Biomedical subjects

Shan-Tair Wang

Publications and source records attributed to Shan-Tair Wang.

At least 19 recordsLinked to original sources

PubMed2006

Impact of influenza vaccination on major cause-specific mortality.

The efficacy of influenza vaccination is not well understood for major cause-specific mortality except pneumonia. For 10 months we followed the mortality data of 35,637 vaccinated elderly (>65 years old) in a county with 102,698 elderly in southern Taiwan. A multivariate Cox model showed that vaccination was significantly associated with lower mortality for all causes, [hazards ratio (HR)=0.56], stroke (HR=0.35), renal disease (HR=0.40), diabetes mellitus (HR=0.45), pneumonia (HR=0.47), COPD (HR=0.55), malignancy (HR=0.74), and heart diseases (HR=0.78), p<0.05. Influenza vaccination was strongly associated with reducing major cause-specific mortality.

Aged↗

PubMed2006

Human PCDD/PCDF levels near a pentachlorophenol contamination site in Tainan, Taiwan.

A pentachlorophenol (PCP) manufacturing plant in southern Taiwan discontinued production in 1989. The site of the abandoned plant was heavily contaminated by PCDD/PCDFs, impurities formed in the PCP production process. Serum samples collected from 27 residents living near the deserted plant were evaluated to determine whether this contamination had associated serum levels of PCDD/PCDFs in local residents. The average level of 17 tested congeners ranged from 556 to 5240 pg/g lipid (mean, 1670 pg/g lipid). The corresponding 2,3,7,8-TCDD toxicity equivalent quotient values calculated by international toxicity equivalent factors (I-TEFs) and those recommended by WHO (WHO-TEFs) were 47.2 pg I-TEQ/g lipid and 53.4 pg WHO-TEQ/g lipid, respectively. Levels in other parts of Taiwan typically range from 15 to 20 pg WHO-TEQ/g lipid; therefore, it is likely that the heavily contaminated plant site caused these unusually high serum levels. The average PCDD/PCDF levels of 29 fish-tissue and nine soil samples collected from the sea reservoir surrounding the abandoned PCP plant were also abnormally high: 8630 pg/g lipid (985 pg WHO-TEQ/g lipid) and 606000 pg/g-sample (922 pg WHO-TEQ/g-sample), respectively. Factor analysis indicated that the congener pattern of human serum samples collected from residents living near the abandoned PCP plant different from samples collected from other areas in Taiwan without known PCDD/PCDF pollution. Similar results were observed for the fish tissue and soil samples. The current study may have discovered a "hot spot" for elevated dioxin human exposure in Taiwan. The preliminary finding has raised a public health concern in the inspected area and requires further investigations to clarify the nature of the contamination and potential impact on the local environment and human health.

Adult↗

PubMed2006

Early presumptive therapy with fluconazole for occult Candida infection after gastrointestinal surgery.

The objective of this retrospective comparative study was to improve the outcome of patients with suspected occult Candida infection after gastrointestinal surgery by early presumptive therapy. It was conducted in the National Cheng Kung University Hospital in Taiwan. A total of 36 patients with prolonged ileus with fever after gastrointestinal tract surgery between January 1995 and December 2002 were examined for two time periods: those treated before and those treated after January 1999. One set of patients did not receive early presumptive therapy (EPT) until Candida infection was confirmed, and they were designated EPT(-). Another group of patients with suspected occult Candida infection received EPT and were designated EPT(+). Fluconazole, 400 mg/day, was given as EPT. Urine, wound, intraperitoneal drainage, and blood specimens were obtained from patients for fungus culture before starting treatment and weekly until symptoms subsided. The primary endpoints were the frequency of candidiasis and the persistence of candidemia; the secondary endpoint was the efficiency of EPT in the clinical outcome. There was no difference in Candida peritonitis, wound colonization, or urine colonization in the two treatment groups. Candida albicans accounted for 87.5%% of the isolated Candida species: 84.6%% in the EPT(+) group and 89.5%% in the EPT(-) group. In the EPT(+) group, the positive blood culture rate was 66.7%%. The fever subsided rapidly in 17 patients (94%%), the hospital stay and intensive care unit stay were shorter, and the mortality decreased significantly: 11%% vs. 78%%, P < 0.001. Persistent gastrointestinal ileus was the main cause of breakthrough candidemia. We concluded that EPT with fluconazole improves the prognosis of patients with occult Candida infection after gastrointestinal surgery. Surgical intervention was required in patients with breakthrough candidemia.

