Publications by authors named "Chia-Yu Lin"

108 Publications

Isolated Middle-Third Clavicle Fracture Causing Horner's Syndrome: A Case Report and Literature Review.

Front Surg 2021 28;8:640900. Epub 2021 May 28.

Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung, Taiwan.

The pathophysiology of Horner's syndrome arises due to compression or destruction of the oculosympathetic nerve pathway. Traumatic Horner's syndrome may indicate lethal neurovascular injury, such as brain stem lesion, cervical spine injury, or carotid artery dissection. The middle-third is the most common type of clavicle fracture. However, the association of the isolated middle-third clavicle fracture and Horner's syndrome is rare. We report the case of a 47 year-old woman who presented to our emergency department with acute trauma. Severe tenderness and limited mobility were observed in her left shoulder. On radiographic examination, a middle-third clavicle fracture was diagnosed. Ptosis and myosis were also noticed on further examination, and she was subsequently diagnosed with Horner's syndrome. A survey of the brain, cervical spine, carotid artery, and lung revealed no pathological findings. Surgery for the clavicle fracture was performed 2 days after the accident. The patient recovered from Horner's syndrome gradually over the 2 months following the surgery, and the syndrome completely resolved by the third month. To the best of our knowledge, this is the first report of traumatic Horner's syndrome caused by an isolated middle-third clavicle fracture. The improved outcome may be attributed to the surgical intervention for middle-third clavicle fracture, which may help release ganglion or neuronal compression.
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http://dx.doi.org/10.3389/fsurg.2021.640900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195325PMC
May 2021

A Portable Wireless Urine Detection System with Power-Efficient Electrochemical Readout ASIC and ABTS-CNT Biosensor for UACR Detection.

IEEE Trans Biomed Circuits Syst 2021 Jun 8;PP. Epub 2021 Jun 8.

This work presents a portable wireless urine detection system which consists of an electrochemical readout application specific integrated circuit (ASIC) and a biosensor composed of 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) and carbon nanotube (ABTS-CNT) for the detection of urine albumin-to-creatinine ratio (UACR). The ASIC includes a potentiostat, a digital circuitry and a power management circuit which can perform electrochemistry techniques with a dual-channel screen-printing carbon electrode (SPCE). Electrochemical experiments on the proposed biosensor (SPCE|ABTS-CNT|Nafion) have revealed promising sensing characteristics for creatinine and human serum albumin detection. Practical urine tests has demonstrated the capability of the proposed urine detection system for UACR detection with both the power-efficient readout ASIC and the ABTS-CNT biosensor. A user-friendly prototype has also been designed which can be useful for either personal health administration or homecare.
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http://dx.doi.org/10.1109/TBCAS.2021.3087475DOI Listing
June 2021

N2b Reflects the Cognitive Changes in Executive Functioning After Concussion: A Scoping Review.

Front Hum Neurosci 2020 17;14:601370. Epub 2020 Dec 17.

Centre for Advanced Research in Experimental and Applied Linguistics (ARiEAL) Research Centre, McMaster University, Hamilton, ON, Canada.

The N2b is an event-related potential (ERP) component thought to index higher-order executive function. While the impact of concussion on executive functioning is frequently discussed in the literature, limited research has been done on the role of N2b in evaluating executive functioning in patients with concussion. The aims of this review are to consolidate an understanding of the cognitive functions reflected by the N2b and to account for discrepancies in literature findings regarding the N2b and concussion. A scoping review was conducted on studies that used the N2b to measure cognitive functioning in healthy control populations, as well as in people with concussions. Sixty-six articles that met inclusion criteria demonstrated that the N2b effectively represents stimulus-response conflict management, response selection, and response inhibition. However, the 19 included articles investigating head injury (using terms such as concussion, mild head injury, and mild traumatic brain injury) found widely varied results: some studies found the amplitude of the N2b to be increased in the concussion group, while others found it to be decreased or unchanged. Based on the available evidence, differences in the amplitude of the N2b have been linked to response selection, conflict, and inhibition deficits in concussion. However, due to large variations in methodology across studies, findings about the directionality of this effect remain inconclusive. The results of this review suggest that future research should be conducted with greater standardization and consistency.
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http://dx.doi.org/10.3389/fnhum.2020.601370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793768PMC
December 2020

Urine High-Sensitivity Troponin I Predict Incident Cardiovascular Events in Patients with Diabetes Mellitus.

J Clin Med 2020 Dec 2;9(12). Epub 2020 Dec 2.

Department of Electrical Engineering, National Cheng-Kung University, Tainan 704, Taiwan.

In patients with diabetes mellitus (DM), incident cardiovascular (CV) events are associated with poor long-term outcomes. Serum high-sensitivity troponin I (hs-TnI) is widely used to diagnose and predict outcomes in patients with acute coronary syndrome, however, few studies have investigated the accuracy of urine hs-TnI as a predictor for incident CV events in patients with DM. The enrolled participants included patients with DM. Fresh urine hs-TnI levels were measured. Medical records of enrolled patients were used to determine the number of incident CV events prospectively for 3 months. The study cohort comprised 378 participants. We observed significantly higher levels of urine hs-TnI in those with than without subsequent incident CV events. The multivariate logistic regression analysis using different models consistently showed that urine hs-TnI > 4.10 pg/mL was an independent factor predictive of incident CV events. The ROC-AUC analysis revealed that the optimal cutoff value for urine hs-TnI for predicting incident CV events was 1.55 pg/mL and the area was 0.611 ( = 0.027). A single measurement of urinary hs-TnI, collected easily and non-invasively, may be an acceptable biomarker for predicting subsequent incident CV events in patients with DM.
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http://dx.doi.org/10.3390/jcm9123917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761585PMC
December 2020

Anthropometric Factors on Safe Distances between Popliteal Vessels to the Femur for Cerclage Wiring of the Distal Femoral Fracture: A Magnetic Resonance Imaging Study.

Medicina (Kaunas) 2020 Nov 28;56(12). Epub 2020 Nov 28.

Department of Orthopedics, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan.

