Browsing by Author "Lin, Yi-Chang"

Now showing 1 - 14 of 14

A penetrating atherosclerotic ulcer rupture in the ascending aorta with hemopericardium: a case report
(2016-07-11)
Liu, Yuan-Hao
;
Ke, Hung-Yen
;
Lin, Yi-Chang
;
Tsai, Chien-Sung
;
生物科技學系
Background: Acute aortic syndrome, including classic aortic dissection, intramural aortic hematoma, and penetrating atherosclerotic ulcer (PAU), is a term used to describe a group of conditions with similar clinical symptoms, but with different pathophysiological mechanisms. PAU is a lesion that penetrates the internal elastic lamina through the media. It is usually located in the descending aorta and rarely observed in the ascending aorta. Case presentation: A 76-year-old man with a history of essential hypertension was brought to the emergency department (ED) because of a sudden-onset chest pain at rest. He had not been taking his medication as ordered. His vital signs in the ED were a blood pressure of 82/60 mmHg, heart rate of 158 beats per min, respiratory rate of 22 breaths per min, and a body temperature of 37.2 degrees C. An electrocardiogram did not show an ST segment elevation, and cardiac enzymes were within normal limits. No widening mediastinum was found on chest radiography, but a large pericardial effusion with an impending cardiac tamponade was revealed on echocardiography. The diagnosis of PAU rupture in the ascending aorta with hemopericardium was made with chest computed tomography. An emergent sternotomy and ascending aorta reconstruction were performed. A ruptured ulcerative plaque through the intima to the adventitia without flap dissection in the ascending aorta was confirmed. The patient was discharged 18 days after the operation. Conclusions: Although PAU in the ascending aorta is uncommon, it is commonly lethal when it ruptures. With the current advances in endovascular techniques and devices, endovascular repair of PAU in the ascending aorta is currently recommended only for high-risk patients unsuitable for open repair. However, we anticipate that endovascular repair may become feasible in patients with PAU in the ascending aorta in the future.
A Rare Experience of Infective Residual Sheath in the Wall of the Innominate Vein after Extraction of Implantable-Defibrillators
(2017-07-01)
Liu, Yuan-Hao
;
Lin, Wei-Shiang
;
Lin, Yi-Chang
;
Lin, Chih-Yuan
;
Tsai, Chien-Sung
Background: Cardiac device-related infective endocarditis is an uncommon but potentially fatal complication. Therefore, cardiac devices should be removed as soon as a device-related infection is suspected. Case Report: A 56-year-old male with a history of arrhythmogenic right ventricular dysplasia with implantable cardioverter-defibrillators (ICDs) 7 years earlier and re-implantation of ICDs due to dysfunction 18 months ago presented with erosion of the ICD pocket with Pseudomonas bacteremia. For the past year, only multiple wound debridements were performed. Accordingly, we performed debridement and removal of the generator during this admission; however, bacteremia still persisted. Using transesophageal echocardiography, we detected vegetation on the pacing leads and tricuspid valve in the right atrium. We performed thoracotomy with tricuspid valve repair and pacing wire removal. However, anterior chest pain and refractory bacteremia occurred 3 months later after discharge, and an infectious foreign body in the wall of the innominate vein was detected using chest computer tomography. Thoracotomy was again performed for resection of the innominate vein with the infection source. Postoperative recovery was good, with no systemic infection or bacteremia. Conclusions: Pacing lead extraction is a common procedure following cardiac rhythm management device-related infection. However, residual foreign body-related bacteremia should be suspected in cases with fever of unknown origin after primary surgery. Preserving the innominate vein with patch repair is a feasible option. However, a postoperative 4-week course of antibiotics is recommended.
BLOOD MIXING UPREGULATES PLATELET MEMBRANE- BOUND CD40 LIGAND EXPRESSION IN VITRO INDEPENDENT OF ABO COMPATIBILITY
(2018-09-01)
Huang, Go-Shine
;
Hu, Mei-Hua
;
Lin, Tso-Chou
;
Lin, Yi-Chang
;
Tsai, Yi-Ting
Platelets play a central role in the inflammation response via CD40 ligand (CD40L) expression, which may lead to transfusion reactions. The precise role of platelet CD40L-mediated inflammation in transfusion reactions is unclear. Therefore, we assessed the effects of in vitro blood mixing on platelet CD40L expression. In addition, we examined the effect of ABO compatibility on CD40L expression. Donor-packed red blood cells were acquired from a blood bank, and recipient blood was obtained from patients undergoing cardiac surgery and prepared as washed platelets. Donor blood was mixed with suspended, washed recipient platelets to obtain a final mixing ratio of 1%, 5%, or 10% (vol/vol). The blood mixtureswere divided into three groups: group M, cross-matched blood-type mixing (n = 20); group S, ABO type-specific uncross-matched blood (n = 20); and group I, ABO incompatibility (not ABO type-specific blood and not process cross-matched) mixing (n = 20). The blood mixtures were used to detect platelet membrane-bound CD40L expression by flow cytometry. Blood mixing resulted in an increase in CD40L expression in group M (P<0.001), group S (P<0.001), and group I (P<0.001). CD40L expression after blood mixing potentially led to a transfusion reaction in each of the groups. There were no differences in CD40L expression among the three groups (P = 0.988) correlated with ABO compatibility or incompatibility. This indicates that the reactions between red blood cell surface antigens and plasma antibodies do not play a role in the induction of CD40L expression.