Adult↗

PubMed2006

Early prognostic factors in patients with acute renal failure requiring dialysis.

PURPOSE: Despite improvements in renal therapy and technology, the mortality rate of patients with acute renal failure (ARF) remains high. Because ARF is a heterogeneous syndrome, occurring in patients with diverse etiologies and comorbid conditions, predicting its outcome is difficult. This study aims to identify early clinical and laboratory prognostic factors, including acute-phase reactants such as C-reactive protein (CRP), fibrinogen, and albumin, in ARF patients requiring dialysis. MATERIAL AND METHODS: From June 2002 to March 2004, 61 patients with ARF requiring dialysis at Chang Gung Memorial Hospital, Chiayi, were prospectively analyzed. For each patient, the worst values of prognostic variables 24 hr before starting dialysis were prospectively assessed. RESULTS: Oliguria, low plasma fibrinogen levels, hypotension, cardiac disease, and neoplastic disease were statistically significant in predicting hospital mortality. Using Youden's index, the best cut-off value for plasma fibrinogen in predicting mortality was 300 mg/dL with a sensitivity and specificity of 61% and 96%, respectively. Serum CRP and serum albumin were not predictive of hospital mortality. CONCLUSION: Early prognostic factors in predicting mortality for patients with ARF requiring dialysis identified by multivariate logistic regression were oliguria, low plasma fibrinogen, hypotension, cardiac disease, and neoplastic disease. Serum CRP and albumin were not predictive of hospital mortality, whereas a plasma fibrinogen level < or =300 mg/dL had 61% sensitivity and 96% specificity in predicting mortality.

Acute Kidney Injury↗

PubMed2006

Pretreatment with Lactobacillus- and Bifidobacterium-containing yogurt can improve the efficacy of quadruple therapy in eradicating residual Helicobacter pylori infection after failed triple therapy.

BACKGROUND: Lactobacillus- and Bifidobacterium-containing yogurt (AB-yogurt) can suppress Helicobacter pylori. Improvement of the eradication rate by quadruple therapy of residual H. pylori after failed triple therapy is needed. OBJECTIVE: We tested whether prior treatment with AB-yogurt improved the efficacy of quadruple therapy in eradicating residual H. pylori after failed triple therapy. DESIGN: One hundred thirty-eight patients in whom triple therapy failed were enrolled for a culture study of H. pylori to assess antimicrobial resistance. These patients were then randomly assigned in equal numbers to either a yogurt-plus-quadruple therapy group or a quadruple therapy-only group. The patients received 1 wk of quadruple therapy with or without a 4-wk pretreatment with AB-yogurt (400 mL/d). In the yogurt-plus-quadruple group, excessive delta(13)CO(2)/mL values of the (13)C-urea breath test were collected before and every 2 wk during the 4-wk ingestion of yogurt. For both groups, a (13)C-urea breath test was conducted > or =6 wk after the quadruple therapy to assess the outcome of residual H. pylori eradication. RESULTS: For the patients in the yogurt-plus-quadruple therapy group infected with either antibiotic-sensitive or -resistant H. pylori, the excessive delta(13)CO(2)/mL values of the (13)C-urea breath test were significantly decreased after the 4-wk ingestion of AB-yogurt (P < 0.0001). The yogurt-plus-quadruple therapy group had a higher H. pylori eradication rate than did the quadruple therapy-only group (intention-to-treat analysis: 85% compared with 71.1%, P < 0.05; per-protocol analysis: 90.8% compared with 76.6%, P < 0.05). CONCLUSION: A 4-wk pretreatment with AB-yogurt can decrease H. pylori loads despite antimicrobial resistance, thus improving the efficacy of quadruple therapy in eradicating residual H. pylori.