: The proximity of the popliteal vessels in the distal femur may increase the risk of iatrogenic vascular injury during cerclage wiring. In this study, the closest location and distance of the popliteal vessels to the femur was examined using magnetic resonance imaging (MRI). The associations between anthropometric factors and the distance that would guide the placement of wires safely during surgery were also identified. : We reviewed adult knee magnetic resonance images and recorded: (1) the relation and the shortest horizontal distance (d-H) from the femoral cortex to the popliteal vessels in axial images and (2) the vertical distance (d-V) from the adductor tubercle to the axial level of the d-H values in coronal images. The effects of anthropometric factors (sex, age, body height, body weight, body mass index, thigh circumference, femoral length and femoral width) on these distances were analysed. Analysis of 206 knee magnetic resonance images revealed that the closet locations of popliteal vessels were at the posteromedial aspect of the femur. The d-H and d-V were 7.38 ± 3.22 mm and 57.01 ± 11.14 mm, respectively, and were both shorter in women than in men ( < 0.001). Multivariate analysis identified thigh circumference and femoral length as the most influential factors for the d-H and d-V, respectively ( < 0.001). Linear regression demonstrated a strong positive linear correlation between the thigh circumference and the d-H and between the femoral length and the d-V (Pearson's r = 0.891 and 0.806, respectively ( < 0.001)). The closet location and distance of the popliteal vessels to the femur provide useful information for wire placement during distal femoral fracture surgery while minimising the risk of vascular injury. Given that patients with a smaller thigh circumference and a shorter femoral length are more likely to have a smaller d-H and a shorter d-V, respectively, cautious measures should be taken in such cases.
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http://dx.doi.org/10.3390/medicina56120655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761162PMC
November 2020

Alleviative effect of L. on NAFLD and hepatic lipid accumulation via modulating hepatic de novo lipogenesis in high-fat diet plus streptozotocin-induced diabetic rats.

Food Sci Nutr 2020 Oct 9;8(10):5710-5716. Epub 2020 Sep 9.

Graduate Program of Nutrition Science National Taiwan Normal University Taipei Taiwan.

a L. (RTL) exhibits phytochemical activities and has been used as a folk medicine for curing diabetes mellitus in East Asia for decades. This study investigated the effect of RTL aqueous and ethanolic extracts on nonalcoholic fatty liver disease (NAFLD) and hepatic lipid accumulation in high-fat diet (HFD) and streptozotocin (STZ)-induced type 2 diabetes mellitus (T2DM) rats. Administration of RTL aqueous extract (RTLW) or ethanolic extract (RTLE) at dosage of 100 or 400 mg/kg body weight for 4 weeks was carried out in HFD/STZ-induced T2DM rats. Liver weight, adipose (epididymal and perirenal adipose tissues) weight, hepatic triglyceride level, and de novo lipogenesis (DNL)-associated protein expression were monitored after scarification. The results revealed that RTLW and RTLE reduced relative liver weight and relative fat weights in HFD/STZ-induced T2DM rats. RTLW and RTLE also ameliorated NAFLD and hepatic triglyceride (TG) accumulation in diabetic rats. Moreover, hepatic DNL-regulated enzymes such as sterol regulatory element-binding protein-1 (SREBP1) and fatty acid synthase (FAS) expression were significantly suppressed by RTLE (100 and 400 mg/kg body weight) in diabetic rats. The evidences of this study suggest that RTL possesses potential on alleviating NAFLD and lipid accumulation via regulating DNL in the liver of HFD/STZ-induced T2DM rats.
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http://dx.doi.org/10.1002/fsn3.1868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590278PMC
October 2020

Utilizing methylglyoxal and D-lactate in urine to evaluate saikosaponin C treatment in mice with accelerated nephrotoxic serum nephritis.

PLoS One 2020 26;15(10):e0241053. Epub 2020 Oct 26.

School of Pharmacy, Taipei Medical University, Taipei, Taiwan.

The relationship between methylglyoxal (MGO) and D-lactate during saikosaponin C (SSC) treatment of mice with accelerated nephrotoxic serum (NTS) nephritis was investigated. NTS nephritis was induced by administration of anti-basement membrane antibodies to C57BL/6 mice and three dosages of SSC were administered for 14 days. Proteinuria, blood urea nitrogen, serum creatinine, renal histology, urinary MGO and d-lactate changes were examined. Compared to the NTS control group, the middle dosage (10 mg/kg/day) of SSC significantly alleviated the development of nephritis based on urine protein measurements (34.40 ± 6.85 vs. 17.33 ± 4.79 mg/day, p<0.05). Pathological observation of the glomerular basement membrane (GBM) revealed monocyte infiltration, hypertrophy, and crescents were alleviated, and injury scoring also showed improved efficacy for the middle dose of SSC during nephritis (7.92 ± 1.37 vs. 3.50 ± 1.14, p<0.05). Moreover, the significant decreases in urinary levels of MGO (24.71 ± 3.46 vs. 16.72 ± 2.36 μg/mg, p<0.05) and D-lactate (0.31 ± 0.04 vs. 0.23 ± 0.02 μmol/mg, p<0.05) were consistent with the biochemical and pathological examinations. This study demonstrates that MGO and D-lactate may reflect the extent of damage and the efficacy of SSC in NTS nephritis; further studies are required to enable clinical application.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241053PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588094PMC
December 2020

Cross-Sectional Study on Relationships Among FoMO, Social Influence, Positive Outcome Expectancy, Refusal Self-Efficacy and SNS Usage.

Int J Environ Res Public Health 2020 08 14;17(16). Epub 2020 Aug 14.

Department of Educational Psychology and Counselling, National Tsing Hua University, Hsin-chu City 300, Taiwan.

Objectives: Use of social networking sites (SNS; i.e., Facebook or Instagram) is common, and people use SNS to communicate and share information. Literature indicates the extent of SNS usage could be influenced by fear of missing out (FoMO). FoMO means a process of appraisal and psychological need for SNS use. This study proposes a model that integrates three determinants of social cognitive theory (SCT) to explain the impact of FoMO on SNS usage.

Design: A cross-sectional study was conducted using data from 259 participants recruited from a website.

Main Outcome Measures: The analysis focused on FoMO, social influence, positive outcome expectancy, refusal self-efficacy, and SNS-related behavior cloud-based sites. Data are examined using descriptive analysis and structural equation modeling.

Results: The proposed model reported proper goodness of fit. FoMO did not directly or indirectly impact SNS usage through the determinants of SCT. However, social influence and refusal self-efficacy had a direct effect.

