Mei Ju Chen

Personal history and family history as a predictor of gastric cardiac adenocarcinoma risk: A case-control study in Taiwan

OBJECTIVES:To clarify the risk of gastric cardiac adenocarcinoma for patients with a personal and/or family history of gastrointestinal diseases.METHODS:The present study was a hospital-based case-control study conducted from 1992 to 1997 in Kaohsiung, Taiwan, consisting of 176 cases and 579 controls matched by age, sex, and time of hospitalization. With informed oral consent, each subject completed a structured questionnaire during hospitalization regarding sociodemographic status, lifestyle, and health history.RESULTS:The response rate was 98%. Adjusting for age, sex, years of schooling, socioeconomic status, body mass index (BMI), and smoking. Multivariate logistic regression models indicated a reduced effect for patients with a personal history of duodenal ulcer (DU) (odds ratio (OR) = 0.8, 95% confidence interval (CI) 0.5–0.9). No association was observed between the risk of gastric cardiac cancer and other forms of gastric disease. Furthermore, we also demonstrated that individuals with a family history of gastric cancer had a higher risk than those who lacked a family history (OR = 2.5, 95% CI 1.3–4.8).CONCLUSIONS:Our findings provide further evidence that individuals with DU history are less likely to have gastric cardiac cancer, and we infer that Helicobacter pylori (H. pylori) infection (85–95% DU patients infected with H. pylori) alone may not be sufficient to cause gastric cardiac adenocarcinoma. In addition, this study also suggests that a positive family history of gastric cancer may predict an increased risk for the disease.

Lifestyle habits and gastric cancer in a hospital-based case-control study in Taiwan

OBJECTIVES:The aim of this study was to evaluate the effect of lifestyle habits on the risk of primary gastric cancer.METHODS:A hospital-based case-control study of matched pairs was conducted in Kaohsiung, Taiwan, from 1992 to 1996. The study included 649 subjects (152 cases and 497 controls). All subjects were personally interviewed face-to-face by a trained interviewer using a structured questionnaire to collect data about lifestyle. An average of approximately three controls were matched to each case based on age (±3 yr), sex, and time of hospitalization (±2 wk). Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to evaluate results, and a multivariate analysis of the data was performed using a conditional logistic regression model.RESULTS:A significantly elevated risk of contracting gastric cancer was observed in cigarette smokers (OR: 2.7, 95% CI: 1.5–4.3), but not in drinkers of alcoholic beverages (OR: 1.5, 95% CI: 0.9–3.2). A synergistically augmented relationship (multiplication effect) was found between smoking and drinking alcohol for controlling the major confounders. The combined adjusted ORs for all subjects with gastric cancer were 3.0 (95% CI: 1.4–7.1) for current smokers and 1.7 (95% CI: 1.2–4.4) for ex-smokers. Furthermore, a statistically significant positive dose-response trend in gastric cancer was demonstrated based on the age at which smoking was initiated, the duration of the habit, the number of cigarettes smoked per day, and the degree of smoke inhalation. We did not find any association between the other risk factors and gastric carcinogenesis.CONCLUSIONS:Our findings provide further evidence that in Taiwan, cigarette smoking may play the most harmful role in the initial development of gastric cancer, and that drinking alcohol may promote the process.

Adjunctive Oral Methylprednisolone in Pediatric Acute Pyelonephritis Alleviates Renal Scarring

OBJECTIVE: To determine if glucocorticoids can prevent renal scar formation after acute pyelonephritis in pediatric patients. METHODS: Patients younger than 16 years diagnosed with their first episode of acute pyelonephritis with a high risk of renal scar formation (ie, inflammatory volume ≥ 4.6 mL on technetium-99m–labeled dimercaptosuccinic acid scan [DMSA] or abnormal renal ultrasonography results) were randomly assigned to receive either antibiotics plus methylprednisolone sodium phosphate (1.6 mg/kg per day for 3 days [MPD group]) or antibiotics plus placebo (placebo group) every 6 hours for 3 days. Patients were reassessed by using DMSA 6 months after treatment. The primary outcome was the development of renal scars. RESULTS: A total of 84 patients were enrolled: 19 in the MPD group and 65 in the placebo group. Patient characteristics were similar between the 2 groups, including the acute inflammatory parameters and the initial DMSA result. Renal scarring was found in 33.3% of children treated with MPD and in 60.0% of those who received placebo (P < .05). The median cortical defect volumes on follow-up DMSA were 0.0 mL (range: 0–4.5 mL) and 1.5 mL (range: 0–14.8 mL) for the MPD and placebo groups, respectively (P < .01). Patients in the MPD group experienced faster defervescence after treatment than the placebo group. CONCLUSIONS: Adjunctive oral MPD therapy reduced the occurrence and/or severity of renal scarring after acute pyelonephritis in these hospitalized children who had a high risk of renal scar formation.

