Jeng-Yi Shieh

Sonographic detection of occult fractures in the foot and ankle

The purpose of this retrospective study was to determine whether high‐resolution sonography can aid in the diagnosis of radiographically occult fractures in the foot and ankle.

Noninvasive assessment of the viscoelasticity of peripheral arteries

Currently used methods of examining the mechanical properties of blood vessel walls are either indirect or invasive, or measure vessel diameter and pressure waveforms at different sites. We developed a noninvasive technique to assess the mechanical properties and viscoelasticity of peripheral arteries. The pressure-strain elastic modulus (Ep) and the viscoelastic properties (energy dissipation ratio, EDR) of the common carotid artery (CCA), brachial artery (BA), radial artery (RA) and dorsalis pedis artery (DPA) were determined by means of palpating pressure and diameter distension waveforms extracted from high-resolution ultrasonography. The methodology was validated in vitro using an elastic tube phantom, as well as in vivo. In vivo study in 10 healthy volunteers (mean age 22 y) showed that the pressure-diameter curves were nonlinear, with an inflection at about 85-90 mmHg, and routed clockwise with slight hysteresis. The CCA (n = 5) had a mean diameter of 6.74 mm and the pulsatile diameter distension was 12.2%. The Ep calculated at the CCA was 0.44 x 10(6) dyne/cm2 with an EDR of 7.18%. The BA, RA and DPA (n = 10) had mean diameters of 3.91 mm, 2.21 mm and 2.12 mm; arterial strains of 4.60%, 4.25% and 8.91%; mean Ep of 1.39, 1.45, 0.90 x 10(6 )dyne/cm2; and mean EDRs of 6.34%, 6.15% and 5.60%, respectively. The method presented is relatively simple to implement clinically and has potential as a new diagnostic tool for detecting local vascular changes.

Down-regulation of membrane glycoprotein in amoeboid microglia transforming into ramified microglia in postnatal rat brain.

SummaryThe present study describes the ultrastructural localization and labelling pattern of lectin in different microglial cell phenotypes in the postnatal rat brain using the isolectin, GSA I-B4. The nascent round and amoeboid microglial cells (round cells and cells displaying short processes) were labelled at their cytoplasmic membrane and the membrane of the subplasmalemmal vacuoles. In the course of their transformation into ramified forms with age, dense lectin labelling was observed successively at different sites in the differentiating cells. The most striking feature was the staining of the Golgi saccules on the trans face, the trans tubular network and associated vesicles and vacuoles in the ‘intermediate’ ramified microglia (ramified cells bearing thick and long processes and those with thin and long processes). The vacuoles with accumulated reaction products were closely associated with many microtubules extending into the cytoplasmic processes. At the surface, the lectin-labelled vacuoles and vesicles appeared to fuse with the membrane and their contents communicated with the exterior. In the advanced or most differentiated ramified microglial cells (cells bearing attenuated processes), the lectin staining at all the above mentioned sites became diminished. In conclusion, in the transformation of the round microglia into their ramified derivatives, the glycoconjugates at the cytoplasmic membrane are progressively reduced. It is postulated from this study that the down-regulation of the glycoconjugates of the microglial plasma membrane is due primarily to their internalization during endocytosis. This process would trigger ade novo galactosyl protein synthesis and/or modification at the trans Golgi saccules and trans tubular network probably in an attempt to degrade the internalized membrane glycoproteins or to replenish the consumption of the membrane glycoconjugates.

Studies of the Motoneurons Following the Injection of Horseradish Peroxidase into the Peripheral Branches of the Facial Nerve in Rats

With the method of retrograde transport of horseradish peroxidase, the present study demonstrated a topographical representation of the peripheral branches of the facial nerve within the rat facial nucleus. The labelled neurons relating to the different peripheral branches were characterized morphometrically with the aid of an image analyser system. While the results were in general agreement with the work of other investigators, a striking difference was observed in this study with respect to the spatial distribution of the labelled neurons of the cervical branch. In the latter, the cells of origin were derived from the dorsal parts of the lateral and intermediate division of the facial nucleus. The present study further demonstrated that the motoneurons giving rise to the respective peripheral branches of the facial nerve varied considerably in cell size. Thus, the neurons of the posterior auricular and the mental branches were significantly larger than those of the nasolabial and zygomatico-orbital branches. Another significant finding in this study was that the neurons supplying the mental branch were predominantly spindle-shaped. It is concluded that the heterogeneity in size and shape of the motoneurons in the facial nucleus is related to the topographical representation of the peripheral branches of the facial nerve.

