Deng-Ho Yang - Academia.edu (original) (raw)

Papers by Deng-Ho Yang

Research paper thumbnail of Pyogenic Baker cyst in a patient with psoriatic arthritis during etanercept therapy

Annals of Saudi medicine

Patients with psoriatic arthritis (PsA) are at increased risk of infection due to disease course ... more Patients with psoriatic arthritis (PsA) are at increased risk of infection due to disease course or treatment-related immunodeficiency. We describe a patient with a 10-year history of PsA, with arthritis of the right knee and pain and edema in the right calf, treated with the TNFa inhibitor etanercept for 6 months. Ultrasound showed accumulation of hypoechoic fluid, which was aspirated and was positive for staphylococcus and aspergillus. The patient recovered after surgical drainage and four weeks of antibiotic and antifungal therapy.

Research paper thumbnail of Oral administration of acarbose ameliorates imiquimod-induced psoriasis-like dermatitis in a mouse model

International Immunopharmacology, 2016

Psoriasis is a chronic autoimmune disease of undefined etiology that involves dysregulated interp... more Psoriasis is a chronic autoimmune disease of undefined etiology that involves dysregulated interplay between immune cells and keratinocytes. Acarbose was found to decrease inflammatory parameters in diabetic patients in addition to its anti-diabetic effects. Here, we report that imiquimod (IMQ)-induced epidermal hyperplasia and psoriasis like-inflammation were significantly inhibited by acarbose treatment. Real-time PCR showed that mRNA levels of the cytokines TNF-α, IL-6, IL-1β IL-17A, and IL-22 in skin were also decreased significantly by acarbose. In addition, we found that acarbose reduced infiltration of CD3(+) T cells and GR-1(+) neutrophils in lesional skin and also reduced the percentage of IL-17-producing CD4(+) T cells (Th17) and IL-17- and IL-22-producing γδ T cells in the spleen. In contrast, acarbose increased the frequency of IL-10-producing CD4(+) regulator Tr1 T cells in the spleen and small intestine. These results indicate that oral administration of acarbose can attenuate the severity of imiquimod-induced psoriasis with local and systemic anti-inflammatory and immune modulation effects, thus suggesting that acarbose is an effective therapeutic strategy for psoriasis regulation.

Research paper thumbnail of Multiple Thromboses in a Patient with Systemic Lupus Erythematosus after Splenectomy

Case Reports in Immunology, 2012

Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history... more Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history of fetal loss. Early diagnosis and adequate treatment is important to prevent multiple organ failures. Here, we described a woman with a two-year history of systemic lupus erythematosus with severe nephrotic syndrome, manifested multiple thrombi over the portal vein and the inferior vena cava, combined with acute renal infarction. The patient underwent splenectomy 10 months ago. Initially, she received anticoagulant treatment and low-dose glucocorticoid, but multiple organ failure progressed. After emergency plasma exchange followed by glucocorticoid pulse therapy, the patient recovered.

Research paper thumbnail of Expression of Complement Receptor Type 1 on Erythrocytes in Autoimmune Diseases

Journal of Molecular Biomarkers & Diagnosis, 2014

ABSTRACT Objective: The expression of complement receptor type 1 on different cells is associated... more ABSTRACT Objective: The expression of complement receptor type 1 on different cells is associated with autoimmunity. Erythrocyte-Complement Receptor Type 1 (E-CR1) is a candidate for early diagnosis of Systemic Lupus Erythematosus (SLE) and assessed the roles of disease activity. We evaluated the expression of E-CR1 in the patients with SLE and other autoimmune diseases. Methods: We conducted a cross-sectional investigation of 3 groups: (1) 36 patients with SLE; (2) 51 patients with other diseases including Rheumatoid Arthritis (RA), Sjögren’s syndrome, anti-phospholipid syndrome, Mixed Connective Tissue Disease (MCTD), Raynaud’s disease, ankylosing spondylitis, pulmonary Tuberculosis (TB); and (3) 26 healthy controls. Erythrocytes were analyzed by flow cytometry to determine levels of E-CR1. Results: We found a significant reduction in the mean levels of E-CR1 in SLE patients compared to patients with healthy controls (1.79 ± 0.16 versus 3.82 ± 0.32, P<0.05). However, in patients with RA, MCTD, and TB, decreased E-CR1 levels were also observed. There was a statistically significant correlation between reduced levels of E-CR1 and SLE disease activity index (r=-0.326, P<0.05). The E-CR1 levels were inversely correlated with urine daily protein loss (r=-0.364, P<0.05). Conclusions: Although E-CR1 levels may be a useful diagnostic marker for SLE, a possible limitation is that no significant differences in E-CR1 levels were observed among patients with SLE, those with MCTD and TB. Overall, E-CR1 levels in SLE patients are related to disease activity index and reflect renal clearance through urine daily protein loss.

