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Weng SC, Lee HC, Yeung CY, Chan WT, Lao HC, Jiang CB. Quality improvement of pediatric colonoscopy by application of bundle and centralization: A single-center review. Pediatr Neonatol 2023:S1875-9572(23)00175-4. [PMID: 37993294 DOI: 10.1016/j.pedneo.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/26/2023] [Accepted: 05/19/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND To assess the quality change of our single-center pediatric colonoscopy after applying bundle for bowel preparation and general anesthesia and centralize the procedure using terminal ileum (TI) intubation rate as the main indicator. METHODS All elective colonoscopies performed for patients younger than 18 years old in MacKay Memorial Hospital from July 2015 through June 2020 (assigned to group 1, before bundle) and from August 2020 through July 2021 (assigned to group 2, after bundle) were retrospectively reviewed for demographic characteristics, indications, bowel preparation agent and cleansing level, diagnostic and therapeutic procedures, maximum intestinal level reached, and cecal intubation and total procedure time. Statistical analysis was done using P value < 0.05 considered to be significant. RESULTS Analysis included 45 and 32 colonoscopies in group 1 and 2, respectively. Bloody stool was the most frequent indication in both groups. Both TI intubation rate (42.2 % vs. 75.0 %, P = 0.004) and biopsy rate (45.0 % vs. 75.9 %, P = 0.01) increased significantly from group 1 to group 2. The narrower standard deviation of bowel preparation score (1.93 vs. 1.15) and total procedure time (37.71 vs. 22.29) in group 2 indicated a more stable quality, although the mean showed no difference. There was no statistical difference in age, gender, body weight, cecal intubation rate, or cecal intubation time. CONCLUSION A higher TI intubation rate and biopsy rate indicated an improved quality of pediatric colonoscopy after applying bundle including bowel preparation and general anesthesia, with additional centralization.
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Affiliation(s)
- Shu-Chao Weng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| | - Chun-Yan Yeung
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hsinchu Municipal MacKay Children's Hospital, Hsinchu City, Taiwan
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Hsuan-Chih Lao
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Department of Anesthesiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
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2
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Cheng YY, Chang KC, Chen PL, Yeung CY, Liou BY, Chen HL. SLCO1B1 and SLCO1B3 genetic mutations in Taiwanese patients with Rotor syndrome. J Formos Med Assoc 2023:S0929-6646(23)00070-0. [PMID: 36964102 DOI: 10.1016/j.jfma.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023] Open
Abstract
Rotor syndrome is a rare, benign, inherited disorder that is commonly associated with mild hyperbilirubinemia. It is caused by bi-allelic pathological variants in both SLCO1B1 and SLCO1B3 genes, causing defective OATP1B1 and OATP1B3 in the sinusoidal membrane and interrupted bilirubin uptake of the hepatocytes. We report five Taiwanese pediatric and adult patients aged 5-32 years presenting with conjugated hyperbilirubinemia, and were found to have genetic variants of SLCO1B1 and SLCO1B3. Two also had history of prolonged neonatal jaundice. Genetic analysis using panel-based next generation sequencing revealed three patients with homozygous mutations c.1738C>T (p.R580∗) in SLCO1B1 and a transposon LINE-1 insertion in SLCO1B3, one patient with homozygous mutations for another haplotype, c.757C>T (p.R253∗) in SLCO1B1 and c.1747+1G>A in SLCO1B3. Another patient had heterozygous c.1738C>T (p.R580∗) in SLCO1B1 linked with a LINE-1 insertion in SLCO1B3, and heterozygous c.757C>T (p.R253∗) in SLCO1B1 linked with c.1747+1G>A in SLCO1B3. In conclusion, we present the first time of genetic diagnosis of Rotor syndrome in Taiwan. Advanced genetic testing has enhanced the diagnosis of rare diseases with mild symptoms.
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Affiliation(s)
- Ya-Yuan Cheng
- School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kai-Chi Chang
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Lung Chen
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taiwan; Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| | - Bang-Yu Liou
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Huey-Ling Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Education and Bioethics, National Taiwan, University College of Medicine, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
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3
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Chen LC, Yeung CY, Chang CW, Lee HC, Chan WT, Jiang CB, Chang SW. Blue Rubber Bleb Nevus Syndrome (BRBNS): A Rare Cause of Refractory Anemia in Children. Children (Basel) 2022; 10:children10010003. [PMID: 36670554 PMCID: PMC9856356 DOI: 10.3390/children10010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Refractory anemia is not uncommon in pediatric patients, and anemia caused by gastrointestinal tract bleeding should always be kept in mind. Aside from infection or intestinal malrotation related bleeding, vascular malformation should also be considered. Blue rubber bleb nevus syndrome (BRBNS) is a rare vascular disorder consisting of multiple venous malformations. Lack of experience in pediatric BRBNS might lead to delayed diagnosis or misdiagnosis. Herein, we report a case of an eleven-year-old boy with recurrent pallor appearance and weakness diagnosed with BRBNS. After a thorough examination, he was treated with endoscopic polypectomy, and further iron supplements and folic acid. He is now under regular follow-up at our outpatient department. No complication is noted for six months. BRBNS is a rare venous malformation syndrome that mostly involves skin and the gastrointestinal tract. Multidisciplinary approach should be arranged for diagnosis and management. Up to date, no consensus for BRBNS treatment has been reached. Management usually depends on clinical symptoms and severity of damage of involved organs. The options of treatment include conservative, medical, endoscopic, and surgical management.
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Affiliation(s)
- Liang-Chun Chen
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 242, Taiwan
| | - Chun-Yan Yeung
- Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Hsinchu Municipal MacKay Children’s Hospital, No. 690, Sec. 2, Guangfu Rd., East Dist., Hsinchu City 300044, Taiwan
- Correspondence: ; Fax: +886-3-6110900
| | - Chen-Wang Chang
- Department of Hepatology and Gastroenterology, MacKay Memorial Hospital, Taipei City 104, Taiwan
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei City 104, Taiwan
| | - Szu-Wen Chang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Mackay Memorial Tamshui Branch Hospital, New Taipei City 251, Taiwan
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4
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Liu YC, Yeh TC, Wu PS, Sheu JC, Lee HC, Yeung CY, Jiang CB, Liu HC, Hou JY, Chan WT. Rare presentation in a rare case of pancreatic extraosseous Ewing's sarcoma: A case report. Medicine (Baltimore) 2022; 101:e31752. [PMID: 36451511 PMCID: PMC9704996 DOI: 10.1097/md.0000000000031752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Extraosseous Ewing's sarcoma is a rare tumor which is aggressive with poor prognosis; it can occur anywhere in the body, but scantily in the pancreas. Pancreatic Ewing's sarcoma is not reported commonly, with inconsistent clinical manifestations. In this regard, early recognition of this disease is very important for the patient's sake. PATIENT CONCERNS A 16-year-old boy presented with left lower quadrant abdominal pain for 2 months, and left flank pain with dysuria for 1 month. DIAGNOSIS Abdominal and renal ultrasonography found a mass between the spleen and left kidney as well as left renal pelvic dilatation. Abdominal computed tomography found a heterogenous mass derived from the tail of the pancreas. Serial examinations revealed that the mass was a pancreatic Ewing's sarcoma. Furthermore, no metastasis was documented. INTERVENTIONS The tumor was totally excised after 6 months of chemotherapy, which included 10 courses of neoadjuvant chemotherapy with vincristine, epirubicin, and cyclophosphamide, alternating with ifosfamide and etoposide. The patient completed consolidation chemotherapy with vincristine, epirubicin, and cyclophosphamide, alternating with ifosfamide and etoposide for 5 courses. Radiotherapy was applied to the tumor-involved region and tumor bed. OUTCOMES To date, the malignancy has not recurred since the treatment was completed 4 years ago. There are no complications from the treatment for the patient. LESSONS The pancreas is a very rare extraosseous location for Ewing's sarcoma. Pancreatic extraosseous Ewing's sarcoma should be regarded as a differential diagnosis of non-urinary originated left flank pain with dysuria in adolescents.
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Affiliation(s)
- Ya-Chih Liu
- Department of Pediatrics, Lienchiang County Hospital, Lienchiang, Taiwan
| | - Ting-Chi Yeh
- Department of Hematology-Oncology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Pao-Su Wu
- Department of Pathology, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Jin-Cherng Sheu
- Division of Pediatric Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hung-Chang Lee
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei, Taiwan
| | - Chun-Yan Yeung
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei, Taiwan
| | - Chuen-Bin Jiang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei, Taiwan
| | - Hsi-Che Liu
- Department of Hematology-Oncology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jen-Yin Hou
- Department of Hematology-Oncology, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Wai-Tao Chan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei, Taiwan
- * Correspondence: Wai-Tao Chan, Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children’s Hospital, Taipei, Taiwan (e-mail: )
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5
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Chang YJ, Lee HC, Yeung CY, Chen WT, Jiang CB. A rare case of pancreatic macrocystic serous cystadenoma in an adolescent: a case report and literature review. J Int Med Res 2022; 50:3000605221129102. [PMID: 36259129 PMCID: PMC9583217 DOI: 10.1177/03000605221129102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While serous cystadenomas of the pancreas usually consist of small cysts, one rare variant has been reported to be composed of macrocysts. Herein, we present the case of the youngest patient with macrocystic serous cystadenoma (MSC) to be reported in the literature. The patient was a 17-year-old girl who presented with the major symptoms of a palpable abdominal mass accompanied by epigastric pain and vomiting for several months. A potential malignancy could not be excluded on the basis of imaging studies, which showed a large macrocystic pancreatic tumor that was 7 cm in diameter. Owing to the patient's symptoms, after diagnosing the mass as a pancreatic cystic tumor with potential malignancy and large tumor size, surgical intervention was arranged. Pathological analysis of the biopsy sample suggested MSC. By reviewing the literature, we found several unique characters of MSCs that cause them to be frequently misdiagnosed as potential malignancies. Additionally, the age of MSC occurrence was found to be lower than of general serous cystadenomas. The potential of MSC should be kept in mind by clinicians when diagnosing young people with pancreatic macrocystic lesions.
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Affiliation(s)
- Yu-Jui Chang
- Department of Pediatrics, Taipei City Hospital Zhongxiao Branch,
Taipei City
| | - Hung-Chang Lee
- Division of Gastroenterology and Hepatology, Department of
Pediatrics, MacKay Children’s Hospital, Taipei City,Department of Medicine, MacKay Medical College, New Taipei
City,Hung-Chang Lee, MacKay Memorial Hospital,
No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104217 (R.O.C.).
| | - Chun-Yan Yeung
- Division of Gastroenterology and Hepatology, Department of
Pediatrics, MacKay Children’s Hospital, Taipei City,Department of Medicine, MacKay Medical College, New Taipei
City,Department of Medical Research, MacKay Memorial Hospital, Taipei
City
| | - Wai-Tao Chen
- Division of Gastroenterology and Hepatology, Department of
Pediatrics, MacKay Children’s Hospital, Taipei City,Department of Medicine, MacKay Medical College, New Taipei
City
| | - Chuen-Bin Jiang
- Division of Gastroenterology and Hepatology, Department of
Pediatrics, MacKay Children’s Hospital, Taipei City,Department of Medicine, MacKay Medical College, New Taipei
City
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6
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Wen CC, Kuo TC, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, Wang NL, Hsu CH, Weng SC, Tseng YJ. Coexisting gastrointestinal and hepatobiliary tract anomalies in omphalocele and gastroschisis: A twenty-year experience in a single tertiary medical center. Pediatr Neonatol 2022; 63:468-473. [PMID: 35641386 DOI: 10.1016/j.pedneo.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/30/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Omphalocele and gastroschisis are the two most common congenital abdominal wall defects; however, no previous study has focused on gastrointestinal and hepatobiliary tract malformations in these two conditions. This study aimed to investigate the demographic characteristics, coexisting congenital gastrointestinal and hepatobiliary tract anomalies, hospital course, and outcomes of patients with gastroschisis and omphalocele. METHODS This is retrospective chart review of all patients admitted to one tertiary medical center in Taiwan between January 1, 2000 and June 30, 2020 with a diagnosis of gastroschisis or omphalocele. The medical records were reviewed to obtain demographic data regarding coexisting gastrointestinal and hepatobiliary tract anomalies and outcomes. RESULTS Of the 51 patients included, 21 had gastroschisis and 30 had omphalocele. Gastroschisis was associated with a significantly younger maternal age and a higher incidence of small for gestational age. Of the 30 patients with omphalocele, twelve had associated gastrointestinal and hepatobiliary anomalies. Seven of the 21 patients with gastroschisis had gastrointestinal anomalies, and none had hepatobiliary anomalies. Among the omphalocele patients, three (10%) had documented malrotation, and one developed midgut volvulus. Among gastroschisis patients, four patients (19%) had malrotation, and two developed midgut volvulus. There were no statistically significant differences in postoperative complications or mortality rates between those with and without gastrointestinal/hepatobiliary tract anomalies. CONCLUSION The diversity of coexisting gastrointestinal and hepatobiliary tract anomalies is higher in the omphalocele than in gastroschisis. In addition, we demonstrate that patients with gastroschisis or omphalocele have a higher rate of intestinal malrotation and midgut volvulus.