Invasive pneumococcal pneumonia is the major cause of paediatric haemolytic-uraemic syndrome in Taiwan

Aim:  Streptococcus pneumoniae‐associated haemolytic uraemic syndrome (SP‐HUS) is a major concern of paediatric acute renal failure in Taiwan; it leads to significant morbidity and mortality during the acute phase and to long‐term morbidity after an acute episode.

Risk Factors for Renal Scarring and Deterioration of Renal Function in Primary Vesico-Ureteral Reflux Children: A Long-Term Follow-Up Retrospective Cohort Study

Background and Purpose The aim was to identify the risk factors for renal scarring and deteriorating renal function in children with primary vesico-ureteral reflux (VUR). Materials and Methods Patients with primary VUR admitted to the National Cheng Kung University Hospital were retrospectively analyzed. The outcomes were renal scarring, assessed by technetium-99 m dimercaptosuccinic acid scanning, and renal function, assessed by estimated glomerular filtration rate. Univariate and multivariate models were applied to identify the corresponding independent predictors. Results A total of 173 patients with primary VUR were recruited. The median age of VUR diagnosis was 10.0 months (IQR: 4.0–43.0 months). After adjusting for confounding factors, it was found that older age of VUR diagnosis (≥5 years vs. <1 year, adjusted OR = 2.78, 95% CI = 1.00–7.70, p = 0.049), higher grade of VUR (high grade [IV–V] vs. none, adjusted OR = 15.17, 95% CI = 5.33–43.19, p<0.0001; low grade [I–III] vs. none, adjusted OR = 5.72, 95% CI = 2.43–13.45, p<0.0001), and higher number of UTI (≥2 vs. 0, adjusted OR = 3.21, 95% CI = 1.06–9.76, p = 0.039) were risk factors for renal scarring, whereas a younger age of VUR diagnosis (≥5 years vs. <1 year, adjusted HR = 0.16, 95% CI: 0.05–0.51, p = 0.002), renal scarring (yes vs. no, adjusted HR = 3.66, 95% CI: 1.32–10.16, p = 0.013), and APN (yes vs. no, adjusted HR = 3.10, 95% CI: 1.05–9.14, p = 0.041) were risk factors for developing chronic kidney disease stage 2 or higher. Conclusions Our findings expand on the current knowledge of risk factors for renal scarring and deteriorating renal function, and this information can be used to modify the management and treatment of VUR.

Bacterial Virulence Factors are Associated With Occurrence of Acute Pyelonephritis but Not Renal Scarring

PURPOSE We evaluated the influence of patient factors and virulence factors of uropathogenic Escherichia coli on the occurrence of acute pyelonephritis and subsequent renal parenchymal scarring. MATERIALS AND METHODS We evaluated 80 boys and 45 girls 1 to 180 months old with febrile urinary tract infections who underwent renal scan to diagnose acute pyelonephritis and followup dimercapto-succinic acid scintigraphy at least 6 months later. Urinalysis, white blood cell count, uropathogenic E. coli genotype and vesicoureteral reflux were measured. Voiding cystourethrogram was investigated after acute pyelonephritis was confirmed by renal scan and acute inflammation subsided, about 2 to 4 weeks later. RESULTS Acute pyelonephritis was significantly more likely to develop in children with urinary tract infections and persistent fever before and after hospitalization, elevated C-reactive protein or positive renal ultrasound findings. E. coli strains with the papG II and iha genes were significantly more likely to occur in patients with acute pyelonephritis. Patients with a fever for more than 3 days and C-reactive protein levels greater than 90.8 mg/l were significantly more likely to have renal scarring. Age was not an independent predictor of acute pyelonephritis, but modified the effect of virulence factors on the development of acute pyelonephritis. CONCLUSIONS Bacterial virulence factors and host factors are associated with the occurrence of acute pyelonephritis. Host factors such as patient age and vesicoureteral reflux severity modify the influence of virulence factors, although only host factors are associated with the occurrence of renal scarring.

Urinary Cytokines and Renal Doppler Study in Kawasaki Disease

OBJECTIVE To investigate whether renal vasculitis is the sole cause or merely a contributing cause of renal inflammation in Kawasaki disease (KD). STUDY DESIGN This prospective study in a university medical center in Taiwan enrolled 24 children with KD between June 2004 and November 2005. All patients underwent a technetium-99 m dimercaptosuccinic acid scintigraphy single-photon emission computed tomography scan, the results of which were used to group the patients with KD as with or without renal involvement. Urine samples underwent a cytokine analysis. Renal Doppler ultrasonography was used to evaluate renal vasculitis by measuring the pulsatility index (PI) and resistance index (RI). RESULTS Ten of the 24 patients (42%) with renal inflammatory foci were the study group; the remainder composed the control group. Urinary interleukin (IL)-6 levels were significantly higher in the study group (496.7 +/- 310.9 vs 115.0 +/- 65.9 ng/g urinary creatinine; P < .01), as were PI values (1.85 +/- 0.70 vs 1.44 +/- 0.53; P < .05). Urinary IL-6 levels and PI values were significantly (P < .05) correlated. CONCLUSIONS Increased urinary IL-6 and elevated renal Doppler measures suggest that immune-mediated vasculitis is one of the mechanisms causing renal inflammation in KD.