Research paper thumbnail of Cyclosporine for Adult Onset Still's Disease Flare with Hepatic Dysfunction

We report on a 27 year-old man with adult onset Still's disease (AOSD) who had a flare after two ... more We report on a 27 year-old man with adult onset Still's disease (AOSD) who had a flare after two years of management with methotrexate (MTX) and prednisolone. The clinical manifestations included hepatitis, jaundice, fever and atypical skin rash. Because of hepatitic dysfucntion, cyclosporine was prescribed instead of MTX. After therapy with cyclosporine, the patient recovered with improved liver enzymes and clinical features.

Research paper thumbnail of Analysis of Erythrocyte C4d to Complement Receptor 1 Ratio: Use in Distinguishing between Infection and Flare-Up in Febrile Patients with Systemic Lupus Erythematosus

BioMed Research International, 2015

Fever in systemic lupus erythematosus (SLE) can be caused by infection or flare-up of the disease... more Fever in systemic lupus erythematosus (SLE) can be caused by infection or flare-up of the disease. This study aimed to determine whether the ratio of the level of erythrocyte-bound C4d to that of complement receptor 1 (C4d/CR1) can serve as a useful biomarker in the differentiation between infection and flare-up in febrile SLE patients. We enrolled febrile SLE patients and determined the ratio on the day of admission. The patients were divided into 2 groups according to the subsequent clinical course. Among the febrile SLE patients, those with flare-up had higher ratios and lower C-reactive protein (CRP) levels than those with infection. Cut-off values of <1.2447 and >4.67 for C4d/CR1 ratio and CRP, respectively, were 40.91% sensitive and 100.0% specific for the presence of infection in febrile SLE patients; similarly, cut-off values of >1.2447 and <2.2, respectively, were 80% sensitive and 100% specific for the absence of infection in febrile SLE patients. The C4d/CR1 ratio is a simple and quickly determinable biomarker that enables the differentiation between infection and flare-up in febrile SLE patients at initial evaluation. Further, when combined with the CRP level, it is useful to evaluate disease activity in SLE patients with infection.

Research paper thumbnail of Chylous Ascites and Pleural Transudate: Rare Presentations in Systemic Lupus Erythematosus in Old Age

Case Reports in Immunology, 2012

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with involvement of multiple... more Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with involvement of multiple organs. Various forms of serositis, including pleural effusion, pericardial effusion, and ascites, may be found during the course of SLE. Peritoneal involvement by ascites is common in the initial presentation of SLE. However, chylous ascites is uncommon in SLE patients. Here, we describe a 93-year-old female with initial presentation of chylous ascites during SLE flares. Marked distention and an ovoid shape of the abdomen were observed. Shifting dullness and central tympanic sounds were found on percussion. Rales were heard in bilateral breathing sounds, multiple oral ulcers appeared in the oral cavity, and chest images showed bilateral pleural effusion. Abdominal sonography revealed moderate ascites and pleural effusion. Neither organisms nor malignant cells were revealed in the culture or cytology of ascites and pleural effusion. The diagnosis of SLE was arrived at by positive antinuclear antibody (ANA), discoid rash, oral ulcers, serositis (pleural effusion and ascites), and proteinuria. The patient received intravenous methylprednisolone 250 mg/day for three days. The pleural effusion resolved dramatically after steroid therapy and abdominal distention related to ascites formation subsided obviously.

