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Biomedical subjects

Hon-Man Liu

Publications and source records attributed to Hon-Man Liu.

At least 19 recordsLinked to original sources

Bifunctional magnetic silica nanoparticles for highly efficient human stem cell labeling.

A superparamagnetic iron oxide (SPIO) nanoparticle is emerging as an ideal probe for noninvasive cell tracking. However, its low intracellular labeling efficiency has limited the potential usage and has evoked great interest in developing new labeling strategies. We have developed fluorescein isothiocyanate (FITC)-incorporated silica-coated core-shell SPIO nanoparticles, SPIO@SiO2(FITC), with diameters of 50 nm, as a bifunctionally magnetic vector that can efficiently label human mesenchymal stem cells (hMSCs), via clathrin- and actin-dependent endocytosis with subsequent intracellular localization in late endosomes/lysosomes. The uptake process displays a time- and dose-dependent behavior. In our system, SPIO@SiO2(FITC) nanoparticles induce sufficient cell MRI contrast at an incubation dosage as low as 0.5 microg of iron/mL of culture medium with 1.2x105 hMSCs, and the in vitro detection threshold of cell number is about 1x104 cells. Furthermore, 1.2x105 labeled cells can also be MRI-detected in a subcutaneous model in vivo. Labeled hMSCs are unaffected in their viability, proliferation, and differentiation capacities into adipocytes and osteocytes which can still be readily MRI detected. This is the first report that hMSCs can be efficiently labeled with MRI contrast nanoparticles and can be monitored in vitro and in vivo with a clinical 1.5-T MRI imager under low incubation concentration of iron oxide, short incubation time, and low detection cell numbers at the same time.

Fluorescein-5-isothiocyanate↗

Effects of lateral trunk support on scoliotic spinal alignment in persons with spinal cord injury: a radiographic study.

OBJECTIVE: To develop a radiographic method for measuring the spinal alignment of a person in a seated position and with which to investigate the effects of lateral trunk supports (LTS) in special seating on the frontal and sagittal spinal alignment in persons with spinal cord injury (SCI). DESIGN: Before-after trial. SETTING: University-based research laboratory. PARTICIPANTS: Ten men and 7 women who had SCI with scoliosis (age, 35.4+/-9.4y; injury level, C5-T11) voluntarily participated. INTERVENTION: An adjustable seating system with LTS. MAIN OUTCOME MEASURES: Radiographs of the spine in the anteroposterior (AP) and lateral directions were taken while sitting on an adjustable seating system without and with LTS. The Cobb angles and scoliotic indices based on the AP radiographic images and the angles of the thoracic and lumbar spine based on lateral were calculated. The relative change in angle (RCA) with LTS in terms of the percentage reduction of the Cobb angles was also obtained. RESULTS: The Cobb angles and scoliotic indices while sitting with LTS were significantly smaller than those without, the mean difference of Cobb angles +/- standard error (SE) being 9.12 degrees +/-1.64 degrees (P<.001) and those for the scoliotic indices being .09+/-.04 (P=.027). The mean RCA +/- SE was 26.16%+/-4.23%. The RCA correlated weakly with the original Cobb angles (r=-.347, P=.172). The LTS caused a significant reduction in the lumbar angles (P<.001), but no significant effects on the thoracic angles were found. CONCLUSIONS: The radiographic findings demonstrate improved scoliotic spinal alignment in the frontal plane and reduced lumbar angles in the sagittal plane in persons with SCI when seated in a special seat and using LTS.

Adolescent↗

Levamisole-induced multifocal inflammatory leukoencephalopathy: clinical characteristics, outcome, and impact of treatment in 31 patients.