Anti-Bacterial Agents↗

PubMed2006

Correlation of serum levels of macrophage migration inhibitory factor with disease severity and clinical outcome in dengue patients.

Dengue virus infection can cause mild dengue fever (DF) or severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Cytokines are believed to be involved in the pathogenesis of dengue infection. However, the role of the pro-inflammatory cytokine macrophage migration inhibitory factor (MIF) in dengue infection is unclear. In this study, serum levels of MIF in adult dengue patients with different disease severity and clinical outcome were determined and compared with the levels of other cytokines, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-10, and interferon gamma (IFN-gamma), in the same patients. Serum levels of MIF, IL-6, and IL-10, but not IFN-gamma or TNF-alpha, were higher in all DHF patients who died than in DHF survivors and DF patients. We conclude that in addition to IL-6 and IL-10, elevated levels of serum MIF are a potential predictor of disease severity and clinical outcome in dengue patients.

Adult↗

PubMed2005

Butyrate regulates the expression of c-Src and focal adhesion kinase and inhibits cell invasion of human colon cancer cells.

Epidemiological studies indicate that dietary fiber-derived fermentation products such as butyrate can prevent colon cancer development. To further dissect the role of butyrate in anticarcinogenesis, its effect on cellular growth and invasion as well as the expression of c-Src and FAK, two mutually interactive nonreceptor tyrosine kinases, in three different human colon cancer cell lines (Caco-2, SW480, and SW620) were investigated. In addition to growth inhibition, butyrate treatment results in a significant downregulation of c-Src and FAK in human colon cancer cells, which can be attributable to their reduced transcripts and implicates the participation of a butyrate-sensitive pathway in modulating their expression. Concurrent to butyrate-reduced c-Src and FAK expression is the decrease of FAK Tyr-decrease 397 phosphorylation. Besides, butyrate also abolished the secretion of MMP-2 and MMP-9. And these butyrate-mediated effects severely impaired invasion of SW620 cells through Matrigel in vitro. Interestingly, in situ parallel enhancement of c-Src and FAK was also observed in human colorectal tumor specimens. These results imply that by virtue of suppression of c-Src and FAK along with other butyrate targets in colonocytes, butyrate could effectively inhibit tumor growth and invasion.

Acetylation↗

PubMed2005

S100A2, a potential marker for early recurrence in early-stage oral cancer.

Early-stage oral cancer patients may have distinct clinical outcomes and respond differently to the same treatment. Up to now, there is still no individual marker to identify such patients with poor outcome. Down-regulation of a tumor suppressor gene, S100A2, in oral cancer cells was identified by mRNA profiling analysis then confirmed by RT-PCR and Southern blotting. The expression of nuclear S100A2 protein examined by immunohistochemistry was not significantly associated with any patient characteristic among the 70 early-stage oral squamous cell carcinoma (SCC) patients. Intriguingly, the loss of nuclear S100A2 positivity was significantly associated with shorter disease-free survival (p=0.019) while having no effect on the overall survival of these patients. Cox regression analysis with backward elimination identified S100A2 (p=0.006), tobacco smoking (p=0.013), and betel quid chewing (p=0.019) as independent predictors of disease-free survival. This is a first study to demonstrate that loss of nuclear S100A2 may serve as an independent prognostic marker for early-stage oral cancer patients at high risk of recurrence. A more aggressive treatment modality and intensive follow-up may be recommended for the patients with reduced expression of S100A2 in tumor cell nuclei.

Adult↗

PubMed2005

Plasma free amino acid profile in cancer patients.