Conclusions: The roles of the three determinants of SCT vary by stage of SNS usage. FoMO and refusal self-efficacy are more strongly related with SNS addiction. Further research, particularly longitudinal and intervention studies, is needed to examine the effects of specific factors on SNS addiction.
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http://dx.doi.org/10.3390/ijerph17165907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459540PMC
August 2020

Methylglyoxal and D-lactate in cisplatin-induced acute kidney injury: Investigation of the potential mechanism via fluorogenic derivatization liquid chromatography-tandem mass spectrometry (FD-LC-MS/MS) proteomic analysis.

PLoS One 2020 10;15(7):e0235849. Epub 2020 Jul 10.

Department of Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.

Nephrotoxicity severely limits the chemotherapeutic efficacy of cisplatin (CDDP). Oxidative stress is associated with CDDP-induced acute kidney injury (AKI). Methylglyoxal (MG) forms advanced glycation end products that elevate oxidative stress. We aimed to explore the role of MG and its metabolite D-lactate and identify the proteins involved in CDDP-induced AKI. Six-week-old female BALB/c mice were intraperitoneally administered CDDP (5 mg/kg/day) for 3 or 5 days. Blood urea nitrogen (42.6 ± 7.4 vs. 18.3 ± 2.5; p < 0.05) and urinary N-acetyl-β-D-glucosaminide (NAG; 4.89 ± 0.61 vs. 2.43 ± 0.31 U/L; p < 0.05) were significantly elevated in the CDDP 5-day group compared to control mice. Histological analysis confirmed AKI was successfully induced. Confocal microscopy revealed TNF-α was significantly increased in the CDDP 5-day group. Fluorogenic derivatized liquid chromatography-tandem mass spectrometry (FD-LC-MS/MS) showed the kidney MG (36.25 ± 1.68 vs. 18.95 ± 2.24 mg/g protein, p < 0.05) and D-lactate (1.78 ± 0.29 vs. 1.12 ± 0.06 mol/g protein, p < 0.05) contents were significantly higher in the CDDP 5-day group than control group. FD-LC-MS/MS proteomics identified 33 and nine altered peaks in the CDDP 3-day group and CDDP 5-day group (vs. control group); of the 35 proteins identified using the MOSCOT database, 11 were antioxidant-related. Western blotting confirmed that superoxide dismutase 1 (SOD-1) and parkinson disease protein 7 (DJ-1) are upregulated and may participate with MG in CDDP-induced AKI. This study demonstrates TNF-α, MG, SOD-1 and DJ-1 play crucial roles in CDDP-induced AKI.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235849PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351171PMC
September 2020

Urine N-terminal pro b-type natriuretic peptide is predictive of heart failure-related emergency department visits.

ESC Heart Fail 2020 10 2;7(5):2672-2678. Epub 2020 Jul 2.

Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan.

Aims: Emergency department (ED) visits for decompensated heart failure (HF) are frequent and associated with poor long-term outcomes in patients with HF. Serum N-terminal pro b-type natriuretic peptide (NT-proBNP) is widely used to assist diagnosis and predict clinical outcomes in HF patients. Few studies have investigated the use of urine NT-proBNP as an HF biomarker. This study aims to assess the value of urine NT-proBNP for predicting ED visits for decompensated HF as compared with that of serum NT-proBNP.

Methods And Results: This study included 122 HF patients with reduced left ventricular ejection fraction (<50%). Serum and urine NT-proBNP levels were measured. Baseline data included demographics, comorbidities, and co-medications. Medical records were used to determine the incidence of visits to the ED for decompensated HF during the 3 months following the last visit. We observed significantly higher levels of both serum and urine NT-proBNP in patients with subsequent ED visits than in those without. Multivariate logistic regression analysis showed that urine NT-proBNP/creatinine ratio (OR, 1.031; 95% CI, 1.001-1.061; P = 0.046) but not serum NT-proBNP was an independent factor associated with subsequent ED visits. According to receiver-operating characteristic-area under the curve analysis, the optimal cut-off value of urine NT-proBNP/creatinine ratio for predicting subsequent heart-failure related ED visits was 0.272 pg/μg Cr (area under the curve, 0.675; P = 0.011).

Conclusions: For HF patients with reduced left ventricular ejection fraction, a single measurement of urinary NT-proBNP/creatinine ratio is predictive of subsequent ED visits for decompensated HF. This non-invasive and easy measurement may be a clinically useful tool for monitoring clinical outcomes and identifying a subset of patients at higher risk of ED visits within a short time.
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http://dx.doi.org/10.1002/ehf2.12856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524049PMC
October 2020

Determination of temporal changes in serum and urinary lactate and 3-hydroxybutyrate enantiomers in mice with nephrotoxic serum nephritis by multi-dimensional HPLC.

J Pharm Biomed Anal 2020 Sep 24;188:113367. Epub 2020 May 24.

School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan. Electronic address:

Nephrotoxic serum (NTS) nephritis occurs in three stages: inflammation, early kidney damage, and severe kidney damage. We quantified the temporal changes in the enantiomers of lactate (LA) and 3-hydroxybutyrate (3HB) in serum and urine during the progression of autoimmune kidney damage in mice with NTS nephritis. Two-dimensional and three-dimensional HPLC were used to quantify the enantiomers. The serum and urinary levels of LA and 3HB enantiomers significantly changed during the progression of NTS nephritis. Specifically, d-LA was significantly higher in the serum (131.8 ± 30.6, 123.7 ± 27.2, 109.3 ± 15.6 vs. 51.2 ± 7.5 μM; p < 0.05) and urine (222.2 ± 34.8, 197.4 ± 53.9, 214.8 ± 68.9 vs. 100.8 ± 37.7 μmol/g creatinine; p < 0.05) of the week 0 (W0), week 1 (W1), and week 2 (W2) groups than the normal group. The l-3HB/d-3HB ratio was significantly lower in the W0, W1, and W2 groups than the normal group in serum (0.0362 ± 0.0082, 0.0346 ± 0.0065, 0.0323 ± 0.0033 vs. 0.0602 ± 0.0214; p < 0.05) and urine (0.0591 ± 0.0304, 0.1524 ± 0.0365, 0.1232 ± 0.1066 vs. 0.3273 ± 0.1394; p < 0.05). The changes in serum and urinary d-LA and l-3HB/d-3HB ratios were stable before severe kidney damage. In conclusion, we successfully determined the levels of LA and 3HB enantiomers in NTS nephritis by HPLC. Serum and urinary d-LA contents and l-3HB/d-3HB ratios may have potential as biomarkers of early autoimmune kidney injury.
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http://dx.doi.org/10.1016/j.jpba.2020.113367DOI Listing
September 2020

Seizure After Percutaneous Endoscopic Surgery-Incidence, Risk Factors, Prevention, and Management.