Research paper thumbnail of Advanced glycation end products induce T cell apoptosis: Involvement of oxidative stress, caspase and the mitochondrial pathway

Mechanisms of ageing and development

Accumulation of advanced glycation end products (AGEs) is a hallmark in aged people. T cells play... more Accumulation of advanced glycation end products (AGEs) is a hallmark in aged people. T cells play important roles in maintaining homeostasis of immune function. This study investigated the effects of AGEs-bovine serum albumin (AGEs) in human T cells. Incubation of Jurkat and several immortalized T cell lines with AGEs resulted in cell death dose-dependently. AGEs-induced cell death was partially but significantly blocked by neutralizing antibodies recognizing receptor of AGEs. In addition to detecting DNA nick, simultaneous stainings of annexin V with 7-amino-actinomycin D further confirmed the apoptotic nature of cell death. AGEs also caused apoptosis in purified T cells. Although AGEs-induced apoptosis could be blocked by the pan-caspase inhibitor, Ala-Asp-fluomethyl ketone (Z-VAD-fmk), there was no activation of caspase-3, -5, -8 and -9. AGEs caused mitochondrial outer membrane permeabilization and this process was prevented by an antioxidant or Z-VAD-fmk. Furthermore, AGEs treat...

Research paper thumbnail of Baker's Cyst With Bacterial Infection in a Patient with Recently Diagnosed Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder characterized by the product... more Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder characterized by the production of numerous pathologic autoantibodies. Patients with SLE are at increased risk of infection because of the disease course or treatment- related immunodeficiency. Infection is a major cause of morbidity and mortality among patients with SLE. Infected Baker's cyst (BC) can occur in patients with trauma, and degenerative or inflammatory arthritis, but is rarely described in SLE patients. We describe the case of a 22-year-old woman with a three-month history of SLE who did not receive any immunosuppressive treatment after diagnosis. Initial manifestations included fever, tachycardia, and hypotension with pain and edema in her left calf. Magnetic resonance imaging revealed a large BC with thickening of the adjacent subcutaneous layer of the calf. Turbid fluids were aspirated from the cyst, and methicillin-susceptible Staphylococcus aureus was cultured. She received antibiotic therapy...

Research paper thumbnail of Significantly Higher Percentage of Circulating CD27 high Plasma Cells in Systemic Lupus Erythematosus Patients with Infection than with Disease Flare-Up

Yonsei Medical Journal, 2010

Research paper thumbnail of Useful biomarkers for assessment of hepatitis C virus infection-associated autoimmune disorders

World Journal of Gastroenterology, 2014

During the course of chronic hepatitis C virus (HCV) infection, various extrahepatic manifestatio... more During the course of chronic hepatitis C virus (HCV) infection, various extrahepatic manifestations of autoimmune disorders may occur, including arthralgia/arthritis, sicca complex, purpura, cutaneous ulcer, and thyroid dysfunction. In addition, the prevalence of circulating autoantibodies is high among patients with HCV infection. Commonly detected autoantibodies in HCVinfected patients include rheumatoid factor, antinuclear antibody, anti-SSA/anti-SSB antibody, cryoglobulin, antineutrophil cytoplasmic antibody, anti-smooth muscle antibody, anti-liver and anti-thyroid autoantibodies.

Research paper thumbnail of Isolated Septic Discitis Associated with Streptococcus bovis Bacteremia

Southern Medical Journal, 2011

Streptococcus bovis is a Gram-positive coccus that can be found in the intestinal flora of health... more Streptococcus bovis is a Gram-positive coccus that can be found in the intestinal flora of healthy people; it is also associated with colon cancer and infective endocarditis. We report on a 79-yearold male who initially presented with acute-onset lower back pain. Streptococcus bovis was detected in repeated blood cultures, and magnetic resonance imaging of the lumbar spine revealed septic discitis of the L2YL3 intervertebral disc. Excision and debridement of the intervertebral disc was performed and a tissue culture tested positive for S. bovis. Repeat echocardiography and colonoscopy showed no signs of vegetation or tumor lesions, respectively. We diagnosed the patient with isolated septic discitis caused by S. bovisinduced bacteremia. The patient was discharged after six weeks of antibiotic therapy.