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Affiliation(s)
- Chen-Chen Wen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Tien-Chueh Kuo
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| | - Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Jin-Cherng Sheu
- Department of Pediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Nien-Lu Wang
- Department of Pediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Neonatology, MacKay Children's Hospital, Taipei, Taiwan
| | - Shu-Chao Weng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.
| | - Yufeng Jane Tseng
- The Metabolomics Core Laboratory, Centers of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan.
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7
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Sun C, Lin KC, Yeung CY, Ching ESC, Huang YT, Lai PY, Chan CK. Revealing directed effective connectivity of cortical neuronal networks from measurements. Phys Rev E 2022; 105:044406. [PMID: 35590680 DOI: 10.1103/physreve.105.044406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 03/23/2022] [Indexed: 06/15/2023]
Abstract
In the study of biological networks, one of the major challenges is to understand the relationships between network structure and dynamics. In this paper, we model in vitro cortical neuronal cultures as stochastic dynamical systems and apply a method that reconstructs directed networks from dynamics [Ching and Tam, Phys. Rev. E 95, 010301(R) (2017)2470-004510.1103/PhysRevE.95.010301] to reveal directed effective connectivity, namely, the directed links and synaptic weights, of the neuronal cultures from voltage measurements recorded by a multielectrode array. The effective connectivity so obtained reproduces several features of cortical regions in rats and monkeys and has similar network properties as the synaptic network of the nematode Caenorhabditis elegans, whose entire nervous system has been mapped out. The distribution of the incoming degree is bimodal and the distributions of the average incoming and outgoing synaptic strength are non-Gaussian with long tails. The effective connectivity captures different information from the commonly studied functional connectivity, estimated using statistical correlation between spiking activities. The average synaptic strengths of excitatory incoming and outgoing links are found to increase with the spiking activity in the estimated effective connectivity but not in the functional connectivity estimated using the same sets of voltage measurements. These results thus demonstrate that the reconstructed effective connectivity can capture the general properties of synaptic connections and better reveal relationships between network structure and dynamics.
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Affiliation(s)
- Chumin Sun
- Institute of Theoretical Physics and Department of Physics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K C Lin
- Institute of Theoretical Physics and Department of Physics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - C Y Yeung
- Institute of Theoretical Physics and Department of Physics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Emily S C Ching
- Institute of Theoretical Physics and Department of Physics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yu-Ting Huang
- Department of Physics and Center for Complex Systems, National Central University, Chungli, Taiwan 320, ROC
- Institute of Physics, Academia Sinica, Taipei, Taiwan 115, ROC
| | - Pik-Yin Lai
- Department of Physics and Center for Complex Systems, National Central University, Chungli, Taiwan 320, ROC
| | - C K Chan
- Institute of Physics, Academia Sinica, Taipei, Taiwan 115, ROC
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8
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Yeung CY, Chiang Chiau JS, Cheng ML, Chan WT, Jiang CB, Chang SW, Liu CY, Chang CW, Lee HC. Effects of Vitamin D-Deficient Diet on Intestinal Epithelial Integrity and Zonulin Expression in a C57BL/6 Mouse Model. Front Med (Lausanne) 2021; 8:649818. [PMID: 34414198 PMCID: PMC8369235 DOI: 10.3389/fmed.2021.649818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background and Aims: Vitamin D (VD) plays an important role not only in mineral balance and skeletal maintenance but also in immune modulation. VD status was found correlated with the pathophysiology and severity of inflammatory bowel diseases and other autoimmune disorders. Epithelial barrier function is primarily regulated by the tight-junction (TJ) proteins. In this study, we try to establish an animal model by raising mice fed VD-deficient diet and to investigate the effects of VD-deficient diet on gut integrity and zonulin expression. Methods: Male C57BL/6 mice were administered either VD-deficient [VDD group, 25(OH)2D3 0 IU/per mouse] or VD-sufficient [VDS group, 25(OH)2D3 37.8 IU/per mouse] special diets for 7 weeks. Body weight and diet intake were recorded weekly. Serum VD levels were detected. After sacrifice, jejunum and colon specimens were collected. The villus length and crypt depth of the jejunum as well as mucosa thickness of the colon were measured. Various serum pro-inflammatory cytokines and intestinal TJ proteins were assessed. The serum level of zonulin and the mRNA expression of jejunum zonulin were also investigated. Results: We found that mice fed a VDD diet had a lower serum level of VD after 7 weeks (p < 0.001). VDD mice gained significant less weight (p = 0.022) and took a similar amount of diet (p = 0.398) when compared to mice raised on a VDS diet. Significantly decreased colon mucosa thickness was found in VDD mice compared with the VDS group (p = 0.022). A marked increase in serum pro-inflammatory cytokine levels was demonstrated in VDD mice. All relative levels of claudin (CLD)-1 (p = 0.007), CLD-3 (p < 0.001), CLD-7 (p < 0.001), and zonulin-1 (ZO-1, p = 0.038) protein expressions were significantly decreased in the VDD group when compared to the VDS group. A significant upregulation of mRNA expression of jejunum zonulin (p = 0.043) and elevated serum zonulin (p = 0.001) were found in the VDD group. Conclusions: We successfully demonstrated that VDD could lead to impaired barrier properties. We assume that sufficient VD could maintain intestinal epithelial integrity and prevent mucosal barrier dysfunction. VD supplementation may serve as part of a therapeutic strategy for human autoimmune and infectious diseases with intestinal barrier dysfunction (leaky gut) in the future. To our knowledge, this is the first study to demonstrate that VDD could lead to a significant upregulation in mRNA expression of the jejunum zonulin level and also a marked elevation of serum zonulin in a mouse model.
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Affiliation(s)
- Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | | | - Mei-Lein Cheng
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Szu-Wen Chang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chia-Yuan Liu
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Hepatology and Gastroenterology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Wei Chang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Hepatology and Gastroenterology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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9
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Hung HH, Lee HC, Yeung CY, Wang NL, Tang TY, Winter HS, Kelsen JR, Jiang CB. Importance of early detection of infantile inflammatory bowel disease with defective IL-10 pathway: A case report. Medicine (Baltimore) 2021; 100:e25868. [PMID: 34032699 PMCID: PMC8154448 DOI: 10.1097/md.0000000000025868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Infantile inflammatory bowel disease (IBD) is an extremely rare subgroup of IBD that includes patients whose age of onset is younger than 2 years old. These patients can have more surgical interventions, and a severe and refractory disease course with higher rates of conventional treatment failure. Monogenic defects play an important role in this subgroup of IBD, and identification of the underlying defect can guide the therapeutic approach. PATIENT CONCERNS In 2007, a 4-month-old girl from a nonconsanguineous family presenting with anal fistula, chronic diarrhea, and failure to thrive. She underwent multiple surgical repairs but continued to have persistent colitis and perianal fistulas. DIAGNOSIS Crohn's disease was confirmed by endoscopic and histologic finding. INTERVENTION Conventional pediatric IBD therapy including multiple surgical interventions and antitumor necrosis factor alpha agents were applied. OUTCOMES The patient did not respond to conventional pediatric IBD therapy. Interleukin-10 (IL-10) receptor mutation was discovered by whole-exome sequencing and defective IL-10 signaling was proved by functional test of IL-10 signaling pathway by the age of 12. The patient is currently awaiting hematopoietic stem cell transplantation. LESSONS Early detection of underlying genetic causes of patients with infantile-IBD is crucial, since it may prevent patients from undergoing unnecessary surgeries and adverse effects from ineffective medical therapies. Moreover, infantile-IBD patients with complex perianal disease, intractable early onset enterocolitis and extraintestinal manifestations including oral ulcers and skin folliculitis, should undergo genetic and functional testing for IL-10 pathway defect.
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Affiliation(s)
- Hua-Hsi Hung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei
| | - Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City
| | - Nien-Lu Wang
- Department of Pediatric Surgery, MacKay Children's Hospital
| | - Tzu-Yin Tang
- Department of Pathology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Harland S. Winter
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MassGeneral Hospital for Children, Boston, MA
| | - Judith R. Kelsen
- Children's Hospital of Philadelphia, Department of Pediatrics, Philadelphia, PA
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City
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Weng SC, Lee HC, Yeung CY, Chan WT, Liu HC, Jiang CB. Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review. Pediatr Neonatol 2020; 61:598-605. [PMID: 32773363 DOI: 10.1016/j.pedneo.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/15/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gallstones are uncommon in infants and children and Asian children are thought to have very low risk. Diagnoses have increased in recent years with the widespread use of ultrasonography (USG). This study aimed to review our experience with risk factors, complications, and treatment of pediatric gallstones in low-incidence populations. METHODS We retrospectively reviewed patients younger than 18 years old diagnosed with gallstones using USG between November 2006 and December 2012 in a tertiary referral hospital in Taiwan. Demographic information including age and sex, follow-up period, USG findings, predisposing factors, complications, treatment approaches and outcomes were recorded. RESULTS Ninety-eight children with gallstones diagnosed with USG were enrolled and reviewed in our study. Females comprised 55% of patients, with no specific gender tendency. No risk factor could be identified in 30.8% of patients. The most common risk factors were cephalosporin (CS) use, presence of a choledochal cyst (CC), and spherocytosis. CS use was not associated with a higher dissolution rate. The presence of type IVa CC implied a high rate of gallstone recurrence after Roux-en-Y hepaticojejunostomy. Complications were seen in 22.4% of patients, but only two needed emergency stone removal. Expectant management was performed in 61% of patients and 62.5% of them achieved spontaneous resolution; the stone dissolution rate was not lower than in the group treated with ursodeoxycholic acid (UDCA). Stone size was significantly decreased after UDCA use if resolution did not occur. CONCLUSIONS Pediatric gallstones showed high resolution rate, and the clinical course was largely benign. CS use was the most common risk factor and did not predict a higher dissolution rate. Type IVa CC was also an important risk factor associated with a high recurrence rate. Conservative treatment and oral UDCA may be reasonable strategies in most patients, unless complications are present.
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Affiliation(s)
- Shu-Chao Weng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taitung Mackay Memorial Hospital, Taitung County, Taiwan.
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.
| | - Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan.
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| | - Hsi-Che Liu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Hematology-Oncology, MacKay Children's Hospital, Taipei, Taiwan.
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan.