World Neurosurg 2020 06 3;138:411-417. Epub 2020 Apr 3.

Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, Republic of China; Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan, Republic of China; Department of Sport Medicine, College of Health Care, China Medical University, Taichung, Taiwan, Republic of China. Electronic address:

Background: Percutaneous endoscopic surgery is a popular surgery to treat lumbar spinal disorders. However, seizure after percutaneous endoscopic surgery is an unpredictable complication. The only prodromal sign for seizure currently known is neck pain. We reviewed the incidence of, and risk factors for, seizure during percutaneous endoscopic surgery and present the cases of 3 patients with seizure and our management.

Case Description: From October 2006 to March 2019, 3 of 816 patients (0.34%) with thoracic lumbar disorders who had undergone percutaneous endoscopic surgery experienced a seizure episode. The cases of those 3 patients were carefully reviewed. Studies of the risk factors for seizure after spinal procedures reported before June 13, 2019 were identified through a PubMed search. We found that infusion fluid containing cefazolin, the infusion rate, a prolonged operative time, the occurrence of a dural tear, and sevoflurane anesthesia might be associated with seizure, both described in the reported data and found in our experience. Three patients who experienced a seizure episode had had general anesthesia with sevoflurane, and the surgical approach used was interlaminar for a herniated disc in L5-S1. We noted a "red flag sign," namely an uncontrollable hypertension episode combined with a decreasing pulse rate, in all 3 patients who had experienced a seizure, which was not observed in the other patients. All 3 patients had received antihypertensive medication (labetalol) ≥3 times without response.

Conclusion: Seizure after percutaneous endoscopic surgery is rare, but lethal. Although its cause remains unknown, all risk factors for seizure should be checked and corrected immediately when a red flag sign, uncontrolled hypertension, appears.
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http://dx.doi.org/10.1016/j.wneu.2020.03.121DOI Listing
June 2020

Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion.

Clin J Sport Med 2019 Dec 24. Epub 2019 Dec 24.

ARiEAL, Centre for Advanced Research in Experimental and Applied Linguistics, McMaster University, Hamilton, Ontario, Canada.

Objective: The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth.

Design: A prospective cohort of children/youth with concussion.

Setting: Childhood Disability Research Centre.

Participants: One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department.

Intervention: Provision of RTS/RTA guidelines.

Main Outcome Measures: Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores.

Results: Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively.

Conclusions: Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.
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http://dx.doi.org/10.1097/JSM.0000000000000800DOI Listing
December 2019

Staging and clinical correlations of lymphoscintigraphy for unilateral gynecological cancer-related lymphedema.

J Surg Oncol 2020 Mar 25;121(3):422-434. Epub 2019 Dec 25.

Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Background: This study was to investigate the lymphoscintigraphy findings for the diagnosis and severity in unilateral gynecological cancer-related lymphedema (GCRL) and to correlate lymphoscintigraphy stages with the clinical findings.

Methods: Patients with unilateral GCRL who underwent lymphoscintigraphy were staged using the presence of ileo-inguinal lymph nodes, distal-lymphatic ducts, and dermal backflow findings. Taiwan Lymphoscintigraphy Staging (TLS) was divided into three patterns and seven stages: normal drainage (L-0); partial obstruction (P-1, P-2, and P-3); and total obstruction (T4, T-5, and T-6). Correlations between clinical lymphedema severity and TLS were evaluated using analysis of variance and multivariable linear regression analyses.

Results: A total of 141 patients with unilateral GCRL were divided as follows: 6 (4.3%) in normal drainage, 56 (39.7%) in partial-obstruction, and 79 (56%) in total obstruction. Cellulitis episodes, circumferential difference, and computed tomography (CT) volumetric difference were shown to be statistically different between TLS stages (P < .001 for all). Total obstruction stages were the most significant factors associated with the severity of circumferential difference (β = 19.72, 25.54, 32.42, respectively; P < .05) and CT volumetric difference (β = 36.04, 45.12, 52.78, respectively; P < .01).

Conclusions: Total lymphatic obstruction was present in 56% of unilateral GCGL. Lymphoscintigraphy stages were statistically correlated with episodes of cellulitis, circumferential difference and CT volumetric difference in unilateral GCRL.
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http://dx.doi.org/10.1002/jso.25817DOI Listing
March 2020

The Accuracy of 3D Printing Assistance in the Spinal Deformity Surgery.

Biomed Res Int 2019 11;2019:7196528. Epub 2019 Nov 11.

Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan.

Background: The pedicle screw is one of the main tools used in spinal deformity correction surgery. Robotic and navigated surgeries are usually used, and they provide superior accuracy in pedicle screw placement than free-hand and fluoroscopy-guided techniques. However, their high cost and space limitation are problematic. We provide a new solution using 3D printing technology to facilitate spinal deformity surgery.

Methods: A workflow was developed to assist spinal deformity surgery using 3D printing technology. The trajectory and profile of pedicle screws were determined on the image system by the surgical team. The engineering team designed drill templates based on the bony surface anatomy and the trajectory of pedicle screws. Their effectiveness and safety were evaluated during a preoperative simulation surgery. The surgery consisted in making a pilot hole through the drill template on a computed tomography- (CT-) based, full-scale 3D spine model for every planned segment. Somatosensory evoke potential (SSEP) and motor evoke potential (MEP) were used for intraoperative neurophysiological monitoring. Postoperative CT was obtained 6 months after the correction surgery to confirm the screw accuracy.

Results: From July 2015 to November 2016, we performed 10 spinal deformity surgeries with 3D printing technology assistance. In total, 173 pedicle screws were implanted using drill templates. No notable change in SSEP and MEP or neurologic deficit was noted. Based on postoperative CT scans, the acceptable rate was 97.1% (168/173). We recorded twelve pedicle screws with medial breach, six with lateral breach, and five with inferior breach. Medial breach (12/23) was the main type of penetration. Lateral breach occurred mostly in the concave side (5/6). Most penetrations occurred above the T8 level (69.6%, 16/23).

Conclusion: 3D printing technology provides an effective alternative for spinal deformity surgery when expensive medical equipment, such as intraoperative navigation and robotic systems, is unavailable.
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http://dx.doi.org/10.1155/2019/7196528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885147PMC
April 2020

Concussion Management for Children Has Changed: New Pediatric Protocols Using the Latest Evidence.

