Publications by authors named "Yu-Ting Cheng"

74 Publications

Molecularly Imprinted Polymer/Anodic Aluminum Oxide Nanocomposite Sensing Electrode for Low-Concentration Troponin T Detection for Patient Monitoring Applications.

ACS Sens 2021 Jun 8. Epub 2021 Jun 8.

Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan 300, ROC.

Various clinical studies have shown that myocardial troponin T (cTnT) is highly correlated with acute myocardial infarction (AMI). A highly sensitive molecularly imprinted polymer (MIP) sensing electrode for the detection of cTnT in patients' blood serum can enable cost-effective, rapid, and real-time testing for patients requiring intensive care. However, the existing MIP-based sensing electrode does not perform well for low-concentration detection of cTnT (<0.2 ng/mL). In this study, a new type of sensing electrode, an anodic aluminum oxide molecularly imprinted (MIP/AAO) nanocomposite electrode is developed. By incorporating the AAO structure, i.e., one-dimensional (1D) pillars, through a semiconductor-compatible process, the new electrode exhibits a great performance improvement, higher sensitivity of 1.08 × 10 and 4.25 × 10 in the low (<0.03 ng/mL)- and high-concentration regions, respectively, and a lower limit of detection (LoD) of 5.34 pg/mL. Because the composite electrode can maintain a linear characteristic in the measurement range of low-concentration cTnT, it can effectively improve the accuracy and reduce the error in cTnT measurement. In addition, the novel sensing electrode exhibits good reusability and specificity.
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http://dx.doi.org/10.1021/acssensors.1c00738DOI Listing
June 2021

Zoledronic acid modulates osteoclast apoptosis through activation of the NF-κB signaling pathway in ovariectomized rats.

Exp Biol Med (Maywood) 2021 Apr 29:15353702211011052. Epub 2021 Apr 29.

Department of Pathology, Guizhou Medical University School of Medicine, Guizhou 550004, P.R. China.

Bone mass loss (osteoporosis) seen in postmenopausal women is an adverse factor for implant denture. Using an ovariectomized rat model, we studied the mechanism of estrogen-deficiency-caused bone loss and the therapeutic effect of Zoledronic acid. We observed that ovariectomized-caused resorption of bone tissue in the mandible was evident at four weeks and had not fully recovered by 12 weeks post-ovariectomized compared with the sham-operated controls. Further evaluation with a TUNEL assay showed ovariectomized enhanced apoptosis of osteoblasts but inhibited apoptosis of osteoclasts in the mandible. Zoledronic acid given subcutaneously as a single low dose was shown to counteract both of these ovariectomized effects. Immunohistochemical staining showed that ovariectomized induced the protein levels of RANKL and the 65-kD subunit of the NF-κB complex mainly in osteoclasts, as confirmed by staining for TRAP, a marker for osteoclasts, whereas zoledronic acid inhibited these inductions. Western blotting showed that the levels of RANKL, p65, as well as the phosphorylated form of p65, and IκB-α were all higher in the ovariectomized group than in the sham and ovariectomized + zoledronic acid groups at both the 4th- and 12th-week time points in the mandible. These data collectively suggest that ovariectomized causes bone mass loss by enhancing apoptosis of osteoblasts and inhibiting apoptosis of osteoclasts. In osteoclasts, these cellular effects may be achieved by activating RANKL-NF-κB signalling. Moreover, zoledronic acid elicits its therapeutic effects in the mandible by counteracting these cellular and molecular consequences of ovariectomized.
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http://dx.doi.org/10.1177/15353702211011052DOI Listing
April 2021

Effects of Fluoroquinolones on Outcomes of Patients With Aortic Dissection or Aneurysm.

J Am Coll Cardiol 2021 Apr;77(15):1875-1887

Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan. Electronic address:

Background: Recent population-based studies have revealed that the use of fluoroquinolones (FQs) is associated with an increased risk of aortic dissection (AD) and aneurysm (AA). However, no evidence is available on whether FQs increase adverse events in patients who had been diagnosed with AD or AA.

Objectives: This study investigated whether the use of FQs increases the risk of aortic-related adverse events and death in this high-risk population.

Methods: A retrospective cohort study was conducted by using the Taiwan National Health Insurance Research Database. A total of 31,570 adult patients who survived after admission for AD or AA between 2001 and 2013 were identified. We divided each calendar year into 6 data units (2 months) for each patient and each year during follow-up. Covariates and exposure of interest (FQs) were reassessed every 2 months. We used another common antibiotic, amoxicillin, as a negative control exposure.

Results: Exposure to FQs was associated with a higher risk of all-cause death (adjusted hazard ratio: 1.61; 95% confidence interval: 1.50 to 1.73), aortic death (adjusted hazard ratio: 1.80; 95% confidence interval: 1.50 to 2.15), and later aortic surgery. However, amoxicillin exposure was not significantly associated with risk of any of the outcomes. A subgroup analysis revealed that the effect of FQs was not significantly different between the AD and AA groups.

Conclusions: Relative to amoxicillin use, FQ exposure in patients with AD or AA was associated with a higher risk of adverse outcomes. FQs should not be used by high-risk patients unless no other treatment options are available.
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http://dx.doi.org/10.1016/j.jacc.2021.02.047DOI Listing
April 2021

Bioprosthetic versus mechanical mitral valve replacements in patients with rheumatic heart disease.

J Thorac Cardiovasc Surg 2021 Mar 18. Epub 2021 Mar 18.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan. Electronic address:

Background: Rheumatic heart disease (RHD) remains a critical problem in developed countries. Few studies have compared the long-term outcomes of bioprosthetic valves and mechanical valves in patients with RHD who have received mitral valve (MV) replacement.

Methods: Patients with RHD who received MV replacement with bioprosthetic or mechanical valves were identified between 2000 and 2013 from Taiwan's National Health Insurance Research Database. The primary late outcomes of interest were all-cause mortality and redo MV surgery. Propensity score matching at a 1:1 ratio was performed.

Results: We identified 3638 patients with RHD who underwent MV replacement. Among those patients, 1075 (29.5%) and 2563 (70.5%) chose a bioprosthetic valve and mechanical valve, respectively. After matching, 788 patients were assigned to each group. No significant difference in the risk of in-hospital mortality was observed between groups (P = .920). Higher risks of all-cause mortality (10-year actuarial estimates: 50.6% vs 45.5%; hazard ratio, 1.19; 95% confidence interval, 1.01-1.41; P = .040) and MV reoperation (10-year actuarial estimates: 8.9% vs 0.93%; subdistribution hazard ratio, 4.56; 95% confidence interval, 1.71-12.17; P <.01) were observed in the bioprosthetic valve group. Furthermore, the relative mortality benefit associated with mechanical valves was more apparent in younger patients and the beneficial effect persisted until approximately 65 years of age.