Redistribution or translocation of plasma free amino acids (PFAAs) to support visceral or tumor protein synthesis is an essential feature in cancer patients. An abnormal PFAA profile might be presented via the total reflection of cancer-induced protein metabolism in tumors, skeletal muscle and the liver in cancer patients. Clinical data from 13 studies have demonstrated a cancer-related PFAA profile, especially in digestive organ cancers. The PFAA profile can differ between the early and late stages of cancer. The profile is also affected by the type of cancer. Therefore, it is postulated that a detailed analysis of the PFAA profile may serve as one of the biological markers for cancer patients.

Amino Acids↗

PubMed2005

Prognostic value of acute physiology and chronic health evaluation II and organ system failure in patients with acute renal failure requiring dialysis.

BACKGROUND: Despite advances in modern technology of dialysis, prognosis of patients with acute renal failure (ARF) remains poor. To give the clinicians the most useful information, a model that accurately predicts outcome early in the course of ARF is required. However, because ARF is a heterogeneous syndrome and occurs in patients with diverse etiologies and some coexisting diseases, predicting outcome early is hard. The aim of this study is to evaluate prospectively the Acute Physiology and Chronic Health Evaluation (APACHE II) and organ system failure (OSF) models, evaluated prior to dialysis, in predicting hospital mortality. METHODS: From June 2002 to March 2004, ARF patients requiring dialysis at Chang Gung Memorial Hospital, Chiayi, were prospectively recruited for this study. The worst clinical and laboratory data in the 24 hours before initiation of dialysis were prospectively evaluated, and the patients' APACHE II score and OSF number were assessed. RESULTS: A total of 61 patients (40 male and 21 female) were enrolled, of whom 38 (62.3%) died before discharge. By multivariate logistic regression, the APACHE II score (odds ratio 1.3 per increase in one score; P<0.001), or OSF number (odds ratio 1.9 per increase in one OSF; P<0.01) and oliguria (odds ratio 4.2; P=0.04), were found to be statistically significant prognostic factors for hospital mortality. Mortality increased progressively and significantly as OSF number (chi-square for trend; P=0.001) or the APACHE II score (chi-square for trend; P < 0.001) increased. By using Youden's index, the best cut-off value for APACHE II was 24, with 63% sensitivity and 96% specificity. The best cut-off value for OSF number was 2, with a sensitivity of 81.6% and a specificity of 60.9%. The areas under the receiver operating characteristic curves for APACHE II and OSF number were 0.847 (95% confidence interval (CI)=0.752-0.942; P<0.01) and 0.769 (95% CI=0.646-892; P<0.001), respectively, indicating good model discrimination. CONCLUSIONS: This study concludes that APACHE II and OSF number measured prior to initiation of dialysis reliably predict outcomes of ARF patients requiring dialysis. The mortality rates increase as the APACHE II score or OSF number increases. For predicting mortality, the APACHE II score > or = 24 was found to have 63% sensitivity and 96% specificity, and OSF number> or = 2 had 81.6% sensitivity and 60.9% specificity.

APACHE↗

PubMed2005

Validity of the Clinical Adaptive Test (CAT)/Clinical Linguistic and Auditory Milestone Scale (CLAMS) as a screening instrument for very low birth weight infants in Taiwan.

The authors investigated the validity of the Clinical Adaptive Test (CAT)/Clinical Linguistic and Auditory Milestone Scale (CLAMS) for developmental screening and early prediction in very low birth weight (VLBW) infants, using the Bayley Scales of Infant Development II (BSID-II) as a reference standard. A total of 808 VLBW infants discharged from neonatal intensive care units in Taiwan from January 1995 to December 1997 were enrolled and followed up at the corrected ages of 6, 12, 18, and 24 months. The CAT/CLAMS and BSID-II were performed separately during each visit. The CAT/CLAMS showed strong concurrent correlations (r = 0.51-0.86, p < .0001) with BSID-II mental developmental index (MDI), and had high conegativity scores (96.7%-100%) but low copositivity scores (30.0%-45.3%) for detecting developmental delay. At 24 months of age, the CAT/CLAMS had better predictive validity for significant (MDI <70) rather than borderline (MDI = 70-84) developmental delay. The authors conclude that the CAT/CLAMS is not an appropriate developmental instrument for screening and early prediction in VLBW infants in Taiwan.

