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Chen YL, Tsai TY, Pan LY, Tsai YJ, Chen SY, Hsiao CH, Yeh LK, Tan HY, Chen HC, Hung KH, Quan W, Chen CB, Chung WH, Ma DHK. Ocular Manifestations and Outcomes in Children With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Comparison With Adult Patients. Am J Ophthalmol 2023; 256:108-117. [PMID: 37633318 DOI: 10.1016/j.ajo.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/16/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE To compare the clinical features and visual outcomes in children and adults with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). DESIGN Retrospective comparative case series. METHODS This retrospective study included 280 eyes of 140 patients (35 children and 105 adults) with SJS/TEN treated between 2010 and 2020. The primary outcome measures were the final best-corrected visual acuity (BCVA) and severity of dry eye. The secondary outcome measure was the medical and surgical therapies used. RESULTS Among 64 eyes of children recruited in the study, acute ocular involvement was found in 58 eyes (90.6%). The chronic score in pediatric patients was significantly higher than that in adult patients (P = .004). The use of antibiotics/nonsteroidal anti-inflammatory drugs (NSAIDs) and Mycoplasma infection were the more common etiologies in children. In all, 75% of eyes in children maintained a visual acuity of 20/40 or better at a mean follow-up time of 4.3 years. The severity of dryness was comparable between the child and adult groups. The proportion of eyes undergoing amniotic membrane and oral mucosa transplantation was significantly higher in children than in adults in the chronic stage, reflecting that children exhibit much more severe complications. CONCLUSIONS Although pediatric SJS/TEN patients have more severe ocular complications than adults, most children maintain long-term good vision. Early intervention and aggressive treatment help to preserve vision.
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Affiliation(s)
- Yueh-Ling Chen
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Ying Tsai
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Li-Yen Pan
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yueh-Ju Tsai
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shin-Yi Chen
- Department of Ophthalmology (S.-Y.C.), Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ching-Hsi Hsiao
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lung-Kun Yeh
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yuan Tan
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chi Chen
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Hung
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wuyong Quan
- Department of Ophthalmology (W.Q., D.H.-K.M.), Xiamen Chang Gung Hospital, Xiamen, China
| | - Chun-Bing Chen
- Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Drug Hypersensitivity Clinical and Research Center (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences (C.-B.C., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Dermatology (C.-B.C., W.-H.C.), Xiamen Chang Gung Hospital, Xiamen, China
| | - Wen-Hung Chung
- Department of Medicine (Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H., C.-BC., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Drug Hypersensitivity Clinical and Research Center (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medical Sciences (C.-B.C., W.-H.C.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Immune-Oncology Center of Excellence (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Cancer Vaccine and Immune Cell Therapy Core Laboratory (C.-B.C., W.-H.C.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Dermatology (C.-B.C., W.-H.C.), Xiamen Chang Gung Hospital, Xiamen, China
| | - David Hui-Kang Ma
- From the Department of Ophthalmology (Y.L.-C, T.-Y.T., L.-Y.P., Y.-J.T., C.-H.H., L.-K.Y., H-Y.T., H.-C.C., K.-S.H.), Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Ophthalmology (W.Q., D.H.-K.M.), Xiamen Chang Gung Hospital, Xiamen, China; Department of Chinese Medicine (D.H.-K.M.), College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering (D.H.-K.M.), Chang Gung Memorial Hospital, Linkou, Taiwan.
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Chang YH, Huang YC, Chen HC, Ma DHK, Yeh LK, Hung KH, Hsiao CH. Molecular and Phenotypic Characterization of Ocular Methicillin-Resistant Staphylococcus epidermidis Isolates in Taiwan. Invest Ophthalmol Vis Sci 2023; 64:33. [PMID: 37862027 PMCID: PMC10599164 DOI: 10.1167/iovs.64.13.33] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023] Open
Abstract
Purpose Staphylococcus epidermidis, a commensal, has emerged as an important opportunistic pathogen, particularly methicillin-resistant S. epidermidis (MRSE). The mechanism behind this transformation remains unclear. This study aimed to investigate the molecular and phenotypic characteristics of MRSE isolated from healthy conjunctiva and ocular infections. Methods We collected MRSE isolates from two groups: healthy conjunctiva from patients undergoing cataract surgeries and ocular infections at our hospital. Genotypic analysis included pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), staphylococcal cassette chromosome mec (SCCmec), and biofilm-related genes (icaA, aap, and bhp). Additionally, phenotypic data on biofilm production and antibiotic susceptibility were recorded. Results A total of 86 isolates, including 42 from healthy conjunctiva and 44 from ocular infections, were analyzed. MLST identified 21 sequence types (STs), with ST59 being the most frequent (n = 33, 39.5%), followed by ST130 (n = 10, 11.6%), ST57 (n = 6, 7.0%), and ST2 (n = 6, 7.0%). All isolates were categorized in 23 PFGE types, and SCCmec IV was the most prevalent SCCmec type (n = 52, 60.5%). The two sources of isolates exhibited overlapping molecular types and phenotypic traits, although the ocular infection isolates exhibited significantly higher multidrug resistance compared to healthy conjunctiva isolates (P = 0.032). When contrasting ST59 with non-ST59, ST59 displayed a significantly higher presence of aap (100%) and bhp (69.7%) while lacking icaA (0%). ST59 also showed lower susceptibility to fluoroquinolones compared to non-ST59 (42.4%-54.5% vs. 75.5%-83.0%; P < 0.01). Conclusions MRSE isolates from healthy conjunctiva and ocular infections demonstrated a degree of resemblance. Specific strains, notably ST59, exhibited distinctive characterizations.
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Affiliation(s)
- Yin-Hsi Chang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - David H. K. Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chen LC, Hung KH, Tseng YJ, Wang HY, Lu TM, Huang WC, Tsao Y. Self-Supervised Learning-Based General Laboratory Progress Pretrained Model for Cardiovascular Event Detection. IEEE J Transl Eng Health Med 2023; 12:43-55. [PMID: 38059127 PMCID: PMC10697297 DOI: 10.1109/jtehm.2023.3307794] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Leveraging patient data through machine learning techniques in disease care offers a multitude of substantial benefits. Nonetheless, the inherent nature of patient data poses several challenges. Prevalent cases amass substantial longitudinal data owing to their patient volume and consistent follow-ups, however, longitudinal laboratory data are renowned for their irregularity, temporality, absenteeism, and sparsity; In contrast, recruitment for rare or specific cases is often constrained due to their limited patient size and episodic observations. This study employed self-supervised learning (SSL) to pretrain a generalized laboratory progress (GLP) model that captures the overall progression of six common laboratory markers in prevalent cardiovascular cases, with the intention of transferring this knowledge to aid in the detection of specific cardiovascular event. METHODS AND PROCEDURES GLP implemented a two-stage training approach, leveraging the information embedded within interpolated data and amplify the performance of SSL. After GLP pretraining, it is transferred for target vessel revascularization (TVR) detection. RESULTS The proposed two-stage training improved the performance of pure SSL, and the transferability of GLP exhibited distinctiveness. After GLP processing, the classification exhibited a notable enhancement, with averaged accuracy rising from 0.63 to 0.90. All evaluated metrics demonstrated substantial superiority ([Formula: see text]) compared to prior GLP processing. CONCLUSION Our study effectively engages in translational engineering by transferring patient progression of cardiovascular laboratory parameters from one patient group to another, transcending the limitations of data availability. The transferability of disease progression optimized the strategies of examinations and treatments, and improves patient prognosis while using commonly available laboratory parameters. The potential for expanding this approach to encompass other diseases holds great promise. CLINICAL IMPACT Our study effectively transposes patient progression from one cohort to another, surpassing the constraints of episodic observation. The transferability of disease progression contributed to cardiovascular event assessment.
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Affiliation(s)
- Li-Chin Chen
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
| | - Kuo-Hsuan Hung
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
| | - Yi-Ju Tseng
- Department of Computer ScienceNational Yang Ming Chiao Tung UniversityHsinchu30010Taiwan
| | - Hsin-Yao Wang
- Department of Laboratory MedicineLinkou Chang Gung Memorial HospitalTaoyuan City33342Taiwan
| | - Tse-Min Lu
- Division of CardiologyDepartment of Internal MedicineTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Health Care CenterTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Internal MedicineSchool of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipei112304Taiwan
| | - Wei-Chieh Huang
- Division of CardiologyDepartment of Internal MedicineTaipei Veterans General HospitalTaipei112201Taiwan
- Department of Internal MedicineSchool of Medicine, College of MedicineNational Yang Ming Chiao Tung UniversityTaipei112304Taiwan
- Department of Biomedical EngineeringNational Taiwan UniversityTaipei10617Taiwan
| | - Yu Tsao
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
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Liu YT, Kang EYC, Chen YL, Yeh LK, Ma DHK, Chen HC, Hung KH, Huang YC, Hsiao CH. Methicillin-Resistant Staphylococcus aureus Ocular Infection in Taiwan: Potential Role of Panton-Valentine Leukocidin Gene. Transl Vis Sci Technol 2023; 12:18. [PMID: 37067364 PMCID: PMC10120380 DOI: 10.1167/tvst.12.4.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Purpose The relationship between Panton-Valentine leucocidin (PVL), a major virulence factor of Staphylococcus aureus, and disease severity and clinical outcomes remains unclear. We investigated the molecular characteristics and role of the PVL gene in methicillin-resistant S. aureus (MRSA) ocular infection in Taiwan. Methods Patients with culture-proven S. aureus ocular infection in Chang Gung Memorial Hospital from 2010 to 2017 were included. The presence of the PVL gene was detected for all S. aureus isolates. MRSA isolates were characterized through pulsed-field gel electrophoresis (PFGE), staphylococcal multilocus sequence type, and staphylococcal cassette chromosome mec (SCCmec) typing. Drug susceptibility was examined using disk diffusion method and E-test. Patients' demographics, diagnoses, and outcomes were collected. Results There were 112 methicillin-sensitive S. aureus and 103 MRSA isolates. Among 50 PVL(+) S. aureus isolates, 43 were MRSA. CC59/PFGE type D/SCCmec IV, VT (38 of 43 isolates, 88%), and CC59/PFGE type C/SCCmec IV (27 of 60 isolates, 45%) were the predominant clones in the PVL(+) and PVL(-) MRSA isolates, respectively. When we compared the two CC59 strains, the patients with PVL(+)/CC59 MSRA infection were significantly younger than those with PVL(-)/CC59 MSRA (39.3 vs. 61.7 years; P = 0.001). PVL(+)/CC59 MSRA caused significantly more eyelid disorders (36.8% vs. 3.7%; P = 0.002) but less keratitis (23.7% vs. 51.9%; P = 0.034). The antibiograms of the two strains were similar. Conclusions PVL(+) MRSA is significantly associated with eyelid infection, especially in young patients. Translational Relevance PVL gene plays a role in clinical features of MRSA ocular infections.
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Affiliation(s)
- Ya-Tung Liu
- Department of General Medicine, Sengkang General Hospital, Singapore
| | | | - Yueh-Ling Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - David H K Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yhu-Chering Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Hsiung C, Liu YT, Su CY, Hsiung CC, Hung KH, Yeh LK. Production of Modified Autologous Conditioned Serum and Ex Vivo Assessment of Its Healing Potential in Murine Corneal Epithelium. J Vis Exp 2023. [PMID: 37036242 DOI: 10.3791/64911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Human blood-derived topical therapies have been a boon to clinicians in recent decades. Autologous serum (AS) and platelet-rich plasma (PRP) are enriched in epitheliotropic growth factors that are essential in corneal wound healing. Unlike AS, PRP is based on a differential centrifugation system, yielding more platelet-derived growth factors. Autologous conditioned serum (ACS) not only preserves the preparation of AS and PRP, but also focuses on immune-modulating properties, which are important in inflammatory diseases. The lack of standardized protocols and high preparation costs are limitations for the clinical application of ACS. This video experiment demonstrates a standard operating procedure for preparing modified autologous conditioned serum (mACS) eye drops. First, glycerol was added into heparin syringes as the blood cell stabilizer during hypoxic incubation. To activate the blood cells, a 4 h incubation at 37 °C was initiated. Then, the blood samples were centrifuged at 3,500 × g for 10 min at room temperature. After filtration of the supernatant through a 0.22 µm filter, the mACS eye drops were fully prepared. A tentative try-out of the therapeutic effect of mACS showed that it may have competitive advantages over conventional AS in the corneal wound healing in ex vivo mouse eyes. The AS used in this study was prepared according to published studies and the clinical practice in our hospital. Therefore, the efficacy of mACS on ocular surface diseases could be evaluated in future research through in vivo animal studies and clinical trials.