Levamisole (LEV) has been used as an immunomodulating medication in patients with recurrent aphthous ulcers and as an adjuvant for chemotherapy. LEV, with or without 5-fluorouracil (5-FU), induces multifocal inflammatory leukoencephalopathy (MIL). We identified 31 patients with LEV-induced MIL: 7 from our institution and 24 from a MEDLINE search. Twenty-one patients (67.7%) had been treated with a combination of LEV and 5-FU, while 10 patients had been treated with LEV alone. The onset of MIL was delayed in patients who took LEV and 5-FU in combination compared with the patients treated with LEV alone (11.7 +/- 3.7 vs. 4 +/- 2.5 wk, p < 0.001). Colon cancer (67.7%) was the most common indication for LEV administration. Gait ataxia occurred in 20 (64.5%) patients, and dysphagia was noted in 16 (51.6%) patients. Imaging studies revealed periventricular enhancement in 17 (54.8%) patients and supratentorial lesions in 16 (51.6%) patients. Cerebrospinal fluid studies showed lymphocytic pleocytosis in 10 of 21 (47.6%) patients. Early diagnosis of MIL and discontinuation of LEV is essential, yielding good recovery in most cases. Treatment with corticosteroids and/or intravenous immunoglobulin may be needed for this serious inflammatory encephalopathy. Twenty-nine patients exhibited improved clinical status and imaging findings after initial steroid or immunoglobulin treatment. Plasmapheresis may be an alternative regimen for patients with steroid resistance.

Adult↗

Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT.

PURPOSE: To prospectively evaluate lung parenchyma on paired inspiration-expiration thin-section computed tomographic (CT) scans in patients recovering from severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: After the institutional review board approved the study and written consent was obtained from patients, 40 patients (25 female, 15 male; mean age, 42.8 years +/- 12.3 [standard deviation]) underwent thin-section CT at 51.8 days +/- 20.2 after onset of SARS symptoms. Twenty of the 40 patients underwent follow-up thin-section CT at 140.7 days +/- 26.7 after symptom onset. Lung findings were scored according to extent and then grouped in three categories (ground-glass opacity, interstitial opacity, and air trapping) for analysis. Mean CT scores for each finding in the various patient subgroups were compared by using the Mann-Whitney test. Clinical parameters and scores were evaluated for correlation by using Spearman rank correlation analysis. Mean scores for each finding were compared between the two serial examinations by using the Wilcoxon matched-pairs signed rank test. RESULTS: Air trapping, ground-glass opacity, and reticulation were found in 37 (92%), 36 (90%), and 28 (70%) of 40 patients, respectively, at initial thin-section CT examination and in 16 (80%), 14 (70%), and 10 (50%) of 20 patients, respectively, at follow-up examination. Scans from patients with adult respiratory distress syndrome (ARDS) had a significantly higher score for ground-glass opacity than did those from patients without ARDS (P = .009). A comparison of scores for the serial thin-section CT examinations indicated a significant reduction in the extent of ground-glass opacity (P < .001) and interstitial opacity (P < .001) but not in that of air trapping (P = .38) at follow-up examination. At initial thin-section CT, scores for ground-glass opacity, interstitial opacity, and air trapping correlated with age; those for ground-glass opacity and air trapping, with peak C-reactive protein level. At the second examination, scores for ground-glass opacity and interstitial opacity correlated with peak lactate dehydrogenase level; that for air trapping, with age and peak C-reactive protein level. CONCLUSION: Thin-section CT scores correlated with clinical and laboratory parameters in patients after SARS. Although ground-glass opacity and interstitial opacity resolve over time, air trapping persists.

Adult↗

Aneurysms in twig-like middle cerebral artery.

BACKGROUND: We report a vascular abnormality of the middle cerebral artery (MCA) that has not been described in the literature before. METHODS: Two patients (1 male and 1 female; age 44 and 67 years, respectively) were found to have a vascular abnormality in which the main trunk of the MCA had a twig-like form. Both patients presented with intracranial hemorrhage. RESULTS: In these 2 patients, the abnormality was seen before the genu of the MCA. They had an intracranial hemorrhage due to an associated aneurysm inside the twigs. The twig appeared to be a network between the bifurcation of internal carotid artery and insular segment of MCA, and it was different from the collateral circulation due to acquired occlusion or moyamoya disease. CONCLUSION: This new type of vascular lesion of the MCA is not benign. It appears to be associated with the occurrence of an aneurysm, an important clinical aspect.

Adult↗

Establishing a Web-based DICOM teaching file authoring tool using open-source public software.