Research paper thumbnail of Etanercept as a rescue agent in patient with adult onset Still’s disease complicated with congestive heart failure

Rheumatology International, 2008

Adult onset Still&amp... more Adult onset Still's disease (AOSD) is an uncommon disorder of unknown cause. The clinical symptoms of AOSD are a spiking fever, a typical rash, arthralgia or arthritis, sore throat, lymphadenopathy, and splenomegaly. Pleuropulmonary and cardiac involvement are rare. We report a patient with a two-year history of AOSD with myocarditis refractory to cyclosporine and glucocorticoid. Significant congestive heart failure due to left ventricle dysfunction and hyperferritinemia developed during the hospital course. After therapy with etanercept, the patient's clinical manifestations recovered and she regained normal left ventricular systolic function.

Research paper thumbnail of Nontyphoid Salmonella-infected mycotic aneurysm in a patient with rheumatoid arthritis

Rheumatology International, 2013

A 60-year-old male presented, and was admitted, to our hospital with a 1-week history of intermit... more A 60-year-old male presented, and was admitted, to our hospital with a 1-week history of intermittent chills and high fever. He has rheumatoid arthritis for 2 years with regular medication of hydroxychloroquine, methotrexate, sulfasalazine, and low-dose prednisolone (5 mg daily). The patient had a history of type 2 diabetes for which he was under regular medication. General malaise and dyspnea would occur during the episode of fever. On admission to our hospital, his blood pressure was 129/74 mm Hg, and his body temperature was 39°C. His heart sounds were normal with no murmur; the lungs were clear to auscultation. The abdomen was soft without palpable masses or tenderness; the liver and spleen were not palpable. The patient had mild back pain. A complete blood count revealed 9,000 leukocytes/lL and 221,000 platelets/uL, with mild anemia (hemoglobin: 9.4 g/dL). The C-reactive protein (CRP) level was 24.1 mg/dL (normal \0.5 mg/dL) and the erythrocyte sedimentation rate (ESR), 64 mm/h (normal \15 mm/h). Urine analysis and culture yielded negative results. Two blood cultures obtained before intravenous antibiotic administration tested positive for salmonella group D. No vegetations or signs of infective endocarditis were detected on transthoracic echocardiography. Computed tomography (CT) showed a saccular aneurysm arising from the abdominal aorta, with fatty stranding, free air-bubbles (arrow indicates air-bubbles and asterisk indicates aneurysm; ) and periaortic fluid accumulation . Mycotic aneurysm was confirmed. The patient received surgical management for debridement of abscess and intravenous ceftriaxone 2 gm daily continuously for 8 weeks. The patient had an excellent clinical response and was discharged 2 months later with no recurrence of fever.

Research paper thumbnail of Remitting seronegative symmetrical synovitis with pitting edema following acute intracranial hemorrhage

Rheumatology International, 2011

Research paper thumbnail of Usefulness of erythrocyte-bound C4d as a biomarker to predict disease activity in patients with systemic lupus erythematosus

Rheumatology, 2009

Objective. SLE is an autoimmune disorder characterized by abnormal complement activation. Numerou... more Objective. SLE is an autoimmune disorder characterized by abnormal complement activation. Numerous new biomarkers have recently been used to diagnose or monitor disease activity in patients with SLE. We checked the levels of erythrocyte-bound C4d (E-C4d), an activationderived fragment of C4 that is deposited on the erythrocytes, under different conditions of SLE in order to correlate these levels with disease activity. Methods. We conducted a cross-sectional investigation of three groups of patients: (i) 63 patients with SLE; (ii) 43 patients with other diseases; and (iii) 26 healthy controls. Erythrocytes were analysed by flow cytometry to determine the levels of E-C4d. Results. We found a significant elevation in the mean levels of E-C4d in SLE patients compared with patients with other diseases or healthy controls. In SLE patients, the levels of E-C4d were correlated with the SLEDAI and inversely correlated with serum C3/C4 levels. In the subgroup of SLE patients with haemolytic anaemia (HA), a significantly higher level of E-C4d was observed than that in SLE patients without HA. However, in SLE patients with HA, there was no correlation between the levels of E-C4d and other markers of disease activity, including SLEDAI and levels of anti-dsDNA, C3 and C4.

