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Article ; Online: Icodextrin-induced acute generalized exanthematous pustulosis in a patient with peritoneal dialysis.

Liu, Chun-Hao / Chen, Chien-Chou / Sung, Chih-Chien

2024

Abstract: Icodextrin has been widely prescribed for peritoneal dialysis (PD) patients with inadequate ultrafiltration, but icodextrin induced acute generalized exanthematous pustulosis (AGEP) has been not well recognized in clinical practice. We described a young- ... ...

Abstract	Icodextrin has been widely prescribed for peritoneal dialysis (PD) patients with inadequate ultrafiltration, but icodextrin induced acute generalized exanthematous pustulosis (AGEP) has been not well recognized in clinical practice. We described a young-aged female with IgA nephropathy and end stage kidney disease under continuous automated peritoneal dialysis. She developed skin erythema with exfoliation over the groin 7th day after initiation of icodextrin based PD dialysate. Initially, her scaling skin lesion with pinhead-sized pustules affected the bilateral inguinal folds, and then it extended to general trunk accompanied by pruritus. She was admitted because of deterioration of skin lesion on 14th day of icodextrin exposure. She was afebrile and physical examination was notable for widespread erythematous papules with pruritus extending over her groins and trunk. Pertinent laboratory examination showed leukocytosis of 18 970 cells/μL with neutrophile count of 17 642 cells/μL (92.3%), and c-reactive-protein: 3.39 mg/dL. Skin biopsy revealed multifocal sub corneal abscess with papillary dermal edema, and upper-dermal neutrophilia with perivascular accentuation, consistent with the diagnosis of AGEP. After discontinuation of PD, she underwent temporary high-flux haemodialysis with treatment of steroid and antihistamine. Her dermatologic lesion resolved without any skin sequalae completely within 4 days, and she underwent icodextrin-free peritoneal dialysis at 17th day. This case highlighted the fact that icodextrin-induced AGEP should be early recognized to avoid inappropriate management.
Language	English
Publishing date	2024-04-10
Publishing country	Australia
Document type	Case Reports
ZDB-ID	1303661-0
ISSN	1440-1797 ; 1320-5358
ISSN (online)	1440-1797
ISSN	1320-5358
DOI	10.1111/nep.14302
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Zs.A 4822: Show issues

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Article ; Online: The Case | A 48-year-old man with recurrent hypercalcemia and uremia after parathyroidectomy.

Chen, Chien-Chou / Yang, I-Fang / Lin, Shih-Hua

Kidney international

2023 Volume 103, Issue 3, Page(s) 645–646

MeSH term(s)	Male ; Humans ; Middle Aged ; Hypercalcemia ; Parathyroidectomy ; Uremia ; Renal Insufficiency
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1016/j.kint.2022.10.006
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Zs.A 797: Show issues

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Article ; Online: Artificial Intelligence Electrocardiography Detecting Thyrotoxic Periodic Paralysis Following a SARS-CoV-2 Infection.

Lu, Ang / Chen, Chien-Chou / Lin, Chin / Wu, Tsung-Jui / Lin, Shih-Hua

The American journal of medicine

2024 Volume 137, Issue 5, Page(s) e91–e93

MeSH term(s)	Humans ; COVID-19/complications ; COVID-19/diagnosis ; Artificial Intelligence ; Electrocardiography ; SARS-CoV-2 ; Male ; Thyrotoxicosis/diagnosis ; Thyrotoxicosis/complications ; Adult ; Female ; Middle Aged
Language	English
Publishing date	2024-01-26
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2024.01.018
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Ua VI Zs.289: Show issues

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Article ; Online: Incorporating knowledge of disease-defining hub genes and regulatory network into a machine learning-based model for predicting treatment response in lupus nephritis after the first renal flare.

Lee, Ding-Jie / Tsai, Ping-Huang / Chen, Chien-Chou / Dai, Yang-Hong

Journal of translational medicine

2023 Volume 21, Issue 1, Page(s) 76

Abstract: Background: Identifying candidates responsive to treatment is important in lupus nephritis (LN) at the renal flare (RF) because an effective treatment can lower the risk of progression to end-stage kidney disease. However, machine learning (ML)-based ... ...