Online teaching files are an important source of educational and referential materials in the radiology community. The commonly used Digital Imaging and Communications in Medicine (DICOM) file format of the radiology community is not natively supported by common Web browsers. The ability of the Web server to convert and parse DICOM is important when the DICOM-converting tools are not available. In this paper, we describe our approach to develop a Web-based teaching file authoring tool. Our server is built using Apache Web server running on FreeBSD operating system. The dynamic page content is produced by Hypertext Preprocessor (PHP). Digital Imaging and Communications in Medicine images are converted by ImageMagick into Joint Photographic Experts Group (JPEG) format. Digital Imaging and Communications in Medicine attributes are parsed by dicom3tools and stored in PostgreSQL database. Using free software available from the Internet, we build a Web service that allows radiologists to create their own online teaching file cases with a common Web browser.

Computer Communication Networks↗

Transcranial color-coded sonography for the detection of middle cerebral artery stenosis.

OBJECTIVE: The purpose of this study was to validate the accuracy and criteria of transcranial color-coded sonography (TCCS) in detecting severe middle cerebral artery (MCA) stenosis. METHODS: One hundred ninety-three patients with acute ischemic cerebrovascular disease who received both TCCS and magnetic resonance angiography (MRA) examinations were evaluated. Middle cerebral artery stenosis assessed by MRA was graded as follows: grade 0, normal to mild (< 50%); grade 1, focal severe stenosis (> or = 50% and stenotic length within the M1 prebifurcation segment); and grade 2, diffuse severe stenosis (> or = 50% and stenotic length greater than the M1 prebifurcation segment). The peak systolic velocity (Vs) and mean velocity (Vm) of bilateral MCAs were obtained by TCCS. Estimates of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for TCCS relative to MRA. RESULTS: After 46 patients were excluded, 309 MCAs (grade 0, 77.3%; grade 1, 15.5%; and grade 2, 7.1%) were evaluated. The optimal diagnostic accuracy of TCCS for the detection of grade 1 MCA stenosis can be reached if Vs is 140 cm/s or higher or Vm is 90 cm/s or higher (sensitivity, 83.3%; specificity, 91.2%). The optimal diagnostic accuracy of grade 2 MCA stenosis can be obtained if V(s) is lower than 50 cm/s or V(s) is 140 cm/s or higher (sensitivity, 81.8%; specificity, 92.1%). In our study, none of the grade 1 but around half of the grade 2 stenosis showed a low flow velocity pattern. CONCLUSIONS: Transcranial color-coded sonography is reliable in detecting severe MCA stenosis. Except for high flow velocity, the addition of a low cutoff of normal flow velocity in our criteria not only increases the study sensitivity but also enables the identification of around half of diffuse severe MCA stenosis.

Arterial Occlusive Diseases↗

Carotid duplex sonography in the follow-up of intracranial dural arteriovenous fistulae.

BACKGROUND AND PURPOSE: Studies to determine the value of noninvasive neurovascular studies for the effectiveness of treatment and long-term follow-up of dural arteriovenous fistulas (AVFs) are of clinical importance. We determined whether the serial changes of carotid duplex sonography (CDS) were correlated with the evolution of dural AVF status after treatment or follow-up. METHODS: Four parameters of CDS were studied in two groups of patients with dural AVF: resistance index, end diastolic velocity, peak systolic velocity, and flow volume of the external carotid artery (ECA). The first group included 13 patients who received endovascular therapy, the efficacy of which was determined by the results of postembolization angiography. In the second group, 16 patients received only clinical and CDS follow-up. Evolution of clinical symptoms was recorded and classified as deteriorating, stationary, or improving. Patients underwent CDS before and after treatment (group 1) or at long-term follow-up (group 2). RESULTS: In the first group, the resistance index of the ECA increased in patients with occluded or nearly occluded dural AVF after embolization (n = 7, P = .01), but it did not change significantly in patients with partial treatment (n = 6, P = .11). Of patients with occluded or nearly occluded dural AVF after embolization, the ECA resistance index increased in patients with noncavernous sinus dural AVF (n = 5, P = .003) but not in patients with cavernous sinus dural AVF (n = 2, P = .48). In the second group, CDS parameters-particularly the resistance index-were well correlated with clinical status during follow-up. CONCLUSION: The resistance index of the ECA is correlated with the effectiveness of treatment and clinical evolution of dural AVF.