Blunt injury of popliteal artery
(2019-01-01)
Chang, Jui-Tsung
;
Lin, Chih-Yuan
;
Tsai, Yi-Ting
;
Lin, Yi-Chang
;
生物科技學系
Decreases in plasma MMP-2/TIMP-2 and MMP-9/TIMP-1 ratios in uremic patients during hemodialysis
(2016-12)
Lu, Li-Che
;
Yang, Chung-Wei
;
Hsieh, Wen-Yeh
;
Chuang, Wan-Hsuan
;
Lin, Yi-Chang
Matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs) play important roles in the pathophysiology of renal diseases. Imbalanced MMPs/TIMPs are implicated in the vascular alterations of uremic patients on hemodialysis (HD). We have investigated the plasma levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 in uremic patients and the effects of a course of HD on the changes in these factors. There were 382 uremic patients on regular HD treatment and 50 healthy controls enrolled in this study. The plasma MMP-2 and MMP-9 levels were detected by gelatin zymography, and TIMP-1 and TIMP-2 concentrations were determined by ELISA assay. Significantly higher plasma MMP-2 and MMP-9 and decreased TIMP-1 in the uremic patients were detected compared with those in the controls. Therefore, there were markedly higher MMP-2/TIMP-2 and MMP-9/TIMP-1 ratios in the uremic patients. In the course of a single HD session, the plasma MMP-2 level was significantly decreased from pre-HD to post-HD. TIMP-1 concentration was significantly increased from pre-HD to post-HD. Although the HD session did not have a significant effect on the levels of plasma MMP-9 and TIMP-2, both plasma MMP-2/TIMP-2 and MMP-9/TIMP-1 ratios were significantly decreased from pre-HD to post-HD levels. HD session could decrease MMP-2 and increase TIMP-1 level in the circulation of uremic patients. The physiological significance of reduced MMPs/TIMPs ratio due to a single HD session is required to further validate.
Efficient Optical Trapping and Detection of Nanoparticle Via Plasmonic Bowtie Notch
(2019-04-01)
Lin, Yi-Chang
;
Lee, Po-Tsung
;
光電工程學系
;
Department of Photonics
For manipulating nanoparticles, we propose a nanotweezer named plasmonic bowtie notch (PBN) by adding a thin metal film to the bottom of plasmonic bowtie aperture. The PBN can exert a large trapping force on nanoparticle because the enhanced field of resonance mode can be much accessed by nanoparticle. The optical properties and factors influencing trapping force of PBN are fully investigated and discussed. The optimized PBN shows an excellent trapping capability with ultralow threshold excitation intensity of 0.64 mW/mu m(2) for stable trapping of a 100 nm polystyrene particle. In addition, it provides a label-free detection of the trapped particle by observing the extinction spectrum. The sensitivity to trapped target size of 71 pm redshift in peak wavelength per 1 nm increase of particle size is relatively high compared with those obtained from most near-field tweezers. Furthermore, the footprint of PBN is only 200 nm x 220 nm. The capabilities of the proposed design show a great potential in the application of nanoparticle trapping and sensing.
Efficient Optical Trapping of Nano-Particle via Waveguide-Coupled Hybrid Plasmonic Nano-Taper
(2019-06-01)
Lin, Yi-Chang
;
Lee, Po-Tsung
;
光電工程學系
;
Department of Photonics
For manipulating nano-bio-specimens, we propose a tweezing device by integrating a triangular-shaped photonic-plasmonic nano-taper on top of a coupling waveguide. The device can exert strong trapping force on nano-particle owing to efficient optical energy usage and accessible field distribution. Working principle and optical characteristics of the device are fully investigated and discussed. The optimized device shows an excellent trapping capability with low threshold power of 3.57 mW for stable trapping n 100 nm polystyrene particle. Simple geometry and high tolerance to pattern misalignment between trap unit and coupling waveguide are beneficial for realistic fabrication. Furthermore, the footprint of trap unit is only 400 nm x 625 nm. We believe this design will be very useful to the development of lab-on-a-chip system.