Case-Control Studies↗

PubMed2005

Epinephrine protects against severe acute gastric bleeding in rats: role of nitric oxide and glutathione.

The aim of this study was to examine the effect of the systemic administration of epinephrine against severe acute gastric bleeding in rats. Epinephrine decreased gastric hemorrhage not only before but also after lipopolysaccharide-induced severe acute gastric bleeding. Epinephrine ameliorated severe gastric hemorrhage and decreased gastric mucosal lipid peroxidation through alpha- and beta-adrenoceptors. Epinephrine modulated alpha-adrenoceptors to increase the levels of gastric mucosal nitric oxide and glutathione. Nitric oxide synthase inhibitors potently reversed the effects of epinephrine on gastric mucosal glutathione. Thus, epinephrine might act through alpha-adrenoceptors to increase the levels of gastric mucosal nitric oxide and glutathione and thus protect against severe acute gastric bleeding in rats.

Adrenergic alpha-Agonists↗

PubMed2004

Reducing major cause-specific hospitalization rates and shortening hospital stays after influenza vaccination.

BACKGROUND: The impact of influenza vaccination on major cause-specific hospitalization and the duration of hospital stay is rarely reported. Our purpose was to study the effect of vaccine efficacy on major disease-specific hospitalization and the duration of hospital stays among elderly persons. SUBJECTS AND METHODS: From 1 January through 30 June 2001, we prospectively observed 35,637 vaccinated elderly persons (age, >or=65 years) and 53,094 unvaccinated elderly persons in Kaohsiung County, Taiwan, by computerized linkage to the National Health Insurance database. Of these persons, 21,347 had been assigned a high-risk status by the Department of Health, Taiwan. Univariate and multivariate logistic regression were used for determining vaccine efficacy in hospitalization. Multiple linear regression analyses were performed for determining the length of hospital stays. RESULTS: In both high-risk and low-risk groups, vaccination was associated with reducing the rates of hospitalization for all causes (20% vs. 23%), lung diseases, congestive heart failure (43% vs. 32%), renal disease, and liver disease (P<.05). It was also significant for stroke, hypertension, diabetes, neoplasm, and injury in low-risk patients (P<.05). Multivariate logistic regression showed that vaccination was significantly associated with reducing the rate of hospitalization (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.86-0.92), but those with high-risk status had an increased risk of hospitalization (OR, 3.69; 95% CI, 3.56-3.82). Multiple linear regression analysis showed that vaccination decreased the duration of all-cause hospital stays (coefficient, -2.4 days; 95% CI, -2.7 to -2.1 days) and of hospitalization due to lung disease (coefficient, -4.9 days; 95% CI, -6.0 to -3.8 days). CONCLUSION: Influenza vaccination may reduce hospitalization rates and shorten hospital stays not only for lung diseases but also for other common diseases in high-risk and low-risk elderly populations.

Aged↗

PubMed2004

Strong association of hepatitis C virus (HCV) infection and thrombocytopenia: implications from a survey of a community with hyperendemic HCV infection.