Research paper thumbnail of Neuropathic pain in hereditary coproporphyria

Pakistan Journal of Medical Sciences, 2013

Acute porphyrias are rare diseases with varying incidences worldwide. These diseases are disorder... more Acute porphyrias are rare diseases with varying incidences worldwide. These diseases are disorders of heme biosynthesis characterized by acute attacks of neurological symptoms. Acute porphyria should be considered in patients with unexplained abdominal pain or neurological damage. Clinical manifestations of acute porphyria are nonspecific and are associated with multiple organ systems. This report examines a rare case of an uncommon type of acute porphyria in a patient with an initial presentation of abdominal pain and progressive polyneuropathy.

Research paper thumbnail of Peripheral Arthritis Caused by Mycobacterium avium-intracellulare in a Patient With Ankylosing Spondylitis

JCR: Journal of Clinical Rheumatology, 2009

Research paper thumbnail of Increased Levels of Circulating Advanced Glycation End-Products in Menopausal Women with Osteoporosis

International Journal of Medical Sciences, 2000

Background: Advanced glycation end-products (AGEs) can accumulate in organs and tissues during ag... more Background: Advanced glycation end-products (AGEs) can accumulate in organs and tissues during ageing and diabetes. Increased levels of AGEs are found in the bone tissue of patients with osteoporosis. The purpose of this study was to evaluate circulating AGEs in patients with osteoporosis. Methods: We evaluated plasma AGEs, osteoporosis-related biomarkers, and bone mass in 82 menopausal women with osteoporosis or osteopenia, 16 young women with osteopenia, and 43 healthy women without osteoporosis or osteopenia. Results: Higher levels of serum AGEs were found in the osteoporosis or osteopenia group compared to healthy women (P < 0.0001). A negative correlation was observed between serum AGEs and lumbar spine bone density (BMD of lumbar spine, r = -0.249, P = 0.028; T-score of lumbar spine, r = -0.261, P = 0.021). Women with a increased level of serum AGEs (> 8.12 U/mL) had a 5.34-fold risk of osteopenia regarding lumbar spine T-score and a 3.31-fold risk of osteopenia regarding the hip T-score. Conclusion: Serum AGEs could be used to monitor the severity and progression of osteoporosis. An increased serum level of AGEs was associated with impaired bone formation and was a risk factor for the development of osteoporosis. Targeting AGEs may represent a novel therapeutic approach for primary or secondary osteoporosis.

Research paper thumbnail of Cecorectal intussusception induced by a cecal hamartoma

Abdominal Imaging, 2011

Cecorectal intussusception, a variant form of intussusception, occurs when the cecum enters throu... more Cecorectal intussusception, a variant form of intussusception, occurs when the cecum enters through the entire course of colon and reaches to the rectum. This condition is rare but often associated with a pathologic lead point. Here, we report a 13-year-old boy, featuring insidious abdominal discomfort and constipation for 1 month, who developed cecorectal intussusception. Before surgical intervention, multi-detector row computed tomography with reconstructed images demonstrated the route of cecorectal intussusception and identified a cecal fatcontaining tumor as the lead point. The patient received surgical reduction with resection of the cecal tumor. Final pathological diagnosis was a hamartoma of the cecum. The relevant literature pertaining to this condition is reviewed, and the possible pathophysiology of the condition discussed.

Research paper thumbnail of Pyogenic Baker cyst in a patient with psoriatic arthritis during etanercept therapy

Annals of Saudi medicine

Patients with psoriatic arthritis (PsA) are at increased risk of infection due to disease course ... more Patients with psoriatic arthritis (PsA) are at increased risk of infection due to disease course or treatment-related immunodeficiency. We describe a patient with a 10-year history of PsA, with arthritis of the right knee and pain and edema in the right calf, treated with the TNFa inhibitor etanercept for 6 months. Ultrasound showed accumulation of hypoechoic fluid, which was aspirated and was positive for staphylococcus and aspergillus. The patient recovered after surgical drainage and four weeks of antibiotic and antifungal therapy.