Abstract	Background: Identifying candidates responsive to treatment is important in lupus nephritis (LN) at the renal flare (RF) because an effective treatment can lower the risk of progression to end-stage kidney disease. However, machine learning (ML)-based models that address this issue are lacking. Methods: Transcriptomic profiles based on DNA microarray data were extracted from the GSE32591 and GSE112943 datasets. Comprehensive bioinformatics analyses were performed to identify disease-defining genes (DDGs). Peripheral blood samples (GSE81622, GSE99967, and GSE72326) were used to evaluate the effect of DDGs. Single-sample gene set enrichment analysis (ssGSEA) scores of the DDGs were calculated and correlated with specific immunology genes listed in the nCounter panel. GSE60681 and GSE69438 were used to examine the ability of the DDGs to discriminate LN from other renal diseases. K-means clustering was used to obtain the separate gene sets. The clustering results were extended to data derived using the nCounter technique. The least absolute shrinkage and selection operator (LASSO) algorithm was used to identify genes with high predictive value for treatment response after the first RF in each cluster. LASSO models with tenfold validation were built in GSE200306 and assessed by receiver operating characteristic (ROC) analysis with area under curve (AUC). The models were validated by using an independent dataset (GSE113342). Results: Forty-five hub genes specific to LN were identified. Eight optimal disease-defining clusters (DDCs) were identified in this study. Th1 and Th2 cell differentiation pathway was significantly enriched in DDC-6. LCK in DDC-6, whose expression positively correlated with various subsets of T cell infiltrations, was found to be differentially expressed between responders and non-responders and was ranked high in regulatory network analysis. Based on DDC-6, the prediction model had the best performance (AUC: 0.75; 95% confidence interval: 0.44-1 in the testing set) and high precision (0.83), recall (0.71), and F1 score (0.77) in the validation dataset. Conclusions: Our study demonstrates that incorporating knowledge of biological phenotypes into the ML model is feasible for evaluating treatment response after the first RF in LN. This knowledge-based incorporation improves the model's transparency and performance. In addition, LCK may serve as a biomarker for T-cell infiltration and a therapeutic target in LN.
MeSH term(s)	Humans ; Lupus Nephritis/genetics ; Kidney ; Kidney Failure, Chronic ; Algorithms ; Machine Learning
Language	English
Publishing date	2023-02-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2118570-0
ISSN	1479-5876 ; 1479-5876
ISSN (online)	1479-5876
ISSN	1479-5876
DOI	10.1186/s12967-023-03931-z
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Article: Case report: Severe rhabdomyolysis and acute liver injury in a high-altitude mountain climber.

Yeh, Yun-Chih / Chen, Chien-Chou / Lin, Shih-Hua

Frontiers in medicine

2022 Volume 9, Page(s) 917355

Abstract: Concurrent severe rhabdomyolysis and acute liver damage are rarely reported in the setting of acute high-altitude illness (AHAI). We described a 53-year-old healthy mountain climber who experienced headache and dyspnea at the summit of Snow Mountain ( ... ...