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Affiliation(s)
- Chun Hsiung
- Department of Education, Chang Gung Memorial Hospital Linkou; School of Medicine, Chang Gung University
| | - Yu-Ting Liu
- Department of Education, Chang Gung Memorial Hospital Linkou; School of Medicine, Chang Gung University
| | - Chen-Ying Su
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology
| | - Chung-Chuan Hsiung
- Cell Therapy Center, Tri-Service General Hospital; Department of General Surgery, Bo-Ai Clinic
| | - Kuo-Hsuan Hung
- School of Medicine, Chang Gung University; Department of Ophthalmology, Chang Gung Memorial Hospital Linkou; Institute of Clinical Medicine, National Yang Ming Chiao Tung University
| | - Lung-Kun Yeh
- School of Medicine, Chang Gung University; Department of Ophthalmology, Chang Gung Memorial Hospital Linkou;
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Hung KH, Kao YC, Tang YH, Chen YT, Wang CH, Wang YC, Lee OKS. Application of a deep learning system in glaucoma screening and further classification with colour fundus photographs: a case control study. BMC Ophthalmol 2022; 22:483. [PMID: 36510171 PMCID: PMC9743575 DOI: 10.1186/s12886-022-02730-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To verify efficacy of automatic screening and classification of glaucoma with deep learning system. METHODS A cross-sectional, retrospective study in a tertiary referral hospital. Patients with healthy optic disc, high-tension, or normal-tension glaucoma were enrolled. Complicated non-glaucomatous optic neuropathy was excluded. Colour and red-free fundus images were collected for development of DLS and comparison of their efficacy. The convolutional neural network with the pre-trained EfficientNet-b0 model was selected for machine learning. Glaucoma screening (Binary) and ternary classification with or without additional demographics (age, gender, high myopia) were evaluated, followed by creating confusion matrix and heatmaps. Area under receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and F1 score were viewed as main outcome measures. RESULTS Two hundred and twenty-two cases (421 eyes) were enrolled, with 1851 images in total (1207 normal and 644 glaucomatous disc). Train set and test set were comprised of 1539 and 312 images, respectively. If demographics were not provided, AUC, accuracy, precision, sensitivity, F1 score, and specificity of our deep learning system in eye-based glaucoma screening were 0.98, 0.91, 0.86, 0.86, 0.86, and 0.94 in test set. Same outcome measures in eye-based ternary classification without demographic data were 0.94, 0.87, 0.87, 0.87, 0.87, and 0.94 in our test set, respectively. Adding demographics has no significant impact on efficacy, but establishing a linkage between eyes and images is helpful for a better performance. Confusion matrix and heatmaps suggested that retinal lesions and quality of photographs could affect classification. Colour fundus images play a major role in glaucoma classification, compared to red-free fundus images. CONCLUSIONS Promising results with high AUC and specificity were shown in distinguishing normal optic nerve from glaucomatous fundus images and doing further classification.
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Affiliation(s)
- Kuo-Hsuan Hung
- grid.413801.f0000 0001 0711 0593Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No.5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan ,grid.145695.a0000 0004 1798 0922Chang-Gung University College of Medicine, No.259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan ,grid.260539.b0000 0001 2059 7017Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.201, Sec.2, Shih-Pai Rd. Peitou, R.O.C, Taipei, 112 Taiwan
| | - Yu-Ching Kao
- Muen Biomedical and Optoelectronics Technologies Inc., Taipei, Taiwan
| | - Yu-Hsuan Tang
- grid.260539.b0000 0001 2059 7017Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.201, Sec.2, Shih-Pai Rd. Peitou, R.O.C, Taipei, 112 Taiwan
| | - Yi-Ting Chen
- Muen Biomedical and Optoelectronics Technologies Inc., Taipei, Taiwan
| | - Chuen-Heng Wang
- Muen Biomedical and Optoelectronics Technologies Inc., Taipei, Taiwan
| | - Yu-Chen Wang
- Muen Biomedical and Optoelectronics Technologies Inc., Taipei, Taiwan
| | - Oscar Kuang-Sheng Lee
- grid.260539.b0000 0001 2059 7017Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.201, Sec.2, Shih-Pai Rd. Peitou, R.O.C, Taipei, 112 Taiwan ,grid.260539.b0000 0001 2059 7017Stem Cell Research Centre, National Yang Ming Chiao Tung University, Taipei, Taiwan ,grid.411508.90000 0004 0572 9415Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan
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Liu KC, Hung KH, Hsieh CY, Huang HY, Chan CT, Tsao Y. Deep-Learning-Based Signal Enhancement of Low-Resolution Accelerometer for Fall Detection Systems. IEEE Trans Cogn Dev Syst 2022. [DOI: 10.1109/tcds.2021.3116228] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kai-Chun Liu
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
| | - Kuo-Hsuan Hung
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
| | - Chia-Yeh Hsieh
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiang-Yun Huang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Tai Chan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu Tsao
- Research Center for Information Technology Innovation, Academia Sinica, Taipei, Taiwan
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Huang TE, Ou JH, Hung N, Yeh LK, Ma DHK, Tan HY, Chen HC, Hung KH, Fan YC, Sun PL, Hsiao CH. Fusarium Keratitis in Taiwan: Molecular Identification, Antifungal Susceptibilities, and Clinical Features. J Fungi (Basel) 2022; 8:jof8050476. [PMID: 35628732 PMCID: PMC9144221 DOI: 10.3390/jof8050476] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
We performed molecular identification and antifungal susceptibilities of pathogens and investigated clinical features of 43 culture-proven Fusarium keratitis cases from 2015–2020 in Taiwan. The pathogens were identified by sequencing of their internal transcribed spacer regions of ribosomal DNA and translation elongation factor 1α gene; their antifungal susceptibilities (to seven agents) were determined by broth microdilution method. We also collected clinical data to compare the drug susceptibilities and clinical features of Fusarium solani species complex (FSSC) isolates with those of other Fusarium species complexes (non-FSSC). The FSSC accounted for 76.7% pathogens, among which F. falciforme (32.6%) and F. keratoplasticum (27.9%) were the most common species. Among clinically used antifungal agents, amphotericin B registered the lowest minimal inhibitory concentration (MIC), and the new azoles efinaconazole, lanoconazole and luliconazole, demonstrated even lower MICs against Fusarium species. The MICs of natamycin, voriconazole, chlorhexidine, lanoconazole, and luliconazole were higher for the FSSC than the non-FSSC, but no significant differences were noted in clinical outcomes, including corneal perforation and final visual acuity. In Taiwan, the FSSC was the most common complex in Fusarium keratitis; its MICs for five tested antifungal agents were higher than those of non-FSSC, but the clinical outcomes did not differ significantly.
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Affiliation(s)
- Tsung-En Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Jie-Hao Ou
- Department of Plant Pathology, National Chung Hsing University, Taichung 402, Taiwan;
| | - Ning Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
| | - Yun-Chen Fan
- Department of Dermatology and Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
| | - Pei-Lun Sun
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Dermatology and Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan;
- Correspondence: (P.-L.S.); (C.-H.H.); Tel.: +886-3-328-1200 (C.-H.H.)
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (T.-E.H.); (N.H.); (L.-K.Y.); (D.H.-K.M.); (H.-Y.T.); (H.-C.C.); (K.-H.H.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: (P.-L.S.); (C.-H.H.); Tel.: +886-3-328-1200 (C.-H.H.)
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Hung KH, Lan YH, Lin JY, Kang EYC, Tan HY, Chen HC, Hsiao CH, Yeh LK. Potential Role and Significance of Ocular Demodicosis in Patients with Concomitant Refractory Herpetic Keratitis. Clin Ophthalmol 2021; 14:4469-4482. [PMID: 33380781 PMCID: PMC7767725 DOI: 10.2147/opth.s282059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/15/2020] [Accepted: 11/27/2020] [Indexed: 01/17/2023] Open
Abstract
Purpose To evaluate the role of Demodex infestation of the eyelids in patients with recurrent herpetic keratitis. Patients and Methods This is a retrospective and noncomparative case series. Twenty-seven patients with ocular demodicosis and recurrent herpetic keratitis under conventional treatments were enrolled. Demographic data and clinical photographs were collected. Ocular demodicosis was confirmed by eyelash examination under a microscope. Eyelid scrub was initiated in these patients after proving Demodex infestation. Response after treatment was reviewed. Results Herpetic keratitis was characterized by epithelial defect, including dendritic lesions (seven eyes, 25.9%), geographic ulcer (three eyes, 11.1%), and neurotrophic ulcer (two eyes, 7.4%), associated with stromal involvement in 12 cases. Six cases with stromal reactivation, including disciform keratitis (two eyes, 7.4%), immune ring (three eyes, 11.1%), and ghost vessel (one eye, 3.7%), presented no epithelial defect. Active anterior uveitis with keratic precipitates was found in 15 cases. Demodex blepharitis was diagnosed with cylindrical dandruff along their lashes in all patients. Other ocular findings include meibomian gland dysfunction (15 eyes, 55.6%), mal-aligned lashes (eight eyes, 29.6%), telangiectasia (14 eyes, 51.9%), conjunctivitis (18 eyes, 66.7%), and ocular rosacea (three eyes, 11.1%). Initial unstable clinical presentations showed deterioration of corneal melting into descemetocele, corneal perforation, recalcitrant stromal infiltration/uveitis, and uncontrollable IOP, despite antiherpetic medication. After treatment of Demodex blepharitis, infestation was under control, followed by subjective improvement of ocular symptoms and a stable clinical outcome. Conclusion Ocular demodicosis should be considered in patients with unstable recurrent herpetic keratitis. A prompt diagnosis and appropriate treatment may curb the progression of herpetic corneal infection.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei City 112, Taiwan
| | - Yu-Hsiang Lan
- Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Jui-Yen Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan.,Chang-Gung University, College of Medicine, Taoyuan 333, Taiwan
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Hung KH, Tan HY, Chen HC, Yeh LK. Clinical characteristics and topographic findings of corneal ectasia in patients with symptomatic Demodex blepharitis. Taiwan J Ophthalmol 2020; 11:146-155. [PMID: 34295620 PMCID: PMC8259524 DOI: 10.4103/tjo.tjo_45_20] [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] [Received: 05/09/2020] [Accepted: 07/09/2020] [Indexed: 12/04/2022] Open
Abstract
PURPOSE: The purpose of this study is to present characteristics and topographic findings of patients with corneal ectasia and symptomatic ocular demodicosis. MATERIALS AND METHODS: A retrospective, noncomparative study. Twenty-one patients with symptomatic ocular demodicosis and corneal ectasia since 2017 to 2019 were enrolled. Patients with dry eye syndrome and meibomian gland dysfunction were identified and treated. Demographic data, topography, and clinical data were collected. All patients underwent lash sampling to confirm Demodex mite infestation by direct visualization under the microscope. RESULTS: Twenty-one ectasia patients (36 eyes) were enrolled with male preponderance (M:F =18:3). Mean age (years) was 28.6 ± 8.12. Of the 21 cases reviewed, the average number of topography taken was 6.8 within 43.8 months of follow-up. Corneal ectasia was characterized by focal thinning area beside central cornea, with corresponding mean thickness of 487.1 μm and 518 μm, respectively. All ectasia patients were combined with Demodex blepharitis and associated symptoms, proven by direct microscopic examination. After treatment with eyelid cleanser (OCuSOFT® Lid Scrub® PLUS), warm compress, and improved daily hygiene, ocular demodicosis and topographic changes were controlled and even reversed. CONCLUSION: Our results indicated that ocular demodicosis may be potentially associated with corneal ectasia. Demodex blepharitis still remains an overlooked differential diagnosis in clinic; however, it may be one of the risk factors triggering eye rubbing. Comorbidity of lid infestation with eye rubbing may lead to corneal ectasia, even in elder patients with thick cornea. Therefore, meticulous examination and intensive treatment were highly recommended in this group of patients.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou.,College of Medicine, Chang-Gung University, Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou.,College of Medicine, Chang-Gung University, Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou.,College of Medicine, Chang-Gung University, Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou.,College of Medicine, Chang-Gung University, Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan
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11
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Chang MC, Kuo YJ, Hung KH, Peng CL, Chen KY, Yeh LK. Liposomal dexamethasone-moxifloxacin nanoparticle combinations with collagen/gelatin/alginate hydrogel for corneal infection treatment and wound healing. ACTA ACUST UNITED AC 2020; 15:055022. [PMID: 32434164 DOI: 10.1088/1748-605x/ab9510] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Infectious keratitis is still one of the major causes of visual impairment and blindness, often affecting developing countries. Eye-drop therapy to reduce disease progression is the first line of treatment for infectious keratitis. The current limitations in controlling ophthalmic infections include rapid precorneal drug loss and the inability to provide long-term extraocular drug delivery. The aim of the present study was to develop a novel ophthalmic formulation to treat corneal infection. The formulation was prepared by constructing moxifloxacin (MFX) and dexamethasone (DEX)-loaded nanostructured lipid carriers (Lipo-MFX/DEX) mixed with a collagen/gelatin/alginate (CGA) biodegradable material (CGA-Lipo-MFX/DEX) for prolonged ocular application. The characteristics of the prepared Lipo-MFX/DEX nanoparticles were as follows: average size, 132.1 ± 73.58 nm; zeta potential, -6.27 ± 4.95 mV; entrapment efficiency, 91.5 ± 3.5%; drug content, 18.1 ± 1.7%. Our results indicated that CGA-Lipo-MFX/DEX could release an effective working concentration in 60 min and sustain the drug release for at least 12 h. CGA-Lipo-MFX/DEX did not produce significant toxicities, but it increased cell numbers when co-cultured with ocular epithelial cells. An animal study also confirmed that CGA-Lipo-MFX/DEX could inhibit pathogen microorganism growth and improve corneal wound healing. Our results suggest that CGA-Lipo-MFX/DEX could be a useful anti-inflammatory formulation for ophthalmological disease treatment.