Research paper thumbnail of Oral administration of acarbose ameliorates imiquimod-induced psoriasis-like dermatitis in a mouse model

International Immunopharmacology, 2016

Psoriasis is a chronic autoimmune disease of undefined etiology that involves dysregulated interp... more Psoriasis is a chronic autoimmune disease of undefined etiology that involves dysregulated interplay between immune cells and keratinocytes. Acarbose was found to decrease inflammatory parameters in diabetic patients in addition to its anti-diabetic effects. Here, we report that imiquimod (IMQ)-induced epidermal hyperplasia and psoriasis like-inflammation were significantly inhibited by acarbose treatment. Real-time PCR showed that mRNA levels of the cytokines TNF-α, IL-6, IL-1β IL-17A, and IL-22 in skin were also decreased significantly by acarbose. In addition, we found that acarbose reduced infiltration of CD3(+) T cells and GR-1(+) neutrophils in lesional skin and also reduced the percentage of IL-17-producing CD4(+) T cells (Th17) and IL-17- and IL-22-producing γδ T cells in the spleen. In contrast, acarbose increased the frequency of IL-10-producing CD4(+) regulator Tr1 T cells in the spleen and small intestine. These results indicate that oral administration of acarbose can attenuate the severity of imiquimod-induced psoriasis with local and systemic anti-inflammatory and immune modulation effects, thus suggesting that acarbose is an effective therapeutic strategy for psoriasis regulation.

Research paper thumbnail of Multiple Thromboses in a Patient with Systemic Lupus Erythematosus after Splenectomy

Case Reports in Immunology, 2012

Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history... more Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history of fetal loss. Early diagnosis and adequate treatment is important to prevent multiple organ failures. Here, we described a woman with a two-year history of systemic lupus erythematosus with severe nephrotic syndrome, manifested multiple thrombi over the portal vein and the inferior vena cava, combined with acute renal infarction. The patient underwent splenectomy 10 months ago. Initially, she received anticoagulant treatment and low-dose glucocorticoid, but multiple organ failure progressed. After emergency plasma exchange followed by glucocorticoid pulse therapy, the patient recovered.

Research paper thumbnail of Expression of Complement Receptor Type 1 on Erythrocytes in Autoimmune Diseases

Journal of Molecular Biomarkers & Diagnosis, 2014

ABSTRACT Objective: The expression of complement receptor type 1 on different cells is associated... more ABSTRACT Objective: The expression of complement receptor type 1 on different cells is associated with autoimmunity. Erythrocyte-Complement Receptor Type 1 (E-CR1) is a candidate for early diagnosis of Systemic Lupus Erythematosus (SLE) and assessed the roles of disease activity. We evaluated the expression of E-CR1 in the patients with SLE and other autoimmune diseases. Methods: We conducted a cross-sectional investigation of 3 groups: (1) 36 patients with SLE; (2) 51 patients with other diseases including Rheumatoid Arthritis (RA), Sjögren’s syndrome, anti-phospholipid syndrome, Mixed Connective Tissue Disease (MCTD), Raynaud’s disease, ankylosing spondylitis, pulmonary Tuberculosis (TB); and (3) 26 healthy controls. Erythrocytes were analyzed by flow cytometry to determine levels of E-CR1. Results: We found a significant reduction in the mean levels of E-CR1 in SLE patients compared to patients with healthy controls (1.79 ± 0.16 versus 3.82 ± 0.32, P&lt;0.05). However, in patients with RA, MCTD, and TB, decreased E-CR1 levels were also observed. There was a statistically significant correlation between reduced levels of E-CR1 and SLE disease activity index (r=-0.326, P&lt;0.05). The E-CR1 levels were inversely correlated with urine daily protein loss (r=-0.364, P&lt;0.05). Conclusions: Although E-CR1 levels may be a useful diagnostic marker for SLE, a possible limitation is that no significant differences in E-CR1 levels were observed among patients with SLE, those with MCTD and TB. Overall, E-CR1 levels in SLE patients are related to disease activity index and reflect renal clearance through urine daily protein loss.

Research paper thumbnail of Cyclosporine for Adult Onset Still's Disease Flare with Hepatic Dysfunction

We report on a 27 year-old man with adult onset Still's disease (AOSD) who had a flare after two ... more We report on a 27 year-old man with adult onset Still's disease (AOSD) who had a flare after two years of management with methotrexate (MTX) and prednisolone. The clinical manifestations included hepatitis, jaundice, fever and atypical skin rash. Because of hepatitic dysfucntion, cyclosporine was prescribed instead of MTX. After therapy with cyclosporine, the patient recovered with improved liver enzymes and clinical features.

