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Han C.,Korea University | Wang S.-M.,Catholic University of Korea | Kwak K.-P.,Dongguk University | Won W.-Y.,Catholic University of Korea | And 5 more authors.
Journal of Psychiatric Research | Year: 2015

No study has directly compared the efficacy and tolerability of aripiprazole augmentation (AA) and antidepressant switching (SW) in patients with major depressive disorder (MDD). This is the first 6-week, randomized, rater-blinded, direct comparison study between AA and SW in outpatients. An inadequate response to antidepressants was defined as a total score ≥14 on the Hamilton Depression Rating Scale-item 17 (HDRS-17) despite adequate antidepressant dosage for at least 6 weeks in the current depressive episode. The primary endpoint was change in the total score of the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to the end of treatment. Secondary efficacy measures included the response and remission rates as priori defined at the end of treatment: changes in total scores of the HDRS-17, Iowa Fatigue Scale (IFS), and Sheehan Disability Scale (SDS) from baseline to the end of treatment and the proportion of patients who scored 1 or 2 on the Clinical Global Impression-Improvement Score (CGI-I) at the end of treatment. Tolerability was assessed with the Barnes Akathisia Rating Scale (BARS) and Arizona Sexual dysfunction scale (ASEX), and the numbers of adverse events were compared between the two groups. A total of 101 patients were randomized to either AA (n=52) or SW (n=49). The mean change in the MADRS score from baseline was significantly higher in the AA, with a difference in magnitude of-8.7 (p<0.0001). The intergroup difference was first evident in week 2. The numbers of responders (p=0.0086) and remitters (p=0.0005) were also significantly higher in the AA (60% and 54%, respectively) compared with the SW (32.6% and 19.6%, respectively). On most secondary endpoints, AA showed better clinical outcomes compared to SW. The tolerability profiles were comparable between the two groups. Overall, AA yielded potentially beneficial clinical outcomes compared to SW. Given the methodological shortcomings of the present study, adequately powered, more rigorously controlled clinical trials are strongly warranted to confirm the present findings. © 2015 Elsevier Ltd. Source

Juan Y.-H.,Chang Gung Memorial Hospital | Juan Y.-H.,Chang Gung University | Hsu M.-Y.,Chang Gung Memorial Hospital | Hsu M.-Y.,Chang Gung University | And 8 more authors.
Chinese Journal of Radiology | Year: 2010

Glioblastoma multiforme (GBM) is one of the most common primary tumors of the central nervous system, comprising up to half of all primary brain tumors; however, primary GBM of the pineal region is extremely rare. To our knowledge, there are only 18 reported cases. We report a rare case of pineal GBM in a 32-year-old male who presented with headache, visual image distortion, and vertigo. Computed tomography, magnetic resonance imaging, and cerebral angiography revealed a tumor mass in the pineal region. The mass was diagnosed as a glioblastoma following subtotal removal. After combined surgery and concurrent chemoradiotherapy treatment, our patient survived longer than 1 year after the initial diagnosis. Here, we present the radiographic features and treatment strategy of pineal GBM, with a review of the literature. Source

Chan P.-Y.S.,Chang Gung University | von Leupoldt A.,Catholic University of Leuven | von Leupoldt A.,University of Hamburg | Liu C.-Y.,Chang Gung Memorial Hospital at Linkuo | And 3 more authors.
Respiratory Physiology and Neurobiology | Year: 2014

There has been evidence for the effect of anxiety on the neural processing of respiratory sensation using the respiratory-related evoked potentials (RREP) elicited by inspiratory occlusions. This study tested the RREP elicited by inspiratory occlusions in a group of outpatients with generalized anxiety disorder (GAD) and a group of healthy controls. We hypothesized that the RREP P3 peak would be modulated in the GAD patients.A RREP oddball paradigm of 150-ms inspiratory occlusion protocol was used in 15 GAD patients and 11 healthy adults with normal lung functions. The RREP was recorded with a 40-channel electroencephalography (EEG) system. A minimum of 100 occlusions was collected for data analysis.We found that the averaged P3 latency of the GAD patients was significantly longer than the P3 latency of the healthy controls. In addition, the GAD group showed significantly reduced P3 amplitudes compared to the control group. No group differences in latency and amplitudes were found for earlier RREP components.These results demonstrated that a delayed and reduced attention peak (P3) is present in patients with GAD. This suggests that GAD as a disease state modulates the higher order processing of respiratory perception. © 2014 Elsevier B.V.All rights reserved. Source