Conclusions: In the patients with RHD who underwent MV replacement, mechanical valves were associated with more favorable long-term outcomes in patients younger than the age of 65 years.
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http://dx.doi.org/10.1016/j.jtcvs.2021.03.033DOI Listing
March 2021

Level of serum soluble lumican and risks of perioperative complications in patients receiving aortic surgery.

PLoS One 2021 4;16(3):e0247340. Epub 2021 Mar 4.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.

Objective: Several serum biomarkers have been investigated for their potential as diagnostic tools in aortic disease; however, no study has investigated the association between serum biomarkers and outcomes after aortic surgery. This study explored the predictive ability of serum soluble lumican in postoperative outcomes after aortic surgery.

Methods: In total, 58 patients receiving aortic surgery for aortic dissection or aneurysm at Linkou Chang Gung Memorial Hospital in Taiwan in December 2011-September 2018 were enrolled. Blood samples were collected immediately upon patients' arrival in the intensive care unit after aortic surgery. The diagnostic properties of soluble lumican levels were assessed by performing receiver operating characteristic (ROC) curve analysis. The confidence interval (CI) of the area under the ROC curve (AUC) was measured using DeLong's nonparametric method and the optimal cutoff was determined using the Youden index.

Results: The serum soluble lumican level distinguished prolonged ventilation (AUC, 73.5%; 95% CI, 57.7%-89.3%) and hospital stay for >30 days (AUC, 78.2%; 95% CI, 61.6%-94.7%). The optimal cutoffs of prolonged ventilation and hospital stay for >30 days were 1.547 and 5.992 ng/mL, respectively. The sensitivity and specificity were respectively 100% (95% CI, 71.5%-100%) and 40.4% (95% CI, 26.4%-55.7%) for prolonged ventilation and 58% (95% 27.7%-84.8%) and 91.3% (95% CI, 79.2%-97.6%) for hospital stay for >30 days.

Conclusions: The serum soluble lumican level can be a potential prognostic factor for predicting poor postoperative outcomes after aortic surgery. However, more studies are warranted in the future.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247340PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932520PMC
March 2021

Association of Long-term Use of Antihypertensive Medications With Late Outcomes Among Patients With Aortic Dissection.

JAMA Netw Open 2021 03 1;4(3):e210469. Epub 2021 Mar 1.

Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.

Importance: The associations between long-term treatment of aortic dissection with various medications and late patient outcomes are poorly understood.

Objective: To compare late outcomes after long-term use of β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or other antihypertensive medications (controls) among patients treated for aortic dissection.

Design, Setting, And Participants: This population-based retrospective cohort study using the National Health Insurance Research Database in Taiwan included 6978 adult patients with a first-ever aortic dissection who survived to hospital discharge during the period between January 1, 2001, and December 31, 2013, and who received during the first 90 days after discharge a prescription for an ACEI, ARB, β-blocker, or at least 1 other antihypertensive medication. Data analysis was conducted from July 2019 to June 2020.

Exposure: Long-term use of β-blockers, ACEIs, or ARBs, with use of other antihypertensive medications as a control.

Main Outcomes And Measures: The primary outcomes of interest were all-cause mortality, death due to aortic aneurism or dissection, later aortic operation, major adverse cardiac and cerebrovascular events, hospital readmission, and new-onset dialysis.

Results: Of 6978 total participants, 3492 received a β-blocker, 1729 received an ACEI or ARB, and 1757 received another antihypertension drug. Compared with patients in the other 2 groups, those in the β-blocker group were younger (mean [SD] age, 62.1 [13.9] years vs 68.7 [13.5] years for ACEIs or ARBs and 69.9 [13.8] years for controls) and comprised more male patients (2520 [72.2%] vs 1161 [67.1%] for ACEIs or ARBs and 1224 [69.7%] for controls). The prevalence of medicated hypertension was highest in the ACEI or ARB group (1039 patients [60.1%]), followed by the control group (896 patients [51.0%]), and was lowest in the β-blocker group (1577 patients [45.2%]). Patients who underwent surgery for type A aortic dissection were more likely to be prescribed β-blockers (1134 patients [32.5%]) than an ACEI or ARB (309 patients [17.9%]) or another antihypertension medication (376 patients [21.4%]). After adjusting for multiple propensity scores, there were no significant differences in any of the clinical characteristics among the 3 groups. No differences in the risks for all outcomes were observed between the ACEI or ARB and β-blocker groups. The risk of all-cause hospital readmission was significantly lower in the ACEI or ARB group (subdistribution hazard ratio [HR], 0.92; 95% CI, 0.84-0.997) and β-blocker group (subdistribution HR, 0.87; 95% CI, 0.81-0.94) than in the control group. Moreover, the risk of all-cause mortality was lower in the ACEI or ARB group (HR, 0.79; 95% CI, 0.71-0.89) and the β-blocker group (HR, 0.82; 95% CI, 0.73-0.91) than in the control group. In addition, the risk of all-cause mortality was lower in the ARB group than in the ACEI group (HR, 0.85; 95% CI, 0.76-0.95).

Conclusions And Relevance: The use of β-blockers, ACEIs, or ARBs was associated with benefits in the long-term treatment of aortic dissection.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.0469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930924PMC
March 2021

Automated Quantification of Hydroxyl Reactivities: Prediction of Glycosylation Reactions.

Angew Chem Int Ed Engl 2021 May 21;60(22):12413-12423. Epub 2021 Apr 21.

Institute of Chemistry, Academia Sinica, Taipei, 115, Taiwan.

