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Search Results: 1 - 10 of 55276 matches for " Chang-Chyi Lin "
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Long-term survival and prognostic implications of Chinese type 2 diabetic patients with coronary artery disease after coronary artery bypass grafting  [PDF]
Ming C Hsiung, Tao-Hsin Tung, Chung-Yi Chang, Yi-Cheng Chuang, Kuo-Chen Lee, Sung-How Sue, Yi-Pen Chou, Richard Hsiung, Chien-Ming Huang, Chang-Chyi Lin, Wei-Hsian Yin, Mason S Young, Jeng Wei
Health (Health) , 2009, DOI: 10.4236/health.2009.13023
Abstract: This study was conducted to determine the sur-vival rates of type 2 diabetic patients after coro-nary artery bypass grafting (CABG) surgery, and the prognostic factors related to all-cause mor-tality during a 7-year follow-up. The medical re-cords of 816 type 2 diabetic patients who un-derwent primary, isolated CABG surgery during 1997-2003 were studied. The Kaplan-Meier me- thod and Cox regression were used to estimate survival and the independence of prognostic factors associated with all-cause mortality. One hundred and five out of 816 patients expired during the 7-year period. The overall survival rate was 83.5% (95%CI: 78.7-88.3%). Associated prog- nostic factors varied by gender. For males, but not for females, smoking (RR=3.44, 95%CI: 1.01- 11.70), myocardial infarction (RR=4.77, 95% CI: 1.23-18.86), respiratory failure (RR=4.21, 95% CI: 1.48-7.99), cardiogenic shock (RR=12.58, 95% CI: 3.25-20.77), and congestive heart failure (RR= 3.77, 95%CI: 1.10-13.45) were significantly related to all-cause mortality. Older age at sur-gery (RR= 1.15, 95%CI: 1.04-1.27), emergent op-eration (RR= 21.29, 95%CI: 10.03-39.43), pul-monary ede-ma (RR=7.72, 95%CI: 1.89-15.59), and days of ICU stay (RR=1.05, 95%CI: 1.02-1.09) were significant- ly related to all-cause mortality in females only. In conclusion, several gen-der-related differences were noted pertaining to all-cause mortality and its relationship to smok- ing, myocardial infarction, respiratory failure, cardiogenic shock, congestive heart failure, older age at surgery, emergent operation, pul-monary edema, and days of ICU stay.
Serum Interleukin-18 at Commencement of Renal Replacement Therapy Predicts Short-Term Prognosis in Critically Ill Patients with Acute Kidney Injury
Chan-Yu Lin, Chih-Hsiang Chang, Pei-Chun Fan, Ya-Chung Tian, Ming-Yang Chang, Chang-Chyi Jenq, Cheng-Chieh Hung, Ji-Tseng Fang, Chih-Wei Yang, Yung-Chang Chen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0066028
Abstract: Background Acute kidney injury (AKI) requiring renal replacement therapy (RRT) in critically ill patients results in a high hospital mortality. Outcome prediction in this selected high-risk collective is challenging due to the lack of appropriate biomarkers. The aim of this study was to identify outcome-specific biomarkers in this patient population. Methodology/Principal Findings Serum samples were collected from 101 critically ill patients with AKI at the initiation of RRT in intensive care units (ICUs) of a tertiary care university hospital between August 2008 and March 2011. Measurements of serum levels of cystatin C (CysC), neutrophil gelatinase-associated lipocalin, and interleukin-18 (IL-18) were performed. The primary outcome measure was hospital mortality. The observed overall mortality rate was 56.4% (57/101). Multiple logistic regression analysis indicated that the serum IL-18 and CysC concentrations and Acute Physiology and Chronic Health Evaluation III (ACPACHE III) scores determined on the first day of RRT were independent predictors of hospital mortality. The APACHE III score had the best discriminatory power (0.872±0.041, p<0.001), whereas serum IL-18 had the best Youden index (0.65) and the highest correctness of prediction (83%). Cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.001) for serum IL-18 <1786 pg/ml vs. ≥1786 pg/ml in these critically ill patients. Conclusions In this study, we confirmed the grave prognosis for critically ill patients at the commencement of RRT and found a strong correlation between serum IL-18 and the hospital mortality of ICU patients with dialysis-dependent AKI. In addition, we demonstrated that the APACHE III score has the best discriminative power for predicting hospital mortality in these critically ill patients.