Abstract	Concurrent severe rhabdomyolysis and acute liver damage are rarely reported in the setting of acute high-altitude illness (AHAI). We described a 53-year-old healthy mountain climber who experienced headache and dyspnea at the summit of Snow Mountain (Xueshan; 3,886 m above sea level) and presented to the emergency room with generalized malaise, diffuse muscle pain, and tea-colored urine. His consciousness was alert, and he had a blood pressure of 114/74 mmHg, heart rate of 66/min, and body temperature of 36.8°C. Myalgia of the bilateral lower limbs, diminished skin turgor, dry oral mucosa, and tea-colored urine were notable. Urinalysis showed positive occult blood without red blood cells. The most striking blood laboratory data included creatine kinase (CK) 33,765 IU/L, inappropriately high aspartate aminotransferase (AST) 2,882 IU/L and alanine aminotransferase (ALT) 2,259 IU/L (CK/AST ratio 11.7, CK/ALT ratio 14.9), creatinine 1.5 mg/dl, serum urea nitrogen (BUN) 26 mg/dl, total bilirubin 1.7 mg/dl, ammonia 147 μg/ml, lactate 2.5 mmol/L, and prothrombin time 17.8 s. The meticulous search for the underlying causes of acute liver injury was non-revealing. With volume repletion, mannitol use, and urine alkalization coupled with avoidance of nephrotoxic and hepatotoxic agents, his clinical features and laboratory abnormality completely resolved in 3 weeks. Despite rarity, severe rhabdomyolysis and/oracute liver injury as a potential life-threatening condition requiring urgent management may occur in high-altitude hypobaric hypoxia.
Language	English
Publishing date	2022-08-08
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2022.917355
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Article ; Online: Spatial Analysis on Supply and Demand of Adult Surgical Masks in Taipei Metropolitan Areas in the Early Phase of the COVID-19 Pandemic.

Chen, Chien-Chou / Lo, Guo-Jun / Chan, Ta-Chien

International journal of environmental research and public health

2022 Volume 19, Issue 11

Abstract: This study aimed to assess the gap between the supply and demand of adult surgical masks under limited resources. Owing to the implementation of the real-name mask rationing system, the historical inventory data of aggregated mask consumption in a ... ...

Abstract	This study aimed to assess the gap between the supply and demand of adult surgical masks under limited resources. Owing to the implementation of the real-name mask rationing system, the historical inventory data of aggregated mask consumption in a pharmacy during the early period of the COVID-19 outbreak (April and May 2020) in Taiwan were analyzed for supply-side analysis. We applied the Voronoi diagram and areal interpolation methods to delineate the average supply of customer counts from a pharmacy to a village (administrative level). On the other hand, the expected number of demand counts was estimated from the population data. The relative risk (RR) of supply, which is the average number of adults served per day divided by the expected number in a village, was modeled under a Bayesian hierarchical framework, including Poisson, negative binomial, Poisson spatial, and negative binomial spatial models. We observed that the number of pharmacies in a village is associated with an increasing supply, whereas the median annual per capita income of the village has an inverse relationship. Regarding land use percentages, percentages of the residential and the mixed areas in a village are negatively associated, while the school area percentage is positively associated with the supply in the Poisson spatial model. The corresponding uncertainty measurement: villages where the probability exceeds the risk of undersupply, that is, Pr (RR < 1), were also identified. The findings of the study may help health authorities to evaluate the spatial allocation of anti-epidemic resources, such as masks and rapid test kits, in small areas while identifying priority areas with the suspicion of undersupply in the beginning stages of outbreaks.
MeSH term(s)	Adult ; Bayes Theorem ; COVID-19/epidemiology ; Humans ; Masks ; Pandemics ; Spatial Analysis
Language	English
Publishing date	2022-05-31
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph19116704
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Article ; Online: Mycophenolate-Induced Hepatotoxicity Precipitates Tacrolimus Nephrotoxicity in a Kidney Transplant Recipient: A Case Report.

Chen, Chien-Chou / Chang, Wen-Cheng / Lin, Shih-Hua

Transplantation proceedings

2022

Abstract: Mycophenolate (mycophenolate mofetil [MMF]; mycophenolate sodium [MPS]) and tacrolimus (FK-506) are commonly and concomitantly used to prevent rejection in organ transplant. Mycophenolate-induced hepatotoxicity causing the reduced FK-506 metabolism with ... ...