Efficient Optical Trapping of Nanoparticle via Plasmonic Bowtie Notch
(2018-01-01)
Lin, Yi-Chang
;
Lee, Po-Tsung
;
光電工程學系
;
Department of Photonics
We propose a metallic nanostructure named plasmonic bowtie notch (PBN) for optical trapping of nanoparticle. As the resonance mode can be highly concentrated at the two top apexes in gap region, PBN exerts strong trapping force on the nanoparticle with ultra-low power consumption. In application, PBN can be utilized for trapped target selecting and sensing.
Effusive Tuberculous Pericarditis
(2017-11-01)
Zheng, Xu-Zhi
;
Tsai, Yi-Ting
;
Lin, Chih-Yuan
;
Tsai, Chien-Sung
;
Lin, Yi-Chang
Imbalanced plasma ACE and ACE2 level in the uremic patients with cardiovascular diseases and its change during a single hemodialysis session
(2017-11-20)
Yang, Chung-Wei
;
Lu, Li-Che
;
Chang, Chia-Chu
;
Cho, Ching-Chang
;
Hsieh, Wen-Yeh
Background: The renin-angiotensin system (RAS) has significant influences on heart and renal disease progression. Angiotensin converting enzyme (ACE) and angiotensin converting enzyme II (ACE2) are major peptidases of RAS components and play counteracting functions through angiotensin II (Ang II)/ATIR and angiotensin-(1-7) (Ang-(1-7))/Mas axis, respectively. Methods: There were 360 uremic patients on regular hemodialysis (HD) treatment (inclusive of 119 HD patients with cardiovascular diseases (CVD) and 241 HD patients without CVD and 50 healthy subjects were enrolled in this study. Plasma ACE, ACE2, Ang II and Ang-(1-7) levels of the HD patients were determined. Results: We compared pre-HD levels of plasma ACE, ACE2, Ang II and Ang-(1-7) in the HD patients with and without CVD to those of the controls. The HD patients, particularly those with CVD, showed a significant increase in the levels of ACE and Ang II, whereas ACE2 and Ang-(1-7) levels were lower than those in the healthy controls. Therefore, imbalanced ACE/ACE2 was observed in the HD patients with CVD. In the course of a single HD session, the plasma ACE, ACE/ACE2 and Ang II levels in the HD patients with CVD were increased from pre-HD to post-HD. On the contrary, ACE2 levels were decreased after the HD session. These changes were not detected in the HD patients without CVD. Conclusions: Pathogenically imbalanced circulating ACE/ACE2 was detected in the HD patients, particularly those with CVD. HD session could increase ACE/Ang II/AT1R axis and decrease ACE2/Ang-(1-7)/Mas axis activity in the circulation of HD patients with CVD.
IMPACT OF BLOOD MIXING AND ABO COMPATIBILITY ON PLATELET-LEUKOCYTE AGGREGATIONS AND PLATELET P-SELECTIN EXPRESSION: AN IN VITRO STUDY
(2018-05-01)
Huang, Go-Shine
;
Hu, Mei-Hua
;
Lin, Tso-Chou
;
Tsai, Yi-Ting
;
Lin, Chih-Yuan
Effects of blood transfusions on platelet- and leukocyte-related inflammation are unclear. We simulated transfusion using in vitro blood mixing to evaluate platelet-leukocyte aggregations (PLA) and platelet P-selectin expression, and the mechanism of PLA. Donor packed red blood cells (pRBCs) were obtained from a blood bank. Recipient whole blood samples were obtained from patients undergoing cardiac surgery. Blood sample mixtures were divided into four groups: group M, cross-matched blood type mixing; group O, donor type O with other blood type mixing (A, B, or AB); group S, ABO type-specific uncross-matched blood mixing; and group I, ABO incompatibility mixing. Donor pRBCswere added to recipient blood to reach 1%, 5%, and 10% (vol/vol) concentrations. Blood sample mixtures were analyzed to determine the PLA; P-selectin expression; and leukocyte CD11a, CD11b, and CD18 subunits of integrin expression. Analysis of variance tests were used to analyze differences. PLA significantly increased only in groups O and I (P=0.003 and P<0.001). Subpopulations of leukocytes significantly increased in all groups. There were no significant differences among the four groups (P=0.578) in PLA increase. Although there was no significant effect on P-selectin expression (P=1.000) and leukocyte CD11a and CD18 expression (P=0.999, P=0.422) within and between the groups, there was an increase in CD11b expression (P=0.018). Blood mixing can increase PLA, especially in platelet-neutrophil and platelet-monocyte aggregations, possibly through nonhemolytic reactions. The CD11b integrin with CD18 may play a role in the formation of PLA.
