Search PubMed⌕ Search

Biomedical subjects

Shu-Jen Chen

Publications and source records attributed to Shu-Jen Chen.

33 records · Page 2Linked to original sources
PubMed2003

Skew ocular deviation: a catastrophic sign on MRI of fetal glioblastoma.

CASE REPORT: We report the prenatal observation of fetal ocular skew deviation in a case of a glioblastoma found prenatally at 33 weeks' gestation by MRI. The fetal MRI, obtained by half-Fourier single-shot turbo spin echo (HASTE) pulse sequences, showed a tumor (80 mm in maximum diameter) in the right deep cerebral hemisphere with extension to the mid-cranial fossa and tentorial hiatus in addition to severe hydrocephalus. On coronal MR images a vertical dysconjugated gaze was recognized. One week after the MRI, frequent delayed deceleration prompted an emergency cesarean section. The baby was born with left hemiparesis and central neurogenic hyperventilation, which evolved into decerebrate rigidity and apneustic breathing within 2 h. Post-mortem examination revealed a glioblastoma in the right deep hemisphere, a tumor with brain stem involvement, and transtentorial herniation. CONCLUSIONS: We suggest, therefore, that recognition of ocular skew deviation on fetal MR images would indicate brain stem involvement and poor postnatal prognosis. Early recognition of the catastrophic sign would lead to proper management.

Adult↗
PubMed2003

Expression and regulation of intracellular SMAD signaling in scleroderma skin fibroblasts.

OBJECTIVE: Scleroderma is characterized by excessive synthesis and accumulation of matrix proteins in lesional tissues. Transforming growth factor beta (TGFbeta) plays a central role in the pathogenesis of fibrosis by inducing and sustaining activation of fibroblasts; however, the underlying mechanisms are poorly understood. We undertook this study to examine the expression and function of SMADs, recently characterized intracellular effectors of TGFbeta signaling, in scleroderma fibroblasts. METHODS: Primary dermal fibroblasts obtained from 14 patients with scleroderma and from 4 healthy adult volunteers were studied. Northern analysis was used to determine the expression of endogenous SMAD messenger RNA (mRNA), and Western analysis was used to determine SMAD protein expression. Intracellular compartmentalization of cellular SMAD proteins in the presence and absence of TGFbeta was studied by antibody-mediated immunofluorescence confocal microscopy. The effect of TGFbeta blockade on SMAD subcellular distribution was determined using anti-TGFbeta antibodies as well as a dominant-negative TGFbeta receptor type II (TGFbetaRII) vector to disrupt TGFbeta responses. SMAD-regulated luciferase reporter expression was examined to investigate the potential functional significance of activation and nuclear accumulation of endogenous SMADs in scleroderma fibroblasts. RESULTS: Protein and mRNA levels of SMAD3, but not of SMAD4 or SMAD7, were variably elevated in scleroderma fibroblasts compared with those from healthy controls. In sharp contrast to control fibroblasts, which displayed predominantly cytoplasmic localization of SMAD3/4 in the absence of exogenous TGFbeta, in scleroderma fibroblasts SMAD3 and SMAD4 consistently showed elevated nuclear localization. Furthermore, phosphorylated SMAD2/3 levels were elevated and nuclear localization of phosphorylated SMAD2/3 was increased, suggesting activation of the SMAD pathway in scleroderma fibroblasts. Blockade of autocrine TGFbeta signaling with antibodies or by expression of dominant-negative TGFbetaRII failed to normalize SMAD subcellular distribution, suggesting that elevated nuclear SMAD import was due to alterations downstream of the TGFbeta receptors. The activity of a SMAD-responsive minimal promoter-reporter construct was enhanced in transiently transfected scleroderma fibroblasts. CONCLUSION: This study is the first to demonstrate apparently ligand-independent constitutive activation of the intracellular TGFbeta/SMAD signaling axis in scleroderma fibroblasts. SMAD signaling may be a mechanism contributing to the characteristic phenotype of scleroderma fibroblasts and playing a role in the pathogenesis of fibrosis.

Adult↗
PubMed2003

Effect of nucleotides on diarrhea and immune responses in healthy term infants in Taiwan.