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Affiliation(s)
- Ming-Cheng Chang
- Isotope Application Division, Institute of Nuclear Energy Research, P.O. Box 3-27, Longtan, Taoyuan 325, Taiwan
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12
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Hung KH, Yeh LK. Clinical appearance and pathological findings of conjunctival myxoma: Case report and literature review. Am J Ophthalmol Case Rep 2020; 19:100860. [PMID: 32803020 PMCID: PMC7419321 DOI: 10.1016/j.ajoc.2020.100860] [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: 07/22/2019] [Revised: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To describe a case with a growing erythematous conjunctival mass in the left eye, diagnosed as conjunctival myxoma. Observations A 31-year-old lady had corrected visual acuity of 6/7.5 and normal intraocular pressure in both eyes. Congested left bulbar conjunctiva with one slightly elevated nodule at nasal area was noted for one year. Excisional biopsy was performed after failed treatment with topical eye drops. Pathology showed conjunctival myxoma with spindle- and stellate-shaped cells, which was a rare ocular surface neoplasia. There was no combined systemic disease found. Conclusions and importance We described the clinical and pathological features of conjunctival myxoma. Systemic evaluation should be considered before and after surgical excision.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taiwan.,Chang Gung University, College of Medicine, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taiwan.,Chang Gung University, College of Medicine, Taiwan
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13
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Liu CH, Raj S, Chen CH, Hung KH, Chou CT, Chen IH, Chien JT, Lin IY, Yang SY, Angata T, Tsai WC, Wei JCC, Tzeng IS, Hung SC, Lin KI. HLA-B27-mediated activation of TNAP phosphatase promotes pathogenic syndesmophyte formation in ankylosing spondylitis. J Clin Invest 2020; 129:5357-5373. [PMID: 31682238 DOI: 10.1172/jci125212] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 10/01/2018] [Accepted: 09/03/2019] [Indexed: 12/31/2022] Open
Abstract
Ankylosing spondylitis (AS) is a type of axial inflammation. Over time, some patients develop spinal ankylosis and permanent disability; however, current treatment strategies cannot arrest syndesmophyte formation completely. Here, we used mesenchymal stem cells (MSCs) from AS patients (AS MSCs) within the enthesis involved in spinal ankylosis to delineate that the HLA-B27-mediated spliced X-box-binding protein 1 (sXBP1)/retinoic acid receptor-β (RARB)/tissue-nonspecific alkaline phosphatase (TNAP) axis accelerated the mineralization of AS MSCs, which was independent of Runt-related transcription factor 2 (Runx2). An animal model mimicking AS pathological bony appositions was established by implantation of AS MSCs into the lumbar spine of NOD-SCID mice. We found that TNAP inhibitors, including levamisole and pamidronate, inhibited AS MSC mineralization in vitro and blocked bony appositions in vivo. Furthermore, we demonstrated that the serum bone-specific TNAP (BAP) level was a potential prognostic biomarker to predict AS patients with a high risk for radiographic progression. Our study highlights the importance of the HLA-B27-mediated activation of the sXBP1/RARB/TNAP axis in AS syndesmophyte pathogenesis and provides a new strategy for the diagnosis and prevention of radiographic progression of AS.
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Affiliation(s)
- Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan.,PhD Program in Translational Medicine, Kaohsiung Medical University and Academia Sinica, Taipei, Taiwan.,Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Sengupta Raj
- Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, United Kingdom
| | - Chun-Hsiung Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kuo-Hsuan Hung
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Chung-Tei Chou
- National Yang-Ming University, Taipei, Taiwan.,Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ing-Ho Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jui-Teng Chien
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Orthopedics, Chiayi Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - I-Ying Lin
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Shii-Yi Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Takashi Angata
- Institute of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Wen-Chan Tsai
- Division of Rheumatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University and Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shih-Chieh Hung
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Integrative Stem Cell Center, Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.,Institute of New Drug Development, New Drug Development Center, China Medical University, Taichung, Taiwan
| | - Kuo-I Lin
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
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14
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Hung KH, Hsiao CH, Tan HY, Chen HC, Ma DHK, Lin HC, Yeh LK. Clinical demographics of pterygium excision and prevalence of conjunctival intraepithelial neoplasia: a 15-year review. Int Ophthalmol 2020; 40:1781-1788. [PMID: 32198608 DOI: 10.1007/s10792-020-01347-y] [Citation(s) in RCA: 4] [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: 12/27/2019] [Accepted: 03/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To find clinical demographics of pterygium surgery and prevalence of conjunctival intraepithelial neoplasia (CIN) in pterygium specimen. METHODS This is a retrospective, institutional study. The records of patients who had received pterygium excision from 2000 to 2014 were reviewed. Patients after complete ophthalmic "examinations", surgical procedures, and pathological reports were enrolled. Surgical procedures, pathology, external eye photography, prevalence of CIN in specimen, and demographic data were described. RESULTS Of 1787 pterygium cases, 928 were male and 859 were female. The mean age was 65.19 ± 14.21 years. Of these 1787 cases, 1435 (80.3%) cases had primary pterygium excision, while the others (n = 352; 19.7%) had pterygium excision for recurrence. Four cases presented CIN within pterygium tissue (0.22%). The mean age of pterygium patients with CIN was 57.75 ± 7.80 years. In stratified data, our patients who received primary and secondary pterygium excision were found prevalent in the eighth (28.2%) and seventh (26.1%) decade, respectively. Twelve percent of patients who underwent secondary pterygium excision had a recurrence and required another surgery. Patients requiring amniotic membrane transplantation (AMT) during primary pterygium excision were significantly younger (median, 58 years) than those (median, 67 years) without the assistance of AMT (p < 0.001). Similarly, AMT was utilized in younger patients (median, 56 years) during secondary pterygium excision, compared to those without AMT (median, 64 years) (p = 0.001). CONCLUSION CIN combined with pterygium is very rare. However, the possibility of the development of ocular surface squamous neoplasia in pterygium tissue should not be ignored. Meticulous pathological investigation of the surgical samples is important.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - Hsin-Chiung Lin
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao Yuan Hsien, Taiwan, ROC.
- Chang-Gung University College of Medicine, No. 259 Wen-Hwa 1st Road, Kuei Shan Hsiang, Tao Yuan Hsien, 333, Taiwan, ROC.
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Tsai DY, Hung KH, Chang CW, Lin KI. Regulatory mechanisms of B cell responses and the implication in B cell-related diseases. J Biomed Sci 2019; 26:64. [PMID: 31472685 PMCID: PMC6717636 DOI: 10.1186/s12929-019-0558-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 06/13/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Terminally differentiated B cell, the plasma cell, is the sole cell type capable of producing antibodies in our body. Over the past 30 years, the identification of many key molecules controlling B cell activation and differentiation has elucidated the molecular pathways for generating antibody-producing plasma cells. Several types of regulation modulating the functions of the important key molecules in B cell activation and differentiation add other layers of complexity in shaping B cell responses following antigen exposure in the absence or presence of T cell help. Further understanding of the mechanisms contributing to the proper activation and differentiation of B cells into antibody-secreting plasma cells may enable us to develop new strategies for managing antibody humoral responses during health and disease. Herein, we reviewed the effect of different types of regulation, including transcriptional regulation, post-transcriptional regulation and epigenetic regulation, on B cell activation, and on mounting memory B cell and antibody responses. We also discussed the link between the dysregulation of the abovementioned regulatory mechanisms and B cell-related disorders.
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Affiliation(s)
- Dong-Yan Tsai
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sec. 2, Nankang Dist, Taipei, 115, Taiwan
| | - Kuo-Hsuan Hung
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sec. 2, Nankang Dist, Taipei, 115, Taiwan
| | - Chia-Wei Chang
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sec. 2, Nankang Dist, Taipei, 115, Taiwan.,Graduate Institute of Immunology, College of Medicine, National Taiwan University, Taipei, 110, Taiwan
| | - Kuo-I Lin
- Genomics Research Center, Academia Sinica, 128 Academia Road, Sec. 2, Nankang Dist, Taipei, 115, Taiwan. .,Graduate Institute of Immunology, College of Medicine, National Taiwan University, Taipei, 110, Taiwan.
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16
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Wang YH, Tsai DY, Ko YA, Yang TT, Lin IY, Hung KH, Lin KI. Blimp-1 Contributes to the Development and Function of Regulatory B Cells. Front Immunol 2019; 10:1909. [PMID: 31474988 PMCID: PMC6702260 DOI: 10.3389/fimmu.2019.01909] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 03/29/2019] [Accepted: 07/29/2019] [Indexed: 01/09/2023] Open
Abstract
Regulatory B cells (Bregs) are a B cell subset that plays a suppressive role in immune responses. The CD19+CD1dhiCD5+ Bregs that can execute regulatory functions via secreting IL-10 are defined as B10 cells. Bregs suppress autoimmune and inflammatory diseases, whereas they exacerbate infectious diseases caused by bacteria, viruses, or parasites. Notably, the molecular mechanisms regulating the development and functions of Bregs are still largely unknown. Furthermore, the biological impact of Bregs in fungal infection has not yet been demonstrated. Here, we compared the gene expression profiles of IL-10-producing and -non-producing mouse splenic B cells stimulated with lipopolysaccharide (LPS) or anti-CD40 antibody. Blimp-1, a transcription factor known to be critical for plasma cell differentiation, was found to be enriched in the IL-10-producing B cells. The frequency of Blimp-1+ B10 cells was increased in LPS-treated mice and in isolated B10 cells that were stimulated with LPS. Surprisingly, B cell-specific Blimp-1 knockout (Cko) mice, generated by CD19 promoter driven Cre recombinase-dependent deletion of Prdm1 (gene encoding Blimp-1), showed higher frequencies of B10 cells both in the steady state and following injection with LPS, as compared with control littermates. However, B10 cells lacking Blimp-1 failed to efficiently suppress the proliferation of naïve CD4+ T cells primed with anti-CD3 and anti-CD28 antibodies. B10 cells can be stimulated for further differentiation into plasmablasts, and a subset of plasmablasts express IL-10. We found that B10 cells from Cko mice failed to generate both IL-10-non-producing and IL-10-producing plasmablasts. Mechanistically, we found that Blimp-1 can directly suppress Il-10, whereas, in the presence of activated STAT3, Blimp-1 works together with activated STAT3 to upregulate Il-10. Moreover, we also found that B10 cells improve the clearance of Candida albicans infection but worsen the infection mortality. Notably, a lack of Blimp-1 in B10 cells did not change these effects of adoptively transferred B10 cells on fungal infections. Together, our data show that Blimp-1 regulates the generation, differentiation, and IL-10 production of Bregs.