Abstract	Mycophenolate (mycophenolate mofetil [MMF]; mycophenolate sodium [MPS]) and tacrolimus (FK-506) are commonly and concomitantly used to prevent rejection in organ transplant. Mycophenolate-induced hepatotoxicity causing the reduced FK-506 metabolism with nephrotoxicity may be less appreciated, leading to inappropriate management. We describe a new living donor kidney recipient receiving pretransplant and post-transplant immunosuppressants including oral mycophenolate (MMF 1 g daily) and tacrolimus (FK-506 4-8 mg daily) who developed progressive liver dysfunction (up to 10-fold increase) despite the reduced FK-506 dosage (6 mg daily). A thorough investigation including infection, inflammation, and autoimmune hepatitis were unremarkable. With a withdrawal of MMF, his liver function improved, but persistently higher trough serum FK-506 level (12-15 ng/mL) and increased serum creatinine were notable. Moreover, the reintroduction of MPS with the reduced FK-506 dosage (4 mg daily) worsened liver function along with FK-506 nephrotoxicity (serum creatinine from 1.4-2.4 mg/dL). The replacement of MPS with mammalian target of rapamycin inhibitor not only resolved liver injury but also normalized serum FK-506 level and kidney function. Mycophenolate should be kept in mind as a cause of drug-induced hepatotoxicity that can reduce tacrolimus metabolism, leading to FK-506 nephrotoxicity and acute kidney injury in organ transplant.
Language	English
Publishing date	2022-11-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2022.10.036
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Zs.A 835: Show issues

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Article ; Online: Reversible cefazolin-induced status epilepticus in a peritoneal dialysis patient

Chen, Chien-Chou / Lee, Ding-Jie / Lin, Shihua

Toxicology Reports. 2022, v. 9 p.1950-1952

2022

Abstract: Cefazolin-induced neurotoxicity with the documented toxic concentration has not been reported in uremic patients on continuous ambulatory peritoneal dialysis (CAPD). We described an elderly female on CAPD for years presented with newly-onset status ... ...

Abstract	Cefazolin-induced neurotoxicity with the documented toxic concentration has not been reported in uremic patients on continuous ambulatory peritoneal dialysis (CAPD). We described an elderly female on CAPD for years presented with newly-onset status epilepticus. Her body weight was 60 kg. And she had received intraperitoneal ceftazidime and cefazolin 1.5 g once daily for her CAPD peritonitis 5 days earlier. She was disoriented but afebrile with normal blood pressure. Laboratory data showed WBC 18,480/uL, pH 6.93, HCO₃⁻ 8.5 mmol/L, free Ca²⁺ 3.5 mmol/L, and albumin 2.8 g/dL. Although antiepileptic drugs and hypocalcemia correction ceased the seizure, her consciousness remained semi-coma. Image studies of brain were unremarkable. Despite undetectable serum ceftazidime, her cefazolin trough level was 149.5 μg/mL. Emergent hemodialysis rapidly resolved her neurological features accompanied by a markedly declined serum cefazolin concentration (28.6 μg/mL). Higher intraperitoneal cefazolin dosing in patients on CAPD may cause drug-induced neurotoxicity with status epilepticus which could be rapidly corrected by hemodialysis.
Keywords	albumins ; blood pressure ; blood serum ; body weight ; brain ; calcium ; cefazolin ; ceftazidime ; consciousness ; dialysis ; elderly ; females ; hemodialysis ; hypocalcemia ; neurotoxicity ; pH ; patients ; peritonitis ; toxicology ; CAPD ; Status epilepticus
Language	English
Size	p. 1950-1952.
Publishing place	Elsevier B.V.
Document type	Article ; Online
Note	Use and reproduction
ZDB-ID	2805786-7
ISSN	2214-7500
ISSN	2214-7500
DOI	10.1016/j.toxrep.2022.10.011
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Artificial intelligence-enabled electrocardiography contributes to hyperthyroidism detection and outcome prediction.

Lin, Chin / Kuo, Feng-Chih / Chau, Tom / Shih, Jui-Hu / Lin, Chin-Sheng / Chen, Chien-Chou / Lee, Chia-Cheng / Lin, Shih-Hua

Communications medicine

2024 Volume 4, Issue 1, Page(s) 42

Abstract: Background: Hyperthyroidism is frequently under-recognized and leads to heart failure and mortality. Timely identification of high-risk patients is a prerequisite to effective antithyroid therapy. Since the heart is very sensitive to hyperthyroidism and ...

