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Article ; Online: Isolated Primary Neurolymphomatosis in the Right Brachial Plexus Proven by Partial Nerve Biopsy.

Lee, Gin Hoong / Hsueh, Hsueh-Wen / Wang, Kuo-Chuan / Yu, Shan-Chi / Huang, Hsin-Yi / Chao, Chi-Chao / Hsieh, Sung-Tsang

The neurologist

2023 Volume 28, Issue 4, Page(s) 247–249

Abstract: Introduction: Isolated primary neurolymphomatosis is a rare manifestation of lymphoma, which is challenging to diagnose as there is only involvement of the nervous system, and nerve biopsy is not frequently pursued due to the high risk of irreversible ... ...

Abstract	Introduction: Isolated primary neurolymphomatosis is a rare manifestation of lymphoma, which is challenging to diagnose as there is only involvement of the nervous system, and nerve biopsy is not frequently pursued due to the high risk of irreversible complications. Case report: We present a case of isolated primary neurolymphomatosis of diffuse large B-cell lymphoma restricted to only the right brachial plexus and right axillary nerve. The clinical course has been indolent for several years. The initial examination, including MRI and the cerebrospinal fluid study, did not yield any evidence of malignancy. Eventually, due to the patient's symptom progression and the follow-up imaging findings, we conducted a partial nerve biopsy of the brachial plexus to confirm the malignancy. His neurological symptoms did not further deteriorate post-biopsy. Conclusion: Isolated primary neurolymphomatosis with an indolent course is rare and challenging to diagnose. Serial MRI and fluorodeoxyglucose-positron emission tomography reveal clues for tumor involvement. Partial nerve biopsy or targeted fascicular nerve biopsy could be an alternative for achieving a pathologic diagnosis.
MeSH term(s)	Humans ; Neurolymphomatosis/diagnostic imaging ; Brachial Plexus/diagnostic imaging ; Brachial Plexus/pathology ; Lymphoma, Large B-Cell, Diffuse/diagnostic imaging ; Positron-Emission Tomography ; Biopsy
Language	English
Publishing date	2023-07-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	1361380-7
ISSN	2331-2637 ; 1074-7931
ISSN (online)	2331-2637
ISSN	1074-7931
DOI	10.1097/NRL.0000000000000471
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Article ; Online: Leukoencephalopathy with Brainstem and Spinal Cord Involvement and Lactate Elevation: A Novel

Li, Jeng-Lin / Lee, Ni-Chung / Chen, Pin-Shiuan / Lee, Gin Hoong / Wu, Ruey-Meei

Movement disorders clinical practice

2021 Volume 8, Issue 7, Page(s) 1116–1122

Abstract: Background: Leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) is characterized by slowly progressive spastic gait, cerebellar symptoms, and posterior cord dysfunction. : Cases: The proband had gait ... ...

Abstract	Background: Leukoencephalopathy with brainstem and spinal cord involvement and lactate elevation (LBSL) is characterized by slowly progressive spastic gait, cerebellar symptoms, and posterior cord dysfunction. Cases: The proband had gait disturbance since age 56, while her younger brother had the gait problem since his 20s and needed cane-assistance at age 45. Both cases showed typical demyelinating features of LBSL on the magnetic resonance imaging (MRI) involving the periventricular white matter, brainstem, cerebellum and spinal cord. Sequencing of both cases showed compound heterozygous mutations: c.228-16C>A and c.508C>T in Literature review: Literatures from PubMed were reviewed. Five families showed intra-familial heterogeneity on age at onset or clinical severity. Conclusion: We identified a family of LBSL with compound heterozygous mutations, and c.508C>T at the exon 6 is a novel one. Clinical heterogeneity was observed in the family and other literatures. Further research for underlying mechanism is required.
Language	English
Publishing date	2021-08-11
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2330-1619
ISSN (online)	2330-1619
DOI	10.1002/mdc3.13281
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Article: Accuracy of Liver-Type Fatty Acid-Binding Protein in Predicting Acute Kidney Injury: A Meta-Analysis.

Chiang, Ting-Hui / Yo, Chia-Hung / Lee, Gin Hoong / Mathew, Amy / Sugaya, Takeshi / Li, Wen-Yi / Lee, Chien-Chang

The journal of applied laboratory medicine

2021 Volume 7, Issue 2, Page(s) 421–436

Abstract: Background: Liver-type fatty acid-binding protein (L-FABP) is a promising biomarker for the early prediction of acute kidney injury (AKI). However, the clinical utility of L-FABP in different populations or settings remains unclear. We present a meta- ... ...

