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Search Results: 1 - 10 of 2654 matches for " Hon-Kan Yip "
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Effect of erythropoietin therapy on clinical outcome in patients after acute ischemic stroke: a debatable issue
Chun-Man Yuen, Cheuk-Kwan Sun, Steve Leu, Hon-Kan Yip
Critical Care , 2011, DOI: 10.1186/cc10145
Abstract: We thank Minnerup and colleagues [5] for their comments in the previous issue of Critical Care. These authors suggested that, for evaluating 90-day neurological outcome, the modified Rankin Scale or the Barthel Index could be superior to the National Institutes of Health Stroke Scale (NIHSS) that was used in our study [5]. They also mentioned that, when the components of the composite endpoint in our study protocol are considered, the significantly higher number of patients with an NIHSS score of at least 8 after placebo treatment is also likely to be caused by the high rate of recurrent strokes and does not necessarily reflect improved neurological function in the EPO group [5]. However, NIHSS is widely accepted as one of the most efficacious tools for evaluating neurological outcome after acute IS. Additionally, the trial in our study was prospective, randomized, and placebo-controlled - this is the best design to minimize the selection bias between the study group and the control group. Accordingly, we suggest that the significantly lower number of patients with an NIHSS score of at least 8 in the EPO group in comparison with the placebo group could reflect simply the therapeutic benefit of EPO therapy in improving the 90-day neurological outcome rather than a mere speculation of a higher rate of recurrent strokes in the placebo group.The optimal dosage of EPO and duration of treatment for patients after IS remain uncertain. This may account for some inconsistency in improvement of neurological outcome after IS in clinical trials [1-4]. Accordingly, we disagree with Minnerup and colleagues [5] that 'the potential side effects and the failed efficacy in large clinical trials will presumably prevent the use of EPO as a therapy to increase EPCs after stroke'.Minnerup and colleagues also underscored that the study was first assigned to a trial register (ISRCTN 96340690) in January 2011, which was 10 months after the inclusion of the last patients in March 2010 [5]. W
Percutaneous Transluminal Angioplasty to Left Internal Mammary Artery Grafts: Immediate and Long-term Clinical Outcomes
Wei-Chin Hung,Chiung-Jen Wu,Hon-Kan Yip,Chih-Yuan Fang
Chang Gung Medical Journal , 2007,
Abstract: Background: Increasing usage of the left internal mammary artery (LIMA) as the graft ofchoice in coronary artery bypass surgery has led to increased incidence ofLIMA graft stenosis.Methods: Thirteen patients with LIMA graft stenosis were identified from a review ofour institutional database, with intervention approach either from the femoral(n = 6) or radial artery (n = 7). There were no LIMA orifice lesions and allpatients presented with anastomosis site stenoses, except one individual whohad combined LIMA shaft stenosis. Clinical outcomes were assessed.Results: The procedural success rate was 92% (12/13). Conventional balloon dilationwas performed in seven cases and stenting in five. Two patients developedLIMA body dissection during the procedure, with one requiring bail-outstenting and the other prolonged balloon inflation. The in-hospital majoradverse cardiac events included 1 non-Q wave myocardial infarction (7.7%)but no deaths, emergency coronary artery bypass surgery or target lesionrevascularization. In the one failure case, the patient died 1 month later athome. Angiographic follow-up of ten patients (83%) revealed a restenosisrate of 20% (2/10). The mean clinical follow-up duration was 34.5 20.9months. One patient expired 32 months later due to acute stroke with sepsis.Conclusion: Percutaneous transluminal intervention of LIMA grafts can be performedsafely from either the femoral or radial approach. High procedure successand low complication rates are achievable by an experienced cardiologist;long-term clinical results were excellent in our patients. It can be consideredas an alternative therapeutic method for a stenosed LIMA graft.