Acute Kidney Injury Biomarkers for Patients in a Coronary Care Unit: A Prospective Cohort Study
Tien-Hsing Chen, Chih-Hsiang Chang, Chan-Yu Lin, Chang-Chyi Jenq, Ming-Yang Chang, Ya-Chung Tian, Cheng-Chieh Hung, Ji-Tseng Fang, Chih-Wei Yang, Ming-Shien Wen, Fun-Chung Lin, Yung-Chang Chen
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0032328
Abstract: Background Renal dysfunction is an established predictor of all-cause mortality in intensive care units. This study analyzed the outcomes of coronary care unit (CCU) patients and evaluated several biomarkers of acute kidney injury (AKI), including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18) and cystatin C (CysC) on the first day of CCU admission. Methodology/Principal Findings Serum and urinary samples collected from 150 patients in the coronary care unit of a tertiary care university hospital between September 2009 and August 2010 were tested for NGAL, IL-18 and CysC. Prospective demographic, clinical and laboratory data were evaluated as predictors of survival in this patient group. The most common cause of CCU admission was acute myocardial infarction (80%). According to Acute Kidney Injury Network criteria, 28.7% (43/150) of CCU patients had AKI of varying severity. Cumulative survival rates at 6-month follow-up following hospital discharge differed significantly (p<0.05) between patients with AKI versus those without AKI. For predicting AKI, serum CysC displayed an excellent areas under the receiver operating characteristic curve (AUROC) (0.895±0.031, p<0.001). The overall 180-day survival rate was 88.7% (133/150). Multiple Cox logistic regression hazard analysis revealed that urinary NGAL, serum IL-18, Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) and sodium on CCU admission day one were independent risk factors for 6-month mortality. In terms of 6-month mortality, urinary NGAL had the best discriminatory power, the best Youden index, and the highest overall correctness of prediction. Conclusions Our data showed that serum CysC has the best discriminative power for predicting AKI in CCU patients. However, urinary NGAL and serum IL-18 are associated with short-term mortality in these critically ill patients.
Prognosis of Patients on Extracorporeal Membrane Oxygenation plus Continuous Arteriovenous Hemofiltration
Tsung-Yu Tsai,Feng-Chun Tsai,Chih-Hsiang Chang,Chang-Chyi Jenq
Chang Gung Medical Journal , 2011,
Abstract: Background: Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as those with life-threatening respiratory failure orpost-cardiotomy cardiogenic shock. Patients on ECMO with acute renal failure have high mortality rates. This study identifies specific predictors of hospital mortality for patients receiving ECMO and continuous arteriovenoushemofiltration (CAVH).Methods: This study reviewed the medical records of 123 critically ill patients onE C M O p l u s C AV H a t a c a r d i o v a s c u l a r s u r g i c a l i n t e n s i v e c a r e u n i t(CVSICU) at a tertiary care university hospital between March 2003 andAugust 2010. Patient baseline, clinical, and laboratory data were collectedretrospectively as survival predicators.Results: The overall mortality rate was 85.4%. The most common conditions requiring ECMO plus CAVH were cardiogenic shock and oliguria. The AcutePhysiology and Chronic Health Evaluation II (APACHE II) score and organsystem failure (OSF) score both indicated good discriminative power (areaunder the receiver operating characteristic curve [AUROC] 0.812 0.048and 0.758 0.057, respectively). Multiple logistic regression analysis indicated that age, mean arterial pressure, and OSF score on day 1 of ECMOplus CAVH were independent risk factors for hospital mortality. Cumulativesurvival rates at the 6-month follow-up differed significantly (p < 0.001)between those with an OSF score ≤ 4 vs. those with an OSF score > 4.Conclusions: During ECMO plus CAVH support, both the OSF and APACHE II scoresshowed good discriminative power in predicting hospital mortality for thesepatients.