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11
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Yeung CY, Chiang Chiau JS, Cheng ML, Chan WT, Chang SW, Chang YH, Jiang CB, Lee HC. Modulations of probiotics on gut microbiota in a 5-fluorouracil-induced mouse model of mucositis. J Gastroenterol Hepatol 2020; 35:806-814. [PMID: 31674687 DOI: 10.1111/jgh.14890] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/29/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Intestinal mucositis remained one of the most deleterious complications in cancer patients undergoing chemotherapy. 5-FU treatment was reported to affect the abundance of gut microbiota and cause mucositis, which might be ameliorated by probiotics. We investigate the potential changes of 5-FU treatment and the modulations of probiotics on gut microbiota in a mouse model. METHODS Male BALB/c mice received either 5-FU or saline (S). They were separated and fed saline, Lactobacillus casei variety rhamnosus (Lcr) and Lactobacillus reuteri DSM 17938 (BG). Lcr and BG were simultaneously administered with 5-FU for 5 days. Stool specimens were collected for DNA extraction and pyrosequenced for bioinformatic analysis. RESULTS Fecal microbial communities were obviously diverse. Bacteroides and Bacteroidaceae were the most abundant microbiota in FU.BG group while S24_7 was the most in S.S group. At phylum and class levels, abundances of Betaproteobacteria, Erysipelotrichi, Gammaproteobacteria, and Verrucomicrobia were significantly increased in the FU groups. Probiotics supplementation did increase the abundances of Enterobacteriales and Turicibacterales. We demonstrated that probiotics did modulate the abundance and diversity of gut microbiota. Bacterial motility proteins were found enriched and upregulated in the S.BG group. No mortality was noted. No bacterial translocation was found in spleen and blood among the six groups. CONCLUSION Gut microbiota of mice undergoing chemotherapy exhibited a distinct disruption in bacterial composition. Probiotic did modulate the abundance and diversity of gut microbiota. This is the first study to analyze the effects and safety of Lactobacillus strains on 5-FU-induced mucositis systematically and assess changes in the intestinal microbiota after probiotic intervention.
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Affiliation(s)
- Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | | | - Mei-Lein Cheng
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Szu-Wen Chang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| | - Yuan-Hao Chang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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12
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Affiliation(s)
- Chun-Yan Yeung
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, No.92, Sec.2, Chung Shan North Road, 10449, Taipei, Taiwan; School of Medicine, MacKay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan.
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13
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Huang L, Chiang Chiau JS, Cheng ML, Chan WT, Jiang CB, Chang SW, Yeung CY, Lee HC. SCID/NOD mice model for 5-FU induced intestinal mucositis: Safety and effects of probiotics as therapy. Pediatr Neonatol 2019; 60:252-260. [PMID: 30150027 DOI: 10.1016/j.pedneo.2018.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 04/20/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND For chemotherapy patients, intestinal mucositis is a frequent complication. Previously, we evaluated the beneficial effect of oral probiotics in 5-Fluorouracil (5-FU) induced mucositis in BALB/c mice. Here, we used SCID/NOD mice instead to simulate the immunodeficiency of chemotherapy patients: first, to evaluate the safety of probiotic supplementation and second, to determine the probiotic effect in response to 5-FU intestinal mucositis. METHODS Thirty-six SCID/NOD mice were injected with saline (three control groups) or 5-FU (three experimental groups) intraperitoneally daily for five days. Mice were given either oral saline daily, probiotic suspension of Lactobacillus casei variety rhamnosus (Lcr35, Antibiophilus™, France) or Lactobacillus acidophilus and Bifidobacterium bifidum (LaBi, Infloran™, Italy). Blood, liver, spleen, and lymph node tissue samples were evaluated for probiotic translocation via culture and Q-PCR. Weight change, diarrhea score, jejunal villus height (VH) and crypt depth (CD), and serum cytokine levels of TNF-α, IFNγ, IL-1β, IL-6, IL-4, IL-10, IL-13, and IL-17 were also assessed. RESULTS No weight loss was found in the SCID control group. Mean weight loss of 10.63 ± 0.87% was noted by day five in 5-FU group without probiotics but it was only 6.2 ± 0.43% if mice were given Lcr35 (p < 0.01) and 7.1 ± 1.80% (p < 0.01) if they were given LaBi. Diarrhea score of 5-FU group without probiotics was 2.0 ± 0.0 by day five, which dropped to 1.33 ± 0.17 (p < 0.05) and 1.42 ± 0.24 (p < 0.05) with Lcr35 and LaBi, respectively. Average VH significantly decreased and CD significantly increased in SCID mice given 5-FU. With probiotics, average CD improved (p < 0.05) while VH lengthened as well. Besides IL-13, all cytokine levels increased in 5-FU SCID mice. Both Lcr35 and LaBi significantly inhibited serum cytokines (p < 0.05). No probiotic strains were detected in blood cultures of any mice. CONCLUSION Using SCID/NOD mice as a novel model for 5-FU induced intestinal mucositis, we find that probiotics Lcr35 and LaBi do not lead to bacteremia, can improve diarrhea and body weight, can restore jejunal crypt depth, and significantly inhibit cytokines TNF-α, IL-1β, IFNγ, IL-6, IL-4, IL-10, and IL-17.
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Affiliation(s)
- Lawrence Huang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan
| | | | - Mei-Lien Cheng
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wai-Tao Chan
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Chuen-Bin Jiang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Szu-Wen Chang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Chun-Yan Yeung
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| | - Hung-Chang Lee
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Department of Pediatrics, Taipei Medical University, Taipei, Taiwan.
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Abstract
RATIONALE Hepatic hemangioma is rarely discovered during the infantile period. Although most of the cases are asymptomatic, some of them may suffer life-threatening situations. In this regard, early detection is mandatory for preventing the ominous consequences that might be culminated from the disease. PATIENT CONCERNS A 2-month-14-day-old female infant was found incidentally to have multiple hepatic lesions during a newborn ultrasound screen. She was born smoothly at term after a non-eventful pregnancy course. Physical examination was completely normal and postnatal vital signs were stable. DIAGNOSIS Infantile multiple hepatic hemangiomas. INTERVENTION High-resolution ultrasound and abdominal computer tomogram were conducted to confirm the diagnosis. Propranolol was started at the age of 3 months and 7 days old with an initial dosage of 1.5 mg/kg per day and increased gradually to 2.5 mg/kg per day. No obvious adverse effects were noted during the treatment course. Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment. Eventually, hepatic lesions totally disappeared 4.5 months later. Propranolol in dosage of 2.5 mg/kg per day was continued until 6 months after the initial prescription. OUTCOMES A period of 11-month follow-up revealed no evidence of recurrence of hemangiomas. LESSONS Early diagnosis and intervention are mandatory for infantile hepatic hemangiomas to prevent possible ominous consequences. Though the propranolol therapy protocol for the disease is still under developing, the current report strengthens the recommendation to use propranolol as the first-line medication for treating infantile hepatic hemangiomas.
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Affiliation(s)
- Mu-Chieh Tsai
- Division of Gastroenterology and Hepatology, Department of Pediatrics, MacKay Children's Hospital
| | - Hsi-Che Liu
- Division of Hematology and Oncology, Department of Pediatrics, MacKay Children's Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City
| | - Chun-Yan Yeung
- Division of Gastroenterology and Hepatology, Department of Pediatrics, MacKay Children's Hospital
- Department of Medicine, MacKay Medical College, New Taipei City
- Institute of Biotechnology and Department of Chemical Engineering, National Taipei University of Technology, Taipei, Taiwan
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15
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Tan K, Cheung CL, Yeung CY, Siu D, Leung J, Pang HK. Genetic screening for familial hypercholesterolaemia in Hong Kong. Hong Kong Med J 2018; 24 Suppl 3:7-10. [PMID: 29937437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- K Tan
- Department of Medicine, The University of Hong Kong
| | - C L Cheung
- Department of Pharmacology and Pharmacy, The University of Hong Kong
| | - C Y Yeung
- Endocrine and Diabetes Centre, Hong Kong Sanatorium and Hospital
| | - D Siu
- Department of Medicine, The University of Hong Kong
| | - J Leung
- Department of Medicine, Ruttonjee Hospital
| | - H K Pang
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital
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16
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Lee MD, Lin CH, Lei WT, Chang HY, Lee HC, Yeung CY, Chiu NC, Chi H, Liu JM, Hsu RJ, Cheng YJ, Yeh TL, Lin CY. Does Vitamin D Deficiency Affect the Immunogenic Responses to Influenza Vaccination? A Systematic Review and Meta-Analysis. Nutrients 2018; 10:E409. [PMID: 29587438 PMCID: PMC5946194 DOI: 10.3390/nu10040409] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
Influenza virus infection is a major global public health problem, and the efficacy of influenza vaccination is not satisfactory. Vitamin D is involved in many immune-mediated inflammatory processes. The impact of vitamin D levels on the immunogenic response to influenza vaccination is not clear. We performed a comprehensive literature search and systematic review of studies that investigated vitamin D and influenza vaccination. Data pertaining to study population, vaccine components, vitamin D levels, and immunogenic response were analyzed. Nine studies, with a combined study population of 2367 patients, were included in the systematic review. Four studies were included in the meta-analysis to investigate the influence of vitamin D deficiency (VDD) on the seroprotection (SP) rates and seroconversion (SC) rates following influenza vaccination. We found no significant association between vitamin D level and the immunogenic response to influenza vaccination. However, strain-specific differences may exist. We observed lower SP rates of influenza A virus subtype H3N2 (A/H3N2) and B strain in VDD patients than patients with normal vitamin D levels (A/H3N2: 71.8% vs. 80.1%, odds ratio (OR): 0.63, 95% confidence interval (CI): 0.43-0.91, p = 0.01; B strain: 69.6% vs. 76.4%, OR: 0.68, 95% CI: 0.5-0.93, p = 0.01). However, the SP rates of A/H1N1 and SC rates of all three strains were not significantly different in VDD and control groups. In conclusion, no association was observed between VDD and immunogenic response to influenza vaccination.
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Affiliation(s)
- Ming-Dar Lee
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Chao-Hsu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Hung-Yang Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Hung-Chang Lee
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Chun-Yan Yeung
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei 104, Taiwan.
| | - Jui-Ming Liu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan.
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan.
- Department of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan.
| | - Yu-Jyun Cheng
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Tzu-Lin Yeh
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu 300, Taiwan.
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Abstract
RATIONALE Menkes disease (MD), also known as Menkes kinky hair disease, is a fatal neurodegenerative disease caused by a defect in copper metabolism. The symptoms involve multiple organ systems, such as the brain, lung, gastrointestinal tract, urinary tract, connective tissue, and skin. There is currently no cure for this disease entity, and patients with the classic form of MD usually die from complications between 6 months and 3 years of age. Intracranial hemorrhage secondary to tortuous intracranial arteries is a well-known complication of MD, but spontaneous retroperitoneal hemorrhage, to the best of our knowledge, has never been reported in a patient with MD. Herein, we describe the first case of retroperitoneal hematoma as a complication of MD in a 4-year-old boy. PATIENT CONCERNS A 4-year-old Taiwanese male patient with MD was referred to the hospital and presented with a palpable epigastric mass. DIAGNOSES On the basis of the findings of ultrasonography and enhanced computed tomography, the diagnosis was retroperitoneal hematoma. INTERVENTIONS Interventions included laparotomy with evacuation of the hematoma, manual compression, and suture of the bleeding vessels. OUTCOMES There were no postoperative complications. LESSONS This case emphasizes that bleeding in patients with MD is possible at any site in the body owing to the unstable structure of the connective tissues. Timely diagnosis with proper imaging studies can lead to prompt and appropriate management and save patients from this life-threatening condition.