Clin Pediatr (Phila) 2020 01 18;59(1):5-20. Epub 2019 Oct 18.

Division of Emergency Medicine, Department of Pediatrics, McMaster University Medical Centre and McMaster University, Hamilton, Ontario, Canada.

Return to activity (RTA) and return to school (RTS) are important issues in pediatric concussion management. This study aims to update CanChild's 2015 RTA and RTS protocols, on the basis of empirical data and feedback collected from our recently completed prospective cohort study, focusing on concussed children and their caregivers; systematic review of evidence published since 2015; and consultation with concussion management experts. The new protocols highlight differences from the earlier versions, mainly, (1) symptom strata to allow quicker progression for those who recover most quickly; (2) a shortened rest period (24-48 hours) accompanied by symptom-guided activity; (3) the recommendation that children progress through the stages before they are symptom free, if symptoms have decreased and do not worsen with activity; (4) specific activity suggestions at each stage of the RTA protocol; (5) recommendations for the amount of time to spend per stage; and (6) integration of RTS and RTA.
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http://dx.doi.org/10.1177/0009922819879457DOI Listing
January 2020

Sandwich-Nanostructured n-CuO/AuAg/p-CuO Photocathode with Highly Positive Onset Potential for Improved Water Reduction.

ACS Appl Mater Interfaces 2019 Oct 14;11(42):38625-38632. Epub 2019 Oct 14.

National Synchrotron Radiation Research Center , Hsinchu 30076 , Taiwan.

An n-CuO layer formed a high-quality buried junction with p-CuO to increase the photovoltage and thus to shift the turn-on voltage positively. Mott-Schottky measurements confirmed that the improvement benefited from a positive shift in flat-band potential. The obtained extremely positive onset potential, 0.8 V in n-CuO/AuAg/p-CuO, is comparable with measurements from water reduction catalysts. The AuAg alloy sandwiched between the homojunction of n-CuO and p-CuO improved the photocatalytic performance. This alloy both served as an electron relay and promoted electron-hole pair generation in nearby semiconductors; the charge transfer between n-CuO and p-CuO in the sandwich structure was measured with X-ray absorption spectra. The proposed sandwich structure can be considered as a new direction for the design of efficient solar-related devices.
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http://dx.doi.org/10.1021/acsami.9b11737DOI Listing
October 2019

What Comes First: Return to School or Return to Activity for Youth After Concussion? Maybe We Don't Have to Choose.

Front Neurol 2019 23;10:792. Epub 2019 Jul 23.

CanChild Centre for Disability Research, McMaster University, Hamilton, ON, Canada.

Return to School (RTS) and Return to Activity/Play (RTA) protocols are important in concussion management. Minimal evidence exists as to sequence and whether progression can occur simultaneously. Experts recommend that children/youth fully return to school before beginning RTA protocols. This study investigates recovery trajectories of children/youth while following RTA and RTS protocols simultaneously, with the following objectives: (1) to compare rates and patterns of progression through the stages of both protocols; (2) to evaluate symptom trajectories of youth post-concussion while progressing through stages of RTS and RTA; and (3) to propose a new model for concussion management in youth that involves the integration of Return to Activity and Return to School protocols. In a 3-year prospective-cohort study of 139 children/youth aged 5-18 years with concussive injury, self-reported symptoms using PCSS and stage of protocols were evaluated every 48 h using electronic surveys until full return to school and activity/sport were attained. Information regarding school accommodation and achievement was collected. Sample mean age is 13 years, 46% male. Youth are returning to school with accommodations significantly quicker than RTA ( = 0.001). Significant negative correlations between total PCSS score and stage of RTS protocol were found at: 1-week ( = -0.376, < 0.0001; = -0.317, = 0.0003), 1-month ( = -0.483, < 0.0001; = -0.555, < 0.0001), and 3-months ( = -0.598, < 0.0001; = -0.617, < 0.0001); indicating lower symptom scores correlated with higher guideline stages. Median full return to school time is 35 days with 21% of youth symptomatic at full return. Median return time to full sport competition is 38 days with 15% still symptomatic. Sixty-four percent of youth reported experiencing school problems during recovery and 30% at symptom resolution, with 31% reporting a drop in their grades during recovery and 18% at study completion. Children/youth return to school faster than they return to play in spite of the self-reported, school-related symptoms they experience while moving through the protocols. Youth can progress simultaneously through the RTS and RTA protocols during stages 1-3. Considering the numbers of youth having school difficulties post-concussion, full contact sport, stage 6, of RTA, should be delayed until full and successful reintegration back to school has been achieved. In light of the huge variability in recovery, determining how to resume participation in activities despite ongoing symptoms is still the challenge for each individual child. There is much to be learned with further research needed in this area.
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http://dx.doi.org/10.3389/fneur.2019.00792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664873PMC
July 2019

Comparison of Outcomes between Side-to-End and End-to-End Lymphovenous Anastomoses for Early-Grade Extremity Lymphedema.

Plast Reconstr Surg 2019 08;144(2):486-496

From the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine.

Background: Lymphovenous anastomosis is technically challenging and can be successfully performed with an advanced operating microscope, supermicrosurgical instruments, and indocyanine green lymphography. This study compared the outcomes between side-to-end and end-to-end lymphovenous anastomosis configurations for unilateral extremity lymphedema.

Methods: Between April of 2013 and June of 2017, lymphovenous anastomosis was indicated for 58 patients who preoperatively had patent lymphatic ducts by indocyanine green lymphography, including 20 patients with upper limb lymphedema and 38 patients with lower limb lymphedema. Either an end-to-end or a side-to-end lymphovenous anastomosis was used to anastomose the subdermal venule to the lymphatic duct. The circumferential difference and episodes of cellulitis were used as outcome measurements.

Results: Twenty-three patients underwent an end-to-end lymphovenous anastomosis and 35 patients underwent side-to-end lymphovenous anastomosis. All patients had an immediate patency evaluated by indocyanine green lymphography and patent blue assessments. All patients returned to their daily routine without the use of any compression garments. At an average follow-up of 16.5 months (range, 13.4 to 19.6 months), the improvement of circumferential difference (3.2 percent; range, 1.8 to 4.6 percent) in the side-to-end group was statistically greater than that in the end-to-end group (2.2 percent; range, 1 to 3.4 percent; p = 0.04). The overall episodes of cellulitis were significantly reduced from 1.7 times/year (range, 1.3 to 2.1 times/year) to 0.7 times/year (range, 0.3 to 1.1 times/year; p < 0.001), but no difference was observed between the two groups.

