF patency rate (84% versus 64.7%; p = 0.017); and increased clinical AVF maturation rate within 12 months (84% versus 62.7%; p = 0.029) compared to the control group. The study demonstrates that FIR therapy can reduce the incremental changes in plasma ADMA concentration, which may be associated with the improvement of AVF prognosis in patients with advanced DKD.
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- 2022
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3. Tacrolimus Blood Level Fluctuation Predisposes to Coexisting BK Virus Nephropathy and Acute Allograft Rejection
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Chia-Lin Shen, An-Hang Yang, Tse-Jen Lien, Der-Cherng Tarng, and Chih-Yu Yang
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Medicine ,Science - Abstract
Abstract BK virus nephropathy (BKVN) and allograft rejection are two distinct disease entities which occur at opposite ends of the immune spectrum. However, they coexist in renal transplant recipients. Predisposing factors for this coexistence remain elusive. We identified nine biopsy-proven BKVN patients with coexisting acute rejection, and 21 patients with BKVN alone. We retrospectively analyzed the dosage and blood concentrations of immunosuppressants during the 3-month period prior to the renal biopsy between the two patient groups. Compared to the BKVN alone group, renal function was noticeably worse in the coexistence group (p = 0.030). Regarding the dose and average drug level of immunosuppressants, there was no difference between the two groups. Interestingly, the coefficient of variance of tacrolimus trough blood level was noticeably higher during the 3-month period prior to the renal biopsy in the coexistence group (p = 0.010). Our novel findings suggest that a higher variability of tacrolimus trough level may be associated with the coexistence of BKVN and acute rejection. Since the prognosis is poor and the treatment is challenging in patients with coexisting BKVN and acute rejection, transplant clinicians should strive to avoid fluctuations in immunosuppressant drug levels in patients with either one of these two disease entities.
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- 2017
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4. Diagnostic Accuracy of Urine Protein/Creatinine Ratio Is Influenced by Urine Concentration.
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Chih-Yu Yang, Fu-An Chen, Chun-Fan Chen, Wen-Sheng Liu, Chia-Jen Shih, Shuo-Ming Ou, Wu-Chang Yang, Chih-Ching Lin, and An-Hang Yang
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Medicine ,Science - Abstract
The usage of urine protein/creatinine ratio to estimate daily urine protein excretion is prevalent, but relatively little attention has been paid to the influence of urine concentration and its impact on test accuracy. We took advantage of 24-hour urine collection to examine both urine protein/creatinine ratio (UPCR) and daily urine protein excretion, with the latter as the reference standard. Specific gravity from a concomitant urinalysis of the same urine sample was used to indicate the urine concentration.During 2010 to 2014, there were 540 adequately collected 24h urine samples with protein concentration, creatinine concentration, total volume, and a concomitant urinalysis of the same sample. Variables associated with an accurate UPCR estimation were determined by multivariate linear regression analysis. Receiver operating characteristic (ROC) curves were generated to determine the discriminant cut-off values of urine creatinine concentration for predicting an accurate UPCR estimation in either dilute or concentrated urine samples.Our findings indicated that for dilute urine, as indicated by a low urine specific gravity, UPCR is more likely to overestimate the actual daily urine protein excretion. On the contrary, UPCR of concentrated urine is more likely to result in an underestimation. By ROC curve analysis, the best cut-off value of urine creatinine concentration for predicting overestimation by UPCR of dilute urine (specific gravity ≦ 1.005) was ≦ 38.8 mg/dL, whereas the best cut-off values of urine creatinine for predicting underestimation by UPCR of thick urine were ≧ 63.6 mg/dL (specific gravity ≧ 1.015), ≧ 62.1 mg/dL (specific gravity ≧ 1.020), ≧ 61.5 mg/dL (specific gravity ≧ 1.025), respectively. We also compared distribution patterns of urine creatinine concentration of 24h urine cohort with a concurrent spot urine cohort and found that the underestimation might be more profound in single voided samples.The UPCR in samples with low or high specific gravity is more likely to overestimate or underestimate actual daily urine protein amount, respectively, especially in a dilute urine sample with its creatinine below 38.8 mg/dL or a concentrated sample with its creatinine above 61.5 mg/dL. In particular, UPCR results should be interpreted with caution in cases that involve dilute urine samples because its overestimation may lead to an erroneous diagnosis of proteinuric renal disease or an incorrect staging of chronic kidney disease.
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- 2015
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5. Plasma protein characteristics of long-term hemodialysis survivors.
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Yao-Ping Lin, Chih-Yu Yang, Chen-Chung Liao, Wen-Chung Yu, Chin-Wen Chi, and Chao-Hsiung Lin
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Medicine ,Science - Abstract
Hemodialysis (HD) patients are under recurrent circulatory stress, and hemodialysis has a high mortality rate. The characteristics of plasma proteomes in patients surviving long-term HD remain obscure, as well as the potential biomarkers in predicting prognoses. This study reports the proteome analyses of patient plasma from non-diabetic long-term HD (LHD, dialysis vintage 14.9±4.1 years, n = 6) and the age/sex/uremic etiology-comparable short-term HD (SHD, dialysis vintage 5.3±2.9 years, n = 6) using 2-DE and mass spectrometry. In addition, a 4-year longitudinal follow-up of 60 non-diabetic HD patients was subsequently conducted to analyze the baseline plasma proteins by ELISA in predicting prognosis. Compared to the SHD, the LHD survivors had increased plasma vitamin D binding proteins (DBP) and decreased clusterin, apolipoprotein A-IV, haptoglobin, hemopexin, complement factors B and H, and altered isoforms of α1-antitrypsin and fibrinogen gamma. During the 45.7±15 months for follow-up of the 60 HD patient cases, 16 patients died. Kaplan-Meier analysis demonstrated that HD patients with the lowest tertile of the baseline plasma DBP level have a significantly higher mortality rate. Multivariate Cox regression analysis further indicated that DBP is an independent predictor of mortality. In summary, the altered plasma proteins in LHD implicated accelerated atherosclerosis, defective antioxidative activity, increased inflammation/infection, and organ dysfunction. Furthermore, lower baseline plasma DBP in HD patients is related to mortality. The results suggest that the proteomic approach could help discover the potential biomarker in HD prognoses.
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- 2012
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6. Ankle-Brachial Index Is a Powerful Predictor of Renal Outcome and Cardiovascular Events in Patients with Chronic Kidney Disease
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Fu-An Chen, Chih-Yu Yang, Wu-Chang Yang, Jinn-Yang Chen, Yee-Yung Ng, Szu-Yuan Li, Wen-Sheng Liu, Shiao-Ti Cheng, Yu-Jen Wang, and Chih-Ching Lin
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Technology ,Medicine ,Science - Abstract
Ankle-brachial index (ABI) is an accurate tool to diagnose peripheral arterial disease. The aim of this study was to evaluate whether ABI is also a good predictor of renal outcome and cardiovascular events in patients with chronic kidney disease (CKD). We enrolled 436 patients with stage 3–5 CKD who had not been undergoing dialysis. Patients were stratified into two groups according to the ABI value with a cut point of 0.9. The composite renal outcome, including doubling of serum creatinine level and commencement of dialysis, and the incidence of cardiovascular events were compared between the two groups. After a median follow-up period of 13 months, the lower ABI group had a poorer composite renal outcome (OR=2.719, P=0.015) and a higher incidence of cardiovascular events (OR=3.260, P=0.001). Our findings illustrated that ABI is a powerful predictor of cardiovascular events and renal outcome in patients with CKD.
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- 2012
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7. Weight-Based Assessment of Access Flow Threshold to Predict Arteriovenous Fistula Functional Patency
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Yi-Fang Wang, Der-Cherng Tarng, Bo-Sheng Wu, Yan-Hwa Wu Lee, and Chih Yu Yang
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medicine.medical_specialty ,Flow (mathematics) ,Nephrology ,business.industry ,medicine ,Arteriovenous fistula ,Radiology ,medicine.disease ,business ,Weight based dosing - Abstract
The 2019 Kidney Disease Outcome Quality Initiative (K/DOQI) guideline recommended evaluating arteriovenous fistula (AVF) malfunction risks primarily based on clinical monitoring, which can be assisted with the value of vascular access flow (Qa). Nevertheless, Qa thresholds recommended by different guidelines vary, ranging from 300 to 500 ml/min. This study investigated the optimal Qa threshold to predict future functional patency in AVFs with Qa 500 ml/min.Both the clinical indicators of access dysfunction and the Qa value were monitored in patients receiving hemodialysis by the radiocephalic AVF. Routine access flow surveillance was performed by the ultrasound dilution method (HD03, Transonic Inc.). The development of clinically significant indicators of access dysfunction, which necessitated percutaneous transluminal angiography (PTA) to maintain functional patency, was analyzed in this cohort.Among the enrolled 302 patients, Qa of 52 patients was under 500 ml/min. These 52 patients received 2 Qa measurements during the follow-up period. Of these 52 patients, serial Qa of 17 patients varied trivially and their AVF remained functional. Multivariable logistic regression analysis revealed that a low Qa per ideal body weight (IBW) is an independent predictor of AVF functional loss. Receiver operating characteristic curve analysis of Qa/IBW in predicting future AVF functional loss revealed that the best cutoff value of Qa is 7.1 times the IBW.For radiocephalic AVFs with Qa 500 ml/min, the minimally required Qa to maintain access function is associated with individual IBW. The IBW-based Qa threshold assessment would allow more flexibility in the treatment of patients and reduce unnecessary invasive measures.
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- 2022
8. IgM mesangial deposition as a risk factor for relapses of adult-onset minimal change disease
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Chih Yu Yang, Der Cherng Tarng, Fan Yu Chen, An Hang Yang, Fu Pang Chang, Yang Ho, Bo Sheng Wu, and Cheng Wen Yang
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Nephrology ,Adult ,Male ,medicine.medical_specialty ,030232 urology & nephrology ,Statistical difference ,lcsh:RC870-923 ,Gastroenterology ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Recurrence ,Risk Factors ,Internal medicine ,medicine ,Humans ,Minimal change disease ,Risk factor ,Relapse ,Retrospective Studies ,Kidney ,biology ,business.industry ,Nephrosis, Lipoid ,Retrospective cohort study ,IgM mesangial deposition ,Middle Aged ,medicine.disease ,lcsh:Diseases of the genitourinary system. Urology ,Adult-onset ,Glomerular Mesangium ,medicine.anatomical_structure ,Immunoglobulin M ,030220 oncology & carcinogenesis ,biology.protein ,Female ,business ,Deposition (chemistry) ,Research Article - Abstract
BackgroundImmunoglobulin M (IgM) mesangial deposition in pediatric minimal change disease (MCD) has been reported to be associated with steroid dependence and poor renal outcomes. However, the evidence linking the impacts of IgM mesangial deposition to the treatment prognosis in adult-onset MCD is still elusive.MethodsIn this retrospective cohort study, 37 adult patients with MCD received kidney biopsies from January 2010 to May 2020. Immunofluorescence microscopy was performed and the patients dichotomized according to IgM mesangial deposition (12 patients with positive IgM deposition; 25 patients with negative IgM deposition). We analyzed the clinical features, the dosage of immunosuppressive agents, and the response to treatment for 2 years between the two groups.ResultsAnalysis of the clinical symptoms, the dosage of immunosuppressive treatment, and the time to remission revealed no statistical difference between the groups. However, compared to the negative IgM group, the frequency of relapses was significantly higher in the positive IgM group during the two-year follow-up period (the negative IgM group 0.25 episodes/year; the positive IgM group 0.75 episodes/year,p = 0.029). Furthermore, multivariate linear regression revealed that the positivity of IgM mesangial deposition is independently associated with the frequency of relapses (regression coefficient B 0.450, 95% CI 0.116–0.784,p = 0.010).ConclusionsOur findings indicated that adult-onset MCD patients with IgM mesangial deposition have a high risk of relapses. Therefore, intensive monitoring of disease activity should be considered in MCD adults with IgM mesangial deposition.