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Affiliation(s)
- Chia-Huei Peng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | | | - Nien-Lu Wang
- Department of Pediatric General Surgery and Urology
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Shuan-Pei Lin
- Department of Genetics and Metabolism, MacKay Children's Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City
- Division of Biochemical Genetics, Department of Medical Research, MacKay Memorial Hospital
- Department of Early Childhood Care, National Taipei University of Nursing and Health Sciences
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
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Chiu NC, Lin CY, Chi H, Yeung CY, Ting WH, Chan WT, Jiang CB, Li ST, Lin CH, Lee HC. Helicobacter pylori infection is not associated with failure to thrive: a case control study. Ther Clin Risk Manag 2017; 13:273-278. [PMID: 28260914 PMCID: PMC5328124 DOI: 10.2147/tcrm.s123148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose The long-term impact of Helicobacter pylori infection is complex, and concerns about the need for eradication exist. We conducted this case control study to investigate the association between H. pylori infection and failure to thrive (FTT). Patients and methods From January 2009 to December 2011, 53 children with FTT group and matched children with the same sex and age and similar socioeconomic status without FTT (control group) were enrolled. A questionnaire was administered to the parents/guardian, and a 13C-urea breath test was performed to detect H. pylori infection. Results We found that the total prevalence of H. pylori infection was 29.2% and that there was no association between FTT and H. pylori infection (FTT group: 32%; control group: 26.4%; P=0.67). Short stature was more common in the FTT group and abdominal pain in the control group (FTT group: 37.7%; control group: 11.3%; P=0.003). In a comparison between the H. pylori-positive and -negative groups, abdominal pain (87.1% vs 64%; P=0.032) and the frequency of endoscopy (74.2% vs 32%; P<0.001) were significantly more common in the H. pylori-positive group. Conclusion We found that children with H. pylori infection are at an increased risk for abdominal pain and that FTT is not associated with H. pylori infection. The decision for eradication should be evaluated carefully and individualized.
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Affiliation(s)
- Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital; Department of Medicine, MacKay Junior College of Medicine, Nursing and Management, Taipei
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital
| | - Chun-Yan Yeung
- Department of Pediatrics, MacKay Children's Hospital; Department of Medicine, MacKay Junior College of Medicine, Nursing and Management, Taipei
| | - Wei-Hsin Ting
- Department of Pediatrics, MacKay Children's Hospital
| | - Wai-Tao Chan
- Department of Pediatrics, MacKay Children's Hospital
| | | | - Sung-Tse Li
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City; Department of Statistics and Information Science, Fu Jen Catholic University, New Taipei, Taiwan
| | - Chao-Hsu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City
| | - Hung-Chang Lee
- Department of Pediatrics, MacKay Children's Hospital; Department of Medicine, MacKay Junior College of Medicine, Nursing and Management, Taipei
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Wen WH, Huang CW, Chie WC, Yeung CY, Zhao LL, Lin WT, Wu JF, Ni YH, Hsu HY, Chang MH, Lin LH, Chen HL. Quantitative maternal hepatitis B surface antigen predicts maternally transmitted hepatitis B virus infection. Hepatology 2016; 64:1451-1461. [PMID: 27044007 DOI: 10.1002/hep.28589] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 03/23/2016] [Accepted: 03/27/2016] [Indexed: 12/20/2022]
Abstract
UNLABELLED Despite immunoprophylaxis, hepatitis B virus (HBV) transmission in highly viremic mothers remains a global health issue. Using quantitative maternal surface antigen (HBsAg) to predict HBV infection in infants has not been investigated. We enrolled 526 mother-infant pairs with positive maternal HBsAg under current immunoprophylaxis. Maternal viral load and quantitative HBsAg were measured in the peripartum period. Infant HBsAg seropositivity for more than 6 months was defined as chronic infection. Rates of chronic infection in infants at various maternal HBsAg levels were estimated using a multivariate logistic regression model. Results showed that maternal HBsAg was positively correlated with maternal viral load (r = 0.69; P < 0.001) and accurately predicted maternal viral load above 6, 7, and 8 log10 IU/mL with an area under the receiver operating characteristic curve (AUC) of 0.97, 0.98, and 0.95. Nineteen infants were chronically infected. After adjustment for the other risk factor, maternal HBsAg level was significantly associated with risk of infection (adjusted odds ratio for each log10 IU/mL increase, 15.02; 95% confidence interval [CI], 3.89-57.94; P < 0.001). The AUC for predicting infection by quantitative maternal HBsAg was comparable to that by maternal viral load (0.89 vs. 0.87; P = 0.459). Estimated rates of infection at maternal HBsAg levels of 4, 4.5, and 5 log10 IU/mL were 2.4% (95% CI, 0.1-4.6; P = 0.04), 8.6% (95% CI, 4.5-12.7; P < 0.001), and 26.4% (95% CI, 12.6-40.2; P < 0.001). CONCLUSION Quantitative maternal HBsAg predicts infection in infants as well as maternal viral load does. Antiviral therapy may be considered in pregnant women with an HBsAg level above 4-4.5 log10 IU/mL to interrupt mother-to-infant transmission. (Hepatology 2016;64:1451-1461).
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Affiliation(s)
- Wan-Hsin Wen
- Department of Pediatrics, Cardinal Tien Hospital, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Wen Huang
- Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Yan Yeung
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Lu-Lu Zhao
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Wen-Terng Lin
- Department of Pediatrics, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Jia-Feng Wu
- Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Yuan Hsu
- Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwei Chang
- Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lung-Huang Lin
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. .,Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
| | - Huey-Ling Chen
- Department of Pediatrics, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Hsiao YH, Wei CH, Chang SW, Chang L, Fu YW, Lee HC, Liu HL, Yeung CY. Juvenile polyposis syndrome: An unusual case report of anemia and gastrointestinal bleeding in young infant. Medicine (Baltimore) 2016; 95:e4550. [PMID: 27631205 PMCID: PMC5402548 DOI: 10.1097/md.0000000000004550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Juvenile polyposis syndrome, a rare disorder in children, is characterized with multiple hamartomatous polyps in alimentary tract. A variety of manifestations include bleeding, intussusception, or polyp prolapse. In this study, we present an 8-month-old male infant of juvenile polyposis syndrome initially presenting with chronic anemia. To the best of our knowledge, this is the youngest case reported in the literature. METHODS We report a rare case of an 8-month-old male infant who presented with chronic anemia and gastrointestinal bleeding initially. Panendoscopy and abdominal computed tomography showed multiple polyposis throughout the entire alimentary tract leading to intussusception. Technetium-99m-labeled red blood cell (RBC) bleeding scan revealed the possibility of gastrointestinal tract bleeding in the jejunum. Histopathological examination on biopsy samples showed Peutz-Jeghers syndrome was excluded, whereas the diagnosis of juvenile polyposis syndrome was established. RESULTS Enteroscopic polypectomy is the mainstay of the treatment. However, polyps recurred and occupied the majority of the gastrointestinal tract in 6 months. Supportive management was given. The patient expired for severe sepsis at the age of 18 months. CONCLUSION Juvenile polyposis syndrome is an inherited disease, so it is not possible to prevent it. Concerning of its poor outcome and high mortality rate, it is important that we should increase awareness and education of the parents at its earliest stages.
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Affiliation(s)
- Yi-Han Hsiao
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
| | - Chin-Hung Wei
- Department of Medicine, Mackay Medical College
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital
| | - Szu-Wen Chang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
| | - Lung Chang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
| | - Yu-Wei Fu
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital
| | - Hung-Chang Lee
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
| | - Hsuan-Liang Liu
- Institute of Biotechnology and Department of Chemical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Yan Yeung
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital
- Department of Medicine, Mackay Medical College
- Institute of Biotechnology and Department of Chemical Engineering, National Taipei University of Technology, Taipei, Taiwan
- Correspondence: Chun-Yan Yeung, Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital, Mackay Medical College, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City 10449, Taiwan (e-mail: )
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21
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Lee M, Chen SCC, Yang HY, Huang JH, Yeung CY, Lee HC. Infant Stool Color Card Screening Helps Reduce the Hospitalization Rate and Mortality of Biliary Atresia: A 14-Year Nationwide Cohort Study in Taiwan. Medicine (Baltimore) 2016; 95:e3166. [PMID: 27015203 PMCID: PMC4998398 DOI: 10.1097/md.0000000000003166] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Biliary atresia (BA) is a significant liver disease in children. Since 2004, Taiwan has implemented a national screening program that uses an infant stool color card (SCC) for the early detection of BA. The purpose of this study was to examine the outcomes of BA cases before and after the launch of this screening program. The objectives of this study were to evaluate the rates of hospitalization, liver transplantation (LT), and mortality of BA cases before and after the program, and to examine the association between the hospitalization rate and survival outcomes.This was a population-based cohort study. BA cases born during 1997 to 2010 were identified from the Taiwan National Health Insurance Research Database. Sex, birth date, hospitalization date, LT, and death data were collected and analyzed. The hospitalization rate by 2 years of age (Hosp/2yr) was calculated to evaluate its association with the outcomes of LT or death.Among 513 total BA cases, 457 (89%) underwent the Kasai procedure. Of these, the Hosp/2yr was significantly reduced from 6.0 to 6.9/case in the earlier cohort (1997-2004) to 4.9 to 5.3/case in the later cohort (2005-2010). This hospitalization rate reduction was followed by a reduction in mortality from 26.2% to 15.9% after 2006. The Cox proportional hazards model showed a significant increase in the risk for both LT (hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.10-1.18) and death (HR = 1.05, 95% CI = 1.01-1.08) for each additional hospitalization. A multivariate logistic regression model found that cases with a Hosp/2yr >6 times had a significantly higher risk for both LT (adjusted odds ratio [aOR] = 4.35, 95% CI = 2.82-6.73) and death (aOR = 1.75, 95% CI = 1.17-2.62).The hospitalization and mortality rates of BA cases in Taiwan were significantly and coincidentally reduced after the launch of the SCC screening program. There was a significant association between the hospitalization rate and final outcomes of LT or death. The SCC screening program can help reduce the hospitalization rate and mortality of BA cases and bring great financial benefit.
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Affiliation(s)
- Min Lee
- From the Department of Pediatrics (ML), Taipei City Hospital, Zhongxiao Branch, Taipei City; Department of Medical Research (SC-CC, H-YY, J-HH), Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City; Department of Pediatrics (SC-CC), School of Medicine, Taipei Medical University, Taipei; Department of Pediatrics (C-YY), MacKay Children's Hospital, Taipei City; and MacKay Memorial Hospital (H-CL), Hsinchu Branch, Hsinchu City, Taiwan
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22
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Lin JS, Chen SCC, Lu CL, Lee HC, Yeung CY, Chan WT. Reduction of the ages at diagnosis and operation of biliary atresia in Taiwan: A 15-year population-based cohort study. World J Gastroenterol 2015; 21:13080-13086. [PMID: 26673041 PMCID: PMC4674726 DOI: 10.3748/wjg.v21.i46.13080] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/07/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the ages at diagnosis and operation of biliary atresia (BA) and its incidence over a 15-year period in Taiwan.
METHODS: This was a population-based cohort study. BA cases were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases, Ninth Revision (ICD-9) code of BA 751.61 plus Kasai operation (ICD-9 procedure code 51.37) or liver transplantation (LT, ICD-9 procedure code 50.5). The patients’ characteristics including sex, age at diagnosis, age at receiving Kasai operation and age at receiving LT were compared among three birth cohorts: (1) 1997 to 2001; (2) 2002 to 2006; and (3) 2007 to 2011.
RESULTS: There were a total of 540 BA cases (275 females) with an incidence of 1.62 per 10000 live births. No seasonality of BA was noted. The mean ages at diagnosis of three cohorts were 57.9, 55.6 and 52.6 d. A linear regression model demonstrated a decreasing trend of the mean age at diagnosis (1.27 d per year). The proportion of BA cases that received the Kasai operation within 60 d of age increased from 76% to 81%. A total of 189 (35%) BA patients underwent LT. The mean age at LT was reduced from 3-year-old to 1-year-old. The rates of LT were 25.6% and 32.3% in patients who received the Kasai operation within 60 d or after 60 d of age, respectively. All patients who did not undergo a Kasai operation eventually required LT.