New vascular ring connectors in surgery for intramural haematoma of the abdominal aorta progressing to rupture
(2013-07-01)
Lee, Chih-Hsien
;
Ko, Li-Wei
;
Lin, Yi-Chang
;
Yen, Chih-Chien
;
Yang, Hsiang-Yu
Aortic intramural haematoma is similar to classic aortic dissection, which causes a life-threatening medical condition, and immediate diagnosis and treatment are crucial. The optimal therapy for intramural haematoma of the abdominal aorta remains controversial. Conservative medical management is usually the first choice of treatment for uncomplicated cases. Surgical intervention is usually required for complicated intramural haematomas of the abdominal aorta, including conventional open repair and endovascular treatment with stent-grafts. A new vascular ring connector that achieves a quick, blood-sealed and sutureless anastomosis has been designed for aortic dissection. We herein report a case of intramural haematoma of the abdominal aorta, progressing to rupture on day 14 after onset, which had successful aortic repair with the new vascular ring connector. The new vascular ring connector could be an alternative method for the treatment of complicated intramural haematomas of the abdominal aorta.
Stimulants associated with reduced risk of hospitalization for motor vehicle accident injury in patients with obstructive sleep apnea-a nationwide cohort study
(2020-02-03)
Lin, Yi-Chang
;
Chen, Tien-Yu
;
Chien, Wu-Chien
;
Chung, Chi-Hsiang
;
Chang, Hsin-An
Background The risk of injury directly related to hospitalization for motor vehicle accidents (MVAs) in the obstructive sleep apnea (OSA) patients has not been thoroughly understood. Our study aimed to examine the association between the OSA and the hospitalization for an MVA injury. Methods This retrospective cohort study used Taiwan's National Health Insurance Research Database (NHIRD) between 2000 and 2015. The OSA patients aged >= 20 years by age, sex, and index-year matched by non-OSA controls were enrolled (1:3). We used the Cox proportional regression model to evaluate the association between the OSA and the hospitalization for an MVA injury. Results The incidence rate of hospitalization for an MVA injury was higher in the OSA cohort (N = 3025) when compared with the non-OSA controls (N = 9075), as 575.3 and 372.0 per 100,000 person-years, respectively (p < 0.001). The Kaplan-Meier analysis showed that the OSA cohort had a significantly higher incidence of hospitalization for the MVA injury (log-rank test, p < 0.001). After adjusting for the covariates, the risk of hospitalization for the MVA injury among the OSA was significantly higher (hazard ratio [HR] =2.18; 95% confidence interval [CI] = 1.79-2.64; p < 0.001). Stimulants usage was associated with a nearly 20% decrease in the risk of an overall hospitalization for an MVA injury in the OSA patients. Conclusions This study provides evidence that patients with OSA are at a two-fold higher risk of developing hospitalization for an MVA injury, and the usage of modafinil and methylphenidate was associated with a lower risk of an overall hospitalization for the MVA injury.
Transplant Recipients Using Tacrolimus Had Higher Utilization of Healthcare Services Than Those Receiving Cyclosporine in Taiwan
(2019-09-19)
Lin, Yi-Chang
;
Tsai, Chien-Sung
;
Li, I-Hsun
;
Tsai, Yi-Ting
;
Huang, Tien-Yu
To date, population-based studies on the healthcare service utilization among stable heart, kidney, and liver transplant recipients with different calcineurin inhibitors are still scarce. Therefore, we used the Taiwan National Health Insurance Research Database to conduct a nationwide cross-sectional study to estimate the healthcare utilization of stable transplant recipients with tacrolimus or cyclosporine (n = 3,482). The sampled patients in this study comprised 377 heart, 1,693 kidney, and 1,412 liver transplant recipients between 1 January 2011 and 31 December 2011. Each subject was followed for a 1-year period to evaluate his/her healthcare service utilization. Outcome variables of the healthcare service utilization were stated as below: numbers of outpatient visits, outpatient costs, numbers of inpatient days, inpatients costs, and total costs of all healthcare services. As for all healthcare service utilization, stable transplant recipients on tacrolimus had significantly more outpatient visits (40.7 vs. 38.6), outpatient costs (US$10,383 vs. US$8,155), and total costs (US$12,516 vs. US$10,372) of all healthcare services than those on cyclosporine during the 1-year follow-up period. Additionally, further analysis showed that heart transplant recipients receiving tacrolimus incurred 1.7-fold higher inpatient costs compared to patients receiving cyclosporine. We concluded that transplant recipients using tacrolimus had significantly higher utilization of all healthcare services than those receiving cyclosporine as immunosuppressive therapy.