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Biomedical subjects

K W Chan

Publications and source records attributed to K W Chan.

At least 145 records · Page 8Linked to original sources

Bone marrow transplantation in Shwachman-Diamond syndrome: report of two cases and review of the literature.

Patients with Shwachman-Diamond syndrome (SDS) have an increased frequency of myelodysplasia and leukemic transformation. We described two patients who received allogeneic stem cell transplantation and developed multiple complications, including seizure, hyperglycemia and renal tubular acidosis. A review of the literature showed that patients with SDS appeared to have an increased incidence of various transplant-associated problems. These patients frequently have underlying organ dysfunction and should be managed with extreme caution when treated with allogeneic stem cell transplantation.

Bone Marrow Transplantation↗

Allogeneic peripheral blood stem cell transplantation for active hemophagocytic lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis (HLH) is a lethal disorder of immune dysregulation. Successful allogeneic BMT is the only therapy that has produced long-term disease-free survival. However, for patients with active HLH the outcome of BMT remains poor when compared with those transplanted in remission. We describe a patient with active, recurrent HLH treated with high-dose chemotherapy and related allogeneic peripheral blood stem cell (PBSC) transplantation. Hematologic recovery was rapid and the post-transplant course was uncomplicated. The patient is alive and well 2 1/2 years after transplant. Allogeneic PBSC transplantation may deserve further evaluation as an alternative source of stem cells for transplantation in patients with active HLH.

Antineoplastic Combined Chemotherapy Protocols↗

Transfusion support using filtered unscreened blood products for cytomegalovirus-negative allogeneic marrow transplant recipients.

It has been suggested that leukoreduced unscreened blood products can be used as an alternative to components from cytomegalovirus (CMV)-seronegative donors in order to prevent transmission of CMV from transfusions for CMV-seronegative marrow transplant recipients with CMV-seronegative donors, but confirmatory data are lacking. A retrospective chart review was undertaken for patients undergoing allogeneic transplantation over a 4-year period during which blood products were filtered for CMV-seronegative patients with CMV-seronegative donors when CMV-seronegative components were not available. Forty-five CMV-seronegative patient-donor pairs were identified. Only one patient developed CMV disease (pneumonia) and no other patients developed an infection. In this group of patients, the rate of CMV infection was 2.7% (95% CI, 0-8%) by life-table analysis. We conclude that filtered unscreened blood products as partial transfusion support for CMV-seronegative marrow transplant recipients were associated with a low incidence of CMV infection, justifying further evaluation of filtered blood products as total transfusion support for this patient population. However, since CMV infections still occur, continued surveillance by periodic culture or other techniques is warranted.

Adolescent↗

Glomerulonephritis associated with basaloid squamous cell carcinoma of the oesophagus. A possible unusual paraneoplastic syndrome.

A 70-year-old man presented with rash, microscopic haematuria and proteinuria. The renal biopsy showed mesangial proliferative glomerulonephritis with mesangial IgA deposition. He was subsequently found to have basaloid squamous carcinoma of the oesophagus. This possible association between IgA nephropathy and oesophageal basaloid squamous carcinoma has never been reported.

Aged↗

Beta blockers in heart failure: a comparison of a vasodilating beta blocker with metoprolol.

OBJECTIVE: To determine whether a third generation vasodilating beta blocker (celiprolol) has long term clinical advantages over metoprolol in patients with chronic heart failure. DESIGN: A double blind placebo controlled randomised trial. SETTING: University teaching Hospital. PATIENTS: 50 patients with stable chronic heart failure (NYHA class II-IV) due to idiopathic dilated, ischaemic, or hypertensive cardiomyopathy, with left ventricular ejection fraction < 0.45. INTERVENTIONS: Celiprolol 200 mg daily (n = 21), metoprolol 50 mg twice daily (n = 19), or placebo (n = 10) for three months with a four week dose titration period. After the double blind period, patients entered an open label study (with placebo group receiving beta blockers) and were assessed after one year. MAIN OUTCOME MEASURES: Clinical response, efficacy, and tolerance were assessed by the Minnesota heart failure symptom questionnaire six minute walk test, Doppler echocardiography (systolic and diastolic function), radionuclide ventriculography, and atrial and brain natriuretic peptides measured at baseline and after three months. RESULTS: In the metoprolol group at 12 weeks v baseline there was a 47% reduction in symptom score (p < 0.001), improvement of NYHA class (mean (SEM), 2.6 (0.12) to 1.9 (0.13), p = 0.001), exercise distance (1246 (54) to 1402 (52) feet, p < 0.001), and left ventricular ejection fraction (26.9(3.1)% to 31(3.0)%, p = 0.016), and a fall in heart rate (resting, 79 (3) to 62 (3) beats/min, p < 0.001). In the celiprolol group there was a 38% reduction in symptom score (p = 0.02), less improvement in exercise distance (1191 (55) to 1256 (61) feet, p = 0.05), and no significant changes in NYHA class, left ventricular ejection fraction, or heart rate. Mortality at one year was 11% in metoprolol and 19% in the celiprolol group, and symptomatic improvement was maintained in the survivors. CONCLUSIONS: Both drugs were well tolerated but the vasodilator properties of celiprolol do not seem to provide any obvious additional benefit in the long term treatment of heart failure.