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Affiliation(s)
- Ying-Hsiu Wang
- National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan.,Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Dong-Yan Tsai
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yi-An Ko
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Tsan-Tzu Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan.,Graduate Institute of Immunology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Ying Lin
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Kuo-Hsuan Hung
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Kuo-I Lin
- National Defense Medical Center, Graduate Institute of Life Sciences, Taipei, Taiwan.,Genomics Research Center, Academia Sinica, Taipei, Taiwan.,Graduate Institute of Immunology, College of Medicine, National Taiwan University, Taipei, Taiwan
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17
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Hung KH, Woo YH, Lin IY, Liu CH, Wang LC, Chen HY, Chiang BL, Lin KI. The KDM4A/KDM4C/NF-κB and WDR5 epigenetic cascade regulates the activation of B cells. Nucleic Acids Res 2019; 46:5547-5560. [PMID: 29718303 PMCID: PMC6009645 DOI: 10.1093/nar/gky281] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
T follicular helper (Tfh) cell-derived signals promote activation and proliferation of antigen-primed B cells. It remains unclear whether epigenetic regulation is involved in the B cell responses to Tfh cell-derived signals. Here, we demonstrate that Tfh cell-mimicking signals induce the expression of histone demethylases KDM4A and KDM4C, and the concomitant global down-regulation of their substrates, H3K9me3/me2, in B cells. Depletion of KDM4A and KDM4C potentiates B cell activation and proliferation in response to Tfh cell-derived signals. ChIP-seq and de novo motif analysis reveals NF-κB p65 as a binding partner of KDM4A and KDM4C. Their co-targeting to Wdr5, a MLL complex member promoting H3K4 methylation, up-regulates cell cycle inhibitors Cdkn2c and Cdkn3. Thus, Tfh cell-derived signals trigger KDM4A/KDM4C - WDR5 - Cdkn2c/Cdkn3 cascade in vitro, an epigenetic mechanism regulating proper proliferation of activated B cells. This pathway is dysregulated in B cells from systemic lupus erythematosus patients and may represent a pathological link.
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Affiliation(s)
- Kuo-Hsuan Hung
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Yong H Woo
- Division of Biological Sciences, King Abdullah University of Science and Technology, Thuwal 23955, Saudi Arabia
| | - I-Ying Lin
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Chin-Hsiu Liu
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan.,PhD Program in Translational Medicine, Kaohsiung Medical University and Academia Sinica, Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
| | - Li-Chieh Wang
- Department of Pediatrics, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hsin-Yu Chen
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, Taipei 100, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Kuo-I Lin
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
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18
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Hung KH, Wu YF, Lin KI. Transcription factor Blimp-1 regulates sebocyte homeostasis and cytokine production. The Journal of Immunology 2019. [DOI: 10.4049/jimmunol.202.supp.185.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
Blimp-1, encoded by Prdm1, is a master transcriptional factor that governs the differentiation fate of many cell types, including epidermal keratinocytes. Previous results from our laboratory showed that inducible deletion of Prdm1 in mouse epidermis spontaneously induces skin inflammation. Epidermis composes of not only epidermal keratinocytes, but also epidermal appendages, including hair follicles, sebaceous glands and sweat glands. Sebaceous glands release the “oil” contents that lubricate the skin. Our previous results also showed that Blimp-1 is required for the maintenance of the homeostasis of terminally differentiated sebocytes. Here, we aim to investigate the potential function of Blimp-1 in inflammation and lipid metabolism in sebocytes. We depleted Blimp-1 by siRNA in SZ95, the immortalized human sebocyte cells. We found accumulated and enlarged lipid droplets in Blimp-1 depleted cells. Consistently, gas chromatography–mass spectrometry (GC-MS) analyses showed that the levels of several long-chain fatty acids, including 1,3-dipalmitoyl-2oleoylglycerol, 1-palmitoyl-2oleoyl-3-lineoleoyl-rac-glycerol, and triolein, were accumulated in Blimp-1-depleted SZ95 cells, linking with the significant increases in the production of pro-inflammatory cytokines, including IL-1β, IL-6, IL-8 and IL-18. Thus, Blimp-1 served as a pivotal mediator in the regulation of the inflammatory responses in epidermis, likely also through affecting the lipid metabolism and cytokine production in sebocytes.
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Affiliation(s)
- Kuo-Hsuan Hung
- 1Genomics Research Center, Academia Sinica, Taipei, Taiwan, Taiwan
| | - Yen-Fei Wu
- 1Genomics Research Center, Academia Sinica, Taipei, Taiwan, Taiwan
| | - Kuo-I Lin
- 1Genomics Research Center, Academia Sinica, Taipei, Taiwan, Taiwan
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19
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Peng CH, Chuang JH, Wang ML, Jhan YY, Chien KH, Chung YC, Hung KH, Chang CC, Lee CK, Tseng WL, Hwang DK, Hsu CH, Lin TC, Chiou SH, Chen SJ. Laminin modification subretinal bio-scaffold remodels retinal pigment epithelium-driven microenvironment in vitro and in vivo. Oncotarget 2018; 7:64631-64648. [PMID: 27564261 PMCID: PMC5323104 DOI: 10.18632/oncotarget.11502] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 05/13/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022] Open
Abstract
Advanced age-related macular degeneration (AMD) may lead to geographic atrophy or fibrovascular scar at macular, dysfunctional retinal microenvironment, and cause profound visual loss. Recent clinical trials have implied the potential application of pluripotent cell-differentiated retinal pigment epithelial cells (dRPEs) and membranous scaffolds implantation in repairing the degenerated retina in AMD. However, the efficacy of implanted membrane in immobilization and supporting the viability and functions of dRPEs, as well as maintaining the retinal microenvironment is still unclear. Herein we generated a biomimetic scaffold mimicking subretinal Bruch's basement from plasma modified polydimethylsiloxane (PDMS) sheet with laminin coating (PDMS-PmL), and investigated its potential functions to provide a subretinal environment for dRPE-monolayer grown on it. Firstly, compared to non-modified PDMS, PDMS-PmL enhanced the attachment, proliferation, polarization, and maturation of dRPEs. Second, PDMS-PmL increased the polarized tight junction, PEDF secretion, melanosome pigment deposit, and phagocytotic-ability of dRPEs. Third, PDMS-PmL was able to carry a dRPEs/photoreceptor-precursors multilayer retina tissue. Finally, the in vivo subretinal implantation of PDMS-PmL in porcine eyes showed well-biocompatibility up to 2-year follow-up. Notably, multifocal ERGs at 2-year follow-up revealed well preservation of macular function in PDMS-PmL, but not PDMS, transplanted porcine eyes. Trophic PEDF secretion of macular retina in PDMS-PmL group was also maintained to preserve retinal microenvironment in PDMS-PmL eyes at 2 year. Taken together, these data indicated that PDMS-PmL is able to sustain the physiological morphology and functions of polarized RPE monolayer, suggesting its potential of rescuing macular degeneration in vivo.
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Affiliation(s)
- Chi-Hsien Peng
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital & Fu-Jen Catholic University, Taipei Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Hua Chuang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Mong-Lien Wang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yong-Yu Jhan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital & National Defense Medical Center, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chien Chung
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Hsuan Hung
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Ching Chang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taipei, Taiwan
| | - Chao-Kuei Lee
- Department of Photonics, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Wei-Lien Tseng
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hwa Chiou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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20
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Wu JL, Chiang MF, Hsu PH, Tsai DY, Hung KH, Wang YH, Angata T, Lin KI. O-GlcNAcylation is required for B cell homeostasis and antibody responses. Nat Commun 2017; 8:1854. [PMID: 29187734 PMCID: PMC5707376 DOI: 10.1038/s41467-017-01677-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 10/06/2017] [Indexed: 01/10/2023] Open
Abstract
O-linked N-acetylglucosamine (O-GlcNAc) transferase (Ogt) catalyzes O-GlcNAc modification. O-GlcNAcylation is increased after cross-linking of the B-cell receptor (BCR), but the physiological function of this reaction is unknown. Here we show that lack of Ogt in B-cell development not only causes severe defects in the activation of BCR signaling, but also perturbs B-cell homeostasis by enhancing apoptosis of mature B cells, partly as a result of impaired response to B-cell activating factor. O-GlcNAcylation of Lyn at serine 19 is crucial for efficient Lyn activation and Syk interaction in BCR-mediated B-cell activation and expansion. Ogt deficiency in germinal center (GC) B cells also results in enhanced apoptosis of GC B cells and memory B cells in an immune response, consequently causing a reduction of antibody levels. Together, these results demonstrate that B cells rely on O-GlcNAcylation to maintain homeostasis, transduce BCR-mediated activation signals and activate humoral immunity. Post-translational modification has a variety of regulatory functions for important immune molecules. Here the authors use B-cell specific knockout mice to show how O-GlcNAcylation is required for functional B cell responses and humoral immunity.
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Affiliation(s)
- Jung-Lin Wu
- Genomics Research Center, Academia Sinica, No. 128, Section 2, Academia Road, Nankang District, Taipei, 115, Taiwan
| | - Ming-Feng Chiang
- Genomics Research Center, Academia Sinica, No. 128, Section 2, Academia Road, Nankang District, Taipei, 115, Taiwan
| | - Pan-Hung Hsu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University, No. 2, Beining Road, Jhongjheng District, Keelung, 202, Taiwan
| | - Dong-Yen Tsai
- Genomics Research Center, Academia Sinica, No. 128, Section 2, Academia Road, Nankang District, Taipei, 115, Taiwan.,Institute of Biochemistry and Molecular Biology, National Yang-Ming University, No. 155, Section 2, Linong Street, Beitou District, Taipei, 112, Taiwan
| | - Kuo-Hsuan Hung
- Genomics Research Center, Academia Sinica, No. 128, Section 2, Academia Road, Nankang District, Taipei, 115, Taiwan
| | - Ying-Hsiu Wang
- Genomics Research Center, Academia Sinica, No. 128, Section 2, Academia Road, Nankang District, Taipei, 115, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, Minquan East Road, Neihu District, Taipei, 114, Taiwan
| | - Takashi Angata
- Institute of Biological Chemistry, Academia Sinica, No. 128, Section 2, Academia Road, Nankang District, Taipei, 115, Taiwan.
| | - Kuo-I Lin
- Genomics Research Center, Academia Sinica, No. 128, Section 2, Academia Road, Nankang District, Taipei, 115, Taiwan.
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21
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Lai PL, Lin H, Chen SF, Yang SC, Hung KH, Chang CF, Chang HY, Lu FL, Lee YH, Liu YC, Huang HC, Lu J. Efficient Generation of Chemically Induced Mesenchymal Stem Cells from Human Dermal Fibroblasts. Sci Rep 2017; 7:44534. [PMID: 28303927 PMCID: PMC5356011 DOI: 10.1038/srep44534] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
Human mesenchymal stromal/stem cells (MSCs) are multipotent and currently undergoing hundreds of clinical trials for disease treatments. To date, no studies have generated induced MSCs from skin fibroblasts with chemicals or growth factors. Here, we established the first chemical method to convert primary human dermal fibroblasts into multipotent, induced MSC-like cells (iMSCs). The conversion method uses a defined cocktail of small molecules and growth factors, and it can achieve efficient conversion with an average rate of 38% in 6 days. The iMSCs have much higher clonogenicity than fibroblasts, and they can be maintained and expanded in regular MSC medium for at least 8 passages and further differentiated into osteoblasts, adipocytes, and chondrocytes. Moreover, the iMSCs can suppress LPS-mediated acute lung injury as effectively as bone marrow-derived mesenchymal stem cells. This finding may greatly benefit stem cell biology, cell therapy, and regenerative medicine.