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- 2021
9. Effect of Renin-Angiotensin-Aldosterone System Blockade on Long-Term Outcomes in Postacute Kidney Injury Patients With Hypertension*
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Yao Ping Lin, Der Cherng Tarng, Chih Yu Yang, Ming Huang Lin, Jia Sin Liu, Ming Tsun Tsai, Zih Kai Kao, Chih Cheng Hsu, and Wei Cheng Tseng
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Adult ,Male ,medicine.medical_specialty ,Angiotensin receptor ,medicine.medical_treatment ,Angiotensin-Converting Enzyme Inhibitors ,Critical Care and Intensive Care Medicine ,Renin-Angiotensin System ,Angiotensin Receptor Antagonists ,Young Adult ,Internal medicine ,Renin–angiotensin system ,medicine ,Humans ,Renal replacement therapy ,Dialysis ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hazard ratio ,Acute kidney injury ,Retrospective cohort study ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Blockade ,Treatment Outcome ,Hypertension ,Female ,business - Abstract
Objectives Renal replacement therapy-requiring acute kidney injury frequently occurs in ICUs, which require evidence-based medical attention. However, in the postacute kidney injury patient population, the evidence regarding effective therapies to improve patient outcomes is lacking. Therefore, we aimed to examine whether the renin-angiotensin-aldosterone system blockade is effective in improving renal outcomes in postacute kidney injury patients who experienced temporary renal replacement therapy and have hypertension. Design A retrospective cohort study. Setting A nationwide database in Taiwan. Patients From January 1, 2000, to December 31, 2013, we identified 8,558 acute kidney injury patients with hypertension in the national registry database. All these patients experienced an acute kidney injury episode, which required temporary renal replacement therapy for at least once. Interventions Users (n = 3,885) and nonusers (n = 4,673) of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. Measurements and main results We used Cox proportional hazards regression models to analyze hazard ratios for the commencement of end-stage renal disease and all-cause mortality for angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users (n = 3,885) and nonusers (n = 4,673). In a median follow-up of 4.3 years, 5,880 patients (68.7%) required long-term dialysis, and 4,841 patients (56.6%) died. Compared with postacute kidney injury patients who did not use angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users are marginally less likely to progress to end-stage renal disease (adjusted hazard ratio 0.95; 95% CI 0.90-1.01; p = 0.06) and significantly less likely to suffer from all-cause mortality (adjusted hazard ratio 0.93; 95% CI 0.87-0.98; p = 0.011). Conclusions In patients who experienced renal replacement therapy-requiring acute kidney injury and have hypertension, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use is associated with better survival outcomes compared with nonuser.
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- 2020
10. Hemodialysis vascular access care during the COVID-19 pandemic
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Yi Fang Wang, Yang Ho, Chiu Yang Lee, Cheng Hsueh Wu, Der Cherng Tarng, and Chih Yu Yang
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medicine.medical_specialty ,medicine.medical_treatment ,Pneumonia, Viral ,MEDLINE ,Infection control ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Renal Dialysis ,Pandemic ,medicine ,Severe acute respiratory syndrome coronavirus 2 ,Humans ,Review Articles ,Pandemics ,Dialysis ,Quality of Health Care ,Hemodialysis vascular access ,business.industry ,SARS-CoV-2 ,Incidence (epidemiology) ,COVID-19 ,General Medicine ,medicine.disease ,Pneumonia ,030220 oncology & carcinogenesis ,Emergency medicine ,Hemodialysis ,business ,Coronavirus Infections ,Vascular Access Devices ,Kidney disease - Abstract
Dialysis patients are more vulnerable and susceptible to the severe coronavirus disease 2019 (COVID-19) infection due to multiple comorbidities. Since Taiwan has the highest incidence and prevalence of treated end-stage kidney disease worldwide, it is crucial to act in advance to prevent a potential disaster. In the face of the COVID-19 pandemic, we implement proactive infection control measures to prevent it from spreading without sacrificing the dialysis care quality. In this article, we focused on hemodialysis vascular access (HVA) care in particular. As a life-line of hemodialysis (HD) patients, HVA care has a profound impact on the patient's quality of dialysis and life. Specifically, in our facility, the working and office areas of the HD units are separated to reduce cross-infection. All elective procedures for HVA are postponed, and operating rooms equipped with a negative-pressure anteroom are used for the suspected or confirmed COVID-19 patients. Herein, we share how we modified our HVA care policy not only to prevent our patients from COVID-19 infection but also to maintain the quality of HVA care.
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- 2020
11. Prediction of the development of acute kidney injury following cardiac surgery by machine learning
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Shih Ping Hsu, Chuen Heng Wang, Oscar Kuang Sheng Lee, Yu Sen Peng, Yi Ting Chen, Kuan Ming Chiu, Kang Lung Chen, Po Yu Tseng, and Chih Yu Yang
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Male ,medicine.medical_specialty ,Letter ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Machine learning ,computer.software_genre ,Logistic regression ,Risk Assessment ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies ,Models, Statistical ,Receiver operating characteristic ,business.industry ,Acute kidney injury ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Reproducibility of Results ,Perioperative ,lcsh:RC86-88.9 ,Middle Aged ,Cardiac surgery ,medicine.disease ,Confidence interval ,ROC Curve ,Female ,Artificial intelligence ,business ,Packed red blood cells ,Prediction ,computer ,Kidney disease - Abstract
Background Cardiac surgery–associated acute kidney injury (CSA-AKI) is a major complication that results in increased morbidity and mortality after cardiac surgery. Most established prediction models are limited to the analysis of nonlinear relationships and fail to fully consider intraoperative variables, which represent the acute response to surgery. Therefore, this study utilized an artificial intelligence–based machine learning approach thorough perioperative data-driven learning to predict CSA-AKI. Methods A total of 671 patients undergoing cardiac surgery from August 2016 to August 2018 were enrolled. AKI following cardiac surgery was defined according to criteria from Kidney Disease: Improving Global Outcomes (KDIGO). The variables used for analysis included demographic characteristics, clinical condition, preoperative biochemistry data, preoperative medication, and intraoperative variables such as time-series hemodynamic changes. The machine learning methods used included logistic regression, support vector machine (SVM), random forest (RF), extreme gradient boosting (XGboost), and ensemble (RF + XGboost). The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC). We also utilized SHapley Additive exPlanation (SHAP) values to explain the prediction model. Results Development of CSA-AKI was noted in 163 patients (24.3%) during the first postoperative week. Regarding the efficacy of the single model that most accurately predicted the outcome, RF exhibited the greatest AUC (0.839, 95% confidence interval [CI] 0.772–0.898), whereas the AUC (0.843, 95% CI 0.778–0.899) of ensemble model (RF + XGboost) was even greater than that of the RF model alone. The top 3 most influential features in the RF importance matrix plot were intraoperative urine output, units of packed red blood cells (pRBCs) transfused during surgery, and preoperative hemoglobin level. The SHAP summary plot was used to illustrate the positive or negative effects of the top 20 features attributed to the RF. We also used the SHAP dependence plot to explain how a single feature affects the output of the RF prediction model. Conclusions In this study, machine learning methods were successfully established to predict CSA-AKI, which determines risks following cardiac surgery, enabling the optimization of postoperative treatment strategies to minimize the postoperative complications following cardiac surgeries.
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- 2020
12. Mechanical and chemical cues synergistically promote human venous smooth muscle cell osteogenesis through integrin β1‐ERK1/2 signaling: A cell model of hemodialysis fistula calcification
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Chih Yu Yang, Pu-Yuan Chang, Oscar K. Lee, Bo-Sheng Wu, and Der-Cherng Tarng
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Fistula ,Myocytes, Smooth Muscle ,Cell ,Integrin ,Biochemistry ,Phosphates ,Pathogenesis ,Osteogenesis ,Renal Dialysis ,Genetics ,medicine ,Humans ,Vein ,Molecular Biology ,Mitogen-Activated Protein Kinase 1 ,Mitogen-Activated Protein Kinase 3 ,biology ,business.industry ,Integrin beta1 ,Calcinosis ,medicine.disease ,Cell biology ,RUNX2 ,medicine.anatomical_structure ,Mitochondrial biogenesis ,biology.protein ,Stress, Mechanical ,Cues ,Signal transduction ,Shear Strength ,business ,Signal Transduction ,Biotechnology ,Calcification - Abstract
Arteriovenous fistula (AVF) is the vascular access of choice for renal replacement therapy. However, AVF is susceptible to calcification with a high prevalence of 40%-65% in chronic hemodialysis patients. Repeated needle puncture for hemodialysis cannulation results in intimal denudation of AVF. We hypothesized that exposure to blood shear stress in the medial layer promotes venous smooth muscle cell (SMC) osteogenesis. While previous studies of shear stress focused on arterial-type SMCs, SMCs isolated from the vein had not been investigated. This study established a venous cell model of AVF using the fluid shear device, combined with a high phosphate medium to mimic the uremic milieu. Osteogenic gene expression of venous SMCs upon mechanical and chemical cues was analyzed in addition to the activated cell signaling pathways. Our findings indicated that upon shear stress and high phosphate environment, mechanical stimulation (shear stress) had an additive effect in up-regulation of an early osteogenic marker, Runx2. We further identified that the integrin β1-ERK1/2 signaling pathway was responsible for the molecular basis of venous SMC osteogenesis upon shear stress exposure. Mitochondrial biogenesis also took part in the early stage of this venopathy pathogenesis, evident by the up-regulated mitochondrial transcription factor A and mitochondrial DNA polymerase γ in venous SMCs. In conclusion, synergistic effects of fluid shear stress and high phosphate induce venous SMC osteogenesis via the ERK1/2 pathway through activating the mechanosensing integrin β1 signaling. The present study identified a promising druggable target for reducing AVF calcification, which deserves further in vivo investigations.
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- 2021
13. AN69 Filter Membranes with High Ultrafiltration Rates during Continuous Venovenous Hemofiltration Reduce Mortality in Patients with Sepsis-Induced Multiorgan Dysfunction Syndrome
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Shuo-Ming Ou, Wei-Cheng Tseng, Ming Tsun Tsai, Kuo-Hua Lee, Der-Cherng Tarng, Chih Yu Yang, and Yao-Ping Lin
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medicine.medical_specialty ,multiple organ failure ,medicine.medical_treatment ,Ultrafiltration ,Urology ,Renal function ,Filtration and Separation ,TP1-1185 ,intensive care unit ,Article ,law.invention ,Sepsis ,Chemical engineering ,law ,Hemofiltration ,medicine ,Chemical Engineering (miscellaneous) ,business.industry ,Chemical technology ,Process Chemistry and Technology ,Multiorgan dysfunction ,blood purification ,medicine.disease ,Intensive care unit ,Membrane ,Continuous venovenous hemofiltration ,critical medicine ,TP155-156 ,business - Abstract
Polyacrylonitrile (AN69) filter membranes adsorb cytokines during continuous venovenous hemofiltration (CVVH). Although high-volume hemofiltration has shown limited benefits, the dose-effect relationship in CVVH with AN69 membranes on severe sepsis remains undetermined. This multi-centered study enrolled 266 patients with sepsis-induced multiorgan dysfunction syndrome (MODS) who underwent CVVH with AN69 membranes between 2014 and 2015. We investigated the effects of ultrafiltration rates (UFR) on mortality. We categorized patients that were treated with UFR of 20–25 mL/kg/h as the standard UFR group (n = 124) and those that were treated with a UFR >, 25 mL/kg/h as the high UFR group (n = 142). Among the patient characteristics, the baseline estimated glomerular filtration rates (eGFR) <, 60 mL/min/1.73 m2, hemoglobin levels <, 10 g/dL, and a sequential organ failure assessment (SOFA) score ≥15 at CVVH initiation were independently associated with in-hospital mortality. In the subgroup analysis, for patients with SOFA scores that were ≥15, the 90-day survival rate was higher in the high UFR group than in the standard UFR group (HR 0.54, CI: 0.36–0.79, p = 0.005). We concluded that in patients with sepsis-induced MODS, SOFA scores ≥15 predicted a poor rate of survival. High UFR setting >, 25 mL/kg/h in CVVH with AN69 membranes may reduce the mortality risk in these high-risk patients.
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- 2021
14. Molecular Mechanisms of Mesenchymal Stem Cell-Based Therapy in Acute Kidney Injury
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Chih Yu Yang, Pei-Wen Lee, Bo-Sheng Wu, and Oscar K. Lee
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QH301-705.5 ,Cell- and Tissue-Based Therapy ,Review ,Bioinformatics ,Kidney ,Mesenchymal Stem Cell Transplantation ,urologic and male genital diseases ,Catalysis ,Inorganic Chemistry ,Cell therapy ,Paracrine signalling ,medicine ,Animals ,Humans ,Regeneration ,Physical and Theoretical Chemistry ,Biology (General) ,Molecular Biology ,QD1-999 ,Spectroscopy ,mesenchymal stem cells ,Mechanism (biology) ,business.industry ,Guided Tissue Regeneration ,urogenital system ,Regeneration (biology) ,Organic Chemistry ,Mesenchymal stem cell ,Acute kidney injury ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,Computer Science Applications ,Clinical trial ,Chemistry ,medicine.anatomical_structure ,acute kidney injury ,business ,extracellular vesicles - Abstract
Acute kidney injury (AKI) causes a lot of harm to human health but is treated by only supportive therapy in most cases. Recent evidence shows that mesenchymal stem cells (MSCs) benefit kidney regeneration through releasing paracrine factors and extracellular vesicles (EVs) to the recipient kidney cells and are considered to be promising cellular therapy for AKI. To develop more efficient, precise therapies for AKI, we review the therapeutic mechanism of MSCs and MSC-derived EVs in AKI and look for a better understanding of molecular signaling and cellular communication between donor MSCs and recipient kidney cells. We also review recent clinical trials of MSC-EVs in AKI. This review summarizes the molecular mechanisms of MSCs’ therapeutic effects on kidney regeneration, expecting to comprehensively facilitate future clinical application for treating AKI.