Abstract	Background: Liver-type fatty acid-binding protein (L-FABP) is a promising biomarker for the early prediction of acute kidney injury (AKI). However, the clinical utility of L-FABP in different populations or settings remains unclear. We present a meta-analysis of studies evaluating the performance of L-FABP in AKI prediction. Methods: We performed a literature search in MEDLINE, EMBASE, and Cochrane library, using search terms "acute kidney injury" and "L-FABP." Studies investigating the performance characteristics of L-FABP for the early diagnosis of AKI were included. Data about patient characteristics, diagnostic criteria of AKI, quantitative data required for construction of a 2 × 2 table (number of participants, sensitivity, specificity, and case number), study settings, and outcomes were extracted. The bivariable model was applied to calculate the estimated sensitivity and specificity of L-FABP. A summary ROC curve was created by plotting the true-positive rate against the false-positive rate at various cutoff values from different studies. Results: We found 27 studies reporting measurement of urine (n = 25 studies) or plasma (n = 2 studies) L-FABP. Overall, the estimated sensitivity was 0.74 (95% CI: 0.69-0.80) and specificity was 0.78 (95% CI: 0.71-0.83). L-FABP demonstrated a stable area under the ROC of 0.82 (95% CI: 0.79-0.85) in variable clinical settings including intensive care unit, surgery, and contrast-induced AKI. In subgroup analysis excluding pediatric and post radiocontrast exposure cohorts, L-FABP had comparative diagnostic performance with neutrophil gelatinase associated lipocalin (NGAL). Conclusions: Despite broad prevalence, L-FABP is a clinically useful marker with moderate accuracy in variable clinical settings as demonstrated in our subgroup analysis. Except for pediatric patients and those post-radiocontrast exposure, L-FABP has comparable discriminative capability as NGAL.
MeSH term(s)	Acute Kidney Injury/diagnosis ; Acute Kidney Injury/metabolism ; Biomarkers ; Child ; Fatty Acid-Binding Proteins ; Female ; Humans ; Lipocalin-2 ; Liver/metabolism ; Male ; ROC Curve
Chemical Substances	Biomarkers ; Fatty Acid-Binding Proteins ; Lipocalin-2
Language	English
Publishing date	2021-09-08
Publishing country	England
Document type	Journal Article ; Meta-Analysis
ISSN	2576-9456
ISSN	2576-9456
DOI	10.1093/jalm/jfab092
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Article ; Online: Prevalence of Nontuberculous Mycobacterium Infections versus Tuberculosis among Autopsied HIV Patients in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Chiang, Cho-Han / Tang, Pui-Un / Lee, Gin Hoong / Chiang, Ting-Hui / Chiang, Cho-Hung / Ma, Kevin Sheng-Kai / Fang, Chi-Tai

The American journal of tropical medicine and hygiene

2020 Volume 104, Issue 2, Page(s) 628–633

Abstract: In industrialized countries, Mycobacterium avium complex and other nontuberculous mycobacteria (NTM) are major causes of opportunistic infection-related deaths in HIV patients. However, in resource-limited regions, data on NTM are scarce, and ... ...

Abstract	In industrialized countries, Mycobacterium avium complex and other nontuberculous mycobacteria (NTM) are major causes of opportunistic infection-related deaths in HIV patients. However, in resource-limited regions, data on NTM are scarce, and tuberculosis (TB) was often assumed to be the cause of death in HIV patients with a positive acid-fast smear. We searched MEDLINE and Embase databases for studies on autopsied HIV patients in sub-Saharan Africa published between January 1997 and April 2020. We included studies that reported histopathological or microbiological evidences for diagnosis of TB and NTM infection. We excluded articles without mycobacterial evidence from culture or molecular testing, such as those that used verbal autopsy, death certificates, or national registry data (systematic review registration number: CRD42019129836 at PROSPERO). We included six eligible studies that reported 391 autopsies in sub-Saharan African HIV patients. The prevalence of NTM and TB at autopsy ranged from 1.3% to 27.3% and 11.8% to 48.7%, respectively. The weighted prevalence ratio of NTM versus TB was 0.16 indicating that for every seven HIV patients died with mycobacterial infections, there was one died with NTM infection. Of the 13 NTM infections, six were caused by M. avium complex. Mycobacterium avium complex and other NTM infections are important differential diagnoses of TB at the time of death among HIV patients in sub-Saharan Africa. Our findings highlight the need to systematically survey the prevalence of NTM infections among HIV patients seeking medical care in resource-limited regions.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Autopsy/statistics & numerical data ; Humans ; Mycobacterium Infections, Nontuberculous/epidemiology ; Mycobacterium Infections, Nontuberculous/mortality ; Mycobacterium avium Complex/pathogenicity ; Nontuberculous Mycobacteria/pathogenicity ; Prevalence ; Tuberculosis/epidemiology ; Tuberculosis/mortality
Language	English
Publishing date	2020-11-23
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.20-0973
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Article ; Online: Time to Implement the European Society of Cardiology 0/1-Hour Algorithm.