Adult↗

Hypotensive spinal cord infarction associated with vertebral body infarction after treatment with short-acting antihypertensive agent.

Spinal cord infarction is a rare condition with heterogeneous causes. An 80-year-old diabetic woman was brought to the emergency department because of retrosternal pain and high blood pressure. Twenty minutes after treatment with sublingual nitroglycerin and short-acting oral antihypertensive agent, blood pressure had dropped from 201/91 mm Hg to 158/68 mm Hg, followed by abrupt onset of weakness in lower limbs, urinary retention and sensory loss in bilateral T4-L1 levels and the left lower limb at two hours after treatment. Magnetic resonance imaging showed contrast-enhanced and high-intensity lesions in the mid and lower thoracic cord, which were consistent with ischemic changes within the spinal cord and in the T4 vertebral body. After rehabilitation therapy for 2 months, she became able to ambulate with the aid of a walker. To reduce the risk of hypotensive sequelae such as spinal cord infarction, blood pressure should be closely monitored in elderly patients presenting with retrosternal chest pain who are treated with short-acting oral antihypertensive agent, particularly when additional risk factors such as atherosclerosis, diabetes mellitus or hypertension are present.

Aged↗

Initial experience with the AneuRx Stent Graft for the treatment of infrarenal abdominal aortic aneurysm.

We report our initial experience with the modular AneuRx Stent Graft System for the treatment of infrarenal abdominal aortic aneurysm (AAA) in National Taiwan University Hospital. From July 2002 to October 2003, 5 patients were recruited for stent graft repair. Patients were all male, and aged from 62 to 82 years. The stent grafts were deployed via the opened femoral arteries under fluoroscopic guidance. Endograft deployment was successful in all 5 patients. The average procedure time was 139 +/- 23 min, and mean blood loss was 310 +/- 167 mL. All patients had a smooth postoperative course. Type II endoleak was noted in 3 patients initially, which sealed spontaneously in 2 of them. One patient developed graft limb thrombosis 1 month after operation, which was treated by femoral-femoral bypass. Treatment was successful in all patients with no mortality during 1-year postoperative follow-up.

Aged↗

Adrenomyeloneuropathy, a dynamic progressive disorder: brain magnetic resonance imaging of two cases.

Adrenomyeloneuropathy (AMN) is a phenotype variant of X-linked adrenoleukodystrophy. We present two patients with adult-onset AMN who were initially suspected to have demyelinating disorders radiologically and finally diagnosed on the basis of laboratory data. The brain magnetic resonance images showed abnormal signal intensity at pyramidal tracts and cerebellar hemisphere bilaterally with abnormal enhancement after contrast medium administration. Review of the literature shows that the brain magnetic resonance findings of adrenomyeloneuropathy may include normal brain, tract demyelination, white matter demyelination, or brain atrophy. Disease progression was demonstrated by follow-up imaging.

Adrenoleukodystrophy↗

Diagnosis of intracranial dural arteriovenous fistulas by carotid duplex sonography.

OBJECTIVE: To validate carotid duplex sonography (CDS) in diagnosis of intracranial dural arteriovenous fistulas (AVFs) against the standard of cerebral catheter angiography. METHODS: We investigated 35 patients with dural AVFs and 64 patients without dural AVFs confirmed by the catheter angiographic studies. Twenty CDS parameters in 4 categories, including resistive index (RI), flow volume, peak systolic velocity, and end-diastolic velocity, were evaluated. Abnormal CDS findings were defined as the data above 95th percentile or below 5th percentile values from 180 control subjects. We determined the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in each CDS parameter. RESULTS: The parameter of RI of the external carotid artery (ECA; cutoff points: right, 0.72; left, 0.71) yielded the highest sensitivity (74%), specificity (89%), positive predictive value (79%), negative predictive value (86%), and accuracy (84%) for predicting dural AVFs. All other ECA-related parameters yielded sensitivity lower than 70%, and those related to the internal carotid artery were lower than 30%. The sensitivity values for the parameter of RI of the ECA in different locations of dural AVFs were 54% (7 of 13 patients) in cavernous sinus dural AVFs and 86% (19 of 22 patients) in non-cavernous sinus dural AVFs (P = .05). CONCLUSIONS: The RI of the ECA is the best CDS parameter for predicting intracranial dural AVFs. Carotid duplex sonography can be used as the initial screening tool for diagnosis in patients having symptoms related to dural AVFs.