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Affiliation(s)
- Pei-Lun Lai
- Genome and Systems Biology Degree Program, College of Life Science, National Taiwan University, Taipei, Taiwan.,Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hsuan Lin
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
| | - Shang-Fu Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan.,Institute of Molecular and Cellular Biology and Department of Life Science, College of Life Science, National Taiwan University, Taipei, Taiwan
| | | | - Kuo-Hsuan Hung
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | | | - Hsiang-Yi Chang
- Genome and Systems Biology Degree Program, College of Life Science, National Taiwan University, Taipei, Taiwan
| | - Frank Leigh Lu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University Medical College, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yu-Chuan Liu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hsiao-Chun Huang
- Genome and Systems Biology Degree Program, College of Life Science, National Taiwan University, Taipei, Taiwan.,Institute of Molecular and Cellular Biology and Department of Life Science, College of Life Science, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Electronics Engineering, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan
| | - Jean Lu
- Genome and Systems Biology Degree Program, College of Life Science, National Taiwan University, Taipei, Taiwan.,Genomics Research Center, Academia Sinica, Taipei, Taiwan.,National RNAi Platform/National Core Facility Program for Biotechnology, Taipei, Taiwan.,Department of Life Science, Tzu Chi University, Hualien, Taiwan
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22
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Tsai DY, Hung KH, Lin IY, Su ST, Wu SY, Chung CH, Wang TC, Li WH, Shih ACC, Lin KI. Uncovering MicroRNA Regulatory Hubs that Modulate Plasma Cell Differentiation. Sci Rep 2015; 5:17957. [PMID: 26655851 PMCID: PMC4675970 DOI: 10.1038/srep17957] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 11/09/2015] [Indexed: 01/08/2023] Open
Abstract
Using genome-wide approaches, we studied the microRNA (miRNA) expression profile during human plasma cell (PC) differentiation induced by stimulation of human blood B cells with T follicular helper cell–dependent signals. Combining the profiles of differentially expressed genes in PC differentiation with gene ontology (GO) analysis revealed that a significant group of genes involved in the transcription factor (TF) activity was preferentially changed. We thus focused on studying the effects of differentially expressed miRNAs on several key TFs in PC differentiation. Cohorts of differentially expressed miRNAs cooperating as miRNA hubs were predicted and validated to modulate key TFs, including a down-regulated miRNA hub containing miR-101-3p, -125b-5p, and -223-3p contributing to induction of PRDM1 as well as an up-regulated miRNA hub containing miR-34a-5p, -148a-3p, and -183-5p suppressing BCL6, BACH2, and FOXP1. Induced expression of NF-κB and PRDM1 during PC differentiation controlled the expression of up- and down-regulated miRNA hubs, respectively. Co-expression of miR-101-3p, -125b-5p, and -223-3p in stimulated B cells showed synergistic effects on inhibition of PC formation, which can be rescued by re-introduction of PRDM1. Together, we catalogue the complex roadmap of miRNAs and their functional interplay in collaboratively directing PC differentiation.
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Affiliation(s)
- Dong-Yan Tsai
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan.,Institute of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei 112, Taiwan
| | - Kuo-Hsuan Hung
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan.,Institute of Microbiology and Immunology, National Yang-Ming University, Taipei 112, Taiwan
| | - I-Ying Lin
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Shin-Tang Su
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Shih-Ying Wu
- Institute of Information Science, Academia Sinica, Taipei 115, Taiwan
| | - Cheng-Han Chung
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Tong-Cheng Wang
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan.,Biodiversity Research Center, Academia Sinica, Taipei 115, Taiwan
| | - Wen-Hsiung Li
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan.,Biodiversity Research Center, Academia Sinica, Taipei 115, Taiwan
| | | | - Kuo-I Lin
- Genomics Research Center, Academia Sinica, Taipei 115, Taiwan.,Institute of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei 112, Taiwan
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23
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Lin TC, Hung KH, Peng CH, Liu JH, Woung LC, Tsai CY, Chen SJ, Chen YT, Hsu CC. Nanotechnology-based drug delivery treatments and specific targeting therapy for age-related macular degeneration. J Chin Med Assoc 2015; 78:635-41. [PMID: 26383186 DOI: 10.1016/j.jcma.2015.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/30/2015] [Indexed: 11/18/2022] Open
Abstract
Nanoparticles combined with cells, drugs, and specially designed genes provide improved therapeutic efficacy in studies and clinical setting, demonstrating a new era of treatment strategy, especially in retinal diseases. Nanotechnology-based drugs can provide an essential platform for sustaining, releasing and a specific targeting design to treat retinal diseases. Poly-lactic-co-glycolic acid is the most widely used biocompatible and biodegradable polymer approved by the Food and Drug Administration. Many studies have attempted to develop special devices for delivering small-molecule drugs, proteins, and other macromolecules consistently and slowly. In this article, we first review current progress in the treatment of age-related macular degeneration. Then, we discuss the function of vascular endothelial growth factor (VEGF) and the pharmacological effects of anti-VEGF-A antibodies and soluble or modified VEGF receptors. Lastly, we summarize the combination of antiangiogenic therapy and nanomedicines, and review current potential targeting therapy in age-related macular degeneration.
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Affiliation(s)
- Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuo-Hsuan Hung
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
| | - Chi-Hsien Peng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital & Fu-Jen Catholic University, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Jorn-Hon Liu
- Department of Ophthalmology, Cheng-Hsin Hospital, Taipei, Taiwan, ROC
| | - Lin-Chung Woung
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Ching-Yao Tsai
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yan-Ting Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan, ROC; Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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Abstract
Degenerative retinal diseases may lead to significant loss of vision. Age-related macular degeneration (AMD) and retinitis pigmentosa (RP), which eventually affect the photoreceptors, are the two most common retinal degenerative diseases. Once the photoreceptorcells are lost, there are no known effective therapies for AMD or RP. The concept of retinal prosthesis is to elicit neural activity in the remaining retinal neurons by detecting light and converting it into electrical stimuli using artificial devices. Subretinal, epiretinal, and other retinal prostheses implants are currently designed to restore functional vision in retinal degenerative diseases. In this review, we have summarized different types of retinal prostheses, implant locations, and visual outcomes. Our discussions will further elucidate the results from clinical trials, and the challenges that will need to be overcome to more efficaciously assist patients with AMD and RP in the future.
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Affiliation(s)
- Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hua-Ming Chang
- Department of Optics and Photonics, National Central University, Taoyuan, Taiwan, ROC; Bade Veterans Home, Taoyuan, Taiwan, ROC
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuo-Hsuan Hung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
| | - Yan-Ting Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan, ROC; Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Szu-Yu Chen
- Department of Optics and Photonics, National Central University, Taoyuan, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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25
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Hung KH, Cheng CY, Liu CJL. Risk factors for predicting visual field progression in Chinese patients with primary open-angle glaucoma: A retrospective study. J Chin Med Assoc 2015; 78:418-23. [PMID: 25819708 DOI: 10.1016/j.jcma.2015.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/14/2014] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Glaucoma is a leading cause of irreversible blindness worldwide. It is characterized by progressive deterioration of the visual field (VF) that results in a complete loss of vision. This study aimed to determine the risk factors associated with VF progression in Chinese patients with primary open-angle glaucoma (POAG). METHODS We reviewed the charts of POAG patients who visited our clinic between July 2009 and June 2010. We included patients with five or more reliable VF tests using the Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA, USA) during a period of at least 2 years. The scoring system of the Collaborative Initial Glaucoma Treatment Study (CIGTS) was used to code the VF. Progression was defined as an increasing score ≥3, compared to the averaged baseline data. Univariate and multivariate logistic regression analyses were performed to identify the risk factors of VF progression. RESULTS There were 92 patients (representing 92 eyes) with an average of 8.9 reliable VFs over a mean follow up of 5.4 years. Multivariate logistic regression showed that eyes with more VF tests [odds ratio (OR) = 1.500, p < 0.010] and either increased peak intraocular pressure (IOP) (OR = 1.235, p = 0.044) or a wide IOP range (OR = 1.165, p = 0.041) favored VF progression. High myopia (less than -6.0 D) was not a risk factor (OR = 1.289, p = 0.698) for VF progression in this study. CONCLUSION In addition to a greater number of VF tests, Chinese patients with treated POAG who experienced a high peak IOP or a wide range of IOP during follow up were more likely to have VF deterioration.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ching-Yu Cheng
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine and Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Catherine Jui-Ling Liu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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Hsu CC, Chang HM, Lin TC, Hung KH, Chien KH, Chen SY, Chen SN, Chen YT. Corneal neovascularization and contemporary antiangiogenic therapeutics. J Chin Med Assoc 2015; 78:323-30. [PMID: 25687646 DOI: 10.1016/j.jcma.2014.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022] Open
Abstract
Corneal neovascularization (NV), the excessive ingrowth of blood vessels from conjunctiva into the cornea, is a common sequela of disease insult that can lead to visual impairment. Clinically, topical steroid, argon laser photocoagulation, and subconjunctival injection of bevacizumab have been used to treat corneal NV. Sometimes, the therapies are ineffective, especially when the vessels are large. Large vessels are difficult to occlude and easily recanalized. Scientists and physicians are now dedicated to overcoming this problem. In this article, we briefly introduce the pathogenesis of corneal NV, and then highlight the existing animal models used in corneal NV research-the alkali-induced model and the suture-induced model. Most of all, we review the potential therapeutic targets (i.e., vascular endothelial growth factor and platelet-derived growth factor) and their corresponding inhibitors, as well as the immunosuppressants that have been discovered in recent years by corneal NV studies.
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Affiliation(s)
- Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hua-Ming Chang
- Department of Optics and Photonics, National Central University, Chungli, Taiwan, ROC
| | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuo-Hsuan Hung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Szu-Yu Chen
- Department of Optics and Photonics, National Central University, Chungli, Taiwan, ROC
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan, ROC; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan, ROC
| | - Yan-Ting Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan, ROC; Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC.
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Wang LC, Hung KH, Hsu CC, Chen SJ, Li WY, Lin TC. Assessment of retinal pigment epithelial cells in epiretinal membrane formation. J Chin Med Assoc 2015; 78:370-3. [PMID: 25708821 DOI: 10.1016/j.jcma.2015.01.003] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/15/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The definite etiology of epiretinal membrane (ERM) is unknown. Clinically, ERM may cause metamorphopsia and decreased vision during the disease exacerbation. Several theories of pathogenesis emphasize a glial tissue origin. However, in some studies, surgically removed ERM specimens were found to contain retinal pigment epithelial (RPE) cells. The actual mechanism by which RPE cells gain access into the inner retina and what roles they play in the formation of ERM remain controversial. The purpose of this study was to evaluate the incidence of RPE cells in ERM and discuss the possible mechanisms. METHODS A retrospective review of the histological findings in 23 surgically removed specimens of ERM was done. The samples were studied using light microscopy and immunohistochemistry. RESULTS Glial cells were the main components in all 23 cases, and RPE cells were found in five of the specimens. Two of these five cases were clinically diagnosed as idiopathic macular pucker, whereas the other three cases were identified as macular pucker associated with previous retinal detachment. A much higher density of myofibroblasts was noted in these five specimens than in the other 18 cases. CONCLUSION The incidence of RPE cells found in ERM is 21.7% (5 out of 23 specimens). A strong association between RPE cells and myofibroblasts in cases of ERM with or without retinal detachment indicates that RPE cells may contribute to the formation of ERM via a wound healing process.
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Affiliation(s)
- Lei-Chi Wang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kuo-Hsuan Hung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
| | - Chih-Chien Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Wing-Yin Li
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Tai-Chi Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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Abstract
Disease affecting the cornea is a common cause of blindness worldwide. To date, the amniotic membrane (AM) is the most widely used clinical method for cornea regeneration. However, donor-dependent differences in the AM may result in variable clinical outcomes. To overcome this issue, biomaterials are currently under investigation for corneal regeneration in vitro and in vivo. In this article, we highlight the recent advances in hydrogels, bioengineered prosthetic devices, contact lenses, and drug delivery systems for corneal regeneration. In clinical studies, the therapeutic effects of biomaterials, including fibrin and collagen-based hydrogels and silicone contact lenses, have been demonstrated in damaged cornea. The combination of cells and biomaterials may provide potential treatment in corneal wound healing in the future.