OBJECTIVES: The aim of this study was to compare the effects of an infant formula fortified with nucleotides (NF) with those of a control formula (CF) on the incidence of diarrhea, respiratory tract infections (RTIs), and immune responses in healthy term infants. METHODS: This 12-month, double-blind study was conducted on 1- to 7-day-old infants randomized to receive NF or CF exclusively until 12 weeks of age, and fed the assigned formula with solid food until 12 months. NF was supplemented with 72 mg/L of nucleotides, based on the total potentially available nucleotide content of human milk. Subjects were evaluated within 1 week of birth, at 4 weeks, and every 4 weeks thereafter until 48 weeks of age. The primary outcome variable was the incidence of diarrhea. Secondary variables included RTIs, serum immunoglobulin concentrations, and response to hepatitis B vaccine. RESULTS: Compared with subjects fed CF (n = 170), those fed NF (n = 166) had a trend toward reduced risk of diarrhea from 8 to 48 weeks of age and a significantly lower risk of 25.4% (P = 0.05) between 8 and 28 weeks. NF subjects had significantly higher serum immunoglobulin A concentrations ( P < 0.05) throughout the 48-week study. The NF group had an increased risk of upper RTIs, the same incidence of lower RTIs, and the same antibody response to hepatitis B vaccination as the CF group, based on one-sided tests. Growth was normal in both groups, and no adverse events were considered to be formula-related. CONCLUSIONS: Healthy term infants from 8 to 28 weeks of life are less likely to experience diarrhea and have higher serum immunoglobulin A concentrations with NF compared with formula without added nucleotides.

Bottle Feeding↗
PubMed2003

Effects of music therapy on oxygen saturation in premature infants receiving endotracheal suctioning.

The purpose of this study was to investigate how premature infants' oxygen saturation changed in response to music therapy while they were receiving endotracheal suctioning. A convenience sample of 30 premature infants was selected from three neonatal intensive care units. A one-group repeated measures design was adopted for this study. The oxygen saturation of all subjects was first measured while they were receiving endotracheal suctioning during a four-hour control period with regular care. Then, four hours after the control period was completed, an experimental period began in which the music " Transitions " was played. One minute before suctioning, the level of oxygen saturation was measured to provide the baseline data. During a period of 30 minutes after suctioning, the oxygen saturation was recorded every minute to analyze the clinical effects of music therapy. The results showed that premature infants receiving music therapy with endotracheal suctioning had a significantly higher SPO(2); than that when not receiving music therapy (p <.01), and the level of oxygen saturation returned to the baseline level faster than when they did not receive music therapy (p <.01). Accordingly, it is hoped that giving appropriate music therapy as developmental care to premature infants when performing any nursing intervention may enhance not only the quality of nursing care but also quality of the infant's life.

Female↗
PubMed2003

Early diagnosis of ventriculoperitoneal shunt infections and malfunctions in children with hydrocephalus.

This retrospective study assessed the parameters of ventriculoperitoneal shunt infection and malfunction found in 129 children with hydrocephalus who had undergone a ventriculoperitoneal shunt placement at Taipei Veterans General Hospital from January 1997 to June 2001. The clinical characteristics and differences among these patients were reviewed to determine the potential predictors of shunt infection and malfunction. Fever (60%, 6/ 10) and seizure (40%, 4/10) occurred significantly more often in the infection group than in the malfunction and control groups (p < 0.05). A higher blood C-reactive protein level was noted in the infection group than in the malfunction and control groups (p < 0.05). Examination of the cerebrospinal fluid of infected patients showed significantly higher white blood cell count and neutrophil count, higher protein concentration, and lower glucose levels compared with the other 2 groups (p < 0.05). However, the number of patients with cerebrospinal fluid eosinophilia was significantly higher in the malfunction group (p < 0.05). The diagnostic usefulness of laboratory parameters in patients with ventriculoperitoneal shunt infection is as follow: cerebrospinal fluid white blood cell count over 100/mm3, 96% specificity and a positive predictive value of 0.55; and cerebrospinal fluid neutrophils over 10%, 90% sensitivity and a negative predictive value of 0.99. In conclusion, Fever, seizure, high blood C-reactive protein, combined with leukocytosis, neutrophil over 10%, low glucose level, and high protein level in the ventricular fluid are factors that may help in distinguishing shunt infection from shunt malfunction.

Adolescent↗
PubMed2003

Coagulase-negative staphylococcal bacteremia in critically ill children: risk factors and antimicrobial susceptibility.