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- 2021
15. An eighth note
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Meng Rong Tsai, Chiu Yang Lee, Chih Yu Yang, and Der-Cherng Tarng
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Advanced and Specialized Nursing ,medicine.medical_specialty ,Eighth note ,Percutaneous ,Arteriovenous Anastomosis ,business.industry ,medicine.medical_treatment ,Arteriovenous fistula ,General Medicine ,medicine.disease ,Collateral circulation ,Stenosis ,Internal medicine ,medicine ,Cardiology ,Vascular Patency ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Safety Research - Abstract
Venous stenosis is the most common cause of arteriovenous fistula (AVF) failure in hemodialysis patients. For patients with AVF stenosis, the pressure over the antecedent part of the AVF stenotic lesion will increase if arterial inflow is sufficient. We report a chronic hemodialysis patient who received an angiographic examination for the juxta-anastomosis stenosis of his AVF. A unique feature of a collateral venous branch antecedent to the stenotic lesion was noted, resembling a musical sign as the “eighth note.” After percutaneous transluminal angioplasty, the eighth note attenuated markedly at once. Of note, the eighth note sign is not seen frequently, and thus we postulate that the formation of an eighth note sign on the radiocephalic fistula should fulfill the following requirements, including a sufficient arterial inflow, an adjacent collateral branch close enough to the arteriovenous anastomosis, a severe juxta-anastomotic stenotic lesion, and an intact ulnar venous drainage system.
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- 2021
16. Relationship between Circulating Galectin-3, Systemic Inflammation, and Protein-Energy Wasting in Chronic Hemodialysis Patients
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Der-Cherng Tarng, Huan Yuan Chen, Chih Yu Yang, Shuo Ming Ou, Kuo Hua Lee, Ming Tsun Tsai, Ruey Bing Yang, and Wei Cheng Tseng
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Male ,Mean arterial pressure ,medicine.medical_specialty ,medicine.medical_treatment ,Galectins ,Systemic inflammation ,Gastroenterology ,Protein-Energy Malnutrition ,Article ,Insulin resistance ,Renal Dialysis ,Internal medicine ,galectin-3 ,medicine ,otorhinolaryngologic diseases ,Humans ,TX341-641 ,Wasting ,Aged ,Inflammation ,systemic inflammation ,Nutrition and Dietetics ,hemodialysis ,business.industry ,Nutrition. Foods and food supply ,Confounding ,Blood Proteins ,Middle Aged ,medicine.disease ,Malnutrition ,Cross-Sectional Studies ,lean tissue mass ,Biomarker (medicine) ,Kidney Failure, Chronic ,protein-energy wasting ,Female ,Hemodialysis ,medicine.symptom ,business ,Food Science - Abstract
Galectin-3 reportedly participates in the inflammatory process that causes insulin resistance in the target tissues. However, the role of high plasma galectin-3 levels as an indicator of protein-energy wasting (PEW) in patients undergoing maintenance hemodialysis remains unclear. This study included 240 hemodialysis patients (64.5 [55.3−74.0] years, 35.8% women) from a tertiary medical center. A baseline assessment of demographic and clinical data, biochemical parameters, and body composition was conducted. Plasma galectin-3 and other biomarkers were measured using a multiplex bead-based immunoassay. Participants were then divided into two subgroups depending on the median value of plasma galectin-3. Malnutrition was identified using the geriatric nutritional risk index (GNRI) and the criteria of the International Society of Renal Nutrition and Metabolism. Independent risk factors for elevated plasma galectin-3 and malnutrition were identified by multivariate logistic regression. The high galectin-3 group was more likely to be older, have lower lean tissue mass and GNRI scores, be diagnosed with PEW, dialyze through a tunneled catheter, and have higher circulating IL-6, TNF-α, and MCP-1 concentrations than the low galectin-3 group. After multivariate adjustment, only low mean arterial pressure, dialyzing with tunneled cuffed catheters, and elevated systemic inflammatory markers correlated with high galectin-3 levels. Plasma galectin-3 concentrations also increased significantly in hemodialysis patients with PEW. However, compared with other commonly used nutritional indicators, galectin-3 did not show superiority in predicting PEW. Although the plasma galectin-3 levels correlated with PEW severity, this correlation disappeared after adjustment for potential confounding variables (OR, 1.000, 95% CI, 0.999–1.001). In conclusion, plasma galectin-3 is a valuable biomarker for systemic inflammation but is less prominent for PEW in patients with maintenance hemodialysis. Further identification of novel biomarkers is required to detect patients at risk for malnutrition and implement appropriate interventions.
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- 2021
17. Cf‐02, a novel benzamide‐linked small molecule, blunts NF‐κB activation and NLRP3 inflammasome assembly and improves acute onset of accelerated and severe lupus nephritis in mice
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Yu Ling Tsai, Chung Yao Wu, Hsu Shan Huang, Yu-Juei Hsu, Kuo Feng Hua, Chih Yu Yang, Chih Yu Hsieh, Jia Feng Chan, Ann Chen, Chia-Chao Wu, Chia Chung Lee, Feng Cheng Liu, Chih Jun Wan, Debabrata Mukhopadhyay, Shuk-Man Ka, Jui Chun Weng, and Shin Ruen Yang
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T cell ,Interleukin-1beta ,Lupus nephritis ,Priming (immunology) ,Biochemistry ,Article ,Mice ,chemistry.chemical_compound ,NLR Family, Pyrin Domain-Containing 3 Protein ,Autophagy ,Genetics ,medicine ,Animals ,Humans ,Immunologic Factors ,Secretion ,Benzamide ,Molecular Biology ,Cells, Cultured ,Chemistry ,Macrophages ,NF-kappa B ,Inflammasome ,Dendritic Cells ,medicine.disease ,Lupus Nephritis ,Small molecule ,Mice, Inbred C57BL ,Sjogren's Syndrome ,medicine.anatomical_structure ,Case-Control Studies ,Cancer research ,Female ,Biotechnology ,medicine.drug - Abstract
In the present study, acute onset of severe lupus nephritis was successfully treated in mice using a new, benzamide-linked, small molecule that targets immune modulation and the NLRP3 inflammasome. Specifically, 6-(2,4-difluorophenyl)-3-(3-(trifluoromethyl)phenyl)-2H-benzo[e][1,3]oxazine-2,4(3H)-dione (Cf-02) (a) reduced serum levels of IgG anti-dsDNA, IL-1β, IL-6, and TNF-α, (b) inhibited activation of dendritic cells and differentially regulated T cell functions, and (c) suppressed the NF-κB/NLRP3 inflammasome axis, targeting priming and activating signals of the inflammasome. Moreover, treatment with Cf-02 significantly inhibited secretion of IL-1β in lipopolysaccharide-stimulated macrophages, but this effect was abolished by autophagy induction. These results recommend Cf-02 as a promising drug candidate for the serious renal conditions associated with systemic lupus erythematosus. Future investigations should examine whether Cf-02 may also be therapeutic in other types of chronic kidney disease involving NLRP3 inflammasome-driven signaling.
- Published
- 2021
18. Comparison of Simplified Creatinine Index and Systemic Inflammatory Markers for Nutritional Evaluation of Hemodialysis Patients
- Author
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Der Cherng Tarng, Chih Yu Yang, Ming Tsun Tsai, Shuo Ming Ou, Wei Cheng Tseng, and Kuo Hua Lee
- Subjects
Male ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,030232 urology & nephrology ,Taiwan ,Clinical nutrition ,030204 cardiovascular system & hematology ,Protein-Energy Malnutrition ,Risk Assessment ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Renal Dialysis ,Risk Factors ,Internal medicine ,medicine ,simplified creatinine index ,Humans ,Mass index ,nutritional screening ,TX341-641 ,Wasting ,Inflammation ,systemic inflammation ,Creatinine ,Nutrition and Dietetics ,hemodialysis ,business.industry ,Nutrition. Foods and food supply ,Confounding ,Middle Aged ,Cross-Sectional Studies ,chemistry ,Lean body mass ,protein-energy wasting ,Female ,Hemodialysis ,medicine.symptom ,business ,Biomarkers ,Food Science - Abstract
Protein-energy wasting (PEW) is associated with adverse outcomes in hemodialysis patients. This study compares the simplified creatinine index (SCI) and circulating inflammatory markers as nutritional screening tools for hemodialysis patients. Maintenance hemodialysis patients (230 total patients, 34.8% women, 64.0 ± 14.3 years old) from a tertiary medical center were assessed for demographic data, body composition analysis, biochemistry tests, and circulating inflammatory biomarkers. The SCI was calculated using Canaud’s formula. Reduced fat-free mass index (FFMI), a surrogate of lean body mass, was identified according to the European Society for Clinical Nutrition and Metabolism guidelines. Nutritional status was assessed by the geriatric nutritional risk index (GNRI) and International Society of Renal Nutrition and Metabolism (ISRNM) criteria. Multivariate logistic regression revealed independent risk factors for low FFMI and malnutrition. Of the patients, 47.4% had low FFMI. Patients with a reduction in FFMI tended to be older females with lower body mass index, SCI, and GNRI scores but significantly higher levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and IL-8. SCI was found to be an independent predictor for reduced FFMI (OR 0.57, 95% CI 0.40–0.81) and presence of PEW according to ISRNM criteria (OR 0.38, 95% CI 0.21–0.68). Although a positive association between systemic inflammatory markers and low FFMI was observed, this association disappeared in multivariate analysis. Moreover, the inflammatory markers examined in this study were not associated with malnutrition after adjusting for potential confounders. Compared with markers of systemic inflammation, SCI achieved better performance in assessing the nutritional status of hemodialysis patients.
- Published
- 2021
19. Diet, gut microbiome and indoxyl sulphate in chronic kidney disease patients
- Author
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Chih Yu Yang and Der Cherng Tarng
- Subjects
education.field_of_study ,business.industry ,Prebiotic ,medicine.medical_treatment ,Population ,030232 urology & nephrology ,Renal function ,Physiology ,Inflammation ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,law.invention ,03 medical and health sciences ,Probiotic ,0302 clinical medicine ,Nephrology ,law ,medicine ,medicine.symptom ,business ,education ,Dysbiosis ,Pathological ,Kidney disease - Abstract
Emerging evidence suggests that intestinal dysbiosis plays an important role in host inflammation locally and systemically. Such pathological condition is even more prevailing in patients with chronic kidney disease (CKD). Of note, indoxyl sulphate (IS), a gut-derived uremic toxin, is notorious for its pro-inflammatory feature in CKD patients. IS accumulates in the body as the urinary excretion of uremic toxins is impaired, and further worsens the kidney function in a vicious cycle to CKD. Dietary restriction in vegetables, fruits and yogurt leads to the predominance of indole-producing intestinal microbial flora and further exaggerates the accumulation of IS in CKD patients. Recently, interventional studies have shown that circulating IS can be reduced by dietary prebiotic and/or probiotic supplements. However, further randomized controlled trials are warranted to examine whether such beneficial effect of dietary prebiotic/probiotic supplements could be extrapolated to better hard outcomes in CKD population. In this review, we would also like to emphasize the importance of achieving sufficient intake of dietary fibre by proper vegetable pre-treatment and accurate fruit selection, instead of directly avoiding these potassium-rich yet fibre-rich and base-producing foods.