Predictors of Mortality in Patients Successfully Weaned from Extracorporeal Membrane Oxygenation
Wei-Wen Chang, Feng-Chun Tsai, Tsung-Yu Tsai, Chih-Hsiang Chang, Chang-Chyi Jenq, Ming-Yang Chang, Ya-Chung Tian, Cheng-Chieh Hung, Ji-Tseng Fang, Chih-Wei Yang, Yung-Chang Chen
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0042687
Abstract: Purpose Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients, such as those with life-threatening respiratory failure or post-cardiotomy cardiogenic shock. This study compares the predictive value of Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Organ System Failure (OSF) obtained on the first day of ECMO removal, and the Acute Kidney Injury Network (AKIN) stages obtained at 48 hours post-ECMO removal (AKIN48-hour) in terms of hospital mortality for critically ill patients. Methods This study reviewed the medical records of 119 critically ill patients successfully weaned from ECMO at the specialized intensive care unit of a tertiary-care university hospital between July 2006 and October 2010. Demographic, clinical, and laboratory data were collected retrospectively as survival predictors. Results Overall mortality rate was 26%. The most common condition requiring ECMO support was cardiogenic shock. By using the areas under the receiver operating characteristic (AUROC) curve, the Sequential Organ Failure Assessment (SOFA) score displayed good discriminative power (AUROC 0.805±0.055, p<0.001). Furthermore, multiple logistic regression analysis indicated that daily urine output on the second day of ECMO removal (UO24–48 hour), mean arterial pressure (MAP), and SOFA score on the day of ECMO removal were independent predictors of hospital mortality. Finally, cumulative survival rates at 6-month follow-up differed significantly (p<0.001) for a SOFA score≤13 relative to those for a SOFA score>13. Conclusions Following successful ECMO weaning, the SOFA score proved a reproducible evaluation tool with good prognostic abilities.
Risk Models and Scoring Systems for Predicting the Prognosis in Critically Ill Cirrhotic Patients with Acute Kidney Injury: A Prospective Validation Study
Heng-Chih Pan, Chang-Chyi Jenq, Ming-Hung Tsai, Pei-Chun Fan, Chih-Hsiang Chang, Ming-Yang Chang, Ya-Chung Tian, Cheng-Chieh Hung, Ji-Tseng Fang, Chih-Wei Yang, Yung-Chang Chen
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0051094
Abstract: Background Cirrhotic patients with acute kidney injury (AKI) admitted to intensive care units (ICUs) show extremely high mortality rates. We have proposed the MBRS scoring system, which can be used for assessing patients on the day of admission to the ICU; this new system involves determination of mean arterial pressure (MAP) and bilirubin level and assessment of respiratory failure and sepsis. We had used this scoring system to analyze the prognosis of ICU cirrhotic patients with AKI in 2008, and the current study was an external validation of this scoring system. Methods A total of 190 cirrhotic patients with AKI were admitted to the ICU between March 2008 and February 2011. We prospectively analyzed and recorded the data for 31 demographic parameters and some clinical characteristic variables on day 1 of admission to the ICU; these variables were considered as predictors of mortality. Results The overall in-hospital mortality rate was 73.2% (139/190), and the 6-month mortality rate was 83.2% (158/190). Hepatitis B viral infection (43%) was observed to be the cause of liver disease in most of the patients. Multiple logistic regression analysis indicated that the MBRS and Acute Physiology and Chronic Health Evaluation III (ACPACHE III) scores determined on the first day of admission to the ICU were independent predictors of in-hospital mortality in patients. In the analysis of the area under the receiver operating characteristic (AUROC) curves, the MBRS scores showed good discrimination (AUROC: 0.863±0.032, p<0.001) in predicting in-hospital mortality. Conclusion On the basis of the results of this external validation, we conclude that the MBRS scoring system is a reproducible, simple, easy-to-apply evaluation tool that can increase the prediction accuracy of short-term prognosis in critically ill cirrhotic patients with AKI.