Adrenergic beta-Antagonists↗

Hepatic hemangioma: quantitative color power US angiography--facts and fallacies.

PURPOSE: To explore the origin of signals detected with color power ultrasound (US) angiography (CPA) and evaluate a semiquantitative method to assess signals in hepatic hemangiomas. MATERIALS AND METHODS: Twenty-four adult patients with 27 hepatic hemangiomas (< 2 cm in diameter) and five patients with five hyperechoic hepatic metastases underwent CPA and conventional color Doppler US in this prospective study. A sponge phantom was studied to determine whether the origin of CPA signals was related to architecture. The mean number of signals and the signal density in each lesion were scored. RESULTS: A "diffuse blush" was seen in all capillary hemangiomas at CPA, whereas no signal was seen at color Doppler US. The sponge phantom test produced a CPA appearance similar to that of capillary hemangiomas. Quantitative analysis of CPA images of hepatic hemangiomas showed a mean of 16.1 signals per cubic centimeter and a mean signal area of 25%. Hyperechoic avascular hepatic metastases resulted in CPA images similar to those of hepatic hemangiomas, with no quantitative difference in signal count, despite a mild qualitative difference at CPA. CONCLUSION: CPA signals in hepatic hemangiomas appear to be related more to architecture than to true capillary flow. There is a qualitative difference in the strength of the blush at CPA between hepatic hemangiomas and metastases, which may be the only possible differentiating factor.

Adult↗

Castleman's disease and mesangial proliferative glomerulonephritis: the role of interleukin-6.

Renal complications of Castleman's disease (angiofollicular lymph node hyperplasia) are uncommon. The reported cases are very heterogeneous and their renal pathology ranged from minimal change disease, mesangial proliferative glomerulonephritis, to amyloidosis. We have previously reported two cases of Castleman's disease with renal complications. We now present two more such cases. In contrast to other reports, all our cases are of the plasma cell type and their renal pathology showed remarkable similarities, namely mesangial proliferation, interstitial plasma cell infiltration and negative immunofluorescence. The level of serum interleukin-6 (IL-6) in both patients was elevated at presentation and came down with immunosuppressive therapy.

Adolescent↗

Identification and characterization of a receptor from goldfish specific for a teleost growth hormone-releasing hormone-like peptide.

In mammals, growth hormone-releasing hormone (GHRH), acting via the GHRH receptor, plays an important role in the regulation of growth hormone (GH) synthesis and secretion as well as the proliferation and differentiation of somatotropes in the pituitary. In fishes, information concerning the functional role of the characterized GHRHs is limited. For that reason, a putative goldfish GHRH receptor cDNA was characterized in this study. The receptor cDNA is 2,243 bp in length, encoding a 438-amino-acid-long polypeptide with 7 putative transmembrane-spanning regions, which is a characteristic of G-protein-coupled receptors. The receptor, when expressed in COS-7 cells, showed minimal responses (2-fold cAMP responses) when stimulated with 100 nM of human GHRH, pituitary adenylate cyclase-activating polypeptide (PACAP) and vasoactive intestinal polypeptide (VIP). However, this receptor was found to be specific for a carp GHRH-like peptide isolated from the brain of common carp (Cyprinus carpio); there was a significant and dose-dependent increase in intracellular cAMP (a maximum response of 22-fold increase with an EC50 of 0.1 nM) when the transfected cells were stimulated with this peptide. As a preliminary study to investigate the functional role of this receptor, the tissue distribution of the mRNA was analyzed by reverse-transcription-polymerase chain reaction. The receptor mRNA was found to be present in the brain, pituitary, gut, gill, heart, liver, skeletal muscle, spleen, ovary and testis. Together with a goldfish PACAP type 1 receptor and a VIP1 receptor recently isolated in our laboratory, characterization of this putative GHRH receptor provides the molecular basis for the future understanding of the neuroendocrine control of growth and reproduction by these neuropeptides in goldfish as well as other teleosts.