- Published
- 2018
20. Adipose-derived mesenchymal stem cells attenuate dialysis-induced peritoneal fibrosis by modulating macrophage polarization via interleukin-6
- Author
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Chih Yu Yang, Oscar K. Lee, Jun Yi Chen, Bo Sheng Wu, An Hang Yang, and Pu Yuan Chang
- Subjects
Macrophage ,Peritoneal dialysis ,Macrophage polarization ,Medicine (miscellaneous) ,Adipose tissue ,Biochemistry, Genetics and Molecular Biology (miscellaneous) ,lcsh:Biochemistry ,Renal Dialysis ,medicine ,Animals ,lcsh:QD415-436 ,Peritoneal Fibrosis ,Adipose-derived mesenchymal stem cell ,lcsh:R5-920 ,Peritoneal fibrosis ,Interleukin-6 ,Chemistry ,Macrophages ,Research ,Mesenchymal stem cell ,Mesenchymal Stem Cells ,Cell Biology ,M2 Macrophage ,Epithelium ,Rats ,medicine.anatomical_structure ,Cancer research ,Molecular Medicine ,Stem cell ,lcsh:Medicine (General) - Abstract
Background Life-long peritoneal dialysis (PD) as a renal replacement therapy is limited by peritoneal fibrosis. Previous studies showed immunomodulatory and antifibrotic effects of adipose-derived mesenchymal stem cells (ADSCs) on peritoneal fibrosis. However, the role of the peritoneal macrophage in this process remains uninvestigated. Methods We examined the therapeutic effects of ADSC and bone marrow-derived mesenchymal stem cells (BM-MSC) in the rat model of dialysis-induced peritoneal fibrosis using methylglyoxal. In addition, treatment of macrophages with the conditioned medium of ADSC and BM-MSC was performed individually to identify the beneficial component of the stem cell secretome. Results In the in vivo experiments, we found dialysis-induced rat peritoneal fibrosis was attenuated by both ADSC and BM-MSC. Interestingly, ADSC possessed a more prominent therapeutic effect than BM-MSC in ameliorating peritoneal membrane thickening while also upregulating epithelial cell markers in rat peritoneal tissues. The therapeutic effects of ADSC were positively associated with M2 macrophage polarization. In the in vitro experiments, we confirmed that interleukin-6 (IL-6) secreted by MSCs upon transforming growth factor-β1 stimulation promotes M2 macrophage polarization. Conclusions In dialysis-induced peritoneal fibrosis, MSCs are situated in an inflammatory environment of TGF-β1 and secrete IL-6 to polarize macrophages into the M2 phenotype. Our findings reveal a previously unidentified role of tissue macrophage in this antifibrotic process. ADSC has the advantage of abundance and accessibility, making the application values extremely promising. Graphical abstract In dialysis-induced peritoneal fibrosis, peritoneal mesothelial cells secrete transforming growth factor-β1 (TGF-β1) when exposed to methylglyoxal (MGO)-containing peritoneal dialysate. When situated in TGF-β1, the inflammatory environment induces mesenchymal stem cells to secrete interleukin-6 (IL-6), IL-6 polarizes macrophages into the M2 phenotype. The dominant peritoneal tissue M2 macrophages, marked by upregulated Arg-1 expression, account for the attenuation of MGO-induced dedifferentiation of peritoneal mesothelial cells to maintain epithelial integrity.
- Published
- 2021
21. BK Polyomavirus Nephropathy in Kidney Transplantation: Balancing Rejection and Infection
- Author
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Tse Jen Lien, Chia Lin Shen, Chih Yu Yang, Bo Sheng Wu, and An Hang Yang
- Subjects
Graft Rejection ,kidney transplant ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:QR1-502 ,030232 urology & nephrology ,BK polyomavirus nephropathy ,Review ,030230 surgery ,acute rejection ,lcsh:Microbiology ,Cell therapy ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,immunosuppressants ,Virology ,medicine ,Humans ,Intensive care medicine ,tacrolimus ,Pathological ,Kidney transplantation ,Immunosuppression Therapy ,Polyomavirus Infections ,business.industry ,Immunosuppression ,medicine.disease ,Kidney Transplantation ,Tacrolimus ,Transplant Recipients ,Tumor Virus Infections ,Infectious Diseases ,BK Virus ,Kidney Diseases ,Differential diagnosis ,business ,Complication - Abstract
BK polyomavirus nephropathy (BKVN) and allograft rejection are two closely-associated diseases on opposite ends of the immune scale in kidney transplant recipients. The principle of balancing the immune system remains the mainstay of therapeutic strategy. While patient outcomes can be improved through screening, risk factors identification, and rapid reduction of immunosuppressants, a lack of standard curative therapy is the primary concern during clinical practice. Additionally, difficulty in pathological differential diagnosis and clinicopathology’s dissociation pose problems for a definite diagnosis. This article discusses the delicate evaluation needed to optimize immunosuppression and reviews recent advances in molecular diagnosis and immunological therapy for BKVN patients. New biomarkers for BKVN diagnosis are under development. For example, measurement of virus-specific T cell level may play a role in steering immunosuppressants. The development of cellular therapy may provide prevention, even a cure, for BKVN, a complex post-transplant complication.
- Published
- 2021
22. Evaluating the energy, health efficiency, and productivity in OECD
- Author
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Yung-Ho Chiu, Chih Yu Yang, Tai Yu Lin, and Ching Cheng Lu
- Subjects
medicine.medical_specialty ,Slovakia ,Environmental Engineering ,010504 meteorology & atmospheric sciences ,Energy (esotericism) ,Efficiency ,010501 environmental sciences ,01 natural sciences ,Agricultural economics ,Geochemistry and Petrology ,Order (exchange) ,medicine ,Economics ,Environmental Chemistry ,Forest protection ,Productivity ,Organisation for Economic Co-Operation and Development ,Finland ,0105 earth and related environmental sciences ,General Environmental Science ,Water Science and Technology ,Research method ,Portugal ,Public health ,General Medicine ,Value (economics) ,Efficient energy use - Abstract
In the past, energy and environmental research focused on the performance of individual efficiencies. In order to make up for the research deficiencies, this research uses SBM (slack-based measures) dynamic network DEA (DN-SBM) to assess energy, health efficiency, and DN-TFP productivity changes from 2011 to 2015. This research uses forest area as the carryover that can objectively measure the performance of OECD energy, health, and total efficiency, and calls for the importance of forest protection and planting. The empirical results show that Estonia, Finland, Hungary, Iceland, Mexico, New Zealand, Portugal, Slovenia, Sweden, and Turkey have the best overall efficiency performance, while Ireland (0.4469), Israel (0.4179), and the Netherlands (0.3697) are the three worst. In total, 29 economies show progress in terms of productivity. Moreover, Chile (0.9706), Mexico (0.9995), Slovak Republic (0.9942), Turkey (0.9815), and the UK (0.9886) exhibit a slight decline. The overall efficiency value of 20 countries is greater than the average, and their productivity is showing an upward trend. Only the UK (0.5081, 0.9886) has an overall efficiency value that is less than the overall average with productivity that is showing a drop. About research method, this study utilizes dynamic intertemporal data to evaluate the changes in the overall efficiency and productivity of OECD members with DN-SBM and DN-TFP indices in order to offer more objective research results for various economies that are useful for formulating policies related to energy, national health, and forest conservation.
- Published
- 2021
23. Synbiotics Alleviate the Gut Indole Load and Dysbiosis in Chronic Kidney Disease
- Author
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Chih Yu Yang, Ching Ping Tseng, Shih Shin Liang, Hsien Da Huang, Der Cherng Tarng, Wan Lun Lu, and Ting-Wen Chen
- Subjects
0301 basic medicine ,Male ,Indoles ,Time Factors ,Synbiotics ,gut indole ,030232 urology & nephrology ,Gut flora ,Kidney ,Gastroenterology ,Feces ,0302 clinical medicine ,Prevotella ,lcsh:QH301-705.5 ,biology ,General Medicine ,Biodiversity ,dysbiosis ,Middle Aged ,Female ,Roseburia ,medicine.medical_specialty ,Article ,03 medical and health sciences ,Internal medicine ,medicine ,Animals ,Humans ,Renal Insufficiency, Chronic ,synbiotics ,Aged ,Bacteria ,business.industry ,Adenine ,Body Weight ,medicine.disease ,biology.organism_classification ,Diet ,Gastrointestinal Microbiome ,Rats ,Gastrointestinal Tract ,Disease Models, Animal ,030104 developmental biology ,lcsh:Biology (General) ,Bacteroides ,business ,Dysbiosis ,Indican ,chronic kidney disease ,Kidney disease - Abstract
Chronic kidney disease (CKD) has long been known to cause significant digestive tract pathology. Of note, indoxyl sulfate is a gut microbe-derived uremic toxin that accumulates in CKD patients. Nevertheless, the relationship between gut microbiota, fecal indole content, and blood indoxyl sulfate level remains unknown. In our study, we established an adenine-induced CKD rat model, which recapitulates human CKD-related gut dysbiosis. Synbiotic treatment in CKD rats showed a significant reduction in both the indole-producing bacterium Clostridium and fecal indole amount. Furthermore, gut microbiota diversity was reduced in CKD rats but was restored after synbiotic treatment. Intriguingly, in our end-stage kidney disease (ESKD) patients, the abundance of indole-producing bacteria, Bacteroides, Prevotella, and Clostridium, is similar to that of healthy controls. Consistently, the fecal indole tends to be higher in the ESKD patients, but the difference did not achieve statistical significance. However, the blood level of indoxyl sulfate was significantly higher than that of healthy controls, implicating that under an equivalent indole production rate, the impaired renal excretion contributes to the accumulation of this notorious uremic toxin. On the other hand, we did identify two short-chain fatty acid-producing bacteria, Faecalibacterium and Roseburia, were reduced in ESKD patients as compared to the healthy controls. This may contribute to gut dysbiosis. We also identified that three genera Fusobacterium, Shewanella, and Erwinia, in the ESKD patients but not in the healthy controls. Building up gut symbiosis to treat CKD is a novel concept, but once proved effective, it will provide an additional treatment strategy for CKD patients.
- Published
- 2021
24. Lentiform fork sign in a uremic patient after inadvertent exposure to metformin
- Author
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Chih Yu Yang, Yen-An Chang, and Der-Cherng Tarng
- Subjects
medicine.medical_specialty ,Lentiform nucleus ,medicine.medical_treatment ,Encephalopathy ,Unsteady gait ,Toxicology ,Dysarthria ,Renal Dialysis ,Internal medicine ,Humans ,Medicine ,Brain Diseases ,business.industry ,Metabolic acidosis ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Metformin ,Cardiology ,Kidney Failure, Chronic ,Female ,Hemodialysis ,medicine.symptom ,business ,Choking ,medicine.drug - Abstract
This case report describes a 56-year-old woman receiving regular hemodialysis for three years who presented with an unsteady gait for one month, dysarthria, and frequent choking on liquids for two weeks. Brain MRI revealed a characteristic "lentiform fork sign" with hyperintense T2W/FLAIR signal in the bilateral lentiform nuclei and restricted diffusion in bilateral globus pallidus. She was inadvertently prescribed metformin 1,000 mg per day one month ago by a physician who was unaware of her end-stage kidney disease. After intensive hemodialysis therapy with eight hemodialysis sessions within 12 days, her neurological deficits fully resolved. Clinicians should be aware of metformin-induced encephalopathy, presenting with relevant medication history, neurological symptoms, and the lentiform fork sign.
- Published
- 2021
25. IgM Mesangial Deposition Predicts Relapses of Adult-Onset Minimal Change Disease
- Author
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An-Hang Yang, Der-Cherng Tarng, Fu-Pang Chang, Fan-Yu Chen, Yang Ho, Chih Yu Yang, and Cheng-Wen Yang
- Subjects
Pathology ,medicine.medical_specialty ,Chemistry ,medicine ,Minimal change disease ,medicine.disease ,Deposition (chemistry) - Abstract
Background: Immunoglobulin M (IgM) mesangial deposition in pediatric minimal change disease (MCD) has been reported to be associated with steroid dependence and poor renal outcomes. However, the evidence regarding the impact of IgM mesangial deposition on the treatment responses or outcomes in adult-onset MCD is lacking.Methods: In this retrospective cohort study, 37 adult patients with MCD received kidney biopsy from January 2010 to May 2020. According to IgM mesangial deposition by immunofluorescence microscopy, the patients were divided into two groups (12 patients with positive IgM deposition; 25 patients with negative IgM deposition). We analyzed the clinical features, the dosage of immunosuppressive agents, and the response to treatment for two years between the two groups.Results: Regarding the clinical symptoms, the dosage of immunosuppressive treatment, and the time to remission, there was no statistically significant difference between the two groups. Compared to the negative IgM group, the frequency of relapses was significantly higher in the positive IgM group within the two-year follow-up period (the negative IgM group 0.25 episodes/year; the positive IgM group 0.75 episodes/year, p = 0.029). Furthermore, multivariate linear regression revealed that the positivity of IgM mesangial deposition is independently associated with the frequency of relapses (regression coefficient B 0.450, 95% CI 0.116-0.784, p = 0.010).Conclusions: Our findings indicated that adult-onset MCD patients with IgM mesangial deposition have a high risk of relapses. Therefore, prolonged and combined immunosuppressive therapy with close follow-up may be considered in MCD adults with IgM mesangial deposition.