Conclusions: Both side-to-end and end-to-end lymphovenous anastomosis configurations were effective surgical approaches for improving early-grade extremity lymphedema. Side-to-end lymphovenous anastomosis has the advantages of having greater efficacy for lymph drainage, requiring only one anastomosis and eliminating the need to use compression garments.

Clinical Question/level Of Evidence: Therapeutic, III.
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http://dx.doi.org/10.1097/PRS.0000000000005870DOI Listing
August 2019

Delayed primary retention suture for inset of vascularized submental lymph node flap for lower extremity lymphedema.

J Surg Oncol 2020 Jan 5;121(1):138-143. Epub 2019 Jul 5.

Department of Plastic and Reconstrucitve Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.

Background: Vascularized lymph node transfer (VLNT) has become one of the effective surgical treatments for extremity lymphedema. This study was to evaluate the re-exploration and total complication rates of VLNT for lower extremity lymphedema between two different flap inset techniques.

Methods: Sixty-nine patients who underwent 74 submental VLNT transfers between 2008 and 2018 were retrospectively studied. Fifty-six flaps were inset using a new delayed primary retention suture (DPRS) technique and other 18 flaps using conventional interrupted sutures as the non-DPRS group.

Results: The overall flap success rate was 100%. The DPRS group was released at a mean of 1.7  ± 0.7 times and took a mean of 10.3 ± 3.3 days for wound closure. There were no statistical differences in demographics, mean symptom duration, and mean Cheng's Lymphedema Grading between two groups. Mean frequency of cellulitis of 2.5 ± 1.5 times/year in non-DPRS group was significantly greater than 1.4 ± 1.6 times/year in DPRS group (P = .01). The re-exploration and total complication rates were 5.4% and 7.1% in DPRS group, and 27.8% and 33.3% in non-DPRS group, respectively (P = .02 and .02, respectively).

Conclusions: The DPRS technique is a safe, simple, and reliable method for insetting the submental VLNT, which statistically decreased the re-exploration and total complication rates.
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http://dx.doi.org/10.1002/jso.25520DOI Listing
January 2020

Long-term outcome of lower extremity lymphedema treated with vascularized lymph node flap transfer with or without venous complications.

J Surg Oncol 2020 Jan 27;121(1):129-137. Epub 2019 Jun 27.

Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taoyuan, Taiwan.

Background: Vascularized submental lymph node (VSLN) transfer is an emerging approach for extremity lymphedema. This study investigated the long-term outcome and venous complications of VSLN for unilateral lower extremity lymphedema.

Methods: Between 2010 and 2018, patients who underwent VSLN for unilateral lower extremity lymphedema were retrospectively evaluated. Patient demographics, operative records, complications, circumferential improvement, and episodes of cellulitis were analyzed. Further comparisons were performed between different types, numbers, and techniques of venous anastomoses.

Results: A total of 75 VSLNs in 70 patients survived, giving a 100% success rate. Six flaps (8%) had venous complications (VC group) and 69 flaps (92%) did not (No-VC group). There were no statistical differences in types, numbers, and techniques of anastomoses between two groups (P = .65, 1, and .56, respectively). At a mean follow-up of 32.0 ± 23.0 months, mean circumferential improvement and episodes of cellulitis between two groups did not statistically differ significantly (P = .31 and .09, respectively).

Conclusions: VSLN is an effective treatment for lower extremity lymphedema. The types, numbers of veins, and techniques of venous anastomoses did not statistically affect the venous complication rates. Functional outcomes of the VSLNs were not compromised if venous complications were salvaged promptly.
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http://dx.doi.org/10.1002/jso.25602DOI Listing
January 2020

Factors associated with professional healthcare advice seeking in breast cancer-related lymphedema.

J Surg Oncol 2020 Jan 18;121(1):67-74. Epub 2019 Jun 18.

Department of Plastic and Reconstructive Surgery, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

Objectives: This study aimed to identify the cognitive factors associated with the professional healthcare advice (PHCA) seeking behavior in breast cancer-related lymphedema (BCRL).

Methods: From January 2018 to December 2018, patients with BCRL were prospectively enrolled for a cross-sectional survey of lymphedema-related perceived risks, lymphedema quality of life (LYMQoL), knowledge scale of lymphedema, and PHCA behavior at first clinical visit, 3 and 6 months postbaseline.

Results: A total of 180 patients including 100 (55.6%) patients underwent a vascularized lymph node transfer (VLNT) and 80 (44.4%) patients received compressive decongestive therapy (CDT) were enrolled. At 6 months of follow-up, mean episodes of cellulitis (from 2.2 to 0.2 times/year), mean circumferential difference (7.8 ± 3.9%), wearing compression garments (from 29% to 0 %) in the VLNT group were statistically reduced than those in the CDT group (p = .01, <.01, and <.01, respectively). The overall LYMQoL had statistical improvement in VLNT group (p < .01). The short symptom duration, greater education level, less episodes of cellulitis, and higher knowledge of lymphedema were associated with increased adherence to PHCA (p = .03, .03, .02, and .01, respectively).

Conclusion: BCRL patients who sought PHCA had great control of lymphedema and improve their quality of life.
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http://dx.doi.org/10.1002/jso.25523DOI Listing
January 2020

Lymphedema microsurgery reduces the rate of implant removal for patients who have pre-existing lymphedema and total knee arthroplasty for knee osteoarthritis.

J Surg Oncol 2020 Jan 13;121(1):57-66. Epub 2019 Jun 13.

Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.

Introduction: Patients with pre-existing lymphedema who undergo total knee arthroplasty (TKA) for osteoarthritis (OA) are at high risk for periprosthetic joint infection. This complication usually requires removal of the implant. This study aimed to investigate whether surgical treatment of lymphedema reduces the rate of prosthesis removal in such patients.

Materials And Methods: We retrospectively reviewed our prospective database of patient information collected between January 2009 and December 2018. A total of 348 cases of lower extremity lymphedema were reviewed, and those who underwent total knee TKA for OA of the knee were included. Patient demographics, clinical data, lymphedema surgical history, and TKA surgical history including any episodes of removal were collected and analyzed.