Amino Acid Sequence↗

An Asian multicenter clinical trial to assess the efficacy and tolerability of acarbose compared with placebo in type 2 diabetic patients previously treated with diet. Asian Acarbose Study Group.

OBJECTIVE: To assess the efficacy, safety, and tolerability of acarbose versus placebo during a 24-week treatment period in Asian type 2 diabetic patients with dietary failure. RESEARCH DESIGN AND METHODS: After a 6-week screening period, 126 multiethnic Asian type 2 diabetic patients (64 men, 62 women; mean age +/- SD, 53.4 +/- 10 years) were randomized to receive acarbose (n = 63) or placebo (n = 63). The dosage was increased from 50 mg t.i.d. at week 0 to 100 mg t.i.d. at week 4. Patients were then followed up at weeks 10, 16, and 24. At each visit, body weight, blood pressure, and metabolic indexes were measured. At weeks 0 and 24, fasting plasma glucose and insulin were measured before and 1 h after the administration of an individually tailored breakfast. RESULTS: Using the intention-to-treat analysis, there were greater reductions in (mean [95% CI]) HbA1c (-0.70 [-1.00 to -0.39] vs. -0.27% [-0.54 to 0]; P = 0.04), fasting plasma glucose (-0.37 [-0.75 to 0.02] vs. 0.41 mmol/l [-0.08 to 0.90]; P = 0.017) and 1-h plasma glucose (-0.77 [-1.44 to -0.10] vs. 0.65 mmol/l [-0.07 to 1.36]; P = 0.05) in the acarbose group compared with the placebo group. With acarbose treatment, 78% of patients achieved an HbAlc < 8% compared with 56% in the placebo group (P = 0.003). There was a greater reduction in body weight (-1.31 [-2.46 to -0.15] vs. 0.16 kg [-3.36 to 0.10]; P = 0.02) and higher incidence of flatulence (56 vs. 37%; P = 0.032) in the acarbose than in the placebo group. Using baseline HbA1c and race as covariates, there were no significant interethnic differences in treatment responses (P = 0.232 for treatment-race interaction; P < 0.001 for treatment effect). The dropout rates were similar between the two groups (acarbose, 11 of 63; placebo, 6 of 63). There were no significant laboratory adverse events in either group. CONCLUSIONS: In this multicenter study involving six ethnic groups, acarbose 100 mg t.i.d. was an effective, safe, and generally well-tolerated therapy in Asian type 2 diabetic patients with dietary failure. In some patients with troublesome gastrointestinal symptoms, a lower dosage may be necessary.

Acarbose↗

Fine needle aspiration of breast masses: an analysis of 1533 cases in private practice.

The diagnostic efficacy of fine needle aspiration cytology of breast masses and the causes for unsatisfactory specimens in private practices were investigated in Hong Kong. All specimens that were submitted to the histopathology unit at the Canossa Hospital between 1 January 1996 and 30 April 1997 formed the basis of this report. A total of 1533 specimens were received from 1447 patients; 274 (17.8%) cases were unsatisfactory for assessment, 1080 (70.4%) were benign, 51 (3.3%) atypical, 19 (1.2%) suspicious, and 67 (4.4%) malignant. The specimens were submitted by 105 doctors, who each performed between 1 and 561 smears. The proportion of unsatisfactory samples was high for doctors who performed an occasional fine needle aspiration (48%; overall mean, 25%). Histological correlation was available in 165 cases. The overall sensitivity was 79%, specificity 98%, positive predictive value (including the 'suspicious' category) 92%, and negative predictive value 94%. Two false positive cases that were reported as suspicious were found to be fibroadenomata following subsequent excision biopsy. No adverse clinical outcomes were recorded for the false positive cases. There were six false negative cases (reported as a cyst in one case, benign in two cases, and atypical in three cases). The results compared favourably with published data and affirmed the effectiveness of the test in private practice.

Journal Article↗

Post-transplantation lymphoproliferative disorder of donor origin in a sex-mismatched renal allograft as proven by chromosome in situ hybridization.