Feasibility and Safety of A Transradial Approach in Intervention for Chronic Total Occlusion of Coronary Arteries: A Single-center Experience
Cheng-Hsu Yang,Gary Bih-Fang Guo,Shyh-Ming Chen,Hon-Kan Yip
Chang Gung Medical Journal , 2010,
Abstract: Background: The transradial approach for cardiac catheterization has become popular;however, its application in percutaneous coronary intervention (PCI) forchronic total occlusion (CTO) has rarely been reported. This study examinesthe feasibility and safety of this approach for performing PCI for CTOlesions.Method: We retrospectively evaluated 419 consecutive patients who underwent PCIfor CTO lesions between February 1998 and December 2003 in our hospital;a transradial artery approach was used in 400 patients and a transfemoralartery approach in 19.Results: The baseline clinical characteristics were similar in the 2 patient groups. Thetransradial group had more de novo lesions (76% vs 47.37%, p = 0.012),fewer in-stent restenotic lesions (11.75% vs 36.84%, p = 0.006) and smallerguiding catheters (p < 0.001) than the transfemoral group. There was no statisticaldifference in the procedure success rates (69.25% and 78.95%, p =0.369) between the 2 groups. The incidence of major complications, includingdeath, Q wave myocardial infarction, and emergency coronary arterybypass surgery, was similar in the 2 groups.Conclusions: The transradial approach for PCI can be a feasible choice for a CTO lesion.If this approach fails because of poor back up support from the guidingcatheter, the transfemoral approach can be attempted with a larger guidingcatheter.
Adipose-derived mesenchymal stem cells markedly attenuate brain infarct size and improve neurological function in rats
Steve Leu, Yu-Chun Lin, Chun-Man Yuen, Chia-Hung Yen, Ying-Hsien Kao, Cheuk-Kwan Sun, Hon-Kan Yip
Journal of Translational Medicine , 2010, DOI: 10.1186/1479-5876-8-63
Abstract: Adult male Sprague-Dawley (SD) rats (n = 30) were divided into IS plus intra-venous 1 mL saline (at 0, 12 and 24 h after IS induction) (control group) and IS plus intra-venous ADMSCs (2.0 × 106) (treated interval as controls) (treatment group) after occlusion of distal left internal carotid artery. The rats were sacrificed and brain tissues were harvested on day 21 after the procedure.The results showed that BIA was larger in control group than in treatment group (p < 0.001). The sensorimotor functional test (Corner test) identified a higher frequency of turning movement to left in control group than in treatment group (p < 0.05). mRNA expressions of Bax, caspase 3, interleukin (IL)-18, toll-like receptor-4 and plasminogen activator inhibitor-1 were higher, whereas Bcl-2 and IL-8/Gro were lower in control group than in treatment group (all p < 0.05). Western blot demonstrated a lower CXCR4 and stromal-cell derived factor-1 (SDF-1) in control group than in treatment group (all p < 0.01). Immunohistofluorescent staining showed lower expressions of CXCR4, SDF-1, von Willebran factor and doublecortin, whereas the number of apoptotic nuclei on TUNEL assay was higher in control group than in treatment group (all p < 0.001). Immunohistochemical staining showed that cellular proliferation and number of small vessels were lower but glial fibrillary acid protein was higher in control group than in treatment group (all p < 0.01).ADMSC therapy significantly limited BIA and improved sensorimotor dysfunction after acute IS.Stroke, a growing epidemic, is the third most frequent cause of mortality in industrialized countries [1-3]. Despite state-of-the-art therapy, clinical outcome after stroke remains poor, with many patients left permanently disabled [4]. Recently, thrombolytic therapy, a more aggressive treatment strategy, has been reported to be effective for some acute ischemic stroke (IS) patients [5,6]. However, its liberal use is hampered by a lot of limitations, including
Comparison of acute versus convalescent stage high-sensitivity C-Reactive protein level in predicting clinical outcome after acute ischemic stroke and impact of erythropoietin
Kuo-Ho Yeh, Tzu-Hsien Tsai, Han-Tan Chai, Steve Leu, Sheng-Ying Chung, Sarah Chua, Yung-Lung Chen, Hung-Sheng Lin, Chun-Man Yuen, Hon-Kan Yip
Journal of Translational Medicine , 2012, DOI: 10.1186/1479-5876-10-6