Coagulase-negative staphylococci (CoNS) are the most common microorganisms isolated from blood cultures in childern, and determining whether there is true bacteremia or merely contamination is a clinical dilemma. A total of 67 episodes of CoNS-positive blood cultures in pediatric and neonatal intensive care units were evaluated during a 3-year period in order to find the possible risk factors involved and the antimicrobial susceptibility of CoNS isolates. In this study, 37 episodes were judged to be infections as opposed to 30 that were not. In comparison with individuals without infection, patients with true infection of CoNS stayed longer in the hospital (32 +/- 32.9 vs 10.7 +/- 9.3 days, p = 0.001), had more surgical procedures (32.4% vs 6.7%, p = 0.014), received more antibiotic treatments in the recent 2 weeks (37.8% vs 0%, p < 0.001), underwent more central venous catheter insertions (86.4% vs 10%, p < 0.001), received more parenteral nutrition (37.8% vs 3.3%, p = 0.001), had higher C-reactive protein profiles (4.8 +/- 5.4 vs 0.6 +/- 0.9 mg/dL, p < 0.001), and had higher neutrophil proportion (58.1% vs 44.3%, p = 0.001). However, there were no significant differences in corticosteroid therapy, hemoglobin level, total leukocyte count, and platelet count. All strains of the infection group were resistant to cefazolin, cefotaxime, penicillin, and erythromycin. Nonetheless, all isolates were susceptible to vancomycin. The percentage of multiple-resistant CoNS in the infection group was 96.9%. Empirical therapy with vancomycin for CoNS bacteremia in critically ill children is therefore recommended.

Anti-Bacterial Agents↗
PubMed2003

Detection of IgE reactivity to fungus antigens by immunoblotting in allergic diseases in children.

BACKGROUND: Fungi are well-known as sources for allergens that cause allergic rhinitis and allergic asthma. The aim of this study was to evaluate the prevalence of sensitization to airborne fungi in allergic diseases in children. METHODS: The presence of IgE antibodies to common allergens in serum samples from 77 atopic and 5 non-atopic children was determined by multiple allergosorbent (MAST) chemiluminescent assay. The allergic extracts, Penicillium notatum, Penicillium oxalicum, and Aspergillus fumigatus, were prepared. IgE-binding fungal components were identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE)-immunoblotting, using sera from the above-mentioned patients. RESULTS: The MAST data demonstrated that 62 (81%) of the 77 sera tested showed IgE antibodies to both Dermatophagoides pteronyssinus and Dermatophagoides farinae. Only 2 and 1 of the 77 atopic sera were positive to Penicillium and Aspergillus, respectively. However, 13 (17%) sera showed positive IgE-immunoblotting. Eight and 6 of them demonstrated IgE antibodies to more than 10 different components of P. notatum and P. oxalicum respectively. Ten of the 13 sera showed IgE-immunoblot reactivity to A. fumigatus, and only 1 of the 10 positive samples showed a positive MAST of class I to Aspergillus. All the other sera showed negative results in the MAST test to Aspergillus. The discrepancy observed between the results of IgE-immunoblotting using self-prepared extracts and the commercial MAST test of the serum samples tested may be due to the variations in the fungal strains and the allergenic extracts used, and the different assay systems employed. CONCLUSIONS: The results confirmed the importance of airborne fungi in association with allergic disorders in children.

Adolescent↗
PubMed2003

Serum interleukin-6 level as a diagnostic test in children with sepsis.

BACKGROUND: This study was performed to determine the serum concentrations of interleukin-6 (IL-6) during the early course of bacterial infections disease in children, and to evaluate the usefulness of IL-6 as a diagnostic test alone and in combination with C-reactive protein (CRP). METHODS: We measured serum IL-6 values in 3 groups of children on their first day of admission, from January 2001 to December 2001: group 1, patients with clinical and microbiological evidence of sepsis (n = 13); group 2, patients with clinical and chest radiographical evidence of pneumonia (n = 18); and group 3, patients with no signs of infection (control group) (n = 16). Kruskal-Wallis tests were used to compare the difference of IL-6 values between groups and control subjects. RESULTS: IL-6 values were significantly higher in groups 1 and 2 compared with those in the control group (p < 0.001). No significant differences were found between the groups 1 and 2. As a diagnostic test, IL-6 (> or = 20 pg/mL) alone yielded a sensitivity of 68%, a specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 58%. A combined parameter of IL-6 (> or = 20 pg/mL) and CRP (> or = 1 mg/dL) yielded a sensitivity of 94%, a specificity of 63%, a positive predictive value of 79%, and a negative predictive value of 87%. CONCLUSION: IL-6 levels increase in children with sepsis. In combination with CRP, IL-6 seems to be a valuable parameter in the early diagnosis of pediatric infections.