We report a case of post-transplantation B-cell lymphoproliferative disorder (PTLPD) associated with Epstein-Barr virus (EBV) that developed in a renal allograft 5 months after transplantation. The lesion had a histologic appearance of diffuse large B-cell lymphoma with monoclonality demonstrated by in situ hybridization (ISH) for kappa and lambda mRNA. Both the male donor and the female recipient were EBV seropositive. The lymphoid cells in this lesion was proven to be of donor origin by ISH for the human Y chromosome on the paraffin-embedded sections of the allograft. The recipient of the other kidney from the same donor did not have evidence of lymphoma, and the patient was also free from disease 2 years after surgical removal of the lymphoma This case is an unusual PTLPD of donor origin; the majority of such lesions in solid organ transplantations are of recipient origin. Our findings demonstrate that the origin of PTLPD can be documented in selected cases using ISH with probes to the Y chromosome.

Adult↗

Factors related to delayed treatment and posttreatment symptom severity in Taiwanese patients with benign prostatic hyperplasia.

We evaluated the sociodemographic and clinical factors of delayed treatment and posttreatment symptom severity in outpatients with benign prostatic hyperplasia (BPH). The study included 146 BPH patients treated at the National Taiwan University Hospital in early 1997. All patients were treated with alpha-adrenergic antagonists or finasteride for at least 2 weeks. A questionnaire based on Andersen's Health Behavior Model was used to assess various sociodemographic features, while the pre- and posttreatment symptoms severity was rated according to the International Prostate Symptom Score (IPSS). Multiple logistic regression was used to assess the associations of these factors with delayed treatment and posttreatment symptom severity. Subjects who had recently quit smoking or were blue-collar workers tended to delay treatment, while those who chose a medical center as the care provider for chronic diseases tended to be less likely to delay treatment. However, none of these associations were statistically significant. No enabling factors (income, insurance) or need factors (symptom scores) evaluated were associated with delayed treatment. Predisposing factors associated with higher posttreatment symptom severity were delayed treatment (over 12 months) (adjusted odds ratio [OR]: 2.67, 95% confidence interval [CI]: 1.16-6.16), quitting smoking (adjusted OR: 4.47, 95% CI: 1.34-14.94), and having never smoked (adjusted OR: 3.73, 95% CI: 1.15-12.11). Subjects with severe pretreatment symptoms were far more likely than subjects with mild pretreatment symptoms to have severe symptoms after treatment (adjusted OR: 52.69, 95% CI: 54.46-621.90). Our findings, though based on a limited number of subjects, suggest sociodemographic factors rather than objective clinical attributes (prostate specific antigen level, prostate volume, and urodynamic results) are associated with delayed treatment in Taiwanese men with BPH. Both pretreatment symptom severity and sociodemographic factors are related to posttreatment symptom severity.

Adult↗

Probing the G-protein regulation of GIRK1 and GIRK4, the two subunits of the KACh channel, using functional homomeric mutants.

In heart, G-protein-activated channels are complexes of two homologous proteins, GIRK1 and GIRK4. Expression of either protein alone results in barely active or non-active channels, making it difficult to assess the individual contribution of each subunit to the channel complex. The residue Phe137, located within the H5 region of GIRK1, is critical to the synergy between GIRK1 and GIRK4 (Chan, K. W., Sui, J. L., Vivaudou, M., and Logothetis, D. E. (1996) Proc. Natl. Acad. Sci. U. S. A. 93, 14193-14198). By modifying this residue or the matching residue of GIRK4, Ser143, we have been able to generate mutant proteins that produced large inwardly rectifying, G-protein-modulated currents when expressed alone in Xenopus oocytes. The enhanced activity of the heterologous expression of each of two active mutants, GIRK1(F137S) and GIRK4(S143T), was not caused by association with an endogenous oocyte channel subunit, and these mutants did not display apparent differences in the ability to localize to the cell surface compared with their wild-type counterparts. When these functional mutant channels were compared individually with wild-type heteromeric channels, they responded with only small differences to a number of maneuvers involving coexpression with muscarinic receptors, G-protein betagamma subunits, wild-type or mutated G-protein alpha subunits, and active protomers of pertussis toxin. These experiments, which confirmed the crucial, though not exclusive, role of Gbetagamma in regulating channel activity, demonstrated that GIRK1(F137S) and GIRK4(S143T), and by extrapolation their wild-type counterparts, interact in a qualitatively similar way with G-protein subunits. These findings suggest that functionally important sites of interaction with G-proteins are likely to be located within the homologous regions of GIRK1 and GIRK4 rather than within the divergent terminal regions. They also raise the question of the functional advantage of a heteromeric over homomeric design for G-protein-gated channels.