The stereoselectivity and yield in glycosylation reactions are paramount but unpredictable. We have developed a database of acceptor nucleophilic constants (Aka) to quantify the nucleophilicity of hydroxyl groups in glycosylation influenced by the steric, electronic and structural effects, providing a connection between experiments and computer algorithms. The subtle reactivity differences among the hydroxyl groups on various carbohydrate molecules can be defined by Aka, which is easily accessible by a simple and convenient automation system to assure high reproducibility and accuracy. A diverse range of glycosylation donors and acceptors with well-defined reactivity and promoters were organized and processed by the designed software program "GlycoComputer" for prediction of glycosylation reactions without involving sophisticated computational processing. The importance of Aka was further verified by random forest algorithm, and the applicability was tested by the synthesis of a Lewis A skeleton to show that the stereoselectivity and yield can be accurately estimated.
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http://dx.doi.org/10.1002/anie.202013909DOI Listing
May 2021

Nationwide cohort study of tricuspid valve repair versus replacement for infective endocarditis.

Eur J Cardiothorac Surg 2021 Apr;59(4):878-886

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.

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Objectives: The aim of this study was to compare the outcomes of tricuspid valve (TV) repair versus replacement for patients with infective endocarditis (IE).

Methods: In this nationwide population-based cohort study, we identified 704 patients from Taiwan National Health Insurance Research Database who underwent TV surgery due to IE between 2000 and 2013. Of them, 412 (58.5%) underwent TV repair and 292 (41.5%) underwent TV replacement, and their perioperative and late outcomes were analysed. Confounding was reduced using the inverse probability of treatment weighting on propensity score.

Results: After inverse probability of treatment weighting, the in-hospital mortality rate between the 2 groups was not significantly different. However, patients who received TV repair had lower rates of perioperative complications, including massive blood transfusion, de novo dialysis and deep wound infection; longer ICU and hospital stays; and higher hospital cost. Regarding late outcomes, TV repair was associated with lower risks of all-cause readmission [subdistribution hazard ratio (HR) 0.68, 95% confidence interval (CI) 0.60-0.78; P < 0.001], readmission for adverse liver outcomes (subdistribution HR 0.75, 95% CI 0.58-0.97; P = 0.025), new permanent pacemaker implantation (subdistribution HR 0.27, 95% CI 0.15-0.48; P < 0.001) and all-cause mortality (HR 0.60, 95% CI 0.51-0.71; P < 0.001) than TV replacement.

Conclusions: For IE, TV repair is associated with better early and late outcomes than TV replacement. A repair-first strategy is recommended for patients with IE for whom TV surgery is indicated.
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http://dx.doi.org/10.1093/ejcts/ezaa390DOI Listing
April 2021

Effect of previous coronary stenting on subsequent coronary artery bypass grafting outcomes.

J Thorac Cardiovasc Surg 2020 Sep 22. Epub 2020 Sep 22.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan. Electronic address:

Objectives: The effect of previous coronary stenting on subsequent coronary artery bypass graft is inconclusive.

Methods: We used Taiwan's National Health Insurance Database to retrospectively evaluate patients with multivessel coronary artery bypass graft between January 2000 and December 2013. Overall, 32,335 patients who received coronary artery bypass graft were included, of whom 3028 had previous coronary stenting. Propensity-score matching yielded 2977 cases each for evaluation under the previous stenting and no stenting groups. The 30-day mortality and major adverse cardiac events, including all-cause mortality, acute myocardial infarction, and revascularization, were considered primary outcomes.

Results: The number of coronary artery bypass grafts decreased per year. However, the percentage of patients who had previous coronary stent implantation before coronary artery bypass graft increased steadily (P for trend <.001), and the average number of stents implanted in a patient also increased per year (P for trend <.001). The previous stent group had a significantly greater 30-day mortality rate than did the no-stent group (7.2% vs 5.0%; odds ratio, 1.47; 95% confidence interval, 1.19-1.82). The previous stent group had a greater rate of revascularization (14.4% and 10.0%; subdistribution hazard ratio, 1.50; 95% confidence interval, 1.30-1.74) in the last follow-up at year 13.

Conclusions: Previous coronary stenting before coronary artery bypass graft for multivessel coronary artery disease significantly increased 30-day mortality but did not affect late survival. However, patients who had coronary stenting before coronary artery bypass graft experienced more revascularization events during late follow-up.
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http://dx.doi.org/10.1016/j.jtcvs.2020.09.068DOI Listing
September 2020

Progressing left-side sciatica revealing a common iliac artery mycotic aneurysm in an elderly patient: A CARE-compliant case report.

Medicine (Baltimore) 2020 Oct;99(41):e22476

Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou.

Rationale: Sciatica is usually caused by lumbar spine disease; the incidence of sciatica from extra-spinal causes is noted to be only about 0.09%.

Patient Concerns: We report a case of a 92-year-old man who came to the neurologist outpatient department due to left buttock pain and numbness that radiated to the left lower leg in the recent 6 months and progressed rapidly over 10 days.

Diagnosis: We arranged magnetic resonance imaging for lumbar nerve lesion. Magnetic resonance imaging showed a common iliac artery mycotic aneurysm, at about 6.3 cm in diameter, which compressed the psoas muscle, nerve plexus, and vein.

Interventions: We used a left-side iliac bifurcation stent graft of 12 mm in diameter for aneurysm repair. An internal iliac artery with a stent graft of 10 mm x 5 cm. An abdomen aortic aneurysm stent was inserted, 1 cm beneath the right renal artery from the right side femoral artery.

Outcomes: After endovascular repair and 4 weeks of antibiotic treatment, he could walk again, and no sciatica was noted. We repeated computed tomography 5 months after the operation and noted that the size of the iliac artery aneurysm decreased without stent graft migration or extravasation. Our patient recovered from sciatic and left leg weakness; above all, he could walk again.

Lessons: We suggest practitioners check for common iliac artery aneurysms in the diagnosis of symptoms mimicking spinal cord origin sciatica, especially in elder patients.
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http://dx.doi.org/10.1097/MD.0000000000022476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544384PMC
October 2020

Mitral valve repair versus replacement in patients with rheumatic heart disease.

J Thorac Cardiovasc Surg 2020 Aug 29. Epub 2020 Aug 29.

Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.

Background: Rheumatic heart disease remains a major cause of cardiovascular death worldwide. Limited real-world nationwide data are available to compare the long-term outcomes between mitral valve repair and replacement in rheumatic heart disease.

Methods: We identified adult patients with rheumatic heart disease who underwent mitral valve repair or replacement surgery between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Outcomes of interest included operation-related complications, all-cause mortality, and mitral valve reoperation rate. Propensity score matching at a 1:1 ratio was conducted to mitigate possible confounding factors.