CONCLUSION: The ages at diagnosis and operation in BA cases have decreased over time. Kasai operation performed at younger age reduces the need for LT. The incidence of BA in Taiwan fluctuates, but without certain trend.
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Yeung CY, Chan WT, Jiang CB, Cheng ML, Liu CY, Chang SW, Chiang Chiau JS, Lee HC. Correction: Amelioration of Chemotherapy-Induced Intestinal Mucositis by Orally Administered Probiotics in a Mouse Model. PLoS One 2015; 10:e0141402. [PMID: 26485652 PMCID: PMC4613823 DOI: 10.1371/journal.pone.0141402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Lee CH, Cheung CYY, Chow WS, Woo YC, Yeung CY, Lang BHH, Fong CHY, Kwok KHM, Chen SPL, Mak CM, Tan KCB, Lam KSL. Genetics of Apparently Sporadic Pheochromocytoma and Paraganglioma in a Chinese Population. Horm Metab Res 2015; 47:833-8. [PMID: 26267327 DOI: 10.1055/s-0035-1555955] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Identification of germline mutation in patients with apparently sporadic pheochromocytomas and paragangliomas is crucial. Clinical indicators, which include young age, bilateral or multifocal, extra-adrenal, malignant, or recurrent tumors, predict the likelihood of harboring germline mutation in Caucasian subjects. However, data on the prevalence of germline mutation, as well as the applicability of these clinical indicators in Chinese, are lacking. We conducted a cross-sectional study at a single endocrine tertiary referral center in Hong Kong. Subjects with pheochromocytomas and paragangliomas were evaluated for the presence of germline mutations involving 10 susceptibility genes, which included NF1, RET, VHL, SDHA, SDHB, SDHC, SDHD, TMEM 127, MAX, and FH genes. Clinical indicators were assessed for their association with the presence of germline mutations. Germline mutations, 2 being novel, were found in 24.4% of the 41 Chinese subjects recruited and 11.4% among those with apparently sporadic presentation. The increasing number of the afore-mentioned clinical indicators significantly correlated with the likelihood of harboring germline mutation in one of the 10 susceptibility genes. (r=0.757, p=0.026). The presence of 2 or more clinical indicators should prompt genetic testing for germline mutations in Chinese subjects. In conclusion, our study confirmed that a significant proportion of Chinese subjects with apparently sporadic pheochromocytoma and paraganglioma harbored germline mutations and these clinical indicators identified from Caucasians series were also applicable in Chinese subjects. This information will be of clinical relevance in the design of appropriate genetic screening strategies in Chinese populations.
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Affiliation(s)
- C H Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - C Y Y Cheung
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - W S Chow
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Y C Woo
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - C Y Yeung
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - B H H Lang
- Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - C H Y Fong
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - K H M Kwok
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - S P L Chen
- Kowloon West Cluster Laboratory Genetic Service, Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China
| | - C M Mak
- Kowloon West Cluster Laboratory Genetic Service, Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China
| | - K C B Tan
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - K S L Lam
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
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Yeung CY, Chan WT, Jiang CB, Cheng ML, Liu CY, Chang SW, Chiang Chiau JS, Lee HC. Amelioration of Chemotherapy-Induced Intestinal Mucositis by Orally Administered Probiotics in a Mouse Model. PLoS One 2015; 10:e0138746. [PMID: 26406888 PMCID: PMC4583404 DOI: 10.1371/journal.pone.0138746] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/03/2015] [Indexed: 12/20/2022] Open
Abstract
Background and Aims Intestinal mucositis is a frequently encountered side effect in oncology patients undergoing chemotherapy. No well-established or up to date therapeutic strategies are available. To study a novel way to alleviate mucositis, we investigate the effects and safety of probiotic supplementation in ameliorating 5-FU-induced intestinal mucositis in a mouse model. Methods Seventy-two mice were injected saline or 5-Fluorouracil (5-FU) intraperitoneally daily. Mice were either orally administrated daily saline, probiotic suspension of Lactobacillus casei variety rhamnosus (Lcr35) or Lactobacillus acidophilus and Bifidobacterium bifidum (LaBi). Diarrhea score, pro-inflammatory cytokines serum levels, intestinal villus height and crypt depth and total RNA from tissue were assessed. Samples of blood, liver and spleen tissues were assessed for translocation. Results Marked diarrhea developed in the 5-FU groups but was attenuated after oral Lcr35 and LaBi administrations. Diarrhea scores decreased significantly from 2.64 to 1.45 and 0.80, respectively (P<0.001). Those mice in 5-FU groups had significantly higher proinflammatory cytokine levels (TNF-α: 234.80 vs. 29.10, P<0.001, IL-6: 25.13 vs. 7.43, P<0.001, IFN-γ: 22.07 vs. 17.06, P = 0.137). A repairing of damage in jejunal villi was observed following probiotics administration. We also found TNF-α, IL-1β and IL-6 mRNA expressions were up-regulated in intestinal mucositis tissues following 5-FU treatment (TNF-α: 4.35 vs. 1.18, IL-1β: 2.29 vs. 1.07, IL-6: 1.49 vs. 1.02) and that probiotics treatment suppressed this up-regulation (P<0.05). No bacterial translocation was found in this study. Conclusions In conclusion, our results show that oral administration of probiotics Lcr35 and LaBi can ameliorate chemotherapy-induced intestinal mucositis in a mouse model. This suggests probiotics may serve as an alternative therapeutic strategy for the prevention or management of chemotherapy-induced mucositis in the future.
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Affiliation(s)
- Chun-Yan Yeung
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wai-Tao Chan
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Bin Jiang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan
| | - Mei-Lien Cheng
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Yuan Liu
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Hepatology and Gastroenterology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Szu-Wen Chang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Hung-Chang Lee
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Woo YC, Cheung BMY, Yeung CY, Lee CH, Hui EYL, Fong CHY, Tso AWK, Tam S, Lam KSL. Cardiometabolic risk profile of participants with prediabetes diagnosed by HbA1c criteria in an urban Hong Kong Chinese population over 40 years of age. Diabet Med 2015; 32:1207-11. [PMID: 25594838 DOI: 10.1111/dme.12691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 12/11/2022]
Abstract
AIMS To investigate the usefulness of the additional measurement of HbA1c , compared with performing only the oral glucose tolerance test (OGTT), in identifying participants at increased cardiometabolic risk, in an urban Chinese population. METHODS All participants from the fourth visit of the population-based Hong Kong Cardiovascular Risk Factors Prevalence Study, without known diabetes, were included. All had their glycaemic status assessed by OGTT and HbA1c , according to American Diabetic Association 2010 criteria. RESULTS Based on OGTT criteria alone, 3.5% of the study cohort (N = 1300) had diabetes and 19.2% had prediabetes. Based on HbA1c criteria only, 6.2% had diabetes and 61.2% had prediabetes. The measurement of HbA1c , in addition to the OGTT, increased the proportion of participants with diabetes to 7.8% and with prediabetes to 65.3%. Subjects with prediabetes having raised HbA1c but normal glycaemia (N = 600) had waist circumference, systolic blood pressure, fasting glucose, insulin resistance index (HOMA-IR), Gutt Index and Framingham 10-year cardiovascular risk scores intermediate between those with both normal HbA1c and glycaemia (N = 350), and those with impaired fasting glucose and/or impaired glucose tolerance (N = 249; all P < 0.01). CONCLUSION The measurement of HbA1c in our population, in addition to the OGTT, results in the detection of a large number of participants with prediabetes having raised HbA1c but normal glycaemia who have a cardiometabolic risk profile intermediate between impaired fasting glucose and/or impaired glucose tolerance and normal participants, and would benefit from early lifestyle intervention.
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Affiliation(s)
- Y C Woo
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - B M Y Cheung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - C Y Yeung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - C H Lee
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - E Y L Hui
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - C H Y Fong
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - A W K Tso
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - S Tam
- Division of Clinical Biochemistry, Queen Mary Hospital, Hong Kong, China
| | - K S L Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
- Department of Medicine, The University of Hong Kong, Hong Kong, China
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Lee CH, Woo YC, Wang Y, Yeung CY, Xu A, Lam KSL. Obesity, adipokines and cancer: an update. Clin Endocrinol (Oxf) 2015; 83:147-56. [PMID: 25393563 DOI: 10.1111/cen.12667] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/17/2014] [Accepted: 11/07/2014] [Indexed: 02/06/2023]
Abstract
Obesity causes dysfunction of adipose tissue, with resultant chronic inflammation and adverse interplay of various adipokines, sex steroids and endocrine hormones. All these drive tumourigenesis and explain the epidemiological link between obesity and cancer. Over the past decade, the associations among obesity, adipokines and cancer have been increasingly recognized. Adipokines and their respective signalling pathways have drawn much research attention in the field of oncology and cancer therapeutics. This review will discuss the recent advances in the understanding of the association of several adipokines with common obesity-related cancers and the clinical therapeutic implications.
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Affiliation(s)
- C H Lee
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Y C Woo
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Y Wang
- Department of Pharmacology & Pharmacy, University of Hong Kong, Hong Kong, Hong Kong
- Research Centre of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong, Hong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, Hong Kong
| | - C Y Yeung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - A Xu
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- Department of Pharmacology & Pharmacy, University of Hong Kong, Hong Kong, Hong Kong
- Research Centre of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong, Hong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, Hong Kong
| | - K S L Lam
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- Research Centre of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong, Hong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, Hong Kong
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Lee CH, Hui EYL, Woo YC, Yeung CY, Chow WS, Yuen MMA, Fong CHY, Xu A, Lam KSL. Circulating fibroblast growth factor 21 levels predict progressive kidney disease in subjects with type 2 diabetes and normoalbuminuria. J Clin Endocrinol Metab 2015; 100:1368-75. [PMID: 25625802 DOI: 10.1210/jc.2014-3465] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Elevated fibroblast growth factor 21 (FGF21) levels have been suggested, from cross-sectional studies, as an indicator of subclinical diabetic nephropathy. We investigated whether serum FGF21 was predictive of the development of diabetic nephropathy. METHOD Baseline serum FGF21 levels were measured in 1136 Chinese type 2 diabetic subjects recruited from the Hong Kong West Diabetes Registry. The role of serum FGF21 in predicting decline in estimated glomerular filtration rate (eGFR) over a median follow-up of 4 years was analyzed using Cox regression analysis. RESULTS At baseline, serum FGF21 levels increased progressively with eGFR category (P for trend <.001). Among 1071 subjects with baseline eGFR ≥ 30 mL/min/1.73 m(2), serum FGF21 levels were significantly higher in those with eGFR decline during follow-up (n = 171) than those without decline (n = 900) (P < .001). In multivariable Cox regression analysis, baseline serum FGF21 was independently associated with eGFR decline (hazard ratio, 1.21; 95% confidence interval [CI], 1.01-1.43; P = .036), even after adjustment for baseline eGFR. In a subgroup of 559 subjects with baseline eGFR ≥ 60 mL/min/1.73 m(2) and normoalbuminuria, serum FGF21 level remained an independent predictor of eGFR decline (hazard ratio, 1.36; 95% CI, 1.06-1.76; P = .016). Integrated discrimination improvement (IDI) suggested that the inclusion of baseline serum FGF21 significantly improved the prediction of eGFR decline (IDI, 1%; 95% CI, 0.1-3.0; P = .013) in this subgroup, but not in the initial cohort involving all subjects. CONCLUSIONS Elevated serum FGF21 levels may be a useful biomarker for predicting kidney disease progression, especially in the early stages of diabetic nephropathy.