Results: There were nine of 15 lymphedema patients with knee OA who subsequently underwent TKA. The mean patient age was 70.4 ± 7.1 years. A total of 18 TKAs were performed in nine patients. The knee prosthesis removal rate was 66.7% (12/18). The prosthesis removal rate was 40% (2/5) in patients who underwent lymphedema microsurgery vs 76.9% (10/13) for those who did not (P = .03).

Conclusions: Pre-existing lymphedema is associated with a high rate of knee prosthesis removal. Lymphedema microsurgery reduced the removal rate of knee prostheses. We recommend that lymphedema microsurgery be considered for patients who require TKA as a treatment for of the knee.
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http://dx.doi.org/10.1002/jso.25517DOI Listing
January 2020

New Strategy for Minimally Invasive Endoscopic Surgery to Treat Infectious Spondylodiscitis in the Thoracolumbar Spine.

Pain Physician 2019 05;22(3):281-293

Department of Orthopaedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.; School of Medicine, China Medical University, Taichung, Taiwan, R.O.C.

Background: Eradicating infection, protecting neurologic function, and maintaining structural alignment are the 3 objectives of treatment for infectious spondylodiscitis. For some patients, surgery may be necessary to achieve these goals; however, open surgeries are associated with high morbidity and mortality in elderly patients and those with multiple comorbidities. Endoscopic surgery provides a minimally invasive surgical option for obtaining a culture sample to aid identification of pathogens, while also providing a route for adequate decompression and drainage. The clinical results of this study were analyzed.

Objectives: To evaluate the efficacy and safety of spinal endoscopic surgery, the basic characteristics of patients analyzed and their inflammatory markers, pain levels, and local kyphotic angles were recorded before surgery and at regular intervals after surgery. The patients' cultured pathogens and previous antibiotic treatments were also recorded and analyzed.

Study Design: Retrospective observational study (institutional review board: CMUH 105-REC2-101).

Setting: Inpatient surgery center.

Methods: From October 2006 to March 2017, of 508 patients who received spinal endoscopic surgery, 60 with infectious spondylodiscitis were treated using this new strategy. All 60 patients underwent plain film radiography and enhanced magnetic resonance imaging of the affected region to obtain evidence of infectious spondylodiscitis. The role of a computed tomography-guided biopsy and some indications for open surgery were replaced with endoscopic surgery.

Results: All the patients reported rapid pain relief after endoscopic surgery and antibiotic treatment. No significant changes in sagittal alignment were observed in final follow-up radiography images. Causative pathogens were identified in 34 patients (culture rate: 77.27%) without previous antibiotic treatment. The patients' erythrocyte sedimentation rates and C-reactive protein levels had decreased significantly 3 months after endoscopic surgery. Two patients (3.3%) experienced infection relapse following initial endoscopic surgery; both of them were efficiently resolved through a second round of endoscopic surgery. No surgery-related complications were observed and no open spinal surgery was required during the follow-up period.

Limitations: This was a retrospective study; bias was unavoidable because of the single-center nature of the study design.

Conclusions: Regarding the culture rate, recurrence rate, kyphotic change, and surgery-related complications, this new strategy for endoscopic surgery is safe and effective for treating infectious spondylodiscitis in the thoracic or lumbar spine and may be considered a new trend in treating diseases of this type.

Key Words: Spine, endoscopic, discectomy, spondylodiscitis, minimally invasive surgery.
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May 2019

MST3 is involved in ENaC-mediated hypertension.

Am J Physiol Renal Physiol 2019 07 10;317(7):F30-F42. Epub 2019 Apr 10.

School of Pharmacy, China Medical University , Taichung , Taiwan.

Liddle syndrome is an inherited form of human hypertension caused by increasing epithelial Na channel (ENaC) expression. Increased Na retention through ENaC with subsequent volume expansion causes hypertension. In addition to ENaC, the Na-K-Cl cotransporter (NKCC) and Na-Cl symporter (NCC) are responsible for Na reabsorption in the kidneys. Several Na transporters are evolutionarily regulated by the Ste20 kinase family. Ste20-related proline/alanine-rich kinase and oxidative stress-responsive kinase-1 phosphorylate downstream NKCC2 and NCC to maintain Na and blood pressure (BP) homeostasis. Mammalian Ste20 kinase 3 (MST3) is another member of the Ste20 family. We previously reported that reduced MST3 levels were found in the kidneys in spontaneously hypertensive rats and that MST3 was involved in Na regulation. To determine whether MST3 is involved in BP stability through Na regulation, we generated a MST3 hypomorphic mutation and designated MST3 and MST3 mice to examine BP and serum Na and K concentrations. MST3 mice exhibited hypernatremia, hypokalemia, and hypertension. The increased ENaC in the kidney played roles in hypernatremia. The reabsorption of more Na promoted more K secretion in the kidney and caused hypokalemia. The hypernatremia and hypokalemia in MST3 mice were significantly reversed by the ENaC inhibitor amiloride, indicating that MST3 mice reabsorbed more Na through ENaC. Furthermore, Madin-Darby canine kidney cells stably expressing kinase-dead MST3 displayed elevated ENaC currents. Both the in vivo and in vitro results indicated that MST3 maintained Na homeostasis through ENaC regulation. We are the first to report that MST3 maintains BP stability through ENaC regulation.
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http://dx.doi.org/10.1152/ajprenal.00455.2018DOI Listing
July 2019

Iron phosphate modified calcium iron oxide as an efficient and robust catalyst in electrocatalyzing oxygen evolution from seawater.

Faraday Discuss 2019 Jul;215(0):205-215

Department of Chemical Engineering, National Cheng Kung University, No. 1, University Road, Tainan City 70101, Taiwan.

Solar fuel generation using seawater as the proton source is fascinating but challenging due to the detrimental chlorochemistry, the lack of active and stable oxygen evolution catalysts operating at seawater pH (∼8) and high turnover conditions. In the present study, iron phosphate modified calcium iron oxide (CaFeOx|FePO4) modified FTO electrodes were prepared, and their electrocatalytic properties towards the oxygen evolution reaction in both synthetic and natural seawater solutions were investigated. CaFeOx|FePO4 was prepared by electrodepositing FePO4 onto CaFeOx, prepared by spin-coating and a follow-up annealing process, under a constant applied current for different durations. Mg2+-induced fouling significantly reduces the activity of CaFeOx and slows down the activation process of CaFeOx, but can be mitigated by surface-modification of CaFeOx with FePO4. In addition, the presence of additional electrodeposited iron phosphate on the surface of CaFeOx attenuates the production of corrosive hypochlorite from chloride oxidation. With these unique properties of FePO4, the activated CaFeOx|FePO4 electrode shows high activity and stability under high turnover conditions, reaching 10 mA cm-2 at an overpotential of ∼710 mV, with a moderate increase in η (∼70 mV), mainly due to the change in solution pH, over 10 h of electrolysis in phosphate-buffered (0.5 M, pH 7) seawater solution.
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http://dx.doi.org/10.1039/c8fd00172cDOI Listing
July 2019

Effectiveness of Vascularized Lymph Node Transfer for Extremity Lymphedema Using Volumetric and Circumferential Differences.