- Published
- 2020
26. Correction to: A Nautilus kidney
- Author
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Bo Sheng Wu, Chih Yu Yang, and Yang Ho
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Heading (navigation) ,biology ,Coronavirus disease 2019 (COVID-19) ,Physiology ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Case presentation ,biology.organism_classification ,medicine.disease ,Computed tomographic ,Nephrology ,Physiology (medical) ,Internal medicine ,Medicine ,Nautilus ,business ,Nuclear medicine ,Hydronephrosis - Abstract
In the original publication of the article, the second sentence under the heading, Case presentation appears incorrectly as A computed tomographic (CT) scan demonstrated left-sided hydronephrosis (Fig. 1).
- Published
- 2020
27. Aggregation Temperature of Escherichia coli Depends on Steepness of the Thermal Gradient
- Author
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Jerome Wong-Ng, Alex Groisman, Michael Erickstad, Chih-yu Yang, Edgar Gutierrez, Loïc Tadrist, Edward Ronan, University of California [San Diego] (UC San Diego), University of California, and The work was funded by the National Science Foundation PHY-1411313 Award.
- Subjects
[PHYS.PHYS.PHYS-BIO-PH]Physics [physics]/Physics [physics]/Biological Physics [physics.bio-ph] ,Biophysics ,medicine.disease_cause ,Thermophoresis ,03 medical and health sciences ,0302 clinical medicine ,Lab-On-A-Chip Devices ,medicine ,Escherichia coli ,Intermediate temperature ,Thermotaxis ,Taxis Response ,[SPI.NANO]Engineering Sciences [physics]/Micro and nanotechnologies/Microelectronics ,030304 developmental biology ,0303 health sciences ,Chemotaxis ,Temperature ,Articles ,Biological Sciences ,[SDV.BIBS]Life Sciences [q-bio]/Quantitative Methods [q-bio.QM] ,Temperature gradient ,Physical Sciences ,Chemical Sciences ,030217 neurology & neurosurgery - Abstract
International audience; Bacterial chemotaxis, the directed migration of bacteria in a gradient of chemoattractant, is one of the most well-studied and well-understood processes in cell biology. On the other hand, bacterial thermotaxis, the directed migration of bacteria in a gradient of temperature, is understood relatively poorly, with somewhat conflicting reports by different groups. One of the reasons for that is the relative technical difficulty of the generation of well-defined gradients of temperature that are sufficiently steep to elicit readily detectable thermotaxis. Here, we used a specially designed microfluidic device to study thermotaxis of Escherichia coli in a broad range of thermal gradients with a high rate of data collection. We found that in shallow temperature gradients with narrow temperature ranges, E. coli tended to aggregate near a sidewall of the gradient channel at either the lowest or the highest temperature. On the other hand, in sufficiently steep gradients with wide temperature ranges, E. coli aggregated at intermediate temperatures, with maximal cell concentrations found away from the sidewalls. We observed this intermediate temperature aggregation in a motility buffer that did not contain any major chemoattractants of E. coli, in contradiction to some previous reports, which suggested that this type of aggregation required the presence of at least one major chemoattractant in the medium. Even more surprisingly, the aggregation temperature strongly depended on the gradient steepness, decreasing by ∼10° as the steepness was increased from 27 to 53°C/mm. Our experiments also highlight the fact that assessments of thermal gradients by changes in fluorescence of temperature-sensitive fluorescent dyes need to account for thermophoresis of the dyes.
- Published
- 2020
28. Bronchoalveolar lavage fluid analysis and mortality risk in systemic lupus erythematosus patients with pneumonia and respiratory failure
- Author
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Chien Chih Lai, Yi Syuan Sun, Fang Chi Lin, Chang-Youh Tsai, and Chih Yu Yang
- Subjects
0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030106 microbiology ,Bacteremia ,Kaplan-Meier Estimate ,Respiratory failure ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Systemic lupus erythematosus ,Risk Factors ,Internal medicine ,medicine ,Odds Ratio ,Immunology and Allergy ,Humans ,Lupus Erythematosus, Systemic ,030212 general & internal medicine ,Mechanical ventilation ,General Immunology and Microbiology ,medicine.diagnostic_test ,Septic shock ,business.industry ,General Medicine ,Odds ratio ,Pneumonia ,Middle Aged ,medicine.disease ,Thrombocytopenia ,Confidence interval ,Bronchoalveolar lavage fluid analysis ,QR1-502 ,Infectious Diseases ,Bronchoalveolar lavage ,Female ,business ,Respiratory Insufficiency ,Bronchoalveolar Lavage Fluid - Abstract
Background Our aim was to characterize etiologic diagnoses obtained from bronchoalveolar lavage fluid (BALF) and blood specimens, and to identify risk factors for mortality in systemic lupus erythematosus (SLE) patients with pneumonia and respiratory failure. Methods We conducted a retrospective analysis of SLE patients with pneumonia and respiratory failure. Clinical characteristics, laboratory profiles, and microbiology in BALF and blood samples were evaluated. We performed univariable analyses to identify mortality risk factors. Results All 24 patients (F:M = 21:3, median age 46.5 years; disease duration 11 years) received mechanical ventilation (median duration: 11 days). Pathogens identified in BALF included Pneumocystis jiroveci (12 patients [50%]), cytomegalovirus (CMV, 7 patients [29.2%]), and bacteria (11 patients [45.8%]). Thirteen patients (54.2%) yielded pathogens in blood (CMV in 8 patients [33.3%] and Escherichia coli in 5 patients [20.8%]). Eight developed septic shock, and 9 died within 30 days. Univariable analysis identified thrombocytopenia (odds ratio [OR]: 8.0, 95% confidence interval [CI]: 1.23–52.25), bacteremia within 30 days before or after endotracheal intubation (OR: 8.0, 95% CI: 1.23–52.5), and P. jiroveci pneumonia (PJP, OR: 7.0, 95% CI: 1.04–46.95) as risk factors for 30-day mortality. Kaplan–Meier analysis confirmed an increased risk of 30-day mortality with thrombocytopenia and bacteremia. Conclusion There are high prevalence rates of PJP and CMV infections as evidenced by BALF analyses in SLE patients with pneumonia and respiratory failure. BALF analysis can facilitate rescue therapy per pathogen. Thrombocytopenia, bacteremia, and PJP in SLE patients can increase their 30-day mortality, so warrant early and aggressive treatments.
- Published
- 2020
29. Timing of kidney biopsy in type 2 diabetic patients: a stepwise approach
- Author
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An Hang Yang, Der Cherng Tarng, Jyh Tong Hsieh, Chih Yu Yang, and Fu Pang Chang
- Subjects
Nephrology ,Male ,medicine.medical_specialty ,Biopsy ,Clinical Decision-Making ,030232 urology & nephrology ,Kidney biopsy ,Taiwan ,Renal function ,030209 endocrinology & metabolism ,Type 2 diabetes ,Diabetic nephropathy ,lcsh:RC870-923 ,Kidney ,Kidney Function Tests ,Time-to-Treatment ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Diabetic Nephropathies ,Hematuria ,Retrospective Studies ,Proteinuria ,Diabetic Retinopathy ,medicine.diagnostic_test ,business.industry ,Odds ratio ,Diabetic retinopathy ,Middle Aged ,lcsh:Diseases of the genitourinary system. Urology ,medicine.disease ,Diabetes Mellitus, Type 2 ,Non-diabetic renal disease ,Disease Progression ,Female ,medicine.symptom ,business ,Research Article - Abstract
Background Diabetic nephropathy (DN) is the most prevalent cause of renal disease in type 2 diabetic patients and is usually diagnosed clinically. A kidney biopsy is considered when non-diabetic renal disease (NDRD) is suspected, such as rapid progression in renal function impairment and severe proteinuria. Still, there is yet no consensus on the timing of kidney biopsy in type 2 diabetic patients. This study aims to identify markers that can help differentiate between DN and NDRD and guide the decision of kidney biopsy. Methods We retrospectively reviewed patients with type 2 diabetes who received kidney biopsy from 2008 to 2017 at Taipei Veterans General Hospital. Ophthalmologist consultation and outpatient records, diagnosis of kidney biopsy, laboratory data, and clinical characteristics were collected. Results This study enrolled 160 type 2 diabetic patients, among which 120 (75%) had isolated DN and 40 (25%) had NDRD ± DN (26 had isolated NDRD, and 14 had NDRD superimposed on DN). In multivariate logistic regression analysis, DM duration (odds ratio [OR]: 0.907; 95% confidence interval [CI]: 0.842–0.977; P = 0.01), diabetic retinopathy (OR: 0.196; 95% CI: 0.061–0.627; P = 0.006), and urinary RBC (OR: 1.068; 95% CI: 1.024–1.115; P = 0.002) were independent predictors of NDRD. In patients with diabetic retinopathy (n = 112, 70%), the presence of proliferative diabetic retinopathy, pan-retinal photocoagulation, and hematuria were factors predicting NDRD; and in patients without diabetic retinopathy (n = 48, 30%), short DM duration and hematuria were factors predicting NDRD. Conclusions Using diabetic retinopathy, DM duration, and hematuria, we developed a 3-step approach to stratify patients into three categories with the different likelihoods of having NDRD. Then different strategies could be taken accordingly. Our stepwise approach is easy to follow and may serve as an appropriate and useful tool to help clinicians in making decisions of kidney biopsy in type 2 DM patients presenting with kidney diseases.
- Published
- 2020
30. Quality Evaluation via PPG on the AVFs of Hemodialysis Patients Based on Both Blood Flow Volume and Degree of Stenosis
- Author
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Chih Yu Yang, Tse-Yi Tu, Pei-Yu Chiang, Paul C.-P. Chao, Chin-Long Wey, Yung-Hua Kao, Der-Cherng Tarng, and Duc Huy Nguyen
- Subjects
Blood flow volume ,Computer science ,medicine.medical_treatment ,020208 electrical & electronic engineering ,010401 analytical chemistry ,Arteriovenous fistula ,Hemodynamics ,02 engineering and technology ,medicine.disease ,01 natural sciences ,0104 chemical sciences ,Stenosis ,Photoplethysmogram ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Hemodialysis ,Biomedical engineering - Abstract
The classifier of support vector machine (SVM) learning for assessing quality of arteriovenous fistula (AVF) at hemodialysis (HD) patients using a new photoplethysmography (PPG) sensor are presented in this work. Based on current medical standard, there are two important indices for assessing AVF quality, the blood flow volume (BFV) and the degree of stenosis (DOS). In current clinical practice, BFV and DOS of AVFs are assessed by using an ultrasound Doppler machine, which is bulky, expensive, hard-to-use and time-consuming. Therefore, a new PPG sensor module is designed to provide patients and doctors an inexpensive and small-sized solution to assess AVF quality. The readout of the sensor is successfully optimized to increase the signal to noise ratio (SNR) and reduce the environment interference, the readout circuitries are designed to fit the full dynamic range of analog-digital converter (ADC) and to filter out the noise. To assess quality of AVF, three different machine learning classifiers are developed, where the input features are selected based on optical Beer Lambert’s law and hemodynamic model. Finally, the clinical experiment results show that the proposed PPG sensor successfully achieves an accuracy of 87.838% in assessing AVF quality based on satisfactory DOS and BFV measured.
- Published
- 2019
31. Theoretical developments and clinical experiments of measuring blood flow volume (BFV) at arteriovenous fistula (AVF) using a photoplethysmography (PPG) sensor
- Author
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Der-Cherng Tarng, Pei-Yu Chiang, Chih-Yu Yang, and Paul C.-P. Chao
- Subjects
Artifact (error) ,Blood flow volume ,Computer science ,010401 analytical chemistry ,0206 medical engineering ,Arteriovenous fistula ,02 engineering and technology ,Condensed Matter Physics ,medicine.disease ,020601 biomedical engineering ,01 natural sciences ,0104 chemical sciences ,Electronic, Optical and Magnetic Materials ,symbols.namesake ,Mathematical equations ,Hardware and Architecture ,Photoplethysmogram ,Calibration ,medicine ,symbols ,Electrical and Electronic Engineering ,Doppler effect ,Biomedical engineering - Abstract
A new theoretical developments of measuring blood flow volume at arteriovenous fistula (AVF) using a photoplethysmography (PPG) sensor is presented in this work. The mathematical equation is derived under the practical perspective, aiming at applying to small-size, portable, inexpensive and easy-to-use PPG sensor, in order to replace bulky, expensive Doppler machines which is the commonly used instruments for accessing AVF noninvasively nowadays. Furthermore, a new, portable and wireless PPG sensor with ambient light compensation and motion artifact detection, is designed for performing clinical validation of the proposed equation. After neural network calibration with the gold standard, dilution concentration sensor, the experiment result reveals that the PPG sensors implementing the proposed equation successfully achieve much higher correlation (R2 = 0.8064) and much lower error (RMSE = 171.68 ml/min, MAPE = 15.84%) compared to the commercial Doppler machine and other previous works.