Abstract: Totally 160 patients were prospectively randomized to receive either EPO therapy (group 1, n = 80) (5,000 IU each time, subcutaneously) at 48 h and 72 h after acute IS, or placebo (group 2, n = 80). Serum level of hs-CRP was determined using ELISA at 48 h and on day 21 after IS and once in 60 healthy volunteers.Serum level of hs-CRP was substantially higher in all patients with IS than in healthy controls at 48 h and day 21 after IS (all p < 0.001). Levels of hs-CRP did not differ between group 1 and 2 at 48 h and day 21 after IS (all p > 0.5). Multivariate analysis showed that hs-CRP levels (at 48 h and day 21) were independently predictive of 90-day major adverse neurological event (MANE) (defined as recurrent stroke, NIHSS≥8, or death) (all p < 0.03), whereas EPO therapy was independently predictive of reduced 90-day MANE (all p < 0.02).EPO therapy which was independently predictive of freedom from 90-day MANE did not alter the crucial role of hs-CRP levels measured at 48 h and 21-day in predicting unfavorable clinical outcome after IS.Numerous studies have already shown that inflammation plays a crucial role in the initiation of endothelial dysfunction, atherosclerosis and plaque formation, propagation of plaque burden, and finally, rupture of the vulnerable plaque and acute arterial obstructive syndrome (AOS) [1-4]. Although a myriad of inflammatory biomarkers have been reported to be useful in predicting endothelial dysfunction and the likelihood of AOS, high-sensitivity C-reactive protein (hs-CRP) remains one of the most extensively studied and widely accepted inflammatory biomarkers in our daily clinical practice [4-10].Indeed, not only is hs-CRP an inflammatory biomarker, but it has also been proved to directly participate in the inflammatory process contributing to acute AOS [3,4,7]. Besides, immense clinical observational studies have demonstrated that serum level of hs-CRP is a useful and powerful inflammatory marker in predicting future cardiovascular a
Myocardium-derived conditioned medium improves left ventricular function in rodent acute myocardial infarction
Steve Leu, Ying-Hsien Kao, Cheuk-Kwan Sun, Yu-Chun Lin, Tzu-Hsien Tsai, Li-Teh Chang, Sarah Chua, Kuo-Ho Yeh, Chiung-Jen Wu, Morgan Fu, Hon-Kan Yip
Journal of Translational Medicine , 2011, DOI: 10.1186/1479-5876-9-11
Abstract: Adult male Sprague-Dawley (SD) rats (n = 36) randomized to receive either left coronary artery ligation (AMI induction) or thoracotomy only (sham procedure) were grouped as follows (n = 6 per group): Group I, II, and III were sham-controls treated by fresh medium, normal rat MDCM, and infarct-related MDCM, respectively. Group IV, V, and VI were AMI rats treated by fresh medium, normal MDCM, and infarct-related MDCM, respectively. Either 75 μL MDCM or fresh medium was administered into infarct myocardium, followed by intravenous injection (3 mL) at postoperative 1, 12, and 24 h.In vitro studies showed higher phosphorylated MMP-2 and MMP-9, but lower α-smooth muscle actin and collagen expressions in neonatal cardiac fibroblasts treated with MDCM compared with those in the cardiac fibroblasts treated with fresh medium (all p < 0.05). Sirius-red staining showed larger collagen deposition area in LV myocardium in Group IV than in other groups (all p < 0.05). Stromal cell-derived factor-1α and CXCR4 protein expressions were higher in Group VI than in other groups (all p < 0.05). The number of von Willebrand factor- and BrdU-positive cells and small vessels in LV myocardium as well as 90-day LV ejection fraction were higher, whereas oxidative stress was lower in Group VI than in Group IV and Group V (all p < 0.05).MDCM therapy reduced cardiac fibrosis and oxidative stress, enhanced angiogenesis, and preserved 90-day LV function in a rat AMI model.Although transplantation of a variety of stem cells has been reported to be beneficial in improving infarct- and ischemia-related LV dysfunction [1-5], the underlying mechanisms are still poorly understood [3-5]. It has been proposed that implanted mesenchymal stem cells (MSCs) differentiated into functional cardiomyocytes to replace the lost myocardium, thereby improving heart function [6]. However, accumulating evidence has shown that only a few implanted stem cells subsequently express myogenic cell-like phenotype in ischemic z
Autologous Transplantation of Adipose-Derived Mesenchymal Stem Cells Markedly Reduced Acute Ischemia-Reperfusion Lung Injury in a Rodent Model