Adult↗

Migrainous infarction involving two different arterial territories: report of two cases.

It is reasonable to speculate that migrainous infarction may develop in different territories of cerebral arteries. However, this condition was rarely reported before. Here we described two patients (one woman, 29 year-old; one man, 47 year-old) with a history of migraine with aura, had ischemic strokes during the migraine attack. The ischemic stroke of the female patient involved the territories of the posterior cerebral and anterior choroidal arteries; whereas the male patient had two episodes of ischemic strokes, involving the territories of the middle and posterior cerebral arteries sequentially. Both patients recovered well during the follow-up periods. We suggest that migrainous infarction can involve different arterial territories.

Adult↗

Diffusion tensor images in children with early-treated, chronic, malignant phenylketonuric: correlation with intelligence assessment.

BACKGROUND AND PURPOSE: Diffusion tensor (DT) images can provide information about the nature of white matter changes, including axonal loss and demyelination. We applied DT imaging to verify white matter changes in patients with malignant phenylketonuria (PKU) and to correlate the findings with clinical intelligence quotients (IQs). METHODS: We compared DT images with T2-weighted images in 12 patients with early-treated, chronic, stable malignant PKU and 12 age-matched control subjects. DT parameters included first, second, and third eigenvalues (EV1-3), apparent diffusion coefficients (ADCs), and fractional anisotropy (FA). Regions of interest were placed the frontoparietal, parieto-occipital, frontal and central white matter and in the anterior and posterior corpus callosum. Eight patients older than 3 years underwent IQ assessment including verbal, performance, and full-scale IQ tests. RESULTS: In the eight patients older than 3 years, no definite abnormal signal intensity changes were found on T2-weighted images. EV2, EV3, and FA of the parieto-occipital white matter were significantly different in patients and control subjects older than 3 years. EV3 and ADC of the parieto-occipital white matter were significantly and negatively correlated with verbal IQ (r = -0.79, P = .04) and performance IQ (r = -0.93, P = .03). FA of the parieto-occipital central white matter was positively correlated with verbal IQ (r = 0.75, P = .05). CONCLUSION: Though treated early, patients with chronic, stable malignant PKU had abnormal DT findings in the parieto-occipital central white matter. EV2, EV3, and FA maps are potential tools for demonstrating brain changes due to malignant PKU.

5-Hydroxytryptophan↗

Treatment of advanced Parkinson's disease by subthalamotomy: one-year results.

We studied effects on parkinsonian features at 6 and 12 months in 12 patients who underwent unilateral ablation of subthalamic nucleus (STN). Microelectrode mapping was used, and a lesion was created in the STN using thermal coagulation and confirmed with magnetic resonance imaging. At 6 months postoperatively, improvements were seen in several areas: 1) Unified Parkinson's Disease Rating Scales II and III (UPDRS II and III) scores, 30% in off period, 38% in on period; 2) Schwab and England Scale (S&E) score, 21%; and 3) on dyskinesia, 85%. Contralateral rigidity, bradykinesia, UPDRS II and III scores, and S&E scores remained improved at 12 months. Daily dosage of levodopa requirement was reduced by 42%. Axial motor features, gait, postural stability, off period tremor, and motor fluctuation improved at 6 and 12 months but showed a decline in benefits at 18 months. Complications include 3 cases of hemiballism, of whom 2 patients recovered spontaneously but 1 died from aspiration pneumonia. One patient had asymptomatic hematoma, and 2 suffered transient postural asymmetries. We conclude that unilateral subthalamotomy results in moderate improvement in all aspects of parkinsonian features, allows reduction in the dose of levodopa required, and ameliorates drug-induced complications throughout 12-month assessments.

Adult↗