- Published
- 2018
32. A Novel Wireless Photoplethysmography Blood-Flow Volume Sensor for Assessing Arteriovenous Fistula of Hemodialysis Patients
- Author
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Chih Yu Yang, Der-Cherng Tarng, Paul C.-P. Chao, and Pei-Yu Chiang
- Subjects
Signal processing ,Blood flow volume ,business.industry ,medicine.medical_treatment ,0206 medical engineering ,Arteriovenous fistula ,02 engineering and technology ,Blood flow ,021001 nanoscience & nanotechnology ,medicine.disease ,020601 biomedical engineering ,symbols.namesake ,Control and Systems Engineering ,Photoplethysmogram ,symbols ,Wireless ,Medicine ,Hemodialysis ,Electrical and Electronic Engineering ,0210 nano-technology ,business ,Doppler effect ,Biomedical engineering - Abstract
A novel blood-flow volume (BFV) sensor is presented for assessing quality of arteriovenous fistula in hemodialysis patients via noninvasive reflectance-type photoplethysmography (PPG). BFV is nowadays in clinic practices evaluated using an ultrasound Doppler monitor, which is expensive, bulky, and can only be operated by well-trained medical personnels. This study is devoted to develop a low-cost, small-sized, portable, and easy-to-use PPG sensor that is capable of continuous measurement of BFV. New designs of front-end analog circuits, signal processing, and an intelligent neural network calibration method are employed to finally achieve high correlation ( R 2 = 0.7176), as opposed to the ultrasound Doppler monitor, with the root-mean-squared errors successfully controlled under 289 ml/min.
- Published
- 2017
33. Machine Learning Analysis of Time-Dependent Features for Predicting Adverse Events During Hemodialysis Therapy: Model Development and Validation Study
- Author
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Chia Chu Chang, Yi Shiuan Liu, Ping Fang Chiu, Chih Yu Yang, Oscar Kuang Sheng Lee, Alan Szu Han Lai, Chung-Chuan Lo, and Hui Chu Lin
- Subjects
Validation study ,medicine.medical_treatment ,Health Informatics ,Machine learning ,computer.software_genre ,Tertiary care ,Machine Learning ,Renal Dialysis ,intradialytic adverse events ,medicine ,Humans ,Model development ,Adverse effect ,Dialysis ,prediction algorithm ,Original Paper ,hemodialysis ,business.industry ,Area under the curve ,Hemodialysis ,Artificial intelligence ,Hypotension ,medicine.symptom ,business ,computer ,Algorithms ,Muscle cramp - Abstract
Background Hemodialysis (HD) therapy is an indispensable tool used in critical care management. Patients undergoing HD are at risk for intradialytic adverse events, ranging from muscle cramps to cardiac arrest. So far, there is no effective HD device–integrated algorithm to assist medical staff in response to these adverse events a step earlier during HD. Objective We aimed to develop machine learning algorithms to predict intradialytic adverse events in an unbiased manner. Methods Three-month dialysis and physiological time-series data were collected from all patients who underwent maintenance HD therapy at a tertiary care referral center. Dialysis data were collected automatically by HD devices, and physiological data were recorded by medical staff. Intradialytic adverse events were documented by medical staff according to patient complaints. Features extracted from the time series data sets by linear and differential analyses were used for machine learning to predict adverse events during HD. Results Time series dialysis data were collected during the 4-hour HD session in 108 patients who underwent maintenance HD therapy. There were a total of 4221 HD sessions, 406 of which involved at least one intradialytic adverse event. Models were built by classification algorithms and evaluated by four-fold cross-validation. The developed algorithm predicted overall intradialytic adverse events, with an area under the curve (AUC) of 0.83, sensitivity of 0.53, and specificity of 0.96. The algorithm also predicted muscle cramps, with an AUC of 0.85, and blood pressure elevation, with an AUC of 0.93. In addition, the model built based on ultrafiltration-unrelated features predicted all types of adverse events, with an AUC of 0.81, indicating that ultrafiltration-unrelated factors also contribute to the onset of adverse events. Conclusions Our results demonstrated that algorithms combining linear and differential analyses with two-class classification machine learning can predict intradialytic adverse events in quasi-real time with high AUCs. Such a methodology implemented with local cloud computation and real-time optimization by personalized HD data could warn clinicians to take timely actions in advance.
- Published
- 2021
34. Targeting cannabinoid signaling for peritoneal dialysis-induced oxidative stress and fibrosis
- Author
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An-Hang Yang, Yat-Pang Chau, Der-Cherng Tarng, Ann Chen, Chih Yu Yang, and Oscar K. Lee
- Subjects
0301 basic medicine ,Cannabinoid receptor ,medicine.medical_treatment ,Peritoneal dialysis ,Inflammation ,Review ,Pharmacology ,medicine.disease_cause ,03 medical and health sciences ,Fibrosis ,medicine ,Cannabinoid receptor type 2 ,Peritoneal Fibrosis ,Peritoneal fibrosis ,business.industry ,medicine.disease ,030104 developmental biology ,Oxidative stress ,Immunology ,Cannabinoid signaling ,Cannabinoid ,medicine.symptom ,business ,Reactive oxygen species - Abstract
Long-term exposure to bioincompatible peritoneal dialysis (PD) solutions frequently results in peritoneal fibrosis and ultrafiltration failure, which limits the life-long use of and leads to the cessation of PD therapy. Therefore, it is important to elucidate the pathogenesis of peritoneal fibrosis in order to design therapeutic strategies to prevent its occurrence. Peritoneal fibrosis is associated with a chronic inflammatory status as well as an elevated oxidative stress (OS) status. Beyond uremia per se, OS also results from chronic exposure to high glucose load, glucose degradation products, advanced glycation end products, and hypertonic stress. Therapy targeting the cannabinoid (CB) signaling pathway has been reported in several chronic inflammatory diseases with elevated OS. We recently reported that the intra-peritoneal administration of CB receptor ligands, including CB1 receptor antagonists and CB2 receptor agonists, ameliorated dialysis-related peritoneal fibrosis. As targeting the CB signaling pathway has been reported to be beneficial in attenuating the processes of several chronic inflammatory diseases, we reviewed the interaction among the cannabinoid system, inflammation, and OS, through which clinicians ultimately aim to prolong the peritoneal survival of PD patients.
- Published
- 2017
35. Prophylactic antibiotics for tubeless percutaneous nephrolithotomy
- Author
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Pi-Che Chen, Ming-Chin Cheng, Cheng-Huang Shen, Chang-Le Lin, Chih-Yu Yang, and Yeong-Chin Jou
- Subjects
Prophylactic antibiotic ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Urinary system ,Antibiotics ,030232 urology & nephrology ,lcsh:Surgery ,tubeless ,03 medical and health sciences ,Postoperative fever ,0302 clinical medicine ,Chart review ,medicine ,percutaneous nephrolithotomy ,Antibiotic prophylaxis ,Percutaneous nephrolithotomy ,business.industry ,Antibiotic ,lcsh:RD1-811 ,medicine.disease ,Surgery ,030220 oncology & carcinogenesis ,Anesthesia ,business ,Hospital stay - Abstract
Objective: The objective of this study was to investigate the efficacy of second-line versus first-line antibiotics in the prevention of postoperative fever after tubeless percutaneous nephrolithotomy (PCNL). Methods: Three hundred consecutive tubeless PCNL procedures performed at our hospital between August 2010 and December 2013 were enrolled in this study. The efficacy of second-line antibiotics in the prevention PCNL-related urinary traction was reviewed by retrospective chart review. Results: The overall postoperative fever rate was 12% (36 of 300 procedures). The second-line antibiotic prophylaxis was provided in 32 procedures according to preoperative urine culture data or physician's judgment. The first-line prophylactic antibiotic was used in 268 procedures with postoperative fever in 29 procedures (10.8%). The second-line prophylactic antibiotic was used in 32 procedures with postoperative fever in seven procedures (21.9%). No significance difference of postoperative fever rate between first-line or second-line prophylactic antibiotic was found (P = 0.069). Conclusions: The second-line prophylactic antibiotic use for tubeless PCNL does not offer additional benefit over the first-line prophylactic antibiotic in the prevention of postoperative fever or shortening of the postoperative hospital stay.
- Published
- 2017
36. A Nautilus kidney
- Author
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Bo Sheng Wu, Yang Ho, and Chih Yu Yang
- Subjects
Nephrology ,medicine.medical_specialty ,Percutaneous ,Flank pain ,Physiology ,medicine.medical_treatment ,030232 urology & nephrology ,Flank Pain ,Hydronephrosis ,030204 cardiovascular system & hematology ,Kidney ,03 medical and health sciences ,0302 clinical medicine ,Sepsis ,Physiology (medical) ,Internal medicine ,Animals ,Humans ,Medicine ,Nephrotomy ,Aged ,business.industry ,Pyonephrosis ,medicine.disease ,medicine.anatomical_structure ,Nautilus ,Female ,Ureteral Stricture ,Radiology ,Atrophy ,Tomography, X-Ray Computed ,business ,Ureteral Obstruction - Abstract
We report a 71-year-old woman who presented with unilateral flank pain and sepsis. A computed tomographic (CT) scan demonstrated left-sided hydronephrosis. Subsequent percutaneous nephrotomy drainage showed pus-like material, confirming the diagnosis of pyonephrosis. The ureteral stricture was caused by previous radiation injury for cervical cancer in this ESRD patient who was on chronic dialysis for years. In our case, the grade IVB hydronephrosis is a result of an extremely atrophic kidney, pyonephrosis, and ureteral stricture. The CT section of pyonephrosis in an extremely atrophic kidney resembles a sagittal section of a Nautilus shell, as the shell corresponds to the diffusely thinned renal cortex.
- Published
- 2020
37. Machine Learning Classification for Assessing the Degree of Stenosis and Blood Flow Volume at Arteriovenous Fistulas of Hemodialysis Patients Using a New Photoplethysmography Sensor Device
- Author
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Paul C.-P. Chao, Chih Yu Yang, Pei Yu Chiang, Yung Hua Kao, Chin-Long Wey, Der Cherng Tarng, and Tse Yi Tu
- Subjects
Computer science ,medicine.medical_treatment ,Hemodynamics ,02 engineering and technology ,Constriction, Pathologic ,Signal-To-Noise Ratio ,lcsh:Chemical technology ,01 natural sciences ,Biochemistry ,Article ,Analytical Chemistry ,Machine Learning ,Photoplethysmogram ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,lcsh:TP1-1185 ,Electrical and Electronic Engineering ,Photoplethysmography ,Instrumentation ,Blood flow volume ,arteriovenous fistula (AVF) ,010401 analytical chemistry ,photoplethysmography (PPG) sensor ,medicine.disease ,machine learning classifiers ,Atomic and Molecular Physics, and Optics ,0104 chemical sciences ,Clinical Practice ,Stenosis ,Statistical classification ,Regional Blood Flow ,Arteriovenous Fistula ,Kidney Failure, Chronic ,hemodialysis (HD) patients ,020201 artificial intelligence & image processing ,support vector machine (SVM) ,Hemodialysis ,Doppler ultrasound ,Biomedical engineering - Abstract
The classifier of support vector machine (SVM) learning for assessing the quality of arteriovenous fistulae (AVFs) in hemodialysis (HD) patients using a new photoplethysmography (PPG) sensor device is presented in this work. In clinical practice, there are two important indices for assessing the quality of AVF: the blood flow volume (BFV) and the degree of stenosis (DOS). In hospitals, the BFV and DOS of AVFs are nowadays assessed using an ultrasound Doppler machine, which is bulky, expensive, hard to use, and time consuming. In this study, a newly-developed PPG sensor device was utilized to provide patients and doctors with an inexpensive and small-sized solution for ubiquitous AVF assessment. The readout in this sensor was custom-designed to increase the signal-to-noise ratio (SNR) and reduce the environment interference via maximizing successfully the full dynamic range of measured PPG entering an analog&ndash, digital converter (ADC) and effective filtering techniques. With quality PPG measurements obtained, machine learning classifiers including SVM were adopted to assess AVF quality, where the input features are determined based on optical Beer&ndash, Lambert&rsquo, s law and hemodynamic model, to ensure all the necessary features are considered. Finally, the clinical experiment results showed that the proposed PPG sensor device successfully achieved an accuracy of 87.84% based on SVM analysis in assessing DOS at AVF, while an accuracy of 88.61% was achieved for assessing BFV at AVF.