Chiang, Cho-Han / Chiang, Cho-Hung / Lee, Gin Hoong / Qian, Frank / Chen, Shyr-Chyr / Lee, Chien-Chang

Annals of emergency medicine

2020 Volume 76, Issue 5, Page(s) 690–692

MeSH term(s)	Algorithms ; Cardiology ; Humans ; Myocardial Infarction ; Troponin I
Chemical Substances	Troponin I
Keywords	covid19
Language	English
Publishing date	2020-05-12
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2020.05.038
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Article ; Online: Safety and efficacy of the European Society of Cardiology 0/1-hour algorithm for diagnosis of myocardial infarction: systematic review and meta-analysis.

Chiang, Cho-Han / Chiang, Cho-Hung / Lee, Gin Hoong / Gi, Weng-Tein / Wu, Yuan-Kun / Huang, Sih-Shiang / Yeo, Yee Hui / Giannitsis, Evangelos / Lee, Chien-Chang

Heart (British Cardiac Society)

2020 Volume 106, Issue 13, Page(s) 985–991

Abstract: Objective: The European Society of Cardiology (ESC) 0/1 hour algorithm has been primarily validated in Europe, America and Australasia with less knowledge of its performance outside of these settings. We aim to evaluate the performance of the ESC 0/1 ... ...

Abstract	Objective: The European Society of Cardiology (ESC) 0/1 hour algorithm has been primarily validated in Europe, America and Australasia with less knowledge of its performance outside of these settings. We aim to evaluate the performance of the ESC 0/1 hour algorithm across different contexts. Methods: We searched PubMed, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials for relevant studies published between 1 January 2008 and 31 May 2019. The primary outcome was index myocardial infarction and the secondary outcome was major adverse cardiac event or mortality. A bivariate random-effects meta-analysis was used to derive the pooled estimate of each outcome. Results: A total of 11 014 patients from 10 cohorts were analysed for the primary outcome. The algorithm based on high-sensitivity cardiac troponin (hs-cTn)T (Roche), hs-cTnI (Abbott) and hs-cTnI (Siemens) had pooled sensitivity of 98.4% (95% CI=95.1% to 99.5%), 98.1% (95% CI=94.6% to 99.3%) and 98.7% (95% CI=97.3% to 99.3%), respectively. The algorithm based on hs-cTnT (Roche) and hs-cTnI (Siemens) had pooled specificity of 91.2% (95% CI=86.0% to 94.6%) and 95.9% (95% CI=94.1% to 97.2%), respectively. Among patients in the rule-out category, the pooled mortality rate at 30 days and at 1 year was 0.1% (95% CI=0.0% to 0.4%) and 0.8% (95% CI=0.5% to 1.2%), respectively. Among patients in the observation zone, the pooled mortality rate was 0.7% (95% CI=0.3% to 1.2%) at 30 days but increased to 8.1% (95% CI=6.1% to 10.4%) at 1 year, comparable to the mortality rate in the rule-in group. Conclusion: The ESC 0/1 hour algorithm has high diagnostic accuracy but may not be sufficiently safe if the 1% miss-rate for myocardial infarction is desired. Prospero registration number: CRD42019142280.
MeSH term(s)	Aged ; Algorithms ; Biomarkers/blood ; Clinical Decision Rules ; Clinical Decision-Making ; Female ; Heart Disease Risk Factors ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Myocardial Infarction/mortality ; Myocardial Infarction/therapy ; Predictive Value of Tests ; Prognosis ; Risk Assessment ; Time Factors ; Troponin I/blood ; Troponin T/blood
Chemical Substances	Biomarkers ; Troponin I ; Troponin T
Language	English
Publishing date	2020-04-03
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2019-316343
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Article ; Online: Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction : An International Collaborative Meta-analysis.