Plast Reconstr Surg Glob Open 2019 Feb 13;7(2):e2003. Epub 2019 Feb 13.

Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.

Background: Circumferential difference of lymphedematous limbs at designated anatomic distances has been the primary mode for measuring lymphedematous extremities. Computed tomography (CT) imaging produces accurate, consistent, hygienic volume measurements and a direct limb representation. This study compares these 2 main modalities and assesses their correlation.

Methods: CT and circumferential difference measurements, costs, and correlation of patient limbs that received vascularized lymph node transfer were compared.

Results: Mean circumferential difference by tape measurement pre- and postoperatively was 31.4% ± 19.1% and 17.4% ± 8.8% for upper limbs and 43.2% ± 16.1% and 22.4% ± 12% for the lower limbs, respectively. Mean CT volumetric difference pre- and postoperatively were 36.1 ± 4.1% and 27.2 ± 2.8% for the upper limb and 46.2 ± 3.2% and 33.2 ± 2.1% for the lower limbs, respectively. CT volume measurements significantly correlated with their respective circumferential difference with Pearson correlation coefficient of = +0.7, which was statistically significant ( = 0.03), indicating a strong positive correlation between circumferential difference and actual limb volume changes as determined by CT imaging. Circumferential differences are more cost effective than CT volume assessments in the domains of measurement frequency ( = 0.03), fee ( < 0.01), time ( = 0.03), total cost per year ( < 0.01), and cost/minute ( = 0.03).

Conclusions: Standardized circumferential differences that are currently used are comparable to unbiased CT volumetric measurements and can be used as a reliable, reproducible, minimally invasive, low cost, and accurate method of measuring the lymphedematous limbs.
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http://dx.doi.org/10.1097/GOX.0000000000002003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416128PMC
February 2019

High Selectivity and Sensitivity of Oligomeric p-Phenylene Ethynylenes for Detecting Fibrillar and Prefibrillar Amyloid Protein Aggregates.

ACS Chem Neurosci 2019 03 6;10(3):1813-1825. Epub 2019 Feb 6.

Misfolding and aggregation of amyloid proteins into fibrillar aggregates is a central pathogenic event in neurodegenerative disorders such as Alzheimer's (AD) and Parkinson's diseases (PD). Currently, there is a lack of reliable sensors for detecting the range of protein aggregates involved in disease etiology, particularly the prefibrillar aggregate conformations that are more neurotoxic. In this study, the fluorescent sensing of two novel oligomeric p-phenylene ethynylenes (OPEs), anionic OPE1- and cationic OPE2+, for detecting prefibrillar and fibrillar aggregates of AD-associated amyloid-β (Aβ40 and Aβ42) and PD-associated α-synuclein proteins (wildtype, and single mutants A30P, E35K, and A53T) over their monomeric counterparts, were tested. Furthermore, the performance of OPEs was evaluated and compared to thioflavin T (ThT), the most widely used fibril dye. Our results show that OPE1- and OPE2+ exhibited aggregate-specific binding inducing large fluorescence turn-on and spectral shifts based on a combination of backbone planarization, hydrophobic unquenching, and superluminescent OPE complex formation sensing modes. OPEs exhibited higher selectivity, higher binding affinity, and comparable limits of detection for Aβ40 fibrils compared to ThT. OPE2+ exhibited the largest fluorescence turn-on and highest sensitivity. Significantly, OPEs detected prefibrillar aggregates of Aβ42 and α-synuclein that ThT failed to detect. The superior sensing performance, the nonprotein specific detection, and the ability to selectively detect fibrillar and prefibrillar amyloid protein aggregates point to the potential of OPEs to overcome the limitations of existing probes and promise significant advancement in the detection of the myriad of protein aggregates involved in the early stages of AD and PD.
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http://dx.doi.org/10.1021/acschemneuro.8b00719DOI Listing
March 2019

Outcomes of Vascularized Lymph Node Transfer and Lymphovenous Anastomosis for Treatment of Primary Lymphedema.

Plast Reconstr Surg Glob Open 2018 Dec 20;6(12):e2056. Epub 2018 Dec 20.

Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Background: Primary lymphedema is a debilitating disease. This study was to investigate the outcomes between vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) for treating primary lymphedema.

Methods: Between January 2010 and December 2016, 17 patients with mean age of 31.5 ± 15.5 (ranged, 2-57) years diagnosed with 19 primary limb lymphedema were recruited. Patients with patent lymphatic ducts on indocyanine green lymphography were indicated for LVA, whereas those without patent lymphatic ducts were indicated for VLNT. Circumferential limb measurements, body weight, episodes of cellulitis and Lymphedema Quality-of-Life (LYMQoL) questionnaire were compared between preoperatively and postoperatively.

Results: Fifteen lymphedematous limbs underwent VLNT (79%) and 4 underwent LVA (21%). All VLNT flaps survived. At a mean follow-up of 19.7 ± 8.5 months, mean reduction of limb circumference, body weight, and episodes of cellulitis were 3.7 ± 2.9 cm and 1.9 ± 2.9 cm ( = 0.2); 6.6 ± 5.9 kg and 1.7 ± 0.6 kg ( < 0.05); 5.1 ± 2.8 times/y and 4.2 ± 0.5 times/y in VLNT and LVA groups, respectively ( = 0.7). Improvements in overall score (from 3.9 ± 1.2 to 6.4 ± 1.1, < 0.05) of the LYMQoL in VLNT group had statistical significant difference than that (from 3.0 ± 1.4 to 5.0 ± 2.4, = 0.07) in LVA group.

Conclusions: Both VLNT and LVA can effectively treat primary lymphedema patients. The reduction of above-knee circumference, body weight, episodes of cellulitis, and the improvement of LYMQoL was significantly greater in LVNT compared with LVA.
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http://dx.doi.org/10.1097/GOX.0000000000002056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326612PMC
December 2018