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Affiliation(s)
- I-Lun Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Chih-Chien Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kuo-Hsuan Hung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Ophthalmology, National Yang-Ming University Hospital, I-Lan, Taiwan, ROC
| | - Chi-Wen Chang
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan, Taiwan, ROC
| | - Yung-Hsin Cheng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
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Chang HM, Hung KH, Hsu CC, Lin TC, Chen SY. Using induced pluripotent stem cell-derived conditional medium to attenuate the light-induced photodamaged retina of rats. J Chin Med Assoc 2015; 78:169-76. [PMID: 25557467 DOI: 10.1016/j.jcma.2014.08.017] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Light injury to photoreceptor cells and retinal pigment epithelium may lead to oxidative stress and irreversible degeneration of retina, especially degeneration of the high energy-demanded macula. The model of retinal photodamage could be applied to age-related macular degeneration and other degenerative retinal diseases for exploring new treatments. Based on broadly investigated induced pluripotent stem cells (iPSC) in the field of retinal degeneration, we aimed to clarify further how the interaction progresses between iPSC-conditional medium (CM) and light-damaged retina. METHODS iPSCs were generated from murine embryonic fibroblasts of C57/B6 mice by retroviral transfection of three factors: Oct4, Sox2, and Klf4. Cytokine array was performed to analyze the components of CM. Sprague-Dawley rats receiving white light exposure to retina were viewed as an animal model of light injury. The rats were divided into four subgroups: light-injured rats receiving intravitreal injection of iPSC-CM, apoptotic iPSC-CM, or sodium phosphate buffer (PBS); and a control group without light damage. The electroretinography and thickness of outer nuclear layer were measured to document the therapeutic effects in each condition. Apoptosis arrays for detecting annexin V and caspase 3 were performed in the retinal tissues from each group. RESULTS Murine embryonic fibroblasts were induced into iPSCs and expressed the marker genes similar to embryonic stem cells. These iPSCs can differentiate into Embryoid bodies (EBs), three germ layers in vitro and develop teratoma in severe combined immunodeficiency mice. The quantitative polymerase chain reaction of our iPSC-CM showed significantly elevated fibroblast growth factor-2, glial cell-derived neurotrophic factor, and insulin-like growth factor-binding proteins-1, -2, and -3. Compared to rats without photodamage, the light-injured rats receiving iPSC-CM had less reduction of outer nuclear layer thickness on Day 21 than other groups treated with either PBS or apoptotic iPSC-CM. In the same animal model, both a- and b-waves of electroretinography measurement in the group treated with iPSC-CM were significantly maintained compared to the control group and others with apoptotic iPSC-CM or PBS treatment. The apoptosis assay also demonstrated lower levels of annexin V and caspase 3 in the group with iPSC-CM treatment than in other groups presenting increasing apoptotic markers. CONCLUSION The conditional medium of iPSCs contains plenty of cytoprotective, immune-modulative and rescue chemicals, contributing to the maintenance of neuronal function and retinal layers in light-damaged retina compared with apoptotic iPSC-CM and PBS. The antiapoptotic effect of iPSC-CM also shows promise in restoring damaged neurons. This result demonstrates that iPSC-CM may serve as an alternative to cell therapy alone to treat retinal light damage and maintain functional and structural integrity of the retina.
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Affiliation(s)
- Hua-Ming Chang
- Department of Optics and Photonics, National Central University, Chung-Li, Taiwan, ROC; Bade Veterans Home, Taoyuan, Taiwan, ROC.
| | - Kuo-Hsuan Hung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Ophthalmology, National Yang-Ming University Hospital, I-Lan, Taiwan, ROC
| | - Chih-Chien Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tai-Chi Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Szu-Yu Chen
- Department of Optics and Photonics, National Central University, Chung-Li, Taiwan, ROC
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Yang CS, Liu JH, Chung YC, Chou YB, Hung KH. Combination therapy with intravitreal bevacizumab and macular grid and scatter laser photocoagulation in patients with macular edema secondary to branch retinal vein occlusion. J Ocul Pharmacol Ther 2015; 31:179-85. [PMID: 25715024 DOI: 10.1089/jop.2014.0069] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To assess the efficacy of combined intravitreal bevacizumab (IVB) and macular grid and scatter laser photocoagulation in the treatment of macular edema secondary to branch retinal vein occlusion (BRVO) over a 12-month period. METHODS A prospective, interventional case series study was conducted in 20 patients. Patients were treated with 3 monthly IVB injections, followed by macular grid laser and scatter laser photocoagulation to nonperfused ischemic retina. Repeated IVB injections were performed on an as-needed basis when patients had recurrent macular edema. RESULTS The best-corrected visual acuity of 20/40 or better was achieved in 17 eyes (85%) and a vision gain of 3 lines or more was noted in 12/20 eyes (60%). Mean visual acuity improved from 0.68 logMAR at baseline to 0.28 logMAR at 3 months, 0.26 logMAR at 6 months, and 0.26 logMAR at 12 months (P<0.01). The mean central macular thickness (CMT) was 442 μm at baseline and decreased to 266, 264, 300, and 294 μm at 1, 3, 6, and 12 months' follow-up, respectively (P<0.01). A mild rebound CMT increase was noted at 6 months, which was reduced after bevacizumab reinjection. Ten patients (50%) required repeated IVB injections. Fifteen eyes (75%) have complete edema resolution on optical coherence tomography scan at the 12-month return visit. Overall, patients received an average of 4 injections during the 12-month period. No adverse ocular or systemic events were observed following injections. CONCLUSIONS Early IVB injections in combination with subsequent macular grid and scatter laser photocoagulation treatment significantly improved vision and reduced macular edema secondary to BRVO. Further studies are warranted to evaluate the long-term outcomes and safety.
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Affiliation(s)
- Chang-Sue Yang
- 1 Department of Ophthalmology, Taipei Veterans General Hospital , Taipei, Taiwan, Republic of China
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Hsu CC, Peng CH, Hung KH, Lee YY, Lin TC, Jang SF, Liu JH, Chen YT, Woung LC, Wang CY, Tsa CY, Chiou SH, Chen SJ, Chang YL. Stem Cell Therapy for Corneal Regeneration Medicine and Contemporary Nanomedicine for Corneal Disorders. Cell Transplant 2014; 24:1915-30. [PMID: 25506885 DOI: 10.3727/096368914x685744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The ocular surface is the outermost part of the visual system that faces many extrinsic or intrinsic threats, such as chemical burn, infectious pathogens, thermal injury, Stevens-Johnson syndrome, ocular pemphegoid, and other autoimmune diseases. The cornea plays an important role in conducting light into the eyes and protecting intraocular structures. Several ocular surface diseases will lead to the neovascularization or conjunctivalization of corneal epithelium, leaving opacified optical media. It is believed that some corneal limbal cells may present stem cell-like properties and are capable of regenerating corneal epithelium. Therefore, cultivation of limbal cells and reconstruction of the ocular surface with these limbal cell grafts have attracted tremendous interest in the past few years. Currently, stem cells are found to potentiate regenerative medicine by their capability of differentiation into multiple lineage cells. Among these, the most common cell sources for clinical use are embryonic, adult, and induced stem cells. Different stem cells have varied specific advantages and limitations for in vivo and in vitro expansion. Other than ocular surface diseases, culture and transplantation of corneal endothelial cells is another major issue for corneal decompensation and awaits further studies to find out comprehensive solutions dealing with nonregenerative corneal endothelium. Recently, studies of in vitro endothelium culture and ρ-associated kinase (ROCK) inhibitor have gained encouraging results. Some clinical trials have already been finished and achieved remarkable vision recovery. Finally, nanotechnology has shown great improvement in ocular drug delivery systems during the past two decades. Strategies to reconstruct the ocular surface could combine with nanoparticles to facilitate wound healing, drug delivery, and even neovascularization inhibition. In this review article, we summarized the major advances of corneal limbal stem cells, limbal stem cell deficiency, corneal endothelial cell culture/transplantation, and application of nanotechnology on ocular surface reconstruction. We also illustrated potential applications of current knowledge for the future treatment of ocular surface diseases.
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Affiliation(s)
- Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Lin TC, Hsu CC, Chien KH, Hung KH, Peng CH, Chen SJ. Retinal stem cells and potential cell transplantation treatments. J Chin Med Assoc 2014; 77:556-61. [PMID: 25238708 DOI: 10.1016/j.jcma.2014.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 08/06/2014] [Indexed: 11/24/2022] Open
Abstract
The retina, histologically composed of ten delicate layers, is responsible for light perception and relaying electrochemical signals to the secondary neurons and visual cortex. Retinal disease is one of the leading clinical causes of severe vision loss, including age-related macular degeneration, Stargardt's disease, and retinitis pigmentosa. As a result of the discovery of various somatic stem cells, advances in exploring the identities of embryonic stem cells, and the development of induced pluripotent stem cells, cell transplantation treatment for retinal diseases is currently attracting much attention. The sources of stem cells for retinal regeneration include endogenous retinal stem cells (e.g., neuronal stem cells, Müller cells, and retinal stem cells from the ciliary marginal zone) and exogenous stem cells (e.g., bone mesenchymal stem cells, adipose-derived stem cells, embryonic stem cells, and induced pluripotent stem cells). The success of cell transplantation treatment depends mainly on the cell source, the timing of cell harvesting, the protocol of cell induction/transplantation, and the microenvironment of the recipient's retina. This review summarizes the different sources of stem cells for regeneration treatment in retinal diseases and surveys the more recent achievements in animal studies and clinical trials. Future directions and challenges in stem cell transplantation are also discussed.
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Affiliation(s)
- Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuo-Hsuan Hung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan, ROC
| | - Chi-Hsien Peng
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital & Fu-Jen Catholic University, Taipei, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
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Cheng YH, Hung KH, Tsai TH, Lee CJ, Ku RY, Chiu AWH, Chiou SH, Liu CJL. Sustained delivery of latanoprost by thermosensitive chitosan-gelatin-based hydrogel for controlling ocular hypertension. Acta Biomater 2014; 10:4360-6. [PMID: 24914827 DOI: 10.1016/j.actbio.2014.05.031] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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: 02/01/2014] [Revised: 05/14/2014] [Accepted: 05/27/2014] [Indexed: 12/22/2022]
Abstract
Glaucoma is an irreversible ocular disease that may lead to progressive visual field loss and eventually to blindness with inadequately controlled intraocular pressure (IOP). Latanoprost is one of the most potent ocular hypotensive compounds, the current first-line therapy in glaucoma. However, the daily instillation required for efficacy and undesirable side-effects are major causes of treatment adherence failure and persistence in glaucoma therapy. In the present study, we developed an injectable thermosensitive chitosan/gelatin/glycerol phosphate (C/G/GP) hydrogel as a sustained-release system of latanoprost for glaucoma treatment. The latanoprost-loaded C/G/GP hydrogel can gel within 1min at 37°C. The results show a sustained release of latanoprost from C/G/GP hydrogel in vitro and in vivo. The latanoprost-loaded C/G/GP hydrogel showed a good in vitro and in vivo biocompatibility. A rabbit model of glaucoma was established by intravitreal injection of triamcinolone acetonide. After a single subconjunctival injection of latanoprost-loaded C/G/GP hydrogel, IOP was significantly decreased within 8days and then remained at a normal level. The results of the study suggest that latanoprost-loaded C/G/GP hydrogel may have a potential application in glaucoma therapy.
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Affiliation(s)
- Yung-Hsin Cheng
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Kuo-Hsuan Hung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Ophthalmology, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Tung-Hu Tsai
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jung Lee
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ruy-Yu Ku
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | | | - Shih-Hwa Chiou
- Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan; Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Catherine Jui-Ling Liu
- National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Chang YC, Chang WC, Hung KH, Yang DM, Cheng YH, Liao YW, Woung LC, Tsai CY, Hsu CC, Lin TC, Liu JH, Chiou SH, Peng CH, Chen SJ. The generation of induced pluripotent stem cells for macular degeneration as a drug screening platform: identification of curcumin as a protective agent for retinal pigment epithelial cells against oxidative stress. Front Aging Neurosci 2014; 6:191. [PMID: 25136316 PMCID: PMC4117985 DOI: 10.3389/fnagi.2014.00191] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [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: 04/22/2014] [Accepted: 07/11/2014] [Indexed: 12/22/2022] Open
Abstract
Age-related macular degeneration (AMD) is one retinal aging process that may lead to irreversible vision loss in the elderly. Its pathogenesis remains unclear, but oxidative stress inducing retinal pigment epithelial (RPE) cells damage is perhaps responsible for the aging sequence of retina and may play an important role in macular degeneration. In this study, we have reprogrammed T cells from patients with dry type AMD into induced pluripotent stem cells (iPSCs) via integration-free episomal vectors and differentiated them into RPE cells that were used as an expandable platform for investigating pathogenesis of the AMD and in-vitro drug screening. These patient-derived RPEs with the AMD-associated background (AMD-RPEs) exhibited reduced antioxidant ability, compared with normal RPE cells. Among several screened candidate drugs, curcumin caused most significant reduction of ROS in AMD-RPEs. Pre-treatment of curcumin protected these AMD-RPEs from H2O2-induced cell death and also increased the cytoprotective effect against the oxidative stress of H2O2 through the reduction of ROS levels. In addition, curcumin with its versatile activities modulated the expression of many oxidative stress-regulating genes such as PDGF, VEGF, IGFBP-2, HO1, SOD2, and GPX1. Our findings indicated that the RPE cells derived from AMD patients have decreased antioxidative defense, making RPE cells more susceptible to oxidative damage and thereby leading to AMD formation. Curcumin represented an ideal drug that can effectively restore the neuronal functions in AMD patient-derived RPE cells, rendering this drug an effective option for macular degeneration therapy and an agent against aging-associated oxidative stress.