Heat Shock protein 90: Role in Enterovirus 71 Entry and Assembly and Potential Target for Therapy
Yueh-Liang Tsou, Yi-Wen Lin, Hsuen-Wen Chang, Hsiang-Yin Lin, Hsiao-Yun Shao, Shu-Ling Yu, Chia-Chyi Liu, Ebenezer Chitra, Charles Sia, Yen-Hung Chow
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077133
Abstract: Although several factors participating in enterovirus 71 (EV71) entry and replication had been reported, the precise mechanisms associated with these events are far from clear. In the present study, we showed that heat shock protein 90 (HSP90) is a key element associated with EV71 entry and replication in a human rhabdomyosarcoma of RD cells. Inhibition of HSP90 by pretreating host cells with HSP90β siRNA or blocking HSP90 with a HSP90-specific antibody or geldanamycin (GA), a specific inhibitor of HSP90, as well as recombinant HSP90β resulted in inhibiting viral entry and subsequent viral replication. Co-immunprecipitation of EV71 with recombinant HSP90β and colocalization of EV71-HSP90 in the cells demonstrated that HSP90 was physically associated with EV71 particles. HSP90 seems to mediate EV71 replication by preventing proteosomal degradation of the newly synthesized capsid proteins, but does not facilitate viral gene expression at transcriptional level. This was evident by post-treatment of host cells with GA, which did not affect the expression of viral transcripts but accelerated the degradation of viral capsid proteins and interfered with the formation of assembled virions. In vivo studies were carried out using human SCARB2-transgenic mice to evaluate the protection conferred by HSP90 inhibitor, 17-allyamino-17-demethoxygeldanamycin (17-AAG), an analog of geldanamycin, that elicited similar activity but with less toxicity. The results showed that the administration of 17-AAG twice conferred the resistance to hSCARB2 mice challenged with C2, C4, and B4 genotypes of EV71. Our data supports HSP90 plays an important role in EV71 infection. Targeting of HSP90 with clinically available drugs might provide a feasible therapeutic approach to treat EV71 infection.
Protective Efficacy of VP1-Specific Neutralizing Antibody Associated with a Reduction of Viral Load and Pro-Inflammatory Cytokines in Human SCARB2-Transgenic Mice
Hsuen-Wen Chang, Yi-Wen Lin, Hui-Min Ho, Min-Han Lin, Chia-Chyi Liu, Hsiao-Yun Shao, Pele Chong, Charles Sia, Yen-Hung Chow
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0069858
Abstract: Hand-foot-mouth diseases (HFMD) caused by enterovirus 71 (EV71) and coxsackievirus 16 (CVA16) in children have now become a severe public health issue in the Asian-Pacific region. Recently we have successfully developed transgenic mice expressing human scavenger receptor class B member 2 (hSCARB2, a receptor of EV71 and CVA16) as an animal model for evaluating the pathogenesis of enterovirus infections. In this study, hSCARB2-transgenic mice were used to investigate the efficacy conferred by a previously described EV71 neutralizing antibody, N3. A single injection of N3 effectively inhibited the HFMD-like skin scurfs in mice pre-infected with clinical isolate of EV71 E59 (B4 genotype) or prevented severe limb paralysis and death in mice pre-inoculated with 5746 (C2 genotype). This protection was correlated with remarkable reduction of viral loads in the brain, spinal cord and limb muscles. Accumulated viral loads and the associated pro-inflammatory cytokines were all reduced. The protective efficacy of N3 was not observed in animals challenged with CVA16. This could be due to dissimilarity sequences of the neutralizing epitope found in CVA16. These results indicate N3 could be useful in treating severe EV71 infections and the hSCARB2-transgenic mouse could be used to evaluate the protective efficacy of potential anti-enterovirus agent candidates.
Gauge Independent Effective Potential and the Higgs Mass Bound
Guey-Lin Lin,Tzu-Kang Chyi
Physics , 1998, DOI: 10.1103/PhysRevD.60.016002
Abstract: We introduce the Vilkovisky-DeWitt formalism for deriving the lower bound of the Higgs boson mass. We illustrate the formalism with a simplified version of the Standard Electroweak Model, where all charged boson fields as well as the bottom-quark field are disregarded. The effective potential obtained in this approach is gauge independent. We derive from the effective potential the mass bound of the Higgs boson. The result is compared to its counterpart obtained from the ordinary effective potential.
Vilkovisky-DeWitt Effective Potential and the Higgs-Mass Bound
Guey-Lin Lin,Tzuu-Kang Chyi
Physics , 1998,
Abstract: We compute the Vilkovisky-DeWitt effective potential of a simplified version of the Standard Electroweak Model, where all charged boson fields as well as the bottom-quark field are neglected. The effective potential obtained in this formalism is gauge-independent. We derive from the effective potential the mass bound of the Higgs boson. The result is compared to its counterpart obtained from the ordinary effective potential.
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