Cheuk-Kwan Sun, Chia-Hung Yen, Yu-Chun Lin, Tzu-Hsien Tsai, Li-Teh Chang, Ying-Hsien Kao, Sarah Chua, Morgan Fu, Sheung-Fat Ko, Steve Leu, Hon-Kan Yip
Journal of Translational Medicine , 2011, DOI: 10.1186/1479-5876-9-118
Abstract: Adult male Sprague-Dawley (SD) rats (n = 24) were equally randomized into group 1 (sham control), group 2 (IR plus culture medium only), and group 3 (IR plus intravenous transplantation of 1.5 × 106 autologous ADMSCs at 1h, 6h, and 24h following IR injury). The duration of ischemia was 30 minutes, followed by 72 hours of reperfusion prior to sacrificing the animals. Blood samples were collected and lungs were harvested for analysis.Blood gas analysis showed that oxygen saturation (%) was remarkably lower, whereas right ventricular systolic pressure was notably higher in group 2 than in group 3 (all p < 0.03). Histological scoring of lung parenchymal damage was notably higher in group 2 than in group 3 (all p < 0.001). Real time-PCR demonstrated remarkably higher expressions of oxidative stress, as well as inflammatory and apoptotic biomarkers in group 2 compared with group 3 (all p < 0.005). Western blot showed that vascular cell adhesion molecule (VCAM)-1, intercellular adhesion molecule (ICAM)-1, oxidative stress, tumor necrosis factor-α and nuclear factor-κB were remarkably higher, whereas NAD(P)H quinone oxidoreductase 1 and heme oxygenase-1 activities were lower in group 2 compared to those in group 3 (all p < 0.004). Immunofluorescent staining demonstrated notably higher number of CD68+ cells, but significantly fewer CD31+ and vWF+ cells in group 2 than in group 3.ADMSC therapy minimized lung damage after IR injury in a rodent model through suppressing oxidative stress and inflammatory reaction.The lung maintains its unique function of effective gaseous exchange because of its remarkably large alveolar surface area, its rich and delicate alveolar capillary network, as well as its physical properties (i.e. elasticity and compliance). On the other hand, it is vulnerable to acute ischemia-reperfusion (IR) injury in situations such as resuscitation from hemorrhagic/septic shock and recovery from cardiac surgeries where pulmonary blood supplies have to be clamped,
Extracorporeal Shock Wave Therapy Reverses Ischemia-Related Left Ventricular Dysfunction and Remodeling: Molecular-Cellular and Functional Assessment
Morgan Fu, Cheuk-Kwan Sun, Yu-Chun Lin, Ching-Jen Wang, Chiung-Jen Wu, Sheung-Fat Ko, Sarah Chua, Jiunn-Jye Sheu, Chiang-Hua Chiang, Pei-Lin Shao, Steve Leu, Hon-Kan Yip
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0024342
Abstract: An optimal treatment for patients with diffuse obstructive arterial disease unsuitable for catheter-based or surgical intervention is still pending. This study tested the hypothesis that extracorporeal shock wave (ECSW) therapy may be a therapeutic alternative under such clinical situation. Myocardial ischemia was induced in male mini-pigs through applying an ameroid constrictor over mid-left anterior descending artery (LAD). Twelve mini-pigs were equally randomized into group 1 (Constrictor over LAD only) and group 2 (Constrictor over LAD plus ECSW [800 impulses at 0.09 mJ/mm2] once 3 months after the procedure). Results showed that the parameters measured by echocardiography did not differ between two groups on days 0 and 90. However, echocardiography and left ventricular (LV) angiography showed higher LV ejection fraction and lower LV end-systolic dimension and volume in group 2 on day 180 (p<0.035). Besides, mRNA and protein expressions of CXCR4 and SDF-1α were increased in group 2 (p<0.04). Immunofluorescence staining also showed higher number of vWF-, CD31-, SDF-1α-, and CXCR4-positive cells in group 2 (all p<0.04). Moreover, immunohistochemical staining showed notably higher vessel density but lower mean fibrosis area, number of CD40-positive cells and apoptotic nuclei in group 2 (all p<0.045). Mitochondrial protein expression of oxidative stress was lower, whereas cytochrome-C was higher in group 2 (all p<0.03). Furthermore, mRNA expressions of MMP-9, Bax and caspase-3 were lower, whereas Bcl-2, eNOS, VEGF and PGC-1α were higher in group 2 (all p<0.01). In conclusion, ECSW therapy effectively reversed ischemia-elicited LV dysfunction and remodeling through enhancing angiogenesis and attenuating inflammation and oxidative stress.