The determinants of daily function in children with cerebral palsy

The aim of this study was to identify determinants of daily function in a population-based sample of children with cerebral palsy (CP). The study took into consideration factors from the entire scope of the International Classification of Functioning, Disability, and Health (ICF). Furthermore, the determinants of daily function were examined from the perspectives of capacity and performance respectively. A total of 216 children with CP (mean age 8.19 years, SD 3.39 years) and their caregivers participated in the study. The potential determinants of daily function from the dimensions of health condition, body functions and structures, environmental and personal factors of the ICF were collected. Stepwise multiple regression models showed that childs age, grade, preferred hand, educational placement, severity of gross and fine motor impairment, and prosocial behavior were important determinants, accounting for 88.29% of the variance of daily capacity. The aforementioned variables together with birth order were determinants of performance of daily function, and accounted for 89.53% of the variance in that performance. Knowledge of determinants of daily function helps clinicians and educators to plan intervention and educational programs targeted at these determinants to improve capacity and performance in daily function for children with CP.

Determinants of quality of life in children with cerebral palsy: A comprehensive biopsychosocial approach

This study investigated the determinants of quality of life (QOL) of children with cerebral palsy (CP) considering possible variables comprehensively from a biopsychosocial perspective by adopting the International Classification of Functioning, Disability and Health (ICF) and using a CP-specific QOL questionnaire. A total of 167 children with CP (mean age 9.06 years, SD 2.61 years) and their caregivers participated in this study. Childrens QOL was measured by the Cerebral Palsy Quality of Life for Children (CP QOL-Child) - primary caregiver proxy-report form. The potential determinants of QOL were collected based on all ICF dimensions. Results of seven multiple regression models showed that the determinants of QOL in children with CP were multidimensional and biopsychosocial in nature, i.e., encompassing the domains of health condition, body functions and structures, and contextual factors of the ICF. Childrens behavioral and emotional problems as well as caregivers psychological and family-related factors were important determinants of QOL in children with CP. Knowledge of the determinants of QOL could serve as a guide in a holistic approach to evaluation and intervention targeted at these determinants to improve the QOL of children with CP.

Human Chorionic Gonadotropin Up-Regulates Expression of Myeloid Cell Leukemia-1 Protein in Human Granulosa-Lutein Cells: Implication of Corpus Luteum Rescue and Ovarian Hyperstimulation Syndrome

CONTEXT The corpus luteum is a dynamic endocrine structure with periodic development and regression during menstrual cycles. Its lifespan can be prolonged by human chorionic gonadotropin (hCG). However, the signal mechanisms of this phenomenon remain unclear. OBJECTIVE Our objective was to investigate the molecular mechanisms of hCG in the maintenance of the viability of granulosa-lutein cells. DESIGN Granulosa-lutein cells were obtained from women undergoing in vitro fertilization. We examined the effects of hCG on the survival of cultured granulosa-lutein cells. The signal pathway inducing antiapoptotic protein was investigated. RESULTS hCG enhanced viability of granulosa-lutein cells through antiapoptosis but not proliferation, because the apoptotic marker of annexin V was decreased, but the proliferative markers of Ki67 and proliferating cell nuclear antigen were not increased. Myeloid cell leukemia-1 (Mcl-1) protein, but not B-cell lymphoma protein-2 or B-cell lymphoma protein-xL, was significantly induced by hCG and LH. The granulosa-lutein cells secreted vascular endothelial growth factor that induced endothelial permeability. Mcl-1 small interfering RNA increased DNA fragmentation and diminished the antiapoptotic effect of hCG. hCG induced Mcl-1 expression through the LH/hCG receptor, adenylate cyclase, protein kinase A, and cAMP response element-binding protein signal pathway. Flavopiridol inhibited Mcl-1 production, released cytochrome c, and induced apoptosis of granulosa-lutein cells. CONCLUSIONS We first demonstrate that hCG prevents apoptosis of granulosa-lutein cells through the induction of Mcl-1 protein via the LH/hCG receptor and a cAMP response element-binding protein-dependent pathway. We may have found the molecular mechanism for luteal rescue during early pregnancy. Mcl-1 prevents apoptosis and increases cell viability but not proliferation as mechanisms for luteal rescue. Mcl-1 is a key molecule of hCG signaling.