BACKGROUND: The role of hepatitis C virus (HCV) infection in thrombocytopenia (defined as a platelet count of <100,000 platelets/ mu L) is unknown. Our aim was to study the association between HCV infection and thrombocytopenia in a community where hepatitis B virus (HBV) and HCV infections are hyperendemic. METHODS: A community-wide survey of subjects > or =40 years old who had undergone a preventive health examination between April 1997 and July 2000 in A-Lein Township, Kaohsiung County, Taiwan. Serum blood platelet counts and HBV surface antigen (HBsAg) and antibody to HCV (anti-HCV) levels were measured. Abdominal sonography was performed on viral hepatitis-positive participants. RESULTS: Among the 1690 subjects, 70% were seronegative, 17.4% were anti-HCV positive, 9.2% were HBsAg positive, and 3.4% were coinfected with HCV and HBV. The mean platelet count in subjects with anti-HCV (180,000 platelets/microL) was lower than in those with HBsAg (201,000 platelets/microL) and in those without anti-HCV and HBsAg (234,000 platelets/microL) (P<.001). The prevalence of thrombocytopenia was 1.3% among seronegative subjects, 1.9% among HBsAg-positive subjects, 5.2% among coinfected subjects, and 10.2% among anti-HCV-positive subjects. Multiple logistic regression analysis revealed that anti-HCV positivity (odds ratio, 6.0; 95% confidence interval, 3.2-11.2), an alanine aminotransferase level of > or =40 U/L, and age of > or =65 years were significantly associated with thrombocytopenia. The prevalence of thrombocytopenia among anti-HCV-positive subjects increased as the severity of liver disease increased, but, in HBsAg-positive subjects, thrombocytopenia presented only in those with advanced liver disease. CONCLUSIONS: HCV infection is strongly associated with thrombocytopenia, which is correlated with hepatocellular damage and hepatic fibrosis. It is advisable to further check the hepatic condition of the patient, especially for HCV infection, if thrombocytopenia is present.

Adult↗

PubMed2004

cAMP response element-binding protein activation in ligation preconditioning in neonatal brain.

Perinatal hypoxic-ischemic (HI) brain injury is a major cause of permanent neurological dysfunction in children. An approach to study the treatment of neonatal HI encephalopathy that allows for neuroprotection is to investigate the states of tolerance to HI. Twenty-four-hour carotid-artery ligation preconditioning established by delaying the onset of hypoxia for 24 hours after permanent unilateral carotid ligation rats markedly diminished the cerebral injury, however, the signaling mechanisms of this carotid-artery ligation preconditioning in neonatal rats remain unknown. Ligation of the carotid artery 24 hours before hypoxia provided complete neuroprotection and produced improved performance on the Morris water maze compared with ligation performed 1 hour before hypoxia. Carotid artery ligation 6 hours before hypoxia produced intermediate benefit. The 24-hour carotid-artery ligation preconditioning was associated with a robust and sustained activation of a transcription factor, the cAMP response element-binding protein (CREB), on its phosphorylation site on Ser133. Intracerebroventricular infusions of antisense CREB oligodeoxynucleotides significantly reduced the 24-hour carotid-artery ligation-induced neuroprotection effects by decreasing CREB expressions. Pharmacological activation of the cAMP-CREB signaling with rolipram 24 hours before hypoxia protected rat pups at behavioral and pathological levels by sustained increased CREB phosphorylation. This study suggests that 24-hour carotid-artery ligation preconditioning provides important mechanisms for potential pharmacological preconditioning against neonatal HI brain injury.

Analysis of Variance↗

PubMed2004

Expression profiles of the DAZ gene family in human testis with and without spermatogenic failure.

OBJECTIVE: To determine the expression profiles of the DAZ gene family in men with and without spermatogenic failure. DESIGN: Prospective case study. SETTING: University-based reproductive clinics and genetics laboratory. PATIENT(S): Thirty-four infertile men presenting with azoospermia. INTERVENTION(S): The mRNA transcript concentrations of the DAZ family genes (BOULE, DAZL, DAZ) and the housekeeping GAPDH gene in the testes of azoospermic men were examined by quantitative competitive-reverse transcription-polymerase chain reaction (QC-RT-PCR). The steady-state concentrations of mRNA encoding for each gene in each testicular sample were normalized by the amounts of GAPDH. MAIN OUTCOME MEASURE(S): Transcript ratios (gene/GAPDH) of BOULE, DAZL, and DAZ. RESULT(S): The transcript ratios for BOULE, DAZL, and DAZ were significantly decreased in tissues with spermatogenic failure (hypospermatogenesis, maturation arrest, and Sertoli cell-only). However, the ratios of BOULE/DAZL and DAZ/DAZL did not reveal any significant difference in all tissues. Three patients with DAZ deletion possess lower transcripts of BOULE and DAZL. CONCLUSION(S): All members of the DAZ gene family play important roles in human spermatogenesis. Decreased concentrations of DAZ family members in men with spermatogenic failure may be due to the secondary effect of germ cell loss, and transcriptional control of BOULE, DAZL, and DAZ are not altered in the various degrees of spermatogenic failure. Although the sample size is limited, no compensatory increase of DAZL or BOULE transcription was found in men with DAZ deletion.