- Published
- 2019
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38. The Anti-Inflammatory, Anti-Oxidative, and Anti-Apoptotic Benefits of Stem Cells in Acute Ischemic Kidney Injury
- Author
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Wei Cheng Tseng, Kuo Hua Lee, Chih Yu Yang, and Der Cherng Tarng
- Subjects
0301 basic medicine ,medicine.medical_treatment ,Apoptosis ,Review ,Systemic inflammation ,urologic and male genital diseases ,ischemia-reperfusion ,lcsh:Chemistry ,0302 clinical medicine ,Leukocytes ,lcsh:QH301-705.5 ,Spectroscopy ,Stem Cells ,Clinical Studies as Topic ,Acute kidney injury ,General Medicine ,Stem-cell therapy ,Cytoprotection ,Computer Science Applications ,Treatment Outcome ,conditioned medium ,acute kidney injury ,030220 oncology & carcinogenesis ,Reperfusion Injury ,medicine.symptom ,Stem cell ,Inflammation ,Mesenchymal Stem Cell Transplantation ,Catalysis ,Inorganic Chemistry ,03 medical and health sciences ,Immune system ,medicine ,Animals ,Humans ,Physical and Theoretical Chemistry ,Molecular Biology ,business.industry ,urogenital system ,Organic Chemistry ,Endothelial Cells ,Epithelial Cells ,medicine.disease ,Transplantation ,stem cell ,Oxidative Stress ,030104 developmental biology ,lcsh:Biology (General) ,lcsh:QD1-999 ,inflammation ,Culture Media, Conditioned ,Cancer research ,business - Abstract
Ischemia-reperfusion injury (IRI) plays a significant role in the pathogenesis of acute kidney injury (AKI). The complicated interaction between injured tubular cells, activated endothelial cells, and the immune system leads to oxidative stress and systemic inflammation, thereby exacerbating the apoptosis of renal tubular cells and impeding the process of tissue repair. Stem cell therapy is an innovative approach to ameliorate IRI due to its antioxidative, immunomodulatory, and anti-apoptotic properties. Therefore, it is crucial to understand the biological effects and mechanisms of action of stem cell therapy in the context of acute ischemic AKI to improve its therapeutic benefits. The recent finding that treatment with conditioned medium (CM) derived from stem cells is likely an effective alternative to conventional stem cell transplantation increases the potential for future therapeutic uses of stem cell therapy. In this review, we discuss the recent findings regarding stem cell-mediated cytoprotection, with a focus on the anti-inflammatory effects via suppression of oxidative stress and uncompromised immune responses following AKI. Stem cell-derived CM represents a favorable approach to stem cell-based therapy and may serve as a potential therapeutic strategy against acute ischemic AKI.
- Published
- 2019
39. Tubo-ovarian abscess with sepsis in a nonagenarian woman: a case report and literature review
- Author
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Jen Yu Tseng, Kuan Yi Chen, and Chih Yu Yang
- Subjects
medicine.medical_specialty ,Physical examination ,Case Report ,lcsh:Gynecology and obstetrics ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Chronic kidney disease ,Pelvic inflammatory disease ,medicine ,Post-menopausal ,Humans ,030212 general & internal medicine ,Nonagenarian ,Ovarian Diseases ,Fever of unknown origin ,Abscess ,Pelvic examination ,lcsh:RG1-991 ,Aged ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,lcsh:Public aspects of medicine ,General surgery ,Obstetrics and Gynecology ,lcsh:RA1-1270 ,General Medicine ,Fallopian Tube Diseases ,medicine.disease ,tubo-ovarian abscess ,Abdominal Pain ,Anti-Bacterial Agents ,Reproductive Medicine ,Female ,Differential diagnosis ,business ,Tubo-ovarian abscess ,Pelvic Inflammatory Disease - Abstract
Background A complete infectious focus survey relies on a thorough physical examination as well as a pelvic examination. Tubo-ovarian abscess, though less likely to occur in senior women, may become a life-threatening disease requiring emergent surgery. Hence, clinical awareness and aggressive management are warranted to avoid delayed diagnosis and subsequent complications. Case presentation We report a post-menopausal woman presented with sepsis of unknown origin, which turned out to be a huge tubo-ovarian abscess. Although tubo-ovarian abscess mostly occurs in women of fertile age, it is likely that the immune status of our post-menopausal patient was compromised because of old age and uremia. Moreover, due to underlying dementia, she could not express her discomfort in the early stage. Her sepsis resolved after a unilateral salpingo-oophorectomy surgery and antibiotic treatment. It is crucial to exclude pelvic inflammatory disease (PID) if no specific source of infection can be identified. Conclusions Rupture of the tubo-ovarian abscess is a condition of high mortality rate. Although tubo-ovarian abscess is more likely to develop in patients aged 15–25 years old, the tubo-ovarian abscess should be listed as a differential diagnosis in all post-menopausal women, especially those who are immunocompromised or with a palpable pelvic mass, to enable timely management and better prognosis.
- Published
- 2019
40. Mediating Retinal Ganglion Cell Spike Rates Using High-Frequency Electrical Stimulation
- Author
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Tianruo Guo, David Tsai, Chih Yu Yang, Amr Al Abed, Perry Twyford, Shelley I. Fried, John W. Morley, Gregg J. Suaning, Socrates Dokos, and Nigel H. Lovell
- Subjects
computational modeling ,genetic structures ,0206 medical engineering ,Retinal implant ,Stimulation ,02 engineering and technology ,Stimulus (physiology) ,Cell morphology ,high-frequency electrical stimulation ,lcsh:RC321-571 ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine ,retinal ganglion cell ,Electrode placement ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,Original Research ,Chemistry ,General Neuroscience ,retinal implant ,Retinal ,Membrane hyperpolarization ,020601 biomedical engineering ,medicine.anatomical_structure ,Retinal ganglion cell ,neuromodulation ,in vitro patch-clamp ,Erratum ,Neuroscience ,030217 neurology & neurosurgery - Abstract
Recent retinal studies have directed more attention to sophisticated stimulation strategies based on high-frequency (>1.0 kHz) electrical stimulation (HFS). In these studies, each retinal ganglion cell (RGC) type demonstrated a characteristic stimulus-strength-dependent response to HFS, offering the intriguing possibility of focally targeting retinal neurons to provide useful visual information by retinal prosthetics. Ionic mechanisms are known to affect the responses of electrogenic cells during electrical stimulation. However, how these mechanisms affect RGC responses is not well understood at present, particularly when applying HFS. Here, we investigate this issue via an in silico model of the RGC. We calibrate and validate the model using an in vitro retinal preparation. An RGC model based on accurate biophysics and realistic representation of cell morphology, was used to investigate how RGCs respond to HFS. The model was able to closely replicate the stimulus-strength-dependent suppression of RGC action potentials observed experimentally. Our results suggest that spike inhibition during HFS is due to local membrane hyperpolarization caused by outward membrane currents near the stimulus electrode. In addition, the extent of HFS-induced inhibition can be largely altered by the intrinsic properties of the inward sodium current. Finally, stimulus-strength-dependent suppression can be modulated by a wide range of stimulation frequencies, under generalized electrode placement conditions. In vitro experiments verified the computational modeling data. This modeling and experimental approach can be extended to further our understanding on the effects of novel stimulus strategies by simulating RGC stimulus-response profiles over a wider range of stimulation frequencies and electrode locations than have previously been explored.
- Published
- 2019
41. Hyperuricemia Predicts an Early Decline in Renal Function among Older People: A Community-Based Cohort Study
- Author
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Wei-Cheng Tseng, Chi Hung Lin, Chih Yu Yang, Der-Cherng Tarng, Yung Tai Chen, Yao-Ping Lin, and Shuo-Ming Ou
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,Renal function ,lcsh:Medicine ,Hyperuricemia ,Kidney ,Kidney Function Tests ,Models, Biological ,Article ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Residence Characteristics ,Risk Factors ,Internal medicine ,medicine ,Humans ,lcsh:Science ,Aged ,Proportional Hazards Models ,Multidisciplinary ,business.industry ,Proportional hazards model ,Incidence (epidemiology) ,Incidence ,lcsh:R ,Odds ratio ,medicine.disease ,Confidence interval ,Uric Acid ,030104 developmental biology ,chemistry ,Uric acid ,lcsh:Q ,Female ,business ,030217 neurology & neurosurgery ,Cohort study ,Follow-Up Studies ,Glomerular Filtration Rate - Abstract
Whether elevated serum uric acid levels (SUA) predict renal dysfunction remains controversial in the elderly. Therefore, we investigated the association between SUA and early renal function decline defined as an estimated glomerular filtration rate (eGFR) reduction ≥30% over 2 years. From 2001 to 2010, we conducted a longitudinal cohort study comprising 44,078 participants aged ≥65 years in the Taipei City Elderly Health Examination Database. Participants were classified by 1-mg/dL increment of SUA. We used multivariable logistic and Cox regression analyses to compare the risk of early renal function decline in different SUA groups. Compared to the reference SUA group of 5.0–5.9 mg/dL, hyperuricemic participants had increased risks of eGFR decline, starting at SUA ≥6.0 mg/dL (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI] = 1.00–1.45). The risk progressively elevated as SUA increased, with the highest in the SUA ≥10.0 mg/dL group (aOR = 3.20, CI = 2.39–4.28). Multivariable Cox regression further confirmed that hyperuricemia was 1.12-fold (CI = 1.03–1.22, SUA ≥6.0 mg/dL) to 1.6-fold (CI = 1.37–1.86, SUA ≥10.0 mg/dL) more likely to develop early eGFR decline. Hyperuricemia-associated increased risks for early eGFR decline were consistent across subgroup and sensitivity analyses. Collectively, SUA ≥6.0 mg/dL independently predicted early renal dysfunction with eGFR decline ≥30% over 2 years in older people.
- Published
- 2019
42. Tranexamic acid retention for gallbladder bleeding
- Author
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Wen Chi Wu, Der Cherng Tarng, and Chih Yu Yang
- Subjects
medicine.medical_specialty ,Text mining ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Gallbladder ,Gastroenterology ,Medicine ,business ,Tranexamic acid ,medicine.drug - Published
- 2021
43. Fixed dose of long-acting erythropoietic stimulating agents at higher frequency improves appetite, reduces inflammation and corrects anaemia in patients on haemodialysis
- Author
-
Da Chen Chu, Pui Ching Lee, Chih Kuang Liu, Chih Yu Yang, Chih Ching Lin, Yu Wei Chen, Wen Sheng Liu, Szu Yuan Li, Yen Ting Lai, and Hsiang Lin Chan
- Subjects
Male ,medicine.medical_specialty ,Physiology ,media_common.quotation_subject ,030232 urology & nephrology ,Appetite ,Inflammation ,030204 cardiovascular system & hematology ,Gastroenterology ,Drug Administration Schedule ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Hepcidin ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Dosing ,Aged ,media_common ,Aged, 80 and over ,Pharmacology ,biology ,business.industry ,Albumin ,Interleukin ,Anemia ,Middle Aged ,medicine.disease ,Continuous erythropoietin receptor activator ,Delayed-Action Preparations ,Immunology ,Hematinics ,biology.protein ,Kidney Failure, Chronic ,Female ,medicine.symptom ,business ,Kidney disease - Abstract
Anaemia is an important issue in patients undergoing haemodialysis. We aimed to identify a better dosing schedule of a fixed monthly dose of continuous erythropoietin receptor activator (CERA) in patients with chronic kidney disease (CKD) on haemodialysis. The CERA dosing schedule included 100 μg once monthly for 2 months, 50 μg twice monthly for 2 months and then 100 μg once monthly for two months. The effectiveness was determined by comparing haematocrit, nutritional status (serum protein and albumin) and inflammatory markers (tumour necrosis factor (TNF)-α, interleukin (IL)-1, IL-6 and Hepcidin) at the beginning of the study with those at the end of the study. Forty-seven out of 67 patients completed the trial. At the end, haematocrit was significantly higher (34.51 vs 33.22%, P=.004), levels of inflammatory markers were significantly lower (TNF-α (30.71 vs 35.67 ng/mL, P=.007), IL-6 (5.12 vs 7.95 ng/mL, P=.033), hepcidin (60.39 vs 74.39 ng/mL, P=.002)), blood glucose levels were significantly lower (112.40 vs 139.02 mg/dL, P=.003) and albumin was significantly higher (4.11 vs 3.98, P=.001). Patients with a better than average response had a lower initial number of red blood cells (3.3 vs 3.6 × 10(6) /mm(3) , P=.025) and a lower IL-1 (3.8 vs 12.9 ng/mL, P=.01). They also had significantly lower blood glucose levels at the end. (91.3 vs 124.0 mg/dL, P=.03). We demonstrate that a fixed monthly dose of CERA at a twice monthly dosing schedule improves nutrition, reduces the inflammation and corrects anaemia in patients on haemodialysis. This finding may provide a new strategy for treating CKD-related anaemia.