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Affiliation(s)
- C H Lee
- Department of Medicine (C.H.L., E.Y.L.H., Y.C.W., C.Y.Y., W.S.C., M.M.A.Y., C.H.Y.F. A.X., K.S.L.L.), Queen Mary Hospital, Hong Kong SAR; Research Centre of Heart, Brain, Hormone and Healthy Aging (E.Y.L.H., A.X., K.S.L.L.), The University of Hong Kong, Pokfulam, Hong Kong SAR; and State Key Laboratory of Pharmaceutical Biotechnology (A.X., K.S.L.L.), The University of Hong Kong, Pokfulam, Hong Kong SAR
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Wei CH, Fu YW, Yeung CY, Chang SW, Wang NL. Laparoscopy-assisted intraoperative enteroscopic polypectomy for an infant with harmatomatous polyposis syndrome. Gastrointest Endosc 2015; 81:758. [PMID: 25150601 DOI: 10.1016/j.gie.2014.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/02/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Chin-Hung Wei
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Wei Fu
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chun-Yan Yeung
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Szu-Wen Chang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Nien-Lu Wang
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Chuang CK, Yeung CY, Jim WT, Lin SP, Wang TJ, Huang SF, Liu HL. Comparison of free fatty acid content of human milk from Taiwanese mothers and infant formula. Taiwan J Obstet Gynecol 2014; 52:527-33. [PMID: 24411038 DOI: 10.1016/j.tjog.2013.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Few studies on the free fatty acid (FFA) content of milk from non-Caucasian mothers have been published. We compared the FFA concentrations in human milk (HM) from Taiwanese mothers of preterm (PTHM) and full-term infants (FTHM) and in infant formula (IF). MATERIALS AND METHODS Thirty-eight HM samples were collected from 23 healthy lactating mothers and 15 mothers who gave birth prematurely (range 29-35 weeks, mean 33 weeks). The regular formula and preterm infant formula (PTIF) for three brands of powdered IF were also evaluated. Milk samples were extracted and methylated for analysis by gas chromatography/mass spectrometry (GC/MS). RESULTS Reference values for individual FFAs in breast milk from Taiwanese mothers were determined. The mean total FFAs were significantly higher in IF (21,554 μmol/L) and PTIF (19,836 μmol/L) than in FTHM (8,540 μmol/L) and PTHM (9,259 μmol/L) (p < 0.05). Saturated FAs were predominant in all types of milk (43.1% for FTHM, 42.8% for PTHM, 45.5% for IF and 45.3% for PTIF). Monounsaturated FAs were significantly higher in IF and PTIF (42.6% and 43.9%) than in FTHM and PTHM (37.7% and 39.5%), and polyunsaturated FAs in FTHM and PTHM (20% and 18.2%) were higher than in IF and PTIF (11.9% and 10.9%). HM had a more desirable linoleic acid/α-linolenic acid ratio than IF. No significant differences in individual FFAs in FTHM were observed among three lactating periods. CONCLUSION FFA levels in HM from Taiwanese mothers are in agreement with results for different geographically distinct populations. Nevertheless, the FFA content in IF did not meet well with HM, particularly, the excess additives of saturated and monounsaturated FAs, and the shortage of polyunsaturated FAs. The effect of variations in FFA content in IF on future unfavorable outcomes such as obesity, atopic syndrome, and less optimal infant neurodevelopment should be further investigated.
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Affiliation(s)
- Chih-Kuang Chuang
- Division of Genetics and Metabolism, Department of Medical Research, Mackay Memorial Hospital, 92 Chung-Shan North Road, Section 2, Taipei 10449, Taiwan; Institute of Biotechnology, National Taipei University of Technology, 1 Zhongxiao East Road, Section 3, Taipei 10608, Taiwan; College of Medicine, Fu-Jen Catholic University, 510 Chung Cheng Road, Hsinchuang, Taipei County 24205, Taiwan.
| | - Chun-Yan Yeung
- Institute of Biotechnology, National Taipei University of Technology, 1 Zhongxiao East Road, Section 3, Taipei 10608, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, 92 Chung-Shan North Road, Section 2, Taipei 10449, Taiwan; Department of Early Childhood Care and Education, Mackay Junior College of Medicine, Nursing and Management, 92 Shengjing Road, Beitou District, Taipei 11260, Taiwan
| | - Wai-Tim Jim
- Department of Pediatrics, Mackay Memorial Hospital, 92 Chung-Shan North Road, Section 2, Taipei 10449, Taiwan; Department of Early Childhood Care and Education, Mackay Junior College of Medicine, Nursing and Management, 92 Shengjing Road, Beitou District, Taipei 11260, Taiwan
| | - Shuan-Pei Lin
- Division of Genetics and Metabolism, Department of Medical Research, Mackay Memorial Hospital, 92 Chung-Shan North Road, Section 2, Taipei 10449, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, 92 Chung-Shan North Road, Section 2, Taipei 10449, Taiwan; Department of Early Childhood Care and Education, Mackay Junior College of Medicine, Nursing and Management, 92 Shengjing Road, Beitou District, Taipei 11260, Taiwan
| | - Tuen-Jen Wang
- Department of Laboratory Medicine, Mackay Memorial Hospital, 92 Chung-Shan North Road, Section 2, Taipei 10449, Taiwan; School of Medical Laboratory Science and Biotechnology, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan
| | - Sung-Fa Huang
- Department of Laboratory Medicine, Mackay Memorial Hospital, 92 Chung-Shan North Road, Section 2, Taipei 10449, Taiwan; School of Medical Laboratory Science and Biotechnology, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan
| | - Hsuan-Liang Liu
- Institute of Biotechnology, National Taipei University of Technology, 1 Zhongxiao East Road, Section 3, Taipei 10608, Taiwan.
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Yeung CY, Lee HC, Chan WT, Jiang CB, Chang SW, Chuang CK. Vertical transmission of hepatitis C virus: Current knowledge and perspectives. World J Hepatol 2014; 6:643-651. [PMID: 25276280 PMCID: PMC4179143 DOI: 10.4254/wjh.v6.i9.643] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/05/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is a major global health issue. Infection by the HCV can cause acute and chronic liver diseases and may lead to cirrhosis, hepatocellular carcinoma or liver failure. The World Health Organization estimates that approximately 3% of the world population have been infected with HCV and the worldwide prevalence is between 1% and 8% in pregnant women and between 0.05% and 5% in children. Following the introduction of blood product screening, vertical transmission becomes the leading cause of childhood HCV infection. The prevalence of pediatric HCV infection varies from 0.05% to 0.36% in developed countries and between 1.8% and 5% in the developing world. All children born to women with anti-HCV antibodies should be checked for HCV infection. Though universal screening is controversial, selective antenatal HCV screening on high-risk populations is highly recommended and should be tested probably. Multiple risk factors were shown to increase the possibility of HCV vertical transmission, including coinfections with human immunodeficiency virus, intravenous drug use and elevated maternal HCV viral load, while breastfeeding and HCV genotypes have been studied to have little impact. At present, no clinical intervention has been clearly studied and proved to reduce the HCV vertical transmission risk. Cesarean section should not be recommended as a procedure to prevent vertical transmission, however, breastfeeding is generally not forbidden. The high prevalence of global HCV infection necessitates renewed efforts in primary prevention, including vaccine development, as well as new approaches to reduce the burden of chronic liver disease. Future researches should focus on the interruption of vertical transmission, developments of HCV vaccine and direct-acting antivirals in infancy and early childhood.
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Cheung CYY, Hui EYL, Cheung BMY, Woo YC, Xu A, Fong CHY, Ong KL, Yeung CY, Janus ED, Tse HF, Sham PC, Lam KSL. Adiponectin gene variants and the risk of coronary heart disease: a 16-year longitudinal study. Eur J Endocrinol 2014; 171:107-15. [PMID: 24760538 DOI: 10.1530/eje-14-0079] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Circulating adiponectin levels have been shown to be associated with a risk of coronary heart disease (CHD). However, its primary role in protecting against the development of CHD remains controversial due to conflicting observations in prospective studies. To gain further insight into the primary role of adiponectin, our major objective was to investigate the relationship between single nucleotide polymorphisms (SNPs) of the adiponectin gene (ADIPOQ) and incident CHD in a population-based cohort with no CHD at baseline. DESIGN AND METHODS We conducted a 16-year longitudinal study in 2196 subjects from the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS). During 33 862 person-years of follow-up, 184 subjects developed CHD (cumulative incidence rate=5.4 per 1000 person-years). Nine ADIPOQ SNPs with potential functional relevance or shown to be associated with adiponectin levels and/or CHD were genotyped. RESULTS Among the nine ADIPOQ SNPs, +276G>T (rs1501299) was independently associated with incident CHD in men but not in women, even after adjustments for traditional cardiovascular risk factors (Padjusted=5.5×10(-3) to 0.023; hazard ratio=1.39-1.54). Furthermore, there was a significant association of the T allele of +276G>T with a lower adiponectin level (P=0.027; β (95% CI)=-0.05 (-0.10, -0.01). CONCLUSIONS This study demonstrated that +276G>T may be an independent predictor of CHD development. Our findings suggest that low adiponectin levels, as may be influenced by +276G>T, confer a higher risk of CHD, in keeping with a role of hypoadiponectinaemia in the development of CHD in the general population.
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Affiliation(s)
- Chloe Y Y Cheung
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elaine Y L Hui
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bernard M Y Cheung
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Y C Woo
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aimin Xu
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carol H Y Fong
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - K L Ong
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Y Yeung
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward D Janus
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hung-Fat Tse
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pak C Sham
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karen S L Lam
- Department of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of MedicineDepartment of PsychiatryResearch Centre of HeartBrain, Hormone and Healthy AgingLi Ka Shing Faculty of MedicineCentre for Genomic Sciences, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, Hong KongCentre for Vascular ResearchUniversity of New South Wales, Sydney, New South Wales 2052, AustraliaDepartment of MedicineNorthwest Academic Centre, Western Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Yeung CY. Assessment of childhood overweight and obesity: any better and feasible tool other than body mass index? Pediatr Neonatol 2014; 55:1-2. [PMID: 24326151 DOI: 10.1016/j.pedneo.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chun-Yan Yeung
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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Lee HC, Fang SB, Yeung CY, Tsai JD. Urinary tract infections in infants: comparison between those with conjugatedvsunconjugated hyperbilirubinaemia. ACTA ACUST UNITED AC 2013; 25:277-82. [PMID: 16297302 DOI: 10.1179/146532805x72421] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIMS The aim was to investigate conjugated and unconjugated hyperbilirubinaemia in association with urinary tract infection (UTI) in young infants. METHODS Fifty infants aged <3 mths who developed prolonged jaundice among 2128 infants with UTI from 1984 to 2004 were enrolled retrospectively. They were divided into conjugated (n=22) and unconjugated (n=28) hyperbilirubinaemia groups and the clinical variables between the two were compared. RESULTS Compared with the unconjugated group, the conjugated hyperbilirubinaemia group had statistically significantly lower haemoglobin (1.57 vs 1.80 micromol/L), higher aspartate aminotransferase (96 vs 32.5 U/L) and alanine aminotransferase (81.5 vs 16 U/L), were older on admission (48.0 vs 32.5 days), had a longer duration of jaundice before treatment (43.5 vs 30 days) and a higher incidence of E. coli infections (19/22 vs 15/28). The direct/total bilirubin ratio was linearly correlated with duration of jaundice before treatment (p=0.004). The most significant cut-off value for the duration of jaundice vis-à-vis the type of jaundice was 38 days (p=0.007). Patients who on presentation had had jaundice for >44 days (p=0.007) were unlikely to have unconjugated hyperbilirubinaemia. CONCLUSIONS Infants with UTI may present with unconjugated hyperbilirubinaemia in the early stage. After 6 weeks, it is always conjugated hyperbilirubinaemia and is frequently associated with anaemia, elevated hepatic aminotransferases and E. coli infections.