Results: A total of 5086 patients with rheumatic heart disease who underwent mitral valve surgery were identified. Of those, 489 (9.6%) and 4597 (90.4%) underwent mitral valve repair and mitral valve replacement, respectively. After propensity score matching was applied, each group had 467 patients. No difference in risk of in-hospital mortality was observed between groups. With a mean follow-up of 6 years, the mitral valve repair group had comparable risks of all-cause mortality with the mitral valve replacement group (33.4% vs 32.5%; hazard ratio, 1.01; 95% confidence interval, 0.81-1.25). However, higher risks of mitral valve reoperation were observed in the mitral valve repair group (subdistribution hazard ratio, 4.32; 95% confidence interval, 2.02-9.23). Previous percutaneous transvenous mitral commissurotomy was identified as a risk factor of mitral valve reoperation in the repair group.

Conclusions: Among patients with rheumatic heart disease, mitral valve repair is not associated with superior long-term outcomes. Patients should be carefully selected for mitral valve repair because of its higher reoperation rate, particularly those with previous percutaneous transvenous mitral commissurotomy.
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http://dx.doi.org/10.1016/j.jtcvs.2020.07.117DOI Listing
August 2020

Late outcomes of endovascular aortic stent graft therapy in patients with chronic kidney disease.

Medicine (Baltimore) 2020 Sep;99(37):e22157

Division of Thoracic and Cardiovascular Surgery, Department of Surgery.

Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are effective and minimally invasive treatment options for high-risk surgical candidates. Nevertheless, knowledge about the management of aortic stent graft therapy in chronic kidney disease (CKD) is scarce. This study aimed to examine outcomes after EVAR and TEVAR in patients with CKD.Utilizing data from the Taiwan National Health Insurance Research Database, we retrospectively assessed patients who underwent EVAR and TEVAR therapy between January 1, 2006, and December 31, 2013. Patients were divided into CKD and non-CKD groups. Outcomes were in-hospital mortality, all-cause mortality, readmission, heart failure, and major adverse cardiac and cerebrovascular events.There were 1019 patients in either group after matching. The CKD group had a higher in-hospital mortality rate than the non-CKD group (15.2% vs 8.3%, respectively; odds ratio, 1.92; 95% confidence interval [CI], 1.46-2.54). Patients with CKD had higher risks of all-cause mortality including in-hospital death (46.1% vs 33.1%; hazard ratio [HR], 1.61; 95% CI, 1.35-1.92), readmission rate (62.6% vs 55.0%; subdistribution HR [SHR], 1.61; 95% CI, 1.32-1.69), redo stent (7.8% vs 6.2%; SHR, 1.50; 95% CI, 1.09-2.07), and major adverse cardiac and cerebrovascular events (13.3% vs 8.8%; SHR, 1.50; 95% CI, 1.15-1.95). The subgroup analysis did not demonstrate a variation in mortality between the TEVAR and EVAR cohorts (P for interaction = .725). The dialysis group had higher risks of all-cause mortality and readmission than the CKD without dialysis and non-CKD groups.Among EVAR/TEVAR recipients, CKD was independently associated with higher in-hospital mortality, postoperative complication, and all-cause mortality rates. Patients with end-stage renal disease on dialysis had worse outcomes than those in the CKD non-dialysis and non-CKD groups.
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http://dx.doi.org/10.1097/MD.0000000000022157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489716PMC
September 2020

Outcomes of Acute Aortic Dissection Surgery in Octogenarians.

J Am Heart Assoc 2020 09 11;9(18):e017147. Epub 2020 Sep 11.

Division of Thoracic and Cardiovascular Surgery Department of Surgery Chang Gung Memorial Hospital Linkou Medical Center Chang Gung University Taoyuan City Taiwan.

Background Octogenarians (≥80 years old) are high-risk patients for acute aortic dissection (AAD) surgery. However, no population-based study has investigated the late outcomes of AAD surgery in octogenarians. This study aimed to investigate the late outcomes of AAD surgery in octogenarians. Methods and Results A total of 3998 patients who received AAD surgery from 2005 to 2013 were identified from the Taiwan National Health Insurance Research Database. In-hospital complications and late outcomes including all-cause mortality, major adverse cardiac and cerebrovascular event, respiratory failure, and redo aortic surgery were evaluated. The risks of late outcomes between octogenarians and nonoctogenarians were compared using the multivariable Cox proportional hazard model or Fine and Gray competing model. The numbers of the octogenarians who underwent type A and B AAD surgeries were 206 (6%; 206/3423) and 79 (13.7%; 79/575), respectively. Compared with the nonoctogenarians, the type A octogenarians had higher risks of in-hospital mortality and several in-hospital complications, whereas the type B octogenarians did not. Furthermore, compared with the nonoctogenarians, the type A octogenarians had a higher risk of all-cause mortality (61.7% vs 32.5%; hazard ratio [HR], 2.35; 95% CI, 1.95-2.84) and a higher cumulative incidence of major adverse cardiac and cerebrovascular event and respiratory failure, and the type B octogenarians demonstrated a higher risk of all-cause mortality (44.3% vs 30.4%; HR, 1.74; 95% CI, 1.18-2.55). The octogenarians receiving AAD surgeries had higher mortality rates than the normal octogenarian population. Conclusions Octogenarians receiving AAD surgeries exhibit worse late outcomes than nonoctogenarian counterparts.
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http://dx.doi.org/10.1161/JAHA.120.017147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726989PMC
September 2020

Outcomes of type Ia endoleaks after endovascular repair of the proximal aorta.

J Thorac Cardiovasc Surg 2020 Jun 27. Epub 2020 Jun 27.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan. Electronic address:

Objective: Thoracic endovascular aortic repair (TEVAR) can be complicated by a type Ia endoleak. However, its natural history remains unclear. This report describes the natural history and midterm outcome of conservatively treated type Ia endoleaks in the proximal aorta.

Methods: Between 2007 and 2015, 395 patients underwent TEVAR at our institution. Only TEVARs landing proximally at landing zones 0, 1, and 2 were included (221/395). Type Ia endoleak's flow was classified as "fast" or "slow" based on the time needed to visualize the aneurysmal sac during arteriogram.

Results: The median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indications for TEVAR; the incidence of type Ia endoleak was not statistically different. Forty-seven patients (21.3%) had a type Ia endoleak. TEVAR landing proximally at zone 1 increased the odds of developing a type Ia endoleak (odds ratio, 2.8; 95% confidence interval, 1.3-5.9; P = .0072). The 30-day mortality and the overall survival was not influenced by the development of immediate-type Ia endoleak. In 34 (72.3%) patients, the endoleak resolved spontaneously. Ninety-four percent of these patients had a SlowE (n = 32/34). All of spontaneous resolutions occurred before the end of the first postoperative year.