Lin C.-C.,Chang Gung Memorial Hospital at Linkuo | Lin C.-C.,Chang Gung University | Pan C.-S.,Chang Gung University | Wang C.-Y.,Chang Gung University | And 5 more authors.
Journal of Biomedical Science | Year: 2015

Background: Tumor necrosis factor-α (TNF-α) is a proinflammatory cytokine and elevated in the regions of tissue injury and inflammatory diseases. The deleterious effects of TNF-α on fibroblasts may aggravate heart inflammation mediated through the up-regulation of adhesion molecules such as vascular cell adhesion molecule-1 (VCAM-1). However, the mechanisms underlying TNF-α-induced VCAM-1 expression in cardiac fibroblasts remain unknown. This study aimed to investigate the roles of TNF-α in VCAM-1 expression and its effects on human cardiac fibroblasts (HCFs). Results: The primary culture HCFs were used in this study. The results obtained with Western blotting, real time-quantitative PCR, and promoter activity analyses showed that TNF-α-induced VCAM-1 expression was mediated through TNF receptor (TNFR) 1-dependent gene up-regulation. Activation of TNFR1 by TNF-α transactivated c-Src-dependent EGF receptor (EGFR) linking to PI3K/Akt cascade, and then led to transcriptional activity of NF-κB. Moreover, the results of promoter reporter assay demonstrated that the phosphorylated p65 NF-κB turned on VCAM-1 gene expression. Subsequently, up-regulation of VCAM-1 promoted monocytes adhesion to HCFs challenged with TNF-α determined by cell adhesion assay. Conclusions: Taken together, these results indicate that in HCFs, activation of NF-κB by c-Src-mediated transactivation of EGFR/PI3K/Akt cascade is required for TNF-α-induced VCAM-1 expression. Finally, increased VCAM-1 enhances monocytes adhering to HCFs challenged with TNF-α. Understanding the mechanisms of VCAM-1 up-regulated by TNF-α on HCFs may provide rationally therapeutic interventions for heart injury or inflammatory diseases. © 2015 Lin et al. Source

Cheung Y.-C.,Chang Gung University | Tsai H.-P.,Chang Gung Memorial Hospital at Linkuo | Tsai H.-P.,Chang Gung University | Lo Y.-F.,Chang Gung Memorial Hospital at Linkuo | And 5 more authors.
European Radiology | Year: 2016

Objective: To assess the utility of dual-energy contrast-enhanced spectral mammography (DE-CESM) for evaluation of suspicious malignant microcalcifications. Methods: Two hundred and fifty-six DE-CESMs were reviewed from 2012–2013, 59 cases fulfilled the following criteria and were enrolled for analysis: (1) suspicious malignant microcalcifications (BI-RADS 4) on mammogram, (2) no related mass, (3) with pathological diagnoses. The microcalcification morphology and associated enhancement were reviewed to analyse the accuracy of the diagnosis and cancer size measurements versus the results of pathology. Results: Of the 59 microcalcifications, 22 were diagnosed as cancers, 19 were atypical lesions and 18 were benign lesions. Twenty (76.9 %) cancers, three (11.55 %) atypia and three (11.55 %) benign lesions revealed enhancement. The true-positive rate of intermediate- and high-concern microcalcifications was significantly higher than that of low-concern lesions (93.75 % vs. 50 %). Overall, the diagnostic sensitivity of enhancement was 90.9 %, with 83.78 % specificity, 76.92 % positive predictive value, 93.94 % negative predictive value and 86.4 % accuracy. Performance was good (AUC = 0.87) according to a ROC curve and cancer size correlation with a mean difference of 0.05 cm on a Bland-Altman plot. Conclusions: DE-CESM provides additional enhancement information for diagnosing breast microcalcifications and measuring cancer sizes with high correlation to surgicohistology. Key Points: • DE-CESM provides additional enhancement information for diagnosing suspicious breast microcalcifications. • The enhanced cancer size closely correlates to microscopy by Bland-Altman plot. • DE-CESM could be considered for evaluation of suspicious malignant microcalcifications. © 2015, European Society of Radiology. Source

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