- Published
- 2016
44. Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and the risk of major adverse cardiac events in patients with diabetes and prior stroke
- Author
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Shu-Chen Kuo, Chia Jen Shih, Der Cherng Tarng, Chih Yu Yang, Szu Yuan Li, Yung Tai Chen, Shuo Ming Ou, Hung Ta Chen, and Pei Wen Chao
- Subjects
Male ,Risk ,medicine.medical_specialty ,Databases, Factual ,Hyperkalemia ,Physiology ,Myocardial Infarction ,Taiwan ,Angiotensin-Converting Enzyme Inhibitors ,Comorbidity ,030204 cardiovascular system & hematology ,Cohort Studies ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Aged ,Proportional Hazards Models ,biology ,business.industry ,Acute kidney injury ,Angiotensin-converting enzyme ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Intention to Treat Analysis ,Hospitalization ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Hypertension ,biology.protein ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Renin-angiotensin-aldosterone system blockers are the preferred antihypertensive medications in patients with diabetes and prior stroke. This study aimed to compare the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in terms of major adverse cardiac events (MACEs) in patients with diabetes who survived ischemic stroke.We conducted an observational, nationwide, propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. Patients aged at least 20 years with type 2 diabetes who initiated ACEI (n = 15,959) or ARB (n = 23,929) use within 90 days after discharge for first ischemic stroke between January 2000 and December 2011 were allocated to ACEI and ARB groups, respectively. The primary outcomes were MACEs (myocardial infarction, ischemic stroke, and cardiovascular mortality). The secondary outcomes were hospitalization for acute kidney injury and hyperkalemia. Intention-to-treat and as-treated models were used.Intention-to-treat analysis showed no significant difference between the ACEI and ARB groups in the outcomes of MACEs [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.95-1.04], including ischemic stroke (HR, 1.01; 95% CI, 0.97-1.06), myocardial infarction (HR, 1.06; 95% CI, 0.95-1.18), and cardiovascular mortality (HR, 0.98; 95% CI, 0.91-1.06). As-treated analysis produced similar results. Additionally, the groups showed no difference in the risk of hospitalization for acute kidney injury or hyperkalemia.Our study supports the hypothesis that the risks of MACEs and two additional secondary outcomes in patients with diabetes who survived ischemic stroke did not differ according to ACEI versus ARB use.
- Published
- 2016
45. Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation
- Author
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Shuo Ming Ou, Der Cherng Tarng, Chia Jen Shih, Szu Yuan Li, Yi Jung Lee, Chih Ching Lin, Shu-Chen Kuo, Pei Wen Chao, Chih Yu Yang, Po Hsun Huang, and Yung Tai Chen
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Statistics as Topic ,Taiwan ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Competing risks ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Risk Factors ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Hospital Mortality ,Intensive care medicine ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,New onset atrial fibrillation ,Population Surveillance ,Cohort ,Oral anticoagulant ,Female ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— Whether oral anticoagulant use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial because of the uncertainty regarding risk-benefit assessments. The purpose of this study was to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF, in comparison with those without arrhythmia. Methods and Results— This nationwide, population-based, propensity score–matched cohort study used data from Taiwan’s National Health Insurance Research Database during 1998 to 2011 for patients on hemodialysis with new-onset nonvalvular AF and matched subjects without arrhythmia. The clinical end points were ischemic stroke (fatal or nonfatal), all-cause death, and other serious adverse cardiovascular events. In comparison with the matched cohort, patients with AF (n=6772) had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.13–1.43), all-cause death (aHR, 1.59; 95% CI, 1.52–1.67), in-hospital cardiovascular death (aHR, 1.83; 95% CI, 1.71–1.94), myocardial infarction (aHR, 1.33; 95% CI, 1.17–1.51), and hospitalization for heart failure (aHR, 1.90; 95% CI, 1.76–2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR, 1.56; 95% CI, 1.45–1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA 2 DS 2 –VASc score for ischemic stroke was diminished in the competing-risk model. Conclusions— The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death.
- Published
- 2016
46. Daptomycin antibiotic lock therapy for hemodialysis patients with Gram-positive bloodstream infections following use of tunneled, cuffed hemodialysis catheters: retrospective single center analysis
- Author
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Hung Wen Yen, Ling Ju Huang, Szu Yuan Li, Chih Chun Wang, Chiao Lin Chuang, Wu Chang Yang, Chih Yu Yang, Der Cherng Tarng, and Pei Yu Lin
- Subjects
0301 basic medicine ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030106 microbiology ,Hemodialysis Catheter ,Retrospective cohort study ,Hematology ,biochemical phenomena, metabolism, and nutrition ,medicine.disease_cause ,Single Center ,medicine.disease ,complex mixtures ,Methicillin-resistant Staphylococcus aureus ,Surgery ,03 medical and health sciences ,Catheter ,Nephrology ,Bacteremia ,otorhinolaryngologic diseases ,Medicine ,Hemodialysis ,Daptomycin ,business ,medicine.drug - Abstract
Catheter-related blood stream infection (CRBSI) is a major complication in hemodialysis patients. We assessed the efficacy of systemic daptomycin (DPT) plus DPT antibiotic lock therapy (DPT-ALT) for catheter salvage in patients with Gram-positive CRBSIs. This is a retrospective study of hemodialysis patients with tunneled and cuffed hemodialysis catheters. All patients were from a single institution in Taipei and received systemic DPT plus DPT-ALT for the treatment of Gram-positive CRBSI. Successful resolution of CRBSI was implemented. Resolution of fever within 48 hours, negative result of repeated blood cultures after resolution of fever, no clinical evidence of CRBSI relapse and no need for catheter removal were measured. Fifteen hemodialysis patients received DPT-ALT for CRBSI, nine with coagulase-negative Staphylococcus (CONS), two with methicillin-resistant Staphylococcus aureus (MRSA), three with methicillin-sensitive Staphylococcus aureus (MSSA) and one with polymicrobial infections. Systemic DPT plus DPT-ALT cured 11 patients (73.3%). Treatment failed in all three MRSA cases (two with MRSA and one with MRSA + Enterococcus faecalis). Retrospective design and small sample size were the limitations of this study. Systemic DPT plus DPT-ALT appears to be a promising treatment for CRBSI from CONS and MSSA, but not for MRSA CRBSI. Systemic DPT plus DPT-ALT should be considered for patients with CRBSIs caused by certain species.
- Published
- 2015
47. Effects on Clinical Outcomes of Adding Dipeptidyl Peptidase-4 Inhibitors Versus Sulfonylureas to Metformin Therapy in Patients With Type 2 Diabetes Mellitus
- Author
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Chih Yu Yang, Szu Yuan Li, Der Cherng Tarng, Shuu Jiun Wang, Hsi Chu, Yi Jung Lee, Chia Jen Shih, Shu-Chen Kuo, Chih Ching Lin, Pei Wen Chao, Yung Tai Chen, Shuo Ming Ou, and Tzeng Ji Chen
- Subjects
Oncology ,medicine.medical_specialty ,endocrine system diseases ,business.industry ,digestive, oral, and skin physiology ,nutritional and metabolic diseases ,Type 2 Diabetes Mellitus ,General Medicine ,Type 2 diabetes ,Hypoglycemia ,medicine.disease ,Lower risk ,Metformin ,Endocrinology ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,business ,Stroke ,Dipeptidyl peptidase-4 ,medicine.drug - Abstract
In a large observational database study of add-on treatments to metformin, the addition of dipeptidyl peptidase-4 (DPP-4) inhibitors was associated with a lower risk for all-cause mortality, stroke...
- Published
- 2015
48. A Gaseous Kidney and Ureter
- Author
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Jyh Tong Hsieh, Chih Yu Yang, and Po Han Huang
- Subjects
Kidney ,medicine.medical_specialty ,medicine.anatomical_structure ,Text mining ,Ureter ,X ray computed ,business.industry ,medicine ,MEDLINE ,General Medicine ,Radiology ,business - Published
- 2019
49. Mathematical derivation, circuits design and clinical experiments of measuring blood flow volume (BFV) at arteriovenous fistula (AVF) of hemodialysis (HD) patients using a newly-developed photoplethysmography (PPG) sensor
- Author
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Paul C. P. Paul, Pei-Yu Chiang, Chih Yu Yang, and D. C. Tarng
- Subjects
Mathematical equations ,Blood flow volume ,Photoplethysmogram ,medicine ,Arteriovenous fistula ,Derivation ,Gold standard (test) ,medicine.disease ,Hemodialysis hd ,Electronic circuit ,Mathematics ,Biomedical engineering - Abstract
Mathematical derivation of calculating blood flow volume (BFV) at arteriovenous fistula (AVF) using a newly-developed photoplethysmography (PPG) sensor is presented in this work. Also, the readout circuit of the PPG sensor intended to increase the signal-noise ratio (S/NR) is designed and presented in this work. The designed PPG sensor equipped with derived mathematical equations shows high correlation (R2 = 0.7563) and low error (RMSE = 212 ml/min) as compared to the gold standard.
- Published
- 2018
50. U-Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All-Cause Mortality in the Elderly: The Role of Malnourishment
- Author
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Wei‐Cheng Tseng, Yung‐Tai Chen, Shuo‐Ming Ou, Chia‐Jen Shih, Der‐Cherng Tarng, Chih‐Yu Yang, Yao‐Ping Lin, Yi‐Fang Chuang, Liang‐Kung Chen, Kwua‐Yun Wang, Yu‐Hsin Chen, Ming‐Tsun Tsai, Yi‐Sheng Lin, Szu‐Chun Hung, Ko‐Lin Kuo, Tung‐Po Hung, Fen‐Hsiang Hu, Nien‐Jung Chen, Yu‐Chi Chen, Chi‐Hung Lin, Tung‐Hu Tsai, Shie‐Liang Hsieh, Yau‐Huei Wei, Chih‐Cheng Hsu, Jia‐Sin Liu, Yu‐Kang Chang, and Ming‐Han Chiang
- Subjects
Male ,medicine.medical_specialty ,Aging ,Time Factors ,Epidemiology ,Taiwan ,Nutritional Status ,Disease ,Hyperuricemia ,030204 cardiovascular system & hematology ,Risk Assessment ,elderly ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,uric acid ,Risk Factors ,Internal medicine ,Cause of Death ,Medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Geriatric Assessment ,Aged ,Original Research ,business.industry ,Proportional hazards model ,Serum uric acid ,Hazard ratio ,Malnutrition ,Age Factors ,medicine.disease ,Prognosis ,mortality ,Nutrition Assessment ,chemistry ,Cardiovascular Diseases ,Cohort ,malnourishment ,Uric acid ,Female ,Mortality/Survival ,Cardiology and Cardiovascular Medicine ,business ,All cause mortality ,Biomarkers - Abstract
Background The link between elevated serum uric acid ( SUA ) levels and cardiovascular disease ( CVD )–related mortality in the elderly population remains inconclusive. Nutritional status influences both SUA and CVD outcomes. Therefore, we investigated whether SUA ‐predicted mortality and the effect‐modifying roles of malnourishment in older people. Methods and Results A longitudinal Taiwanese cohort including 127 771 adults 65 years and older participating in the Taipei City Elderly Health Examination Program from 2001 to 2010 were stratified by 1‐mg/dL increment of SUA . Low SUA (2 . Study outcomes were all‐cause and CVD ‐related mortality. Cox models were used to estimate hazard ratios ( HRs ) of mortality, after adjusting for 20 demographic and comorbid covariates. Over a median follow‐up of 5.8 years, there were 16 439 all‐cause and 3877 CVD ‐related deaths. Compared with the reference SUA strata of 4 to SUA HR , 1.16; 95% confidence interval, 1.07–1.25) and ≥8 mg/dL ( HR , 1.13; confidence interval, 1.06–1.21), with progressively elevated risks at both extremes. Similarly, increasingly higher CVD ‐related mortality was found at the SUA level HR , 1.19; confidence interval, 1.00–1.40) and ≥7 mg/dL ( HR , 1.17; confidence interval, 1.04–1.32). Remarkably, among the low SUA (CVD ‐related mortality. This modifying effect of malnourishment remained consistent across subgroups. Conclusions SUA ≥8 or CVD ‐related mortality in the elderly, particularly in those with malnourishment.
- Published
- 2018
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