Abstract	Background: Hyperthyroidism is frequently under-recognized and leads to heart failure and mortality. Timely identification of high-risk patients is a prerequisite to effective antithyroid therapy. Since the heart is very sensitive to hyperthyroidism and its electrical signature can be demonstrated by electrocardiography, we developed an artificial intelligence model to detect hyperthyroidism by electrocardiography and examined its potential for outcome prediction. Methods: The deep learning model was trained using a large dataset of 47,245 electrocardiograms from 33,246 patients at an academic medical center. Patients were included if electrocardiograms and measurements of serum thyroid-stimulating hormone were available that had been obtained within a three day period. Serum thyroid-stimulating hormone and free thyroxine were used to define overt and subclinical hyperthyroidism. We tested the model internally using 14,420 patients and externally using two additional test sets comprising 11,498 and 596 patients, respectively. Results: The performance of the deep learning model achieves areas under the receiver operating characteristic curves (AUCs) of 0.725-0.761 for hyperthyroidism detection, AUCs of 0.867-0.876 for overt hyperthyroidism, and AUC of 0.631-0.701 for subclinical hyperthyroidism, superior to a traditional features-based machine learning model. Patients identified as hyperthyroidism-positive by the deep learning model have a significantly higher risk (1.97-2.94 fold) of all-cause mortality and new-onset heart failure compared to hyperthyroidism-negative patients. This cardiovascular disease stratification is particularly pronounced in subclinical hyperthyroidism, surpassing that observed in overt hyperthyroidism. Conclusions: An innovative algorithm effectively identifies overt and subclinical hyperthyroidism and contributes to cardiovascular risk assessment.
Language	English
Publishing date	2024-03-12
Publishing country	England
Document type	Journal Article
ISSN	2730-664X
ISSN (online)	2730-664X
DOI	10.1038/s43856-024-00472-4
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Article ; Online: Lactic acidosis associated with standard dose linezolid in a kidney recipient with impaired renal function.

Chen, Chien-Chou / Liu, Wei-Ting / Lin, Shih-Hua

The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases

2021 Volume 26, Issue 1, Page(s) 101701

Abstract: Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal ... ...

Abstract	Severe lactic acidosis, a mitochondrial toxicity caused by the recommended standard dosage of linezolid (LZD), may occur in patients with impaired renal function. We describe an adult male who underwent kidney transplantation with stably impaired renal function, severe dyspnea, and abdominal discomfort. He received a standard oral dose of LZD (600 mg twice daily) and azithromycin for three weeks with a reduced immunosuppressant dose due to pulmonary non-tuberculosis mycobacterial infection. He was alert and afebrile, with a blood pressure of 140/60 mmHg. Pertinent laboratory data showed: pH 7.12, PaCO2 13.6 mmHg; HCO3- 4.3 mmol/L and serum lactate 18.4 mmol/L. His trough serum LZD concentration reached toxic levels (21.4 μg/mL). With hemodialysis, his clinical symptoms improved, with a decline in serum LZD (9.8μg/mL) and lactate (3.2 mmol/L). Chronic standard dose LZD in patients with impaired renal function can lead to life-threatening lactic acidosis, especially in coexisting conditions that reduce LZD metabolism.
MeSH term(s)	Acidosis, Lactic/chemically induced ; Acidosis, Lactic/diagnosis ; Adult ; Humans ; Kidney/physiology ; Linezolid/adverse effects ; Male
Chemical Substances	Linezolid (ISQ9I6J12J)
Language	English
Publishing date	2021-12-21
Publishing country	Brazil
Document type	Case Reports
ZDB-ID	2041400-6
ISSN	1678-4391 ; 1413-8670
ISSN (online)	1678-4391
ISSN	1413-8670
DOI	10.1016/j.bjid.2021.101701
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