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Affiliation(s)
- Yun-Ching Chang
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan ; School of Medicine, Institute of Pharmacology, National Yang-Ming University Taipei, Taiwan ; Department of Ophthalmology, Taipei Veterans General Hospital Taipei, Taiwan
| | - Wei-Chao Chang
- Graduate Institute of Cancer Biology, China Medical University Taichung, Taiwan ; Center for Molecular Medicine, China Medical University Hospital Taichung, Taiwan
| | - Kuo-Hsuan Hung
- Division of Ophthalmology, National Yang-Ming University Hospital I-Lan, Taiwan ; School of Medicine, Institute of Clinical Medicine, National Yang-Ming University Taipei, Taiwan
| | - Der-Ming Yang
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan
| | - Yung-Hsin Cheng
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan ; School of Medicine, Institute of Pharmacology, National Yang-Ming University Taipei, Taiwan
| | - Yi-Wen Liao
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan
| | - Lin-Chung Woung
- Department of Ophthalmology, Taipei City Hospital Taipei, Taiwan
| | - Ching-Yao Tsai
- Department of Ophthalmology, Taipei City Hospital Taipei, Taiwan
| | - Chih-Chien Hsu
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan ; Department of Ophthalmology, Taipei Veterans General Hospital Taipei, Taiwan
| | - Tai-Chi Lin
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan ; Department of Ophthalmology, Taipei Veterans General Hospital Taipei, Taiwan
| | - Jorn-Hon Liu
- Department of Ophthalmology, Cheng-Hsin Hospital Taipei, Taiwan
| | - Shih-Hwa Chiou
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan ; School of Medicine, Institute of Pharmacology, National Yang-Ming University Taipei, Taiwan ; Department of Ophthalmology, Taipei Veterans General Hospital Taipei, Taiwan ; School of Medicine, Institute of Clinical Medicine, National Yang-Ming University Taipei, Taiwan
| | - Chi-Hsien Peng
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan ; Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital and Fu Jen Catholic University Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital Taipei, Taiwan ; Department of Ophthalmology, Taipei Veterans General Hospital Taipei, Taiwan
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Hsiao MH, Chiou SH, Larsson M, Hung KH, Wang YL, Liu CJL, Liu DM. A temperature-induced and shear-reversible assembly of latanoprost-loaded amphiphilic chitosan colloids: characterization and in vivo glaucoma treatment. Acta Biomater 2014; 10:3188-96. [PMID: 24681374 DOI: 10.1016/j.actbio.2014.03.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/20/2014] [Accepted: 03/19/2014] [Indexed: 12/22/2022]
Abstract
Hydrogels composed of assembled colloids is a material class that is currently receiving much interest and shows great promise for use in biomedical applications. This emerging material class presents unique properties derived from the combination of nanosized domains in the form of colloidal particles with a continuous gel network and an interspersed liquid phase. Here we developed an amphiphilic chitosan-based, thermogelling, shear-reversible colloidal gel system for improved glaucoma treatment and addressed how preparation procedures and loading with the anti-glaucoma drug latanoprost and commonly used preservative benzalkonium chloride influenced the mechanical properties of and drug release from the colloidal gels. The results highlight that incorporated substances and preparation procedures have effects both on mechanical properties and drug release, but that the release of drug loaded in the colloidal carriers is mainly limited by transport out of the carriers, rather than by diffusion within the gel. The developed colloidal chitosan based gels hold outstanding biomedical potential, as confirmed by the ease of preparation and administration, low cytotoxicity in MTT assay, excellent biocompatibility and lowering of intraocular pressure for 40 days in a rabbit glaucoma model. The findings clearly justify further investigations towards clinical use in the treatment of glaucoma. Furthermore, the use of this shear-reversible colloidal gel could easily be extended to localized treatment of a number of critical conditions, from chronic disorders to cancer, potentially resulting in a number of new therapeutics with improved clinical performance.
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Fan NW, Hwang DK, Ko YC, Tseng FC, Hung KH, Liu CJL. Risk factors for progressive visual field loss in primary angle-closure glaucoma: a retrospective cohort study. PLoS One 2013; 8:e69772. [PMID: 23861982 PMCID: PMC3704517 DOI: 10.1371/journal.pone.0069772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/16/2013] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate risk factors associated with progressive visual field (VF) loss in primary angle closure glaucoma (PACG). Methods We retrospectively reviewed medical record of PACG patients who had ≥5 reliable VF examinations (central 24-2 threshold test, Humphrey Field Analyzer) and ≥2 years of follow-up. Each VF was scored using Collaborative Initial Glaucoma Treatment Study system. Progression was defined if 3 consecutive follow-up VF tests had an increased score of ≥3 above the mean of the first 2 VF scores. Factors associated with VF progression were evaluated by Cox proportional hazards models. Results A total of 89 eyes from 89 patients (mean age, 69.8 ± 7.9 years), who received a mean of 6.9 ± 2.3 VF tests (mean deviation at initial, -8.1 ± 4.4 dB) with a mean follow-up of 63.9 ± 23.9 months were included. VF progression was detected in 9 eyes (10%). The axial length (AL), anterior chamber depth, and intraocular pressure (IOP) in patients with and without progression were 22.5 ± 0.6 and 23.1 ± 0.9 mm, 2.5 ± 0.3 and 2.5 ± 0.3 mm, 14.8 ± 2.4 and 14.3 ± 2.3 mm Hg, respectively. AL was the only factor associated with progression in both Cox proportional hazards univariate (p = 0.031) and multivariate models (p = 0.023). Conclusion When taking into account age, IOP, follow-up period, and number of VF tests, a shorter AL is the only factor associated with VF progression in this cohort of Chinese patients with PACG. Further studies are warranted to verify the role of AL in progressive VF loss in PACG.
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Affiliation(s)
- Nai-Wen Fan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taoyuan Veterans Hospital, Taoyuan, Taiwan
- Department of Public Health and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Fan-Chen Tseng
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kuo-Hsuan Hung
- Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Ophthalmology, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail:
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Hung KH, Yang CS, Kao SC, Lee FL, Lee SM. Management of double-penetrating ocular injury with retained intraorbital metallic foreign body. J Chin Med Assoc 2011; 74:523-6. [PMID: 22100024 DOI: 10.1016/j.jcma.2011.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 01/10/2011] [Accepted: 03/18/2011] [Indexed: 11/22/2022] Open
Abstract
The prognosis of double penetrating ocular trauma is usually guarded. We report the good anatomical and functional outcome in a patient with double-penetrating ocular trauma associated with intraorbital foreign body. A 58-year-old man presented at the emergency room complaining of blurred vision of the left eye with stinging pain after he hammered an iron plate. Best-corrected visual acuity was hand movement/30 cm. Subconjunctival hemorrhage with one 1.4-mm laceration wound was noted over the nasal conjunctiva. Fundus examination showed vitreous hemorrhage with one whitish patch over the nasal retina. Orbital computed tomography scan revealed one metallic foreign body at the posterior nasal upper orbit. Double-penetrating globe injury with intraorbital foreign body was impressed, and immediate vitrectomy surgery with endolaser photocoagulation was carried out. One exit wound nasal to the disc was noted during operation. The intraorbital metallic foreign body was left alone. Vision recovered to 6/8.6 without ocular complication after a 20-month follow-up. Prompt, careful preoperative evaluation and meticulous vitrectomy intervention are essential in the successful management of such patients. Posteriorly located intraorbital metallic foreign body should be managed conservatively. Long-term regular electroretinography evaluation is needed for possible retinal toxicity from intraorbital foreign body.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Hung KH, Lee SM, Lee SY, Lee FL, Yang CS. Intravitreal bevacizumab (avastin) in the treatment of macular edema associated with perfused retinal vein occlusion. J Ocul Pharmacol Ther 2010; 26:85-90. [PMID: 20148661 DOI: 10.1089/jop.2009.0090] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of intravitreal bevacizumab (Avastin) injection in patients with macular edema (ME) secondary to retinal vein occlusive diseases. METHODS A prospective, interventional cases series study was conducted in patients with ME secondary to perfused retinal vein occlusions (RVOs), who were treated with intravitreal bevacizumab (2.5 mg per injection in a volume of 0.1 mL). Patients underwent complete ophthalmic evaluation, including Snellen visual acuity, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline, 1 month, and 3 months after the first injection and at the final visit. RESULTS Twenty-five patients (25 eyes) received intravitreal bevacizumab injections. The mean follow-up time was 6.5 months. Mean Snellen visual acuity improved from 20/125 at baseline to 20/74 at 1 month, 20/69 at 3 months, and 20/57 at the last follow-up (P < 0.01). Five of the 25 eyes (20%) had vision gain of >3 lines. The mean central 1 mm macular thickness was 422 microm at baseline and decreased to 263, 333, and 239 microm at 1 month, 3 months, and the last follow-up, respectively. Recurrent macular edema with a rebound increase of central retinal thickness was observed 3 months after the first injection, and improved after repeated bevacizumab injections. Patients received an average of 2 injections (range 1-3). FA showed no evidence of increased nonperfusion avascular area. No adverse ocular or systemic events were observed following injections. CONCLUSIONS The observed anatomic and visual acuity improvements after intravitreal bevacizumab injection demonstrate that bevacizumab is a useful adjunctive treatment for ME secondary to RVO without safety concerns in a short term. However, repeated injections are needed to maintain visual improvement. Long-term study is warranted to assess the long-term efficacy and safety.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
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Hung KH, Yang CS, Lin TC, Lee FL, Lee SM. Optical coherence tomography in spontaneous resolution of vitreomacular traction syndrome. J Chin Med Assoc 2010; 73:334-7. [PMID: 20603094 DOI: 10.1016/s1726-4901(10)70072-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 12/14/2009] [Accepted: 03/24/2010] [Indexed: 10/19/2022] Open
Abstract
Vitreomacular traction syndrome (VTS) is a vitreoretinal interface abnormality. The disorder is caused by incomplete posterior vitreous detachment with persistent traction on the macula that produces symptoms and decreased vision. Most symptomatic eyes with VTS undergo a further decrease in visual acuity. Spontaneous complete vitreomacular separation occurs infrequently in eyes with VTS. Surgical intervention may be considered if severe metamorphopsia and decreased visual quality occur. Herein, we report 2 typical cases of idiopathic VTS with spontaneous resolution of vitreo-retinal traction demonstrated by optical coherence tomography. Optical coherence tomography is a sensitive and useful tool for the confirmation of diagnosis and for the serial anatomical evaluation of patients with VTS.
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Affiliation(s)
- Kuo-Hsuan Hung
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Yang HB, Cheng HC, Sheu BS, Hung KH, Liou MF, Wu JJ. Chronic celecoxib users more often show regression of gastric intestinal metaplasia after Helicobacter pylori eradication. Aliment Pharmacol Ther 2007; 25:455-61. [PMID: 17270001 DOI: 10.1111/j.1365-2036.2006.03224.x] [Citation(s) in RCA: 25] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM To test whether the chronic users of celecoxib, a selective cyclo-oxygenase-2 inhibitor, had less Helicobacter pylori-related intestinal metaplasia or if such users' intestinal metaplasia could be prone to disappear after H. pylori eradication. METHODS The study enrolled 150 chronic celecoxib users and 216 non-users who underwent pan-endoscopy to detect H. pylori infection and its related intestinal metaplasia. One hundred and three H. pylori-infected patients with intestinal metaplasia (43 chronic celecoxib users and 60 non-users) received anti-H. pylori therapy and completed the 12-month follow-up to survey the regression of intestinal metaplasia by mean intestinal metaplasia score. RESULTS There were no differences in the prevalence of H. pylori-related intestinal metaplasia between the chronic celecoxib users and controls (P > 0.05). On the 12th month of follow-up, chronic celecoxib users had a lower mean intestinal metaplasia score (1.2 vs. 1.8, P < 0.005) and a higher regression rate of intestinal metaplasia (42% vs. 20%, P = 0.027) than non-users. CONCLUSIONS With H. pylori infection, chronic celecoxib users still showed limited effects to decrease intestinal metaplasia. Nevertheless, celecoxib should be promising to assist H. pylori eradication for the control of gastric intestinal metaplasia and cancer risk.