Bacterial Infections↗
PubMed2002

Design, synthesis, and structure-activity relationship of pyridyl imidazolidinones: a novel class of potent and selective human enterovirus 71 inhibitors.

When skeletons of Win compounds were used as templates, computer-assisted drug design led to the identification of a novel series of imidazolidinone derivatives with significant antiviral activity against enterovirus 71 (EV 71), the infection of which had resulted in about 80 fatalities during the 1998 epidemic outbreak in Taiwan. In addition to inhibiting all the genotypes (A, B, and C) of EV 71 in the submicromolar to low micromolar range, compounds 1 and 8 were extensively evaluated against a variety of viruses, showing potent activity against coxsackievirus A9 (IC(50) = 0.47-0.55 microM) and coxsackievirus A24 (IC(50) = 0.47-0.55 microM) as well as moderate activity against enterovirus 68 (IC(50) = 2.13 microM) and echovirus 9 (IC(50) = 2.6 microM). Our SAR studies revealed that imidazolidinone analogues with an aryl substituent at the para position of the phenoxyl ring, such as compounds 20, 21, 27, 57, 58, and 61, in general exhibited the highest activity against EV 71. Among them, compound 20 and its corresponding hydrochloride salt 57, in terms of potency and selectivity index, appear to be the most promising candidates in this series for further development of anti-EV-71 agents. Preliminary results of the study on the mode of action by a time-course experiment suggest that test compounds 1 and 8 can effectively inhibit the virus replication at the early stages, referring to virus attachment or uncoating. This indicates that the surface protein may be the target for this type of compounds.

Animals↗
PubMed2002

Circulating adhesion molecules in sera of asthmatic children.

Infiltration of cells into the lung in asthma is regulated by several expressions of cell adhesion molecules (CAMs) on cells present in the airways, and may play a role in the pathogenesis of bronchial asthma. We sought to evaluate the role of serum concentrations of the soluble forms of intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), and E-selectin (sE-selectin) in the control of disease activity in acute asthma. Circulating levels of sICAM-1, sVCAM-1, and sE-selectin in sera from 15 normal control subjects and from 20 allergic asthmatic children with acute exacerbations who had returned to stable condition were determined by using commercially available enzyme-linked immunosorbent assay kits. The mean concentration of serum sICAM-1 levels was significantly higher during an acute exacerbation of asthmatic children than in those with stable asthma (19.41 +/- 10.65 ng/mL vs. 13.46 +/- 5.44 ng/mL; P < 0.001) or in control subjects (9.83 +/- 2.02 ng/mL; P < 0.001). For sVCAM-1 and sE-selectin, the mean serum concentration of sVCAM-1 was slightly higher in children during an acute exacerbation asthma than when stable. However, the differences did not reach statistical significance. The mean serum concentrations of sVCAM-1 and sE-selectin in acute asthma or stable asthma were significantly higher than in control subjects. This study provides further evidence that serum concentrations of sICAM-1, sVCAM-1, and sE-selectin are increased in acute asthma. These findings further confirm that leukocyte endothelial adhesion plays a role in inflammatory airway disease.

Acute Disease↗
PubMed2002

Cardiopulmonary response in obese children using treadmill exercise testing.