Renal abscess in children: a clinical retrospective study.

A renal abscess is rare in children and diagnosis is not readily apparent before hospitalization, because symptoms are often insidious and nonspecific. To evaluate the diagnostics and therapy of renal abscess in the pediatric group, we will report eight cases of renal abscess in children to illustrate the variable features of this condition. Eight patients, 6 to 156 (mean, 45.9) months old, with renal abscesses in 9 kidneys were identified. Ultrasound and computed tomography proved to be the most valuable diagnostic tool, revealing a hypoechoic or hypodense mass. Fever, abdominal pain, and leukocytosis were common presenting features, but no child presented symptoms of loin pain. Escherichia coli was identified in the urine culture among the 6 cases and blood culture in one case. Three children were associated with mild to moderate vesicoureteral reflux. All patients had an intensive antibiotic treatment, which led to resolution of the abscess in eight of the nine kidneys. In one case, the abscess had to be drained using the CT-guided percutaneous drainage. During follow-up, seven children received 99mTc DMSA renal SPECT and only two of them had complete remission without sequelae of renal scar. We concluded that the renal abscesses must be assumed, especially, in children with prolonged fever, abdominal pain, and a high value of CRP. Ultrasonography is just a screening test to detect renal swelling, bulging, and enlargement; however, a CT scan is more sensitive and can detect abscess formation, as well as define the extent of the disease for planning conservative antibiotic treatment or additional drainage. Finally, DMSA renal SPECT is the best and the most sensitive examination for detecting the extension area of renal inflammation and correlated with the renal outcome.

Etiology and pediatric chronic kidney disease progression: Taiwan Pediatric Renal Collaborative Study.

BACKGROUND/PURPOSE This study aims to examine the characteristics of Taiwanese children with chronic kidney disease (CKD) and delineate the factors that lead to disease progression in this population. METHODS We reviewed the records of the Taiwan Pediatric Renal Collaborative Study, a multicenter database of Taiwanese children with CKD. Multivariate regression analysis was used to identify the main factors associated with disease progression. RESULTS A total of 382 children aged 1-18 years were included in the study (median age was 10.6 years; interquartile range: 6.4-13.8). There were 197 males (51.6%) and 185 females. CKD Stage 1 was diagnosed in 159 children (41.6%), Stage 2 in 160 (41.9%), Stage 3 in 51 (13.4%), and Stage 4 in 12 (3.1%). Fifty-six children (14.7%) experienced CKD progression. A multivariate analysis for all patients indicated that the risk for disease progression was increased in children with CKD secondary to a structural abnormality, genetic disease, anemia, elevated diastolic blood pressure, or elevated blood urea nitrogen. Compared with children with Stage 1 CKD, those with Stage 2 and Stage 4 CKD had decreased risk for CKD progression in this short-term cohort follow-up. CONCLUSION CKD etiology affects disease progression. Careful monitoring and treatment of anemia and elevated blood pressure in children with CKD may slow disease progression.

Cyclosporine-based immunosuppressive therapy for patients with steroid-resistant focal segmental glomerulosclerosis: a meta-analysis

Abstract Objective: Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage kidney disease that requires immunosuppressive treatment as therapy. Few studies have been specifically designed to assess the efficacy of cyclosporine (CSA) in patients with steroid-resistant FSGS. This study investigated the efficacy of CSA-based therapy in steroid-resistant FSGS. Methods: Medline, Cochrane, EMBASE, and Google Scholar databases were searched through April 30, 2014 using the keywords “cyclosporine”, “steroid-resistant”, “focal segmental glomerulosclerosis”, and “FSGS”. Studies with an adult and children with steroid-resistant primary FSGS treated with CSA-based therapy with or without steroid use were included. Complete, partial, and overall remission were the primary outcomes. Change in proteinuria, serum creatinine, and estimated glomerular filtration rate (eGFR) following treatment were secondary outcomes. Results: Seven randomized controlled trials with a total of 373 patients were included. Five studies were included in the meta-analysis to assess complete, partial, and overall remission of FSGS. Compared with other treatments, CSA-based therapy resulted in a significantly greater partial remission rate (p = .018), but complete (p = .226) or overall remission rate (p = .050). CSA-based therapy also resulted in similar change in proteinuria (p = .084), serum creatinine (p = .772), and eGFR (p = .155) compared with other therapy. Study limitations included small sample size and heterogeneity in age and comparative treatments across the studies. Conclusions: Cyclosporin-based treatments provided a significantly better partial remission rate as compared with other therapies.