Case-Control Studies↗

PubMed2004

Hemoglobin promotes Abeta oligomer formation and localizes in neurons and amyloid deposits.

The objective of this study was to search for brain-specific binding proteins that participated in Abeta aggregation. Immunoprecipitation of Abeta in Alzheimer's brain homogenate revealed a major co-precipitating 16-kDa protein band, which was identified through mass spectrometry as hemoglobin (Hb) alpha and beta chains. Hemoglobin was distributed in Alzheimer's disease (AD) patients in a brain region-dependent manner, with the highest levels in the hippocampus and parietal gray (PG) matter, followed by parietal white matter (PW), and the lowest in cerebellum (Cb). AD parietal gray and white matters exhibited higher Hb levels than those in the nondemented (ND) group. Likewise, RT-PCR revealed that the Hb mRNA levels in AD inferior temporal gyri were higher than those of ND subjects. Furthermore, Hb was shown to promote Abeta oligomer formation. Immunohistochemical studies indicated that Hb was localized within the cytosol of pyramidal neurons in the hippocampus, suggesting a potential source of intracerebral Hb. Finally, double immunofluorescent assay confirmed the co-localization of Hb with senile plaques (SP) and cerebral amyloid angiopathy (CAA). We propose that an elevation in brain Hb via circulation leakage or perturbations of Hb gene regulation may participate in AD pathogenesis.

Aged↗

PubMed2004

Factors associated with the outcomes of children with unilateral ureteropelvic junction obstruction.

PURPOSE: Children with congenital unilateral ureteropelvic junction obstruction were evaluated with 99mtechnetium-labeled diethylenetriaminepentaacetic acid furosemide renal scans (DTPA) to determine the correlation of tubular function tests, growth factors and renal function. MATERIALS AND METHODS: A total of 38 children diagnosed with congenital unilateral ureteropelvic junction obstruction and recipients of dismembered pyeloplasty were prospectively studied. Before pyeloplasty split renal tubular function, creatinine clearance, urinary growth factors and a marker for apoptosis of each kidney were examined. Renal function of the obstructed kidney was evaluated by DTPA before and after pyeloplasty. Initially patients with DTPA greater than 40% were designated group 1 and those with DTPA 40% or less were assigned to group 2. After surgery followup patients with DTPA greater than 40% were designated the well preserved group and those with DTPA 40% or less were assigned to the poorly preserved group. Statistical analyses were performed to determine the best predictive variable for treatment. RESULTS: Mean initial DTPA split renal function values of groups 1 and 2 were 47.3% and 28.8%, respectively and subsequently, they were 48.4% and 35.3%. Initial DTPA on the obstructed side of less than 35% had a 100% sensitivity and 100% positive predictive rate for a poorly preserved renal outcome. Among the various tubular functions, only percent fractional excretion of sodium and percent fractional excretion of chloride correlated with post-pyeloplasty DTPA. Urinary epidermal growth factor/creatinine correlated with preservation of renal function on postoperative DTPA renal scans. Although urinary transforming growth factor/creatinine levels and apoptosis ratios were higher on the obstructed side, they were not significantly different between the groups. CONCLUSIONS: Proximal tubular dysfunction, such as increased percent fractional excretion of sodium and chloride, and initial DTPA 35% or less, suggest a high possibility of poorly preserved renal outcome. Urinary transforming growth factor-beta1 and apoptosis are not correlated with renal outcome. A high urinary level of epidermal growth factor might be a potential indicator of preservation of renal growth.

Adolescent↗