Conclusions: SlowE tends to resolve within 1 year after TEVAR. Initial conservative treatment seems to be a reasonable approach in patients with SlowE.
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http://dx.doi.org/10.1016/j.jtcvs.2020.06.026DOI Listing
June 2020

Radial artery harvesting in coronary artery bypass grafting surgery-Endoscopic or open method? A meta-analysis.

PLoS One 2020 24;15(7):e0236499. Epub 2020 Jul 24.

Department of Thoracic and Cardiovascular Surgery Chang Gung Memorial Hospital at Keelung, Chiayi, Taiwan.

We analyzed the clinical outcomes of open radial artery harvesting (OAH) and endoscopic radial artery harvesting (EAH) undergoing coronary artery bypass grafting (CABG). We designed this meta-analysis conducted using Pubmed, Medline, the Cochrane Library, and EMBASE. Articles with comparisons of OAH and EAH undergoing CABG were included. Primary outcomes included the wound infection rate, the wound complication rate, neurological complications of the forearm, in-hospital mortality, long-term survival, and the patency rate. The results of our study included six randomized controlled trials (RCTs), two non-randomized controlled trials (NRCTs) with matching, and 10 NRCTs. In total, 2919 patients were included in 18 studies, while 1187 (40.7%) and 1732 (59.3%) patients received EAH and OAH, respectively. EAH was associated with a lower incidence of wound infection (RR = 0.29, 95% confidence interval (CI) = 0.14 to 0.60, p = 0.03), and neurological complications over the harvesting site (RR = 0.41, 95% CI = 0.27 to 0.62, p < 0.0001). There was no significant difference in 30-day mortality, long-term survival (over one year), and the graft patency rate. According to our analysis, endoscopic radial artery harvesting can improve the outcome of the harvesting site, without affecting the mortality, long-term survival, and graft patency.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236499PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380611PMC
September 2020

Short physical performance battery discriminates clinical outcomes in hospitalized patients aged 75 years and over.

Arch Gerontol Geriatr 2020 Sep - Oct;90:104155. Epub 2020 Jun 15.

Department of Community Healthcare and Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan.

Aim: Low physical function is associated with poor outcomes in hospitalized patients; however, little is known about vulnerable populations such as those aged ≥ 75 years. We examined whether the Short Physical Performance Battery (SPPB) was associated with clinical outcomes in hospitalized patients aged ≥ 75 years.

Methods: In total, 147 patients aged ≥ 75 years (mean age, 86.5 ± 4.7 years; 89 males) completed the SPPB and Mini-Mental State Examination (MMSE) before hospital discharge. Patients were divided into three groups by SPPB score: 0 (unable to perform SPPB), 1-6 (low performance), and 7-12 (high performance). The first occurrence of all-cause unplanned readmission or all-cause mortality within 1 year after discharge was set as the endpoint.

Results: The median SPPB score of the study population was 2; 41 % were unable to perform SPPB, 33 % had low performance, and 26 % had high performance. High SPPB was associated with younger age, higher body weight, and higher MMSE score. During the follow-up period, 35 (23.8 %) patients were readmitted to hospital and 19 (12.9 %) died. Even after adjusting for covariates, SPPB score was a significant and independent predictor of poor outcomes (hazard ratio for 1 point increase in SPPB, 0.88; P = .002). The subgroup analysis showed SPPB was inversely associated with the occurrence of poor outcomes in patients with cognitive impairment.

Conclusions: SPPB is inversely associated with risks for readmission and mortality in hospitalized patients aged ≥ 75 years, especially those with cognitive impairment. The present results indicate the SPPB is useful for accurate prognosis in hospital settings.
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http://dx.doi.org/10.1016/j.archger.2020.104155DOI Listing
December 2020

Size-dependent behavior and failure of young's equation for wetting of two-component nanodroplets.

J Colloid Interface Sci 2020 Oct 30;578:69-76. Epub 2020 May 30.

Department of Chemical Engineering, National Taiwan University, Taipei 106, Taiwan. Electronic address:

Hypothesis: For macroscopic systems, the interfacial properties are size-independent and Young's equation is generally valid for smooth substrates. For nanoscale systems, however, size-dependence and failure of Young's equation may emerge.

Experiments: The wetting behavior of a nanodroplet containing two miscible liquids on a smooth substrate is explored by many-body dissipative particle dynamics simulations. The size-dependent surface tension of nanofilms is investigated as well.

Findings: It is found that Young's equation is valid for nanodroplets of pure fluids but fails for two-component nanodroplets. The actual contact angle is always larger than the Young's contact angle, and their difference is getting smaller as the composition approaches pure fluids or the compatibility of the mixture is increased. The failure of Young's equation is closely associated with the size-dependent behavior in two-component nanodroplets and nanofilms. As the nanodroplet size is increased, the actual contact angle is found to decline but approaches a constant expected in macroscopic systems. Similarly, as the nanofilm thickness is increased, surface tension decreases and reaches its macroscopic value. The change of surface tension is attributed to the size-dependent surface composition, which is responsible for the failure of Young's equation.
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http://dx.doi.org/10.1016/j.jcis.2020.05.104DOI Listing
October 2020

Balloon-expandable versus self-expanding transcatheter aortic valve replacement for bioprosthetic dysfunction: A systematic review and meta-analysis.

PLoS One 2020 1;15(6):e0233894. Epub 2020 Jun 1.

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.

Background: Transcatheter aortic valve-in-valve (VIV) procedure is a safe alternative to conventional reoperation for bioprosthetic dysfunction. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the 2 major types of devices used. Evidence regarding the comparison of the 2 valves remains scarce.

Methods: A systematic review and meta-analysis was conducted to compare the outcomes of BEV and SEV in transcatheter VIV for aortic bioprostheses dysfunction. A computerized search of Medline, PubMed, Embase, and Cochrane databases was performed. English-language journal articles reporting SEV or BEV outcomes of at least 10 patients were included.