Logistic Regression Analyses for Predicting Clinically Important Differences in Motor Capacity, Motor Performance, and Functional Independence after Constraint-Induced Therapy in Children with Cerebral Palsy.

Given the growing evidence for the effects of constraint-induced therapy (CIT) in children with cerebral palsy (CP), there is a need for investigating the characteristics of potential participants who may benefit most from this intervention. This study aimed to establish predictive models for the effects of pediatric CIT on motor and functional outcomes. Therapists administered CIT to 49 children (aged 3-11 years) with CP. Sessions were 1-3.5h a day, twice a week, for 3-4 weeks. Parents were asked to document the number of restraint hours outside of the therapy sessions. Domains of treatment outcomes included motor capacity (measured by the Peabody Developmental Motor Scales II), motor performance (measured by the Pediatric Motor Activity Log), and functional independence (measured by the Pediatric Functional Independence Measure). Potential predictors included age, affected side, compliance (measured by time of restraint), and the initial level of motor impairment severity. Tests were administered before, immediately after, and 3 months after the intervention. Logistic regression analyses showed that total amount of restraint time was the only significant predictor for improved motor capacity immediately after CIT. Younger children who restrained the less affected arm for a longer time had a greater chance to achieve clinically significant improvements in motor performance. For outcomes of functional independence in daily life, younger age was associated with clinically meaningful improvement in the self-care domain. Baseline motor abilities were significantly predictive of better improvement in mobility and cognition. Significant predictors varied according to the aspects of motor outcomes after 3 months of follow-up. The potential predictors identified in this study allow clinicians to target those children who may benefit most from CIT.

Power Doppler Presentation of Shoulders With Biceps Disorder

OBJECTIVES To investigate the patterns of power Doppler signals on the long head of the biceps tendon at asymptomatic controls and shoulders with clinically diagnosed biceps disorder. DESIGN Cross-sectional study. SETTING Hospital rehabilitation department. PARTICIPANTS Asymptomatic adults (n=27) were included in the control group, and patients with unilateral biceps disorder (n=17) were recruited for the patient group. Basic gray color ultrasound screening was performed for rotator cuff tendons antecedently. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three scan views were taken on the anterior shoulder by power Doppler sonography, including the transverse plane of the long head of the biceps tendon, and the longitudinal planes along the lateral and medial edge of the bicipital groove. We compared the patterns and the power Doppler signal area within and between both groups. RESULTS In shoulders of healthy controls and the asymptomatic side of patients, the power Doppler signal area of the longitudinal planes along the lateral edge of the bicipital groove was significantly larger than that along the medial edge of the bicipital groove. However, there was no significant difference in the painful side of patients. Moreover, the painful shoulders had a higher prevalence of power Doppler signal medial to the biceps tendon in the transverse plane, which paralleled bicipital peritendinous effusion and rotator cuff abnormalities. CONCLUSIONS The power Doppler signal was more frequently observed medial to the biceps tendon in shoulders with clinically diagnosed biceps disorder. Whether shoulders with this specific power Doppler signal pattern benefit more from anti-inflammatory therapy needs further exploration.

Pregnancy achieved by intracytoplasmic sperm injection using cryopreserved vasal-epididymal sperm from a man with spinal cord injury☆☆☆

Anejaculation and poor semen quality are two major causes of infertility in men with spinal cord injury (SCI). The poor motility of retrieved sperm usually has low fertilization potential and is thought to be unfavorable for cryopreservation. This report describes a pregnancy after intracytoplasmic sperm injection (ICSI) with cryopreserved vasal-epididymal sperm from a man with SCI and anejaculation. An attempt was made to obtain sperm through electroejaculation, but no motile sperm were found in two trials. Therefore, the subject underwent vasal aspiration. The retrieved sperm had a concentration of 26 x 10(6)/mL and a motility of 3%. ICSI was considered to be the best choice for the couple, but the wife did not become pregnant in the first cycle of treatment. A successful pregnancy was achieved by ICSI in the second cycle using frozen-thawed sperm, supernumerary in the previous cycle, with a density of 5 x 10(6)/mL and 1% motility. A set of healthy twins, one boy and one girl, were delivered via cesarean section at 36 weeks of gestation. Complementary to other assisted reproductive techniques, ICSI may provide men with SCI a greater opportunity to father children. The supernumerary sperm, regardless of quality, should be cryopreserved to avoid the necessity and risk of repeated assisted ejaculations and aspirations of the genital tract.