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Affiliation(s)
- Hung-Chang Lee
- Department of Paediatrics, Mackay Memorial Hospital, Taiwan; Department of Paediatrics, Taipei Medical Uinversity, Taiwan
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Liu CC, Yeung CY, Chen PH, Yeh MK, Hou SY. Salmonella detection using 16S ribosomal DNA/RNA probe-gold nanoparticles and lateral flow immunoassay. Food Chem 2013; 141:2526-32. [PMID: 23870991 DOI: 10.1016/j.foodchem.2013.05.089] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/05/2013] [Accepted: 05/16/2013] [Indexed: 11/29/2022]
Abstract
An ultrasensitive, simple, and fast lateral flow immunoassay for Salmonella detection using gold nanoparticles conjugated with a DNA probe, which is complementary to the 16S ribosomal RNA and DNA of Salmonella, has been developed. The detection limit is 5 fmol for the synthetic single-stranded DNA. For the Salmonella cultured samples, the nucleic acids from 10(7) bacteria were rapidly detected in 30 min. After silver enhancement, the detection limit was as low as 10(4) cells which is lower than 10(5) bacteria cells, the human infective dose of food-borne Salmonella. Furthermore, the probes used in this study are specific to Salmonella compared to several other Enterobacteriaceae. This approach would be a useful tool for microbial detection regarding food safety or clinical diagnosis. It is also suitable for large-scale screening in developing countries because it is low-cost, sensitive, specific and convenient.
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Affiliation(s)
- Cheng-Che Liu
- Graduate Institute of Engineering Technology Doctoral, National Taipei University of Technology, Taipei, Taiwan
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Hsu WL, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, Wang NL, Shih SL. Recurrent Intussusception: when Should Surgical Intervention be performed? Pediatr Neonatol 2012; 53:300-3. [PMID: 23084722 DOI: 10.1016/j.pedneo.2012.07.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 01/22/2012] [Accepted: 02/08/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the optimal timing of surgery for recurrent intussusception. METHODS We retrospectively reviewed medical records of patients aged from 0 to 18 years old with diagnosis of intussusception in the Pediatric Department at Mackay Memorial Hospital between January 1995 and May 2010. RESULTS During the study period, there were 686 children (divided into three age groups: 367 < 2 years, 289 aged 2 to 5 years, 30 > 5 years) with diagnoses of intussusception. Eighty-five of the 686 patients had recurrent intussusception, of whom 56 had two, 16 had three, 11 had four, and 2 had five episodes. The recurrence rate after the first, second, third, and fourth barium enema reductions were 15.7%, 37.7%, 68.4%, and 100.0%, respectively. The incidence of recurrence and failure rate of barium enema reduction did not differ significantly among these three age groups. Surgery was performed in 177 children (146 during the first episode and 31 in recurrent cases). The probability of eventual surgery after first enema reduction was 21.8%, after the second 35.7%, and after the third 70.0%. Lead points were found in 15 children, and all of them were found during surgery for the first episode of intussusception. CONCLUSION The probability of recurrence was 100% after the fourth episode of intussusception in our study. After the third episode of intussusception, the probability of recurrence and eventual surgery were 68% and 70%, respectively. From this study, surgical intervention should be considered at the third episode of intussusception.
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Affiliation(s)
- Wei-Lun Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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Lee HC, Chang TY, Yeung CY, Chan WT, Jiang CB, Chen WF, Chan HW, Yang HW, Lin M, Lee YJ. Genetic variability of interleukin 4 gene in Taiwanese children with biliary atresia. Cytokine 2012; 57:402-5. [PMID: 22227092 DOI: 10.1016/j.cyto.2011.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 12/05/2011] [Accepted: 12/14/2011] [Indexed: 01/28/2023]
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Lee HC, Jiang CB, Chan WT, Yeung CY. Sonogram of Biliary Dilatation in Children. Sonography 2012. [DOI: 10.5772/28317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lin HH, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, Wang NL. Congenital webs of the gastrointestinal tract: 20 years of experience from a pediatric care teaching hospital in taiwan. Pediatr Neonatol 2012; 53:12-7. [PMID: 22348489 DOI: 10.1016/j.pedneo.2011.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 01/03/2011] [Accepted: 01/20/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND To classify and evaluate the clinical spectrum of congenital webs in the gastrointestinal (GI) tract, including clinical courses and related factors. METHODS A retrospective chart review was performed on 37 patients with congenital GI webs at a pediatric care teaching hospital in north Taiwan. All of the related parameters were collected and analyzed. RESULTS Twelve patients had gastric webs, 22 had duodenal webs, and three had jejunal webs. The mean time to diagnosis was 1576 days for gastric webs, 116 days for duodenal and 230 days for jejunal webs. There was a statistically significant difference between the gastric and duodenal groups (p = 0.001). The major symptom was vomiting (78%). Patients with duodenal webs had a high association with congenital anomalies (50%). The major anomalies included cardiac (27%) and GI anomalies (18%). Endoscopy was performed in 10 gastric cases, and all of them were noted to have positive findings, including a fixed nonfolded stenotic ring following a second gastric chamber and a real pylorus. All of the patients received surgery except for three with gastric webs, and no mortality was noted. The mean postoperative days of tolerated feeding was 6 for those with gastric webs, 10 for those with duodenal and 11 for those with jejunal webs. CONCLUSION The clinical course of gastrointestinal webs may be chronic or obscure. A delay from onset of symptoms to treatment may exist, especially in gastric webs. We suggest that prompt endoscopic confirmation and surgical intervention for these lesions, when suspected due to clinical and radiologic abnormalities, will decrease the morbidity of unexplained recurrent symptoms or signs of GI obstruction in these patients.
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Affiliation(s)
- Hsin-Hong Lin
- Department of Pediatrics, Keelung Hospital, Department of Health, Executive Yuan, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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Huang CT, Lee HC, Chen WT, Jiang CB, Shih SL, Yeung CY. Usefulness of magnetic resonance cholangiopancreatography in pancreatobiliary abnormalities in pediatric patients. Pediatr Neonatol 2011; 52:332-6. [PMID: 22192261 DOI: 10.1016/j.pedneo.2011.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 10/31/2010] [Accepted: 11/29/2010] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is an innovative and noninvasive technique for evaluating the biliary tree and pancreatic duct in children. The aim of this study was to assess the usefulness of MRCP as a noninvasive method to evaluate the biliary system in children. METHODS We retrospectively reviewed the records of patients undergoing MRCP between October 2002 and May 2007 for suspected biliary system abnormalities. MRCP findings were compared with other imaging modalities, operative findings, and clinical endpoints. RESULTS Complete data were available for 60 patients (35 girls, 25 boys; mean age 2 years, 33 children less than 1 year old). Ultrasound was performed in all 60 patients. Twenty-two patients had choledochal cyst, and 19 had a thin or invisible gall bladder. Endoscopic retrograde cholangiopancreatography was done in two patients. The sensitivities and specificities of MRCP for diagnosing choledochal cyst and biliary atresia were 100.0% and 100.0% and 86.7% and 100.0%, respectively. Surgery was performed in 37 patients, including 21 with a choledochal cyst, 14 with biliary atresia, and 1 with a pancreatic duct stone. CONCLUSION MRCP is useful method for evaluation of the pancreaticobiliary system in pediatric patients. It yields a high degree of accuracy in the diagnosis of biliary atresia and choledochal cyst.
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Affiliation(s)
- Chang-Ting Huang
- Department of Pediatrics, Mackay Memorial Hospital, Taitung, Taiwan.
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Ko GTC, Yeung CY, Leung WYS, Chan KW, Chung CH, Fung LM, Ip TP, Kum G, Lau KP, Lau IT, Li JKY, Siu SC, Tsang MW, Yeung VTF, Tong PCY, So WY, Chan JCN. Cost implication of team-based structured versus usual care for type 2 diabetic patients with chronic renal disease. Hong Kong Med J 2011; 17 Suppl 6:9-12. [PMID: 22147352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- G T C Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Lin DS, Chang JH, Liu HL, Wei CH, Yeung CY, Ho CS, Shu CH, Chiang MF, Chuang CK, Huang YW, Wu TY, Jian YR, Huang ZD, Lin SP. Compound heterozygous mutations in PYCR1 further expand the phenotypic spectrum of De Barsy syndrome. Am J Med Genet A 2011; 155A:3095-9. [PMID: 22052856 DOI: 10.1002/ajmg.a.34326] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 09/05/2011] [Indexed: 12/25/2022]
Abstract
De Barsy syndrome (DBS) is characterized by progeroid features, ophthalmological abnormalities, intrauterine growth retardation, and cutis laxa. Recently, PYCR1 mutations were identified in cutis laxa with progeroid features. Herein, we report on a DBS patient born to a nonconsanguineous Chinese family. The exceptional observation of congenital glaucoma, aortic root dilatation, and idiopathic hypertrophic pyloric stenosis in this patient widened the range of symptoms that have been noted in DBS. Mutation analysis of PYCR1 revealed compound heterozygous PYCR1 mutations, including a p.P115fsX7 null mutation allele and a second allele with two missense mutations in cis: p.G248E and p.G297R. The effect of mutation results in a reduction of PYCR1 mRNA expression and PYCR1 protein expression in skin fibroblasts from the patient. The findings presented here suggest a mutation screening of PYCR1 and cardiovascular survey in patients with DBS.
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Affiliation(s)
- Dar-Shong Lin
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
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43
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Kong APS, Yamasaki A, Ozaki R, Saito H, Asami T, Ohwada S, Ko GTC, Wong CK, Leung GTC, Lee KF, Yeung CY, Chan JCN. A randomized-controlled trial to investigate the effects of rivoglitazone, a novel PPAR gamma agonist on glucose-lipid control in type 2 diabetes. Diabetes Obes Metab 2011; 13:806-13. [PMID: 21492364 DOI: 10.1111/j.1463-1326.2011.01411.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the efficacy, safety and tolerability of rivoglitazone, a novel thiazolidinedione (TZD), and explore its effects on glucose and lipid control compared to placebo and pioglitazone in Chinese type 2 diabetic patients who are treatment naÏve or treated with a single oral blood glucose-lowering drug. METHODS This was a double-blind, randomized, placebo- and active-controlled study. A total of 287 Chinese type 2 diabetic patients with suboptimal glycaemic control (defined as HbA1c ≥6.5 to <10% and fasting plasma glucose ≥7 to ≤15 mmol/l) were enrolled. One hundred and seventy-four eligible patients were randomized into one of the five treatment arms for 12 weeks: placebo, pioglitazone 30 mg daily, rivoglitazone of dose 0.5, 1.0 or 1.5 mg daily. In a full set analysis, we used analysis of covariance to compare the primary endpoint defined as change in HbA1c from baseline to week 12/last observation carried forward in the rivoglitazone group at each dose level with the placebo group. RESULTS Changes in HbA1c were -0.11% in the 0.5-mg group; -0.22% in the 1-mg group and -0.17% in the 1.5-mg rivoglitazone group; -0.06% in the 30-mg pioglitazone group and 0.61% in the placebo group. Compared to placebo, changes were significant in all active treatment groups (all p < 0.05). Increase in high-density lipoprotein cholesterol and decrease in triglyceride were observed in the rivoglitazone 1 and 1.5 mg groups, respectively, compared to placebo from baseline to week 12 (p < 0.05). Drug-related oedema was reported in eight patients (7.7%) in all rivoglitazone groups compared to six patients (16.2%) in the pioglitazone group and one patient (3.0%) in the placebo group. CONCLUSIONS Rivoglitazone is an efficacious, safe and well-tolerated TZD which improved glycaemic control in Chinese type 2 diabetic patients up to 3 months.