Animals↗

The effect of in vivo ethanol consumption on cyclic AMP and delta-opioid receptors in mouse striatum.

In this study the effect of in vivo ethanol consumption on cyclic AMP (cAMP) and [D-Ala2,D-Leu5]enkephalin (DADLE) inhibition of forskolin-stimulated cAMP production was examined in mouse striatum. Effects of ethanol on striatal delta-opioid receptor (DOR) density and mRNA were also examined. Mice had unlimited access to 7% (v/v) ethanol alone or water for 1 or 7 days and were then sacrificed and striatum removed for analysis. There was no difference in basal cAMP formation between water and ethanol-treated mouse striatum following 7 day treatment, and a small, but statistically significant increase in basal cAMP in the ethanol group following 1 day treatment. Both 1 day and 7 day ethanol treatment did not significantly alter the percentage increase in cAMP following treatment with 10 microM forskolin. There was a significant effect of ethanol treatment on the maximum inhibitory effect of DADLE on forskolin-stimulated cAMP formation following both 1 and 7 day ethanol treatment. The DADLE IC50 was unaffected by ethanol treatment. Saturation binding studies ([3H]Deltorphin II) indicated no effect of ethanol on Bmax or Kd in striatum. Similarly, no difference between water and ethanol-treated was observed for DOR mRNA in striatum. These data indicate that ethanol consumption can alter opioid regulation of cAMP formation. However, this effect is not related to changes in any delta-opioid receptor parameters that were examined.

Animals↗

Effectiveness of low-dose ASA in prevention of secondary ischemic stroke, the ASA Study Group in Taiwan.

This randomized double-blind controlled study was carried out to investigate the effect of 100 mg acetylsalicylic acid (ASA) per day on the secondary prevention of ischemic stroke. Patients who suffered a first ischemic stroke from 13 participating hospitals were enrolled. They were independent or only partially dependent in activities of daily living and all had received brain CT for diagnosis. Eligible patients were randomly allocated to the 100 mg ASA or the nicametate citrate (a vasodilator) groups, and trial medications were started within three to six weeks after the onset of stroke. The primary end point was cerebral reinfarction, and intracranial hemorrhage was classified as an adverse event. Four hundred and sixty-six patients participated in this study; and 222 cases (136 males and 86 females) were allocated to the ASA group while 244 cases (150 males and 94 females) were assigned to the nicametate group. No significant difference in baseline characteristics between the two groups was observed. Cerebral reinfarction developed 6.3% (14/222) in the ASA group and 11.9% (29/244) in the nicametate group. According to the Cox's proportional hazards model, the estimated risk ratio (ASA group vs. nicametate group) was 0.538, with a 95% confidence interval of 0.284-1.019. The result was of borderline statistical significance. The risk for cerebral reinfarction was reduced by almost 50% among those who took 100 mg ASA versus those who took nicametate.

Aged↗

Specific regions of heteromeric subunits involved in enhancement of G protein-gated K+ channel activity.

Heterologous coexpression of recombinant, G protein-gated, inwardly rectifying K+ (GIRK) channel subunits has yielded large currents, severalfold greater than those obtained from expression of the individual subunits. Such current enhancement has been obtained from coexpression of the inactive GIRK1 subunit with the low activity GIRK2-5 subunits in Xenopus oocytes. Using deletion and chimeric constructs, we now report the identification of a C-terminal region unique to GIRK1 and a larger central region of GIRK4 highly homologous to GIRK1, both of which are critical for production of large currents. Chimeras containing these two regions produced homomeric channels, exhibiting currents severalfold greater than those from either wild-type subunit alone. G protein regulation of such chimeric channel currents resembled that of wild-type currents. Green fluorescent protein-tagged channels showed that the amount of chimeric channel expressed on the oocyte cell surface was similar to its wild-type counterpart, suggesting that the enhanced activity was not due to differences in relative levels of expression but rather to the coexistence of the chimeric regions. Single-channel recordings of the active chimeras exhibited patterns of activities with open-time kinetics and conductance characteristics representative of those of GIRK4, indicating that the presence of the GIRK1 C-terminal region caused an increase in the frequency of channel openings without affecting their duration.

Amino Acid Sequence↗