Results: In total, 27 studies were included, with 2,269 and 1,671 patients in the BEV and SEV groups, respectively. Rates of 30-day mortality and stroke did not differ significantly between the 2 groups. However, BEV was associated with significantly lower rates of postprocedural permanent pacemaker implantation (3.8% vs. 12%; P < 0.001). Regarding echocardiographic parameters, SEV was associated with larger postprocedural effective orifice area at 30 days (1.53 cm2 vs. 1.23 cm2; P < 0.001) and 1 year (1.55 cm2 vs. 1.22 cm2; P < 0.001).

Conclusions: For patients who underwent transcatheter aortic VIV, SEV was associated with larger postprocedural effective orifice area but higher rates of permanent pacemaker implantation. These findings provide valuable information for optimizing device selection for transcatheter aortic VIV.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233894PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263630PMC
August 2020

Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis.

PeerJ 2020 12;8:e9102. Epub 2020 May 12.

Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan.

Background: The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes.

Methods: We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison.

Results: In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4-10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8-6.8]; for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, for heterogeneity = 0.023) than was TAx TAVR.

Conclusions: DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.
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http://dx.doi.org/10.7717/peerj.9102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227658PMC
May 2020

Late Outcomes of Valve Repair Versus Replacement in Isolated and Concomitant Tricuspid Valve Surgery: A Nationwide Cohort Study.

J Am Heart Assoc 2020 04 17;9(8):e015637. Epub 2020 Apr 17.

Department of Cardiology Chang Gung Memorial Hospital Linkou Medical Center Taoyuan City Taiwan.

Background Surgery for tricuspid valve (TV) diseases is associated with poor prognosis, but few studies have described the long-term outcomes by comparing TV repair and replacement in isolated and concomitant TV surgeries separately. Methods and Results Between 2000 and 2013, adult patients who underwent TV repair or replacement surgeries were identified from the Taiwan National Health Insurance Research Database. Outcomes of interest included all-cause mortality, composite outcome, and readmission attributable to any cause. Inverse probability of treatment weighting was used to reduce confounding effects. A total of 2644 patients with a mean follow-up of 4.9 years were included. Of them, 12.6% and 87.4% underwent isolated and concomitant TV surgery, respectively. The in-hospital mortality rates for isolated and concomitant TV surgery were 8.7% and 8.6%, respectively, whereas all-cause mortality rates were 41.7% and 36.8%, respectively. Compared with TV replacement, TV repair demonstrated significantly lower risks of all-cause mortality (concomitant: hazard ratio [HR], 0.76; 95% CI, 0.59-0.99), composite outcome (isolated: subdistribution HR, 0.55; 95% CI, 0.35-0.89; concomitant: subdistribution HR, 0.63; 95% CI, 0.46-0.86), and readmission (isolated: subdistribution HR, 0.64; 95% CI, 0.46-0.91; concomitant: subdistribution HR, 0.72; 95% CI, 0.60-0.86), except insignificant difference in all-cause mortality in isolated surgery. Conclusions Compared with replacement, TV repair is associated with better short- and long-term outcomes in both isolated and concomitant TV surgery. However, further prospective clinical trials are warranted.
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http://dx.doi.org/10.1161/JAHA.119.015637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428522PMC
April 2020

Continuous Cell Separation Using Microfluidic-Based Cell Retention Device with Alternative Boosted Flow.

Appl Biochem Biotechnol 2020 May 21;191(1):151-163. Epub 2020 Feb 21.

Department of Chemical Engineering, National Tsing Hua University, No. 101, Sec. 2, Kuang-Fu Rd., Hsinchu, 30013, Taiwan.

The development of a continuous process for cell separation is growing rapidly due to the current trend of cost-effective manufacturing in biological industries. The continuous cell separation process has a significant reduction in capital equipment costs and facility size compared to the conventional batch process. In the study, a multi-layered microfluidic-based device integrated with the porous membranes was fabricated for continuous size-based isolation of the cells based on the mechanism of restrictive cross-flow filtration, allowing the biological sample entered in a single inlet of the device and separated into two outlet streams. One stream which contained the cells returned back to the original sample fluid, while another stream with conditioned medium only was collected for later applications. The membrane fouling issue was overcome by introducing the alternative flow rate consisted of a set of higher and lower flows. The device integrated with the controllable flow restriction allows to increase the permeate flow rate, and alternative boosted flow demonstrates the high permeate flow rate (0.3 mL/min), high cell viability (> 98%), and increase of cell concentration (48%). As a result, we believe that the microfluidic-based continuous cell separation system is a promising tool for downstream bioprocess.
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http://dx.doi.org/10.1007/s12010-020-03288-9DOI Listing
May 2020

Indoor ozone and particulate matter modify the association between airborne endotoxin and schoolchildren's lung function.

Sci Total Environ 2020 Feb 30;705:135810. Epub 2019 Nov 30.

Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan; Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address:

Background: To date, the effect of household airborne pollutants on the association between airborne endotoxin and lung function of schoolchildren is unknown.

Objectives: The objective of this study is to evaluate whether indoor air pollutants such as carbon monoxide (CO), carbon dioxide (CO), nitrogen dioxide (NO), sulfur dioxide (SO), ozone (O), particulate matter with aerodynamic diameter <10 and 2.5 μm (PM, PM) can modify the association between airborne endotoxin and school children's lung function in a heavy industrial city in Taiwan.

Methods: We recruited 120 elementary school-age children in Kaohsiung City, Taiwan. Aerosol samples were collected on a filter membrane for 24 h period and then analyzed for endotoxin. Air pollutants were measured for 24 h in living rooms while school children's lung function was measured. The modification of air pollutants on the relationship between airborne endotoxin and children's lung function was estimated after adjusting the gender, age, height, weight, and case-control status.

Results: We found that both O and PM concentrations significantly modified the relationships between airborne endotoxin and school children's lung function. Among children living in homes with O ≥ 0.01 ppm or PM ≥ 62 μg/m, airborne endotoxin was negatively associated with lung functions, whereas among those living in homes with O < 0.01 ppm or PM < 62 μg/m, airborne endotoxin was positively associated with lung functions.

Conclusions: The indoor air pollutant concentration of O and PM modifies the association between airborne endotoxin and school children's lung function.
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http://dx.doi.org/10.1016/j.scitotenv.2019.135810DOI Listing
February 2020

Dynamic change of vegetation and its response to climate and topographic factors in the Xijiang River basin, China.

Environ Sci Pollut Res Int 2020 Apr 22;27(11):11637-11648. Epub 2020 Jan 22.

State Key Laboratory of Simulation and Regulation of Water Cycle in River Basin, Beijing, 100048, China.