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Affiliation(s)
- A P S Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Lin DS, Yeung CY, Liu HL, Ho CS, Shu CH, Chuang CK, Huang YW, Wu TY, Huang ZD, Jian YR, Lin SP. A novel mutation in PYCR1 causes an autosomal recessive cutis laxa with premature aging features in a family. Am J Med Genet A 2011; 155A:1285-9. [PMID: 21567914 DOI: 10.1002/ajmg.a.33963] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 01/22/2011] [Indexed: 01/18/2023]
Abstract
The autosomal recessive form of type II cutis laxa (ARCL II) is characterized by the appearance of redundant, inelastic skin with wrinkling, an aged look and additional variable systemic involvement including intrauterine growth retardation, failure to thrive, developmental delay, dysmorphism, osseous abnormality, and CNS manifestations. Several genetic defects have been found in patients and families with the clinical manifestations of ARCL II. Recently, mutations in PYCR1 have been linked to cutis laxa with progeroid features. We ascertained two siblings with of ARCL II born to non-consanguineous parents. Mutation analysis of PYCR1 revealed a novel single-base deletion (c.345delC) in exon 4 leading to frame-shift and premature stop of translation. The effect of this mutation results in a strong reduction of PYCR1 expression in skin fibroblasts from affected siblings. These two cases extend the genotypic spectrum of PYCR1-related ARCL II.
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Affiliation(s)
- Dar-Shong Lin
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
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Chen JJ, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC. Meta-analysis: the clinical features of the duodenal duplication cyst. J Pediatr Surg 2010; 45:1598-606. [PMID: 20713206 DOI: 10.1016/j.jpedsurg.2010.01.010] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Revised: 01/05/2010] [Accepted: 01/06/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Duplication cyst of the duodenum is rare. This study describes a case of duodenal duplication and evaluates its clinical features through a literature review. METHODS A case of duodenal duplication is reported, and related articles published from 1999 to 2009 on PubMed were reviewed. Clinical manifestations, diagnostic examinations, and methods of management were analyzed. RESULTS Including this report, there had been 38 citations in literature that provide adequate descriptions of 47 cases of duodenal duplication cysts. Nineteen (40.4%) were discovered before 10 years of age, whereas 10 (21.3%) were found in the second decade. The remaining 18 patients (38.3%) were older than 20 years. The case number decreased as age increased. Overall, 80% of cases presented with abdominal pain, and 53% were complicated with pancreatitis. CONCLUSIONS The most common symptom in duodenal duplication cysts is abdominal pain with or without nausea or vomiting. The most common complication is pancreatitis. Differential diagnoses of pancreatitis, hepatitis, cholestasis, or intussusception should include duplication cyst of the duodenum.
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Affiliation(s)
- Jeng-Jung Chen
- Department of Pediatrics, Mackay Memorial Hospital, Taipei 10449, Taiwan
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46
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Lin CY, Chiu NC, Lee HC, Chuang CK, Lin SP, Yeung CY. The Emerging Importance of Norovirus as the Etiology of Pediatric Gastroenteritis in Taipei. Journal of Microbiology, Immunology and Infection 2010; 43:105-10. [PMID: 20457426 DOI: 10.1016/s1684-1182(10)60017-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 03/20/2009] [Accepted: 04/30/2009] [Indexed: 10/19/2022]
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47
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Chang SW, Lee HC, Yeung CY, Chan WT, Hsu CH, Kao HA, Hung HY, Chang JH, Sheu JC, Wang NL. A twenty-year review of early and late-presenting congenital Bochdalek diaphragmatic hernia: are they different clinical spectra? Pediatr Neonatol 2010; 51:26-30. [PMID: 20225535 DOI: 10.1016/s1875-9572(10)60006-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Congenital Bochdalek diaphragmatic hernia (CDH) is easily recognized if it is present shortly after birth. However, cases of delayed CDH presentation are more subtle and therefore less easily diagnosed. METHODS We retrospectively analyzed 85 patients who were under 18 and diagnosed with CDH between June 1987 and May 2007. Those diagnosed before 1 month of age were categorized as having early-presenting CDH and those diagnosed after 1 month were categorized as having late-presenting CDH. RESULTS Of the 85 cases, 68 (80%) were early-presenting and 17 (20%) were late-presenting CDH. Respiratory symptoms were more common in early-presenting CDH, while gastrointestinal complaints were more dominant in the late-presenting group, particularly in patients with left diaphragmatic defects. Late-presenting CDH, which was more likely to be associated with chronic gastrointestinal symptoms, was associated with a lower mortality than acute early-presenting CDH with respiratory symptoms, despite the more prompt diagnosis of the latter. The small bowel was the organ most commonly herniated into the thorax. Congenital heart disease was the most commonly associated malformation, but the presence of associated anomalies did not increase mortality. CONCLUSION Early-presenting CDH shows acute symptoms, is readily diagnosed, and requires prompt intervention to prevent death. In contrast, late-presenting CDH shows more subtle symptoms and is more difficult to diagnose. Although the late-presenting CHD has better prognosis, it still requires surgery intervention to alleviate the symptoms. Clinicians must maintain a high index of suspicion for CDH, regardless of its presentation.
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Affiliation(s)
- Szu-Wen Chang
- Department of Pediatrics, Mackay Memorial Hospital, Taitung, Taiwan
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48
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Fang HW, Fang SB, Chiang Chiau JS, Yeung CY, Chan WT, Jiang CB, Cheng ML, Lee HC. Inhibitory effects of Lactobacillus casei subsp. rhamnosus on Salmonella lipopolysaccharide-induced inflammation and epithelial barrier dysfunction in a co-culture model using Caco-2/peripheral blood mononuclear cells. J Med Microbiol 2010; 59:573-579. [PMID: 20110387 DOI: 10.1099/jmm.0.009662-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In this study, we investigated the anti-inflammatory and reinforcing barrier effects of Lactobacillus casei subsp. rhamnosus (Lcr35) on Caco-2 intestinal epithelial cells already exposed to Salmonella LPS. Using the Transwell co-culture model, Salmonella LPS was apically added to polarized Caco-2 cells co-cultured with peripheral blood mononuclear cells (PBMCs) in the basolateral compartment. LPS-stimulated Caco-2 cells were incubated with Lcr35 for 1, 6, 24 or 48 h. Apical inoculation of Lcr35 after 48 h significantly inhibited the basolateral secretion of interleukin-8 (IL-8) in the Caco-2/PBMC co-culture. The PCR analysis showed that Lcr35 significantly downregulated mRNA expression of monocyte chemoattractant protein 1 (MCP-1) (P<0.05) and had a trend of decreasing mRNA expression of IL-8 (P=0.05), but did not alter mRNA expression of transforming growth factor-beta1 in LPS-stimulated Caco-2 cells at 48 h after addition of Lcr35. Compared to non-LPS-pretreated controls, transepithelial electrical resistance (TEER) of the polarized Caco-2 cell monolayers pretreated with LPS for 48 h was decreased by 9.9 % (P<0.05). Additionally, compared to those cells only treated with LPS, apical co-incubation with Lcr35 showed biphasic TEER levels increased by 12.1 % (P<0.001), 5.7 % (P<0.05) and 86.8 % (P<0.001) in the Caco-2 cell monolayers compared to those without Lcr35 treatment after 1, 6 and 48 h, respectively. In conclusion, Lcr35 can exert anti-inflammatory effects and ameliorate barrier dysfunction in the Salmonella LPS-pretreated inflamed intestinal epithelium in vitro.
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Affiliation(s)
- Hsu-Wei Fang
- Division of Medical Engineering Research, National Health Research Institutes, Miaoli, Taiwan, ROC.,Department of Chemical Engineering and Biotechnology, National Taipei University Technology, Taipei, Taiwan, ROC
| | - Shiuh-Bin Fang
- Centre for Paediatric Gastroenterology, Royal Free Campus, University College London Medical School, London, UK
| | | | - Chun-Yan Yeung
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan, ROC.,Department of Paediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Wai-Tao Chan
- Department of Paediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Chuen-Bin Jiang
- Department of Paediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Mei-Lien Cheng
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Hung-Chang Lee
- Department of Paediatrics, Taipei Medical University, Taipei, Taiwan, ROC.,Department of Paediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC
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Chuang CK, Wang TJ, Yeung CY, Lin DS, Lin HY, Liu HL, Ho HT, Hsieh WS, Lin SP. A method for lactate and pyruvate determination in filter-paper dried blood spots. J Chromatogr A 2009; 1216:8947-52. [PMID: 19913794 DOI: 10.1016/j.chroma.2009.10.074] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 10/19/2009] [Accepted: 10/23/2009] [Indexed: 10/20/2022]
Abstract
Lactic acidemia is commonly associated with severe diseases in pediatric patients. Quantitation of blood lactate and pyruvate is important for the diagnosis and clinical management. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method using dried blood spots (DBS) was developed and could be used for simultaneous quantification of blood lactate and pyruvate. The applicability of the developed method was tested and confirmed by the regression analysis between LC-MS/MS method and enzymatic assay. Lactate and pyruvate were extracted from DBS obtained from 580 full-term, 120 pre-term infants (gestations ranging from 24 to 36 weeks), and 65 patients with suspected lactic acidemia, with methanolic internal standard (IS) solutions of sodium L-lactate-(13)C(3) and pyruvate-(13)C(3). An API-2000 LC-MS/MS system with multiple reaction monitoring (MRM) mode was applied. The within-run and between-run precisions (CV%) were determined and the results were 1.9% and 3.9% for lactate (n=20) and 5.7% and 7.3% for pyruvate (n=20). The linearity of lactate (r=0.9986) and pyruvate (r=0.9973) based on the IS was excellent. The parameter r squared (r(2)) of linear regression between LC-MS/MS method and enzymatic assay was 0.9405 for lactate and 0.9447 for pyruvate, respectively, and the agreement between these methods was consistent and acceptable. The stability of lactate and pyruvate on DBS was also confirmed. The LC-MS/MS method we developed is a specific, sensitive, and reproducible method for measuring blood lactate and pyruvate concentrations. The use of DBS in this method makes it particularly attractive for pediatric patients.
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Affiliation(s)
- Chih-Kuang Chuang
- Division of Genetics and Metabolism, Department of Medical Research, Mackay Memorial Hospital, No. 92, Sec. 2, Chung-Shan N. Rd., Taipei 10449, Taiwan
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50
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Abstract
BACKGROUND Gastrointestinal polyps are common in children. The purpose of this study was to review the clinical manifestations, diagnostic procedures, endoscopic findings, management, pathology, and recurrence of gastrointestinal polyps in children at Mackay Memorial Hospital. METHODS We retrospectively reviewed the charts of 50 children with a diagnosis of gastrointestinal polyps managed at Mackay Memorial Hospital between January 1984 and April 2007. Demographic data; clinical features; polyp size, number and location; endoscopic findings; management; pathology; and information on recurrences were extracted from the clinical records. RESULTS The distribution of polyps in the 50 patients included gastric (4 patients), duodenal (2), ileocecal (4) and colorectal polyps (40). All patients with gastric polyps presented with vomiting, and three of the four patients with ileocecal polyps presented with intussusception. The mean age of the 40 patients with colorectal polyps was 6.8 years. The majority of those polyps were in the rectosigmoid colon; 36 patients presented with hematochezia. Solitary polyps were identified in 33 patients and multiple polyps were identified in seven patients. Most of the colorectal polyps were less than 2cm in diameter. Histologically, the most frequent type was juvenile polyp. CONCLUSION Gastrointestinal polyps in children are usually benign. Pediatricians treating a child with a gastrointestinal polyp should pay attention to the immediate complications of the polyps, such as intussusception or bleeding, the extraintestinal manifestations and long-term risk for malignancy.
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Affiliation(s)
- Li-Chun Wang
- Department of Pediatrics, Mackay Memorial Hospital, Taiwan
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