Effect of erythropoietin on level of circulating endothelial progenitor cells and outcome in patients after acute ischemic stroke
Hon-Kan Yip, Tzu-Hsien Tsai, Hung-Sheng Lin, Shu-Fang Chen, Cheuk-Kwan Sun, Steve Leu, Chun-Man Yuen, Teng-Yeow Tan, Min-Yu Lan, Chia-Wei Liou, Cheng-Hsien Lu, Wen-Neng Chang
Critical Care , 2011, DOI: 10.1186/cc10002
Abstract: In total, 167 patients were prospectively randomized to receive either EPO therapy (group 1) (5,000 IU each time, subcutaneously) at 48 h and 72 h after acute IS, or serve as placebo (group 2). The circulating level of EPCs (double-stained markers: CD31/CD34 (E1), CD62E/CD34 (E2) and KDR/CD34 (E3)) was determined using flow cytometry at 48 h and on days 7 and 21 after IS. EPC level was also evaluated once in 60 healthy volunteers.Circulating EPC (E1 to E3) level at 48 h after IS was remarkably higher in patients than in control subjects (P < 0.02). At 48 h and on Day 7 after IS, EPC (E1 to E3) level did not differ between groups 1 and 2 (all P > 0.1). However, by Day 21, EPC (E1 to E3) level was significantly higher in group 1 than in group 2 (all P < 0.03). Additionally, 90-day recurrent stroke rate was notably lower in group 1 compared with group 2 (P = 0.022). Multivariate analysis demonstrated that EPO therapy (95% confidence interval (CI), 0.153 to 0.730; P = 0.006) and EPC (E3) (95% CI, 0.341 to 0.997; P = 0.049) levels were significantly and independently predictive of a reduced 90-day major adverse neurological event (MANE) (defined as recurrent stroke, National Institutes of Health Stroke scale ≥8, or death).EPO therapy significantly improved circulating EPC level and 90-day MANE.ISRCTN: ISRCTN96340690Stroke, a growing epidemic, remains a leading cause of mortality and disability worldwide [1-3]. Surprisingly, while the epidemiology, etiologies, mechanisms, classification, and prognostic outcomes of ischemic stroke (IS) have been widely investigated for several decades, a safe and effective treatment strategy for patients after acute IS has not been fully developed [4-8].Recently, thrombolysis using tissue plasminogen activator (tPA), a more aggressive management strategy, has been shown to be effective for some acute IS patients early after the onset of symptoms [9,10]. However, tPA use is hampered by many limitations in daily clinical practice [10-13]. In
Levels and values of circulating endothelial progenitor cells, soluble angiogenic factors, and mononuclear cell apoptosis in liver cirrhosis patients
Chih-Hung Chen, Li-Teh Chang, Wei-Chih Tung, Yung-Lung Chen, Chia-Lo Chang, Steve Leu, Cheuk-Kwan Sun, Tzu-Hsien Tsai, I-Ting Tsai, Hsueh-Wen Chang, Hon-Kan Yip
Journal of Biomedical Science , 2012, DOI: 10.1186/1423-0127-19-66
Abstract: Blood sample was prospectively collected once for assessing EPC level and function, MCA, and plasma levels of VEGF and SDF-1α using flow cytometry and enzyme-linked immunosorbent assay (ELISA), respectively, in 78 LC patients and 25 age- and gender-matched healthy controls.Number of EPCs (E1, E2, E3) was lower (all p?<?0.0001), whereas SDF-1α level and MCA were higher (p?<?0.001) in study patients compared with healthy controls. Number of EPCs (E2, E3) was higher but MCA was lower (all p?<?0.05) in Child's class A compared with Child's class B and C patients, although no difference in VEGF and SDF-1α levels were noted among these patients. Chronic hepatitis B and esophageal varices bleeding were independently, whereas chronic hepatitis C, elevated aspartate aminotransferase (AST), and decompensated LC were inversely and independently correlated with circulating EPC level (all p?<?0.03). Additionally, angiogenesis and transwell migratory ability of EPCs were reduced in LC patients than in controls (all p?<?0.001).The results of this study demonstrated that level, angiogenic capacity, and function of circulating EPCs were significantly reduced, whereas plasma levels of SDF-1α and circulating MCA were substantially enhanced in cirrhotic patients.
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