Vegetation plays an important role in the energy exchange, water cycle, carbon cycle, biogeochemical cycle, and maintenance of surface ecosystems. In recent years, regional vegetation cover has changed significantly. This study used statistical analyses, including the Mann-Kendall trend test, the Hurst exponent, and Pettitt test, to analyze the characteristics of temporal and spatial variation of vegetation coverage in the Xijiang River basin from 2000 to 2013. The results showed that vegetation coverage of 98.76% of the Xijiang River basin is weakly variable (Cv < 0.1). The area with significantly increased vegetation accounts for 43.45% of the total area (p < = 0.05). A total of 19.47% of vegetation coverage in the Xijiang River basin had significant change-points from 2004 to 2008 (p < = 0.05), and the area of concave change-points accounted for 25.99% of the total area of point increased the vegetation coverage. At an altitude of 500-2000 m, the altitude has an inhibitory effect on vegetation coverage. When the slope is less than 35 degrees, the slope has a promoting effect on vegetation coverage. Rich precipitation resources are the main source of soil water supply, and higher temperature provides better thermal energy resources, which may have a significant impact on vegetation growth in the future and cause time lag effects of climatic factors on vegetation coverage. The vegetation coverage and the area affected by the precipitation and temperature (time lag factors) accounted for 32.99% and 31.47% of the total watershed, respectively. The correlation between climatic factors, topographic factors, and vegetation coverage increased over time. The results from this study will help to further deepen the understanding of vegetation cover and its influencing factors, and provide a scientific basis for ecological restoration projects such as vegetation restoration in the Xijiang River basin of China.
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http://dx.doi.org/10.1007/s11356-020-07692-wDOI Listing
April 2020

p-TsOH-mediated synthesis of substituted 2,4-diaryl-3-sulfonylquinolines from functionalized 2-aminobenzophenones and aromatic β-ketosulfones under microwave irradiation.

Org Biomol Chem 2020 01;18(2):305-315

Institute of Chemistry, Academia Sinica, Taipei 115, Taiwan.

This study describes an efficient protocol for the preparation of substituted 2,4-diaryl-3-sulfonylquinolines from functionalized 2-aminobenzophenones and aromatic β-ketosulfones by using p-toluenesulfonic acid monohydrate under microwave irradiation. In this atom-economical synthetic route, a series of pharmaceutically active 3-arylsulfonylquinolines with good functional group tolerance are prepared in good to excellent yields. Some structures are confirmed by single-crystal X-ray diffraction analysis.
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http://dx.doi.org/10.1039/c9ob02445jDOI Listing
January 2020

Synergistic symptom-specific effects of ketorolac-tramadol and ketorolac-pregabalin in a rat model of peripheral neuropathy.

J Chin Med Assoc 2019 Jun;82(6):457-463

Department of Life Science, National Taiwan University, Taipei, Taiwan, ROC.

Background: Although current neuropathic pain treatment guidelines do not recommend the use of nonsteroidal anti-inflammatory drugs (NSAIDs), whether NSAIDs can serve as a useful adjuvant to conventional multimodal therapy remains unclear.

Methods: The spared nerve injury (SNI) rats rapidly developed profound and long-lasting spontaneous and evoked pain behaviors, including mechanical and cold allodynia of the ipsilateral hind paw. At day 5, we first characterized the nociceptive responses to ketorolac, tramadol, pregabalin, and their combinations.

Results: We found that tramadol and pregabalin exerted dose-dependent analgesic effects on both spontaneous and evoked behaviors. However, ketorolac alone did not suppress any behaviors regardless of the dose. Ketorolac-tramadol and ketorolac-pregabalin produced variable degrees of additive suppression of spontaneous and evoked behavioral responses. Cold allodynia was profoundly diminished after ketorolac was added to ineffective pregabalin or tramadol. Mechanical allodynia was markedly attenuated by ketorolac-pregabalin but less so by ketorolac-tramadol mixtures.

Conclusion: Our data demonstrated that an NSAID alone failed to relieve spontaneous or evoked pain behaviors in the rat SNI model, but when combined with a weak opioid and α-2-δ-ligand produced a profound synergistic analgesic effect on cold allodynia and discrepant efficacy for mechanical allodynia and spontaneous pain.
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http://dx.doi.org/10.1097/JCMA.0000000000000115DOI Listing
June 2019

Zoledronic acid inhibits osteoclast differentiation and function through the regulation of NF-κB and JNK signalling pathways.

Int J Mol Med 2019 Aug 23;44(2):582-592. Epub 2019 May 23.

School/Hospital of Stomatology and Key Laboratory of Endemic and Ethnic Diseases, Guizhou Medical University, Ministry of Education, Guiyang, Guizhou 550004, P.R. China.

It is well known that extensive osteoclast formation plays a key role in osteoporosis in post‑menopausal women and the elderly. The suppression of extensive osteoclastogenesis and bone resorption may be an effective preventive strategy for osteoporosis. Zoledronic acid (ZOL) has been indicated to play an essential role in regulating bone mineral density and has already been used in large clinical trials. However, the effects of ZOL on osteoclastogenesis remain to be fully elucidated. Therefore, the present study aimed to determine the effects of ZOL on osteoclastogenesis, and to explore the corresponding signalling pathways. By using a cell viability assay, as well as in vitro osteoclastogenesis, immunofluorescence and resorption pit assays, we demonstrated that ZOL (0.1‑5 µM) suppressed receptor activator of nuclear factor‑κB ligand (RANKL)‑induced osteoclast differentiation and bone resorptive activity. Furthermore, western blot analysis and reverse transcription‑quantitative PCR indicated that ZOL inhibited the RANKL‑induced activation of NF‑κB and the phosphorylation of JNK in RAW264.7 cells, and subsequently decreased the expression of osteoclastogenesis‑associated genes, including calcitonin receptor, tartrate‑resistant acid phosphatase and dendritic cell‑specific transmembrane protein. ZOL inhibited osteoclast formation and resorption in vitro by specifically suppressing NF‑κB and JNK signalling. On the whole, the findings of this study indicate that ZOL may serve as a potential agent for the treatment of osteoclast‑associated diseases, including osteoporosis.
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http://dx.doi.org/10.3892/ijmm.2019.4207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605660PMC
August 2019

Surgical preparations, labeling strategies, and optical techniques for cell-resolved, in vivo imaging in the mouse spinal cord.

Exp Neurol 2019 08 13;318:192-204. Epub 2019 May 13.

Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA. Electronic address:

In vivo optical imaging has enabled detailed studies of cellular dynamics in the brain of rodents in both healthy and diseased states. Such studies were made possible by three advances: surgical preparations that give optical access to the brain; strategies for in vivo labeling of cells with structural and functional fluorescent indicators; and optical imaging techniques that are relatively insensitive to light scattering by tissue. In vivo imaging in the rodent spinal cord has lagged behind than that in the brain, largely due to the anatomy around the spinal cord that complicates the surgical preparation, and to the strong optical scattering of the dorsal white matter that limits the ability to image deep into the spinal cord. Here, we review recent advances in surgical methods, labeling strategies, and optical tools that have enabled in vivo, high-resolution imaging of the dynamic behaviors of cells in the spinal cord in mice. Surgical preparations that enable long-term optical access and robust stabilization of the spinal cord are now available. Labeling strategies that have been used in the spinal cord tend to follow those that have been used in the brain, and some recent advances in genetically-encoded labeling strategies remain to be capitalized on. The optical imaging methods used to date, including two photon excited fluorescence microscopy, are largely limited to imaging the superficial layers of the spinal cord by the optical scattering of the white matter. Finally, we show preliminary data that points to the use of higher-order nonlinear optical processes, such as three photon excited fluorescence, as a means to image deeper into the mouse spinal cord.
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http://dx.doi.org/10.1016/j.expneurol.2019.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588420PMC
August 2019

Improving Two-Step Prepared CHNHPbI Perovskite Solar Cells by Co-Doping Potassium Halide and Water in PbI Layer.

Nanomaterials (Basel) 2019 Apr 27;9(5). Epub 2019 Apr 27.

Department of Electrical Engineering, National Cheng Kung University, Tainan 70101, Taiwan.

Incorporating additives into organic halide perovskite solar cells is the typical approach to improve power conversion efficiency. In this paper, a methyl-ammonium lead iodide (CHNHPbI, MAPbI) organic perovskite film was fabricated using a two-step sequential process on top of the poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) hole-transporting layer. Experimentally, water and potassium halides (KCl, KBr, and KI) were incorporated into the PbI precursor solution. With only 2 vol% water, the cell efficiency was effectively improved. Without water, the addition of all of the three potassium halides unanimously degraded the performance of the solar cells, although the crystallinity was improved. Co-doping with KI and water showed a pronounced improvement in crystallinity and the elimination of carrier traps, yielding a power conversion efficiency (PCE) of 13.9%, which was approximately 60% higher than the pristine reference cell. The effect of metal halide and water co-doping in the PbI layer on the performance of organic perovskite solar cells was studied. Raman and Fourier transform infrared spectroscopies indicated that a PbI-dimethylformamide-water related adduct was formed upon co-doping. Photoluminescence enhancement was observed due to the co-doping of KI and water, indicating the defect density was reduced. Finally, the co-doping process was recommended for developing high-performance organic halide perovskite solar cells.
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http://dx.doi.org/10.3390/nano9050666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566305PMC
April 2019

Improving Two-Step Prepared CHNHPbI Perovskite Solar Cells by Co-Doping Potassium Halide and Water in PbI Layer.

Nanomaterials (Basel) 2019 Apr 27;9(5). Epub 2019 Apr 27.

Department of Electrical Engineering, National Cheng Kung University, Tainan 70101, Taiwan.

Incorporating additives into organic halide perovskite solar cells is the typical approach to improve power conversion efficiency. In this paper, a methyl-ammonium lead iodide (CHNHPbI, MAPbI) organic perovskite film was fabricated using a two-step sequential process on top of the poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) hole-transporting layer. Experimentally, water and potassium halides (KCl, KBr, and KI) were incorporated into the PbI precursor solution. With only 2 vol% water, the cell efficiency was effectively improved. Without water, the addition of all of the three potassium halides unanimously degraded the performance of the solar cells, although the crystallinity was improved. Co-doping with KI and water showed a pronounced improvement in crystallinity and the elimination of carrier traps, yielding a power conversion efficiency (PCE) of 13.9%, which was approximately 60% higher than the pristine reference cell. The effect of metal halide and water co-doping in the PbI layer on the performance of organic perovskite solar cells was studied. Raman and Fourier transform infrared spectroscopies indicated that a PbI-dimethylformamide-water related adduct was formed upon co-doping. Photoluminescence enhancement was observed due to the co-doping of KI and water, indicating the defect density was reduced. Finally, the co-doping process was recommended for developing high-performance organic halide perovskite solar cells.
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http://dx.doi.org/10.3390/nano9050666DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566305PMC
April 2019

Impact of neurological level and spinal curvature on pulmonary function in adults with spina bifida.

J Pediatr Rehabil Med 2018 ;11(4):243-254

Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA.

Purpose: To describe pulmonary function and determine the impact of neurological level, scoliosis, and obesity on pulmonary function in people with spina bifida (SB).

Methods: Participants with SB (N= 29) (15 females; age, 30 ± 12 years) completed spirometry and body plethysmographic lung volume testing. Univariate and multivariate regression analyses were used to describe the factors associated with pulmonary function in people with SB.

Results: Distribution of category of impairment in pulmonary function was: 55% (n= 16) restricted, 6.9% (n= 2) spirometric restricted, 1 combined obstructed and restricted, and 35.5% (n= 10) normal. In univariate analyses, neurological level was negatively associated with pulmonary function parameters, i.e., forced vital capacity (FVC) (p= 0.005), forced expiratory volume in 1 second (FEV1) (p= 0.008), total lung capacity (TLC) (p= 0.001), and degree of scoliosis were inversely associated with FVC (p= 0.005), FEV1 (p= 0.003), and TLC (p= 0.004). In multivariate models, level of lesion and degree of scoliosis independently contributed to the degree of lung function impairment. Restrictive pulmonary function was observed in 9/10 (90%) of those with thoracic neurological levels and was associated with decreased inspiratory capacity (IC) and expiratory reserve volume (ERV). Lumbar level lesions were associated with either normal lung function or an isolated reduction in FVC due to reduction in only ERV and preserved TLC representing spirometric restriction.

Conclusions: High prevalence of restrictive pulmonary physiology is present in people with SB, with more rostral neurological levels and greater degree of scoliosis associated with a higher degree of pulmonary function impairment.
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http://dx.doi.org/10.3233/PRM-179451DOI Listing
October 2019