Chiang, Cho-Han / Chiang, Cho-Hung / Pickering, John W / Stoyanov, Kiril M / Chew, Derek P / Neumann, Johannes T / Ojeda, Francisco / Sörensen, Nils A / Su, Ke-Ying / Kavsak, Peter / Worster, Andrew / Inoue, Kenji / Johannessen, Tonje R / Atar, Dan / Amann, Michael / Hochholzer, Willibald / Mokhtari, Arash / Ekelund, Ulf / Twerenbold, Raphael /

Mueller, Christian / Bahrmann, Philipp / Buttinger, Nicolas / Dooley, Maureen / Ruangsomboon, Onlak / Nowak, Richard M / DeFilippi, Christopher R / Peacock, William F / Neilan, Tomas G / Liu, Michael A / Hsu, Wan-Ting / Lee, Gin Hoong / Tang, Pui-Un / Ma, Kevin Sheng-Kai / Westermann, Dirk / Blankenberg, Stefan / Giannitsis, Evangelos / Than, Martin P / Lee, Chien-Chang

Annals of internal medicine

2021 Volume 175, Issue 1, Page(s) 101–113

Abstract: Background: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for ... ...

Abstract	Background: The 2020 European Society of Cardiology (ESC) guidelines recommend using the 0/1-hour and 0/2-hour algorithms over the 0/3-hour algorithm as the first and second choices of high-sensitivity cardiac troponin (hs-cTn)-based strategies for triage of patients with suspected acute myocardial infarction (AMI). Purpose: To evaluate the diagnostic accuracies of the ESC 0/1-hour, 0/2-hour, and 0/3-hour algorithms. Data sources: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from 1 January 2011 to 31 December 2020. (PROSPERO: CRD42020216479). Study selection: Prospective studies that evaluated the ESC 0/1-hour, 0/2-hour, or 0/3-hour algorithms in adult patients presenting with suspected AMI. Data extraction: The primary outcome was index AMI. Twenty unique cohorts were identified. Primary data were obtained from investigators of 16 cohorts and aggregate data were extracted from 4 cohorts. Two independent authors assessed each study for methodological quality. Data synthesis: A total of 32 studies (20 cohorts) with 30 066 patients were analyzed. The 0/1-hour algorithm had a pooled sensitivity of 99.1% (95% CI, 98.5% to 99.5%) and negative predictive value (NPV) of 99.8% (CI, 99.6% to 99.9%) for ruling out AMI. The 0/2-hour algorithm had a pooled sensitivity of 98.6% (CI, 97.2% to 99.3%) and NPV of 99.6% (CI, 99.4% to 99.8%). The 0/3-hour algorithm had a pooled sensitivity of 93.7% (CI, 87.4% to 97.0%) and NPV of 98.7% (CI, 97.7% to 99.3%). Sensitivity of the 0/3-hour algorithm was attenuated in studies that did not use clinical criteria (GRACE score <140 and pain-free) compared with studies that used clinical criteria (90.2% [CI, 82.9 to 94.6] vs. 98.4% [CI, 88.6 to 99.8]). All 3 algorithms had similar specificities and positive predictive values for ruling in AMI, but heterogeneity across studies was substantial. Diagnostic performance was similar across the hs-cTnT (Elecsys; Roche), hs-cTnI (Architect; Abbott), and hs-cTnI (Centaur/Atellica; Siemens) assays. Limitation: Diagnostic accuracy, inclusion and exclusion criteria, and cardiac troponin sampling time varied among studies. Conclusion: The ESC 0/1-hour and 0/2-hour algorithms have higher sensitivities and NPVs than the 0/3-hour algorithm for index AMI. Primary funding source: National Taiwan University Hospital.
MeSH term(s)	Algorithms ; Biomarkers/blood ; Diagnosis, Differential ; Europe ; Humans ; Myocardial Infarction/diagnosis ; Practice Guidelines as Topic ; Predictive Value of Tests ; Reproducibility of Results ; Risk Factors ; Societies, Medical ; Time Factors ; Triage/methods ; Troponin/blood
Chemical Substances	Biomarkers ; Troponin
Language	English
Publishing date	2021-11-23
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M21-1499
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Article ; Online: Isolated Primary Neurolymphomatosis in the Right Brachial Plexus Proven by Partial Nerve Biopsy.

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Article ; Online: Leukoencephalopathy with Brainstem and Spinal Cord Involvement and Lactate Elevation: A Novel

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Article: Accuracy of Liver-Type Fatty Acid-Binding Protein in Predicting Acute Kidney Injury: A Meta-Analysis.

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Article ; Online: Prevalence of Nontuberculous Mycobacterium Infections versus Tuberculosis among Autopsied HIV Patients in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

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Article ; Online: Time to Implement the European Society of Cardiology 0/1-Hour Algorithm.

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Article ; Online: Safety and efficacy of the European Society of Cardiology 0/1-hour algorithm for diagnosis of myocardial infarction: systematic review and meta-analysis.

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Article ; Online: Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction : An International Collaborative Meta-analysis.

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