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Affiliation(s)
- H B Yang
- Department of Pathology, National Cheng Kung University, Tainan, Taiwan
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Abstract
We report on a 51-year-old woman with initial hypercalcaemia and unknown ascites. In spite of unyielding laparoscopy, laparotomy showed findings compatible with tuberculous peritonitis (TBP). Unexpectedly, a series of examinations eventually revealed the concurrence of hyperparathyroidism due to a parathyroid adenoma. Anti-tuberculous regimen was given and was uneventful. However, hypercalcaemia was not decreased but sustained at a high level even after anti-tuberculous therapy for 3 months. Parathyroidectomy was performed with subsequent normalisation of hypercalcaemia. The aetiology of hypercalcaemia in a patient with an explored disease able to cause this electrolyte abnormality such as TBP may be a coexistent occult parathyroid adenoma.
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Affiliation(s)
- K H Hung
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
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Ko YC, Lee CT, Cheng YF, Hung KH, Kuo CY, Huang CC, Chen JB. Hypercalcaemia and haemophagocytic syndrome: rare concurrent presentations of disseminated tuberculosis in a dialysis patient. Int J Clin Pract 2004; 58:723-5. [PMID: 15311732 DOI: 10.1111/j.1368-5031.2004.00054.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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] Open
Abstract
Tuberculosis remains an important cause of infection in chronic haemodialysis patients. Frequent extrapulmonary involvement, non-specific presentation and limited diagnostic tools usually make early diagnosis difficult. Herein, we report on an 83-year-old female patient who had been on regular heamodialysis therapy for 15 years, who presented with asymptomatic hypercalcaemia and pancytopenia. Haemophagocytic syndrome was documented during the admission period. Mycobacterium tuberculosis was cultured from bone marrow 1 month after her demise. This case report highlights the non-specific manifestations of extrapulmonary tuberculosis in dialysis patients and the limited value of conventional diagnostic methods. We would like to recommend aggressive intervention and early tissue aspiration from possible infectious sites when tuberculosis cannot be completely ruled out. Disseminated tuberculosis should be considered as an indication of hypercalcaemia where haemophagocytic syndrome occurs simultaneously.
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Affiliation(s)
- Y C Ko
- Division of Pulmonary Medicine, Department of Internal Medicine, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
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Abstract
AIMS To identify clinical features and treatment response of tuberculous peritonitis (TBP) in a uremic population, a retrospective case-control study was performed. MATERIALS AND METHODS Thirteen uremic patients with TBP (Group I: 62.7 +/- 6.8 years, male 54%) collected between January 1986 and January 2002 were compared with another two age- and sex-matched controls: 19 non-azotemic patients with TBP (Group II: 62.9 +/- 7.3 years, male 47%) and 30 uremic patients without TBP (Group III: 61.1 +/- 8.7 years, male 47%). Clinical information and data of ascites and blood examinations were evaluated. RESULTS Significant differences between Groups I and II were found in comorbidity, hypertension, anorexia, percentages of neutrophil and lymphocyte from blood and ascites, and serum calcium (sCa), phosphorus and albumin-adjusted calcium (sAACa). However, no significant differences in duration of symptoms, coexistent pulmonary tuberculosis (p = 0.061), duration or complications of therapy and mortality (p = 0.13) were detected. Significant differences between Groups I and III were found in peripheral white cell counts and percentages of neutrophil and lymphocyte as well as in serum creatinine (sCr), albumin, sCa, sAACa and intact parathyroid hormone (iPTH). CONCLUSIONS Non-specific symptoms make the diagnosis of TBP in a uremic population difficult. However, neutrophil predominance in blood and ascites, hypoalbuminemia, relatively lower sCr and hypercalcemia with suppressed serum iPTH were found to be characteristic. In TBP uremic patients, therapy complications were not common and there was a tendency for higher mortality, largely due to septic shock.
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Affiliation(s)
- K H Hung
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC.
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Lee CT, Hung KH, Fang JS, Chen MC, Chen JB, Hsu KT. Implications of sonographic identification of duplex kidney in adults. Chang Gung Med J 2001; 24:779-85. [PMID: 11858393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Duplication of the renal pelvis and ureter constitutes the most common anomalies of the upper urinary tract. Most patients are asymptomatic and don't need treatment. However, the associated anomaly and acquired renal disease may cause morbidity and mortality. The aim of this study was to investigate the prevalence of duplex kidney in sonographic examinations and the predictive capability of this method. An analysis of patients with urography-confirmed duplication anomaly was also performed. METHODS During a period of 9 year (from 1988 to 1996), sonographic examination records of 19,287 patients were reviewed. Patients with a diagnosis of duplex kidney were enrolled. Their clinical characteristics and radiological images were recorded and evaluated. RESULTS One hundred and sixty-three patients were found by sonography to have duplex kidney, for an prevalence of 0.85%. Urography studies were done on 64 (39.2%) patients, and 42 patients were proven to have duplex kidney. The positive predictive rate of sonography was 65.6%. Eighty percent of patients with duplex kidney had associated ureteral duplication. No associated anomalies were found. Four patients had urolithiasis, and 3 patients had recurrent urinary tract infection. One patient had coexisting uroepithelial malignancy, and 1 patient had refractory gross hematuria. CONCLUSIONS Duplex kidney is an uncommon finding during adult sonographic examinations. The sensitivity and specificity of sonography in identifying this anomaly are controversial. An experienced hand with good knowledge of the anomaly and its sonographic signs is helpful in more accurately diagnosing this anomaly.
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Affiliation(s)
- C T Lee
- Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
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Hung KH, Lee CT, Gau YL, Chen JB. Neglected bilateral femoral neck fractures in a patient with end-stage renal disease before chronic dialysis. Ren Fail 2001; 23:827-31. [PMID: 11777322 DOI: 10.1081/jdi-100108194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/03/2022] Open
Abstract
Bilateral femoral neck fractures are rarely reported in patients with end-stage renal disease before chronic dialysis. We report on a 39-year-old woman with neglected bilateral femoral neck fractures, who presented with severe uremic complications prior to chronic dialysis. Three years before admission, she had injured herself in a trivial slip with subsequent bilateral hip pain. She had progressively waddled since then. Pelvic X-ray taken after admission revealed bilateral femoral neck fractures. Bilateral hip hemiarthroplasties were subsequently performed. Displaced femoral neck fractures were found intraoperatively. Pathologic findings and results of examinations supported the coexistence of osteoporosis and high turnover renal osteodystrophy, rendering this woman at high risk of bilateral femoral neck fractures. Therefore, preventing a simple fall or trivial accident and treating renal osteodystrophy and osteoporosis are paramount in patients with chronic renal failure even before the start of dialysis therapy. We also emphasize the need to seek any possible underlying metabolic bone disease once a patient presents with unusual fractures.
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Affiliation(s)
- K H Hung
- Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC
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Lai TH, Wu MH, Hung KH, Cheng YC, Chang FM. Successful pregnancy by transmyometrial and transtubal embryo transfer after IVF in a patient with congenital cervical atresia who underwent uterovaginal canalization during Caesarean section: case report. Hum Reprod 2001; 16:268-71. [PMID: 11157818 DOI: 10.1093/humrep/16.2.268] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [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: 11/12/2022] Open
Abstract
Successful pregnancy in a patient with congenital cervical atresia is a great challenge for assisted reproductive techniques and reproductive medicine. We report a case of successful pregnancy by transmyometrial and transtubal embryo transfer simultaneously after in-vitro fertilization (IVF) in a 33 year-old patient with congenital cervical atresia diagnosed at the age of 18 years. The patient had experienced cyclic abdominal pain and amenorrhoea since she was 13 years old. She had had two unsuccessful attempts to create a new uterovaginal canal in another hospital. At the age of 32 years, she was referred to our unit and had a successful pregnancy after transmyometrial and transtubal embryo transfer. Caesarean section was performed at 36 weeks gestation due to progressive pre-eclampsia and gestational diabetes. A healthy male baby weighing 2812 g was safely delivered. Uterovaginal canalization with amniotic membrane for the covering of the neo-endocervical wall was performed during Caesarean section. Normal menstrual outflow and symptomatic relief have continued for 5 months after the operation. To the best of our knowledge, this is the first reported case of successful pregnancy by transmyometrial and transtubal embryo transfer as well as uterovaginal canalization performed during Caesarean section in a patient with congenital cervical atresia.
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Affiliation(s)
- T H Lai
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan
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Hung KH, Lee CT, Lam KK, Chuang FR, Hsiu KT, Chen JB, Chien YS, Pan HH. Ischemic bowel disease in chronic dialysis patients. Changgeng Yi Xue Za Zhi 1999; 22:82-7. [PMID: 10418214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Ischemic bowel disease, especially acute mesenteric ischemia, carries high morbidity and mortality rates. Any delay in diagnosis or treatment aggravates the patient's outcome. Owing to the scarcity of reports concerning ischemic bowel disease in chronic dialysis patients, we investigated the ischemic bowel disease in chronic dialysis patients. METHODS From January 1986 through April 1997, medical records of 2416 chronic dialysis patients at our hospital were reviewed. Among them, 5 patients with surgically documented ischemic bowel disease were enrolled. The clinical manifestations, laboratory findings, operative findings, pathologic test results and prognoses of these patients are reported. RESULTS Abdominal pain, abdominal distension and bloody stool were major initial presentations. The mean age of the patients was 62.4 years at the time of diagnosis of ischemia. All patients had hypertension, 3 patients had hyperlipidemia, three patients had diabetes mellitus and three patients had history of shunt occlusion. Four patients had leukocytosis. Image studies revealed dilatation of bowel loops in four patients. Peritonitis made exploratory laparotomy necessary. The findings during operation showed turbid ascites and variable degrees of bowel ischemia or gangrene. The methods of surgical intervention depended on the severity of the disease. Only one patient died due to extensive ischemic bowel involvement and subsequent sepsis. CONCLUSION It is mandatory to have an index suggestive of ischemic bowel disease in chronic dialysis patients with unexplained abdominal pain or discomfort. Early diagnosis and aggressive surgical intervention is the cure modality for patients with acute ischemic bowel disease.
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Affiliation(s)
- K H Hung
- Department of Nephrology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C
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Lai PH, Yang CF, Pan HB, Chen C, Lo YK, Hung KH. Intracranial acute arterial ischemia of the anterior circulation: evaluation with three-dimensional time-of-flight magnetic resonance angiography. Zhonghua Yi Xue Za Zhi (Taipei) 1999; 62:20-7. [PMID: 10063708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Stroke has been the second most common cause of death, after cancer, in Taiwan since 1983. The cost of stroke to society in terms of morbidity, mortality and economics is profound. Heightened interest in the early diagnosis and treatment of acute stroke challenges neuroimagers to optimize available modalities and to develop new techniques for the evaluation of cerebrovascular disease. The aim of this study was to investigate the effectiveness of magnetic resonance angiography (MRA) in conjunction with spin-echo imaging in patients with acute brain infarction of the anterior circulation. METHODS Magnetic resonance imaging and three-dimensional Fourier transformed time-of-flight MRA studies, performed on 50 patients within one week after the onset of cerebral ischemia, were retrospectively reviewed and correlated with clinical records. Five of the 50 MRAs were considered nondiagnostic and excluded because of poor patient cooperation. RESULTS In 41 of the 45 cases, the area of infarct corresponding to the clinical deficit at the time of study was identified on T2-weighted spin-echo images. Arterial occlusions or severe stenoses that corresponded to ischemic manifestations were identified with MRA in 37 of the 45 patients. A focal discontinuity with decreased arterial caliber corresponded to stenosis and nonvisualization of distal branches represented arterial occlusion. MRA provided information for 23 cases not obtained from the MR images. CONCLUSIONS Vascular lesions demonstrated on intracranial MRA show a high correlation with infarct distribution. MRA, which provides information adjunctive to conventional MR imaging in a majority of cases, is concluded to be an important component of the complete evaluation of brain infarction.
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Affiliation(s)
- P H Lai
- Department of Radiology, Veterans General Hospital-Kaohsiung, Taiwan, ROC
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Hung KH, Chang MH, Lai PH, Shy CG, Lo YK. Traumatic dissection of the vertebral artery: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1997; 59:210-5. [PMID: 9198299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This report concerns a patient suffering from a severe neck pain on the third day after a traffic accident. This condition was followed by a lateral medullary infarction on the next day. One week later, he was transferred to this hospital and dissection of the vertebral artery was disclosed. It should be emphasized that in case of acute cervical spine injury or severe neck pain after a major trauma, vertebral artery dissection should be considered, as its early diagnosis may have crucial therapeutic implications. In addition, the advantages of the combination of magnetic resonance imaging and magnetic resonance angiography as diagnostic tools-of-choice are emphasized.
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Affiliation(s)
- K H Hung
- Department of Internal Medicine, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C
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