BACKGROUND: Obesity impairs performance in most athletic events. The prevalence of obesity in Taiwan has increased over the past decades. It is important to understand any alterations in cardiopulmonary responses to exercise in obese children. The purpose of this study is to evaluate the cardiorespiratory response to graded treadmill exercise testing protocol in obese children. METHODS: Twenty obese and 10 control children between 8 to 12 years of age were recruited among patients at Pediatric Clinics. The treadmill was set at a grade of 10% to perform continuous treadmill walking. Measures of cardiopulmonary responses were recorded. Height, weight and body mass index were determined before testing. RESULTS: Cardiopulmonary responses including heart rate (HR), systolic pressure (SP), rate-pressure product (RPP) and forced vital capacity (FVC) were significantly different between obese children and normal children during and after exercise. The correlations of cardiopulmonary function to age, sex, height, body weight, triceps and biceps skinfold thickness were assessed, and a significant correlation was found between HR and age (r = 0.5, p < 0.05), as well as biceps skinfold thickness (r = 0.5, p < 0.05). There was also a good correlation between predicted values of FVC and age (r = -0.5, p < 0.05). The HR (r = 0.79, p < 0.05) was in correlation with tricep skinfold thickness in normal healthy children. CONCLUSIONS: In conclusion, there appears to show a relatively less efficient cardiopulmonary response in obese children. Regular exercise that improves fitness and body composition should have a favorable effect on obese children.

Blood Pressure↗
PubMedDate not supplied

Reevaluation of recent criteria for blood exchange transfusion in term infants with hyperbilirubinemia.

For hyperbilirubinemic infants treated according to the higher criterion for a blood exchange transfusion (BET), auditory brainstem response (ABR) was performed to evaluate whether the treatment was adequate. Twenty hyperbilirubinemic infants were collected as the study group. They were divided into 2 groups; group A consisted of 17 infants receiving intensive phototherapy only, while group B consisted of 3 infants receiving BET plus phototherapy. Fourteen healthy neonates were collected as the control group. Language development was evaluated with "language/communication development milestone: infancy through school-age" at the age of 5 months to 3 years old. Wave V at 30 dB HL was clearly identified in all infants in group A and in the control group. There was no significant difference in the latency between them (p > 0.05). In group A, peak bilirubin levels of 16 cases reached the former criteria for BET Their ABRs were normal. Language development was normal in 12 cases, while 4 cases were lost to follow-up. In group B, 2 cases had abnormal ABRs, while the third had normal ABR and language development. By analyzing the condition of these babies, we could conclude that in addition to peak bilirubin level and age, other factors such as anemia, the duration of hyperbilirubinemia, and the decline rate of bilirubin in response to intensive phototherapy should also be taken into consideration. For infants with borderline bilirubin levels for BET, we suggest performing BET if they have severe anemia or if intensive phototherapy fails to produce a proper decline in bilirubin.

Child, Preschool↗
PubMedDate not supplied

Retinopathy of prematurity: optimal timing of the initial check and progression after discharge.

Timely detection of the threshold retinopathy of prematurity (ROP) is very important. The goal of this study was to discuss the optimal timing of the initial screening for ROP as well as ROP progression in the outpatient department (OPD) follow-up after discharge. Herein we retrospectively review the charts of 224 preterm babies with gestational ages (GAs) of less than 35 weeks or birth weights (BWs) of less than or equal to 2000 g. These babies were admitted to Taipei Veterans General Hospital from January 1998 to December 2000. The relationship between the severity and the time course of ROP with respect to various BWs was recorded. These infants were also divided into groups according to the ROP stage of the last retinal examination before discharge, and the recorded results of OPD follow-up. In this study, there was a total of 41 infants with stage III ROP, of which 36 progressed to threshold ROP, including 13 (13/41, 31.7%) and 10 (10/36, 27.8%) who were respectively detected after discharge. In 89 infants with positive findings, the postnatal age (PNA) at the time ROP was detected for the first time was about 7 weeks in extremely low birth weight (ELBW, BW < or = 1000 g) infants and about 4-5 weeks in larger infants; however the postconceptional age (PCA) was about 35 to 36 weeks, and this was not influenced by birth weight. The earliest PCA and PNA when infants with a BW of < or = 1,000 g or GA < or = 28 weeks reached the threshold ROP were 33 and 7 weeks; infants with a BW of 1,001-1,250 g or GA of 28-30 weeks, the times were 34 and 6 weeks; and for infants with a BW of > 1,250 g or GA of more than 30 weeks, they were 35 and 4 weeks, respectively. Although it seemed that ROP tended to develop at the same PCA, the dual criteria of 4 weeks of PNA or 33 weeks of PCA, whichever comes later, may be the optimal timing for the initial retinal examination for premature infants. It is also important to keep in mind that follow-up programs should not be interrupted because of discharge.

Birth Weight↗