Research paper thumbnail of Analysis of Erythrocyte C4d to Complement Receptor 1 Ratio: Use in Distinguishing between Infection and Flare-Up in Febrile Patients with Systemic Lupus Erythematosus

BioMed Research International, 2015

Fever in systemic lupus erythematosus (SLE) can be caused by infection or flare-up of the disease... more Fever in systemic lupus erythematosus (SLE) can be caused by infection or flare-up of the disease. This study aimed to determine whether the ratio of the level of erythrocyte-bound C4d to that of complement receptor 1 (C4d/CR1) can serve as a useful biomarker in the differentiation between infection and flare-up in febrile SLE patients. We enrolled febrile SLE patients and determined the ratio on the day of admission. The patients were divided into 2 groups according to the subsequent clinical course. Among the febrile SLE patients, those with flare-up had higher ratios and lower C-reactive protein (CRP) levels than those with infection. Cut-off values of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1.2447 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;4.67 for C4d/CR1 ratio and CRP, respectively, were 40.91% sensitive and 100.0% specific for the presence of infection in febrile SLE patients; similarly, cut-off values of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1.2447 and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2.2, respectively, were 80% sensitive and 100% specific for the absence of infection in febrile SLE patients. The C4d/CR1 ratio is a simple and quickly determinable biomarker that enables the differentiation between infection and flare-up in febrile SLE patients at initial evaluation. Further, when combined with the CRP level, it is useful to evaluate disease activity in SLE patients with infection.

Research paper thumbnail of Chylous Ascites and Pleural Transudate: Rare Presentations in Systemic Lupus Erythematosus in Old Age

Case Reports in Immunology, 2012

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with involvement of multiple... more Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with involvement of multiple organs. Various forms of serositis, including pleural effusion, pericardial effusion, and ascites, may be found during the course of SLE. Peritoneal involvement by ascites is common in the initial presentation of SLE. However, chylous ascites is uncommon in SLE patients. Here, we describe a 93-year-old female with initial presentation of chylous ascites during SLE flares. Marked distention and an ovoid shape of the abdomen were observed. Shifting dullness and central tympanic sounds were found on percussion. Rales were heard in bilateral breathing sounds, multiple oral ulcers appeared in the oral cavity, and chest images showed bilateral pleural effusion. Abdominal sonography revealed moderate ascites and pleural effusion. Neither organisms nor malignant cells were revealed in the culture or cytology of ascites and pleural effusion. The diagnosis of SLE was arrived at by positive antinuclear antibody (ANA), discoid rash, oral ulcers, serositis (pleural effusion and ascites), and proteinuria. The patient received intravenous methylprednisolone 250 mg/day for three days. The pleural effusion resolved dramatically after steroid therapy and abdominal distention related to ascites formation subsided obviously.

Research paper thumbnail of Advanced glycation end products induce T cell apoptosis: Involvement of oxidative stress, caspase and the mitochondrial pathway

Mechanisms of ageing and development

Accumulation of advanced glycation end products (AGEs) is a hallmark in aged people. T cells play... more Accumulation of advanced glycation end products (AGEs) is a hallmark in aged people. T cells play important roles in maintaining homeostasis of immune function. This study investigated the effects of AGEs-bovine serum albumin (AGEs) in human T cells. Incubation of Jurkat and several immortalized T cell lines with AGEs resulted in cell death dose-dependently. AGEs-induced cell death was partially but significantly blocked by neutralizing antibodies recognizing receptor of AGEs. In addition to detecting DNA nick, simultaneous stainings of annexin V with 7-amino-actinomycin D further confirmed the apoptotic nature of cell death. AGEs also caused apoptosis in purified T cells. Although AGEs-induced apoptosis could be blocked by the pan-caspase inhibitor, Ala-Asp-fluomethyl ketone (Z-VAD-fmk), there was no activation of caspase-3, -5, -8 and -9. AGEs caused mitochondrial outer membrane permeabilization and this process was prevented by an antioxidant or Z-VAD-fmk. Furthermore, AGEs treat...

Research paper thumbnail of Baker's Cyst With Bacterial Infection in a Patient with Recently Diagnosed Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder characterized by the product... more Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder characterized by the production of numerous pathologic autoantibodies. Patients with SLE are at increased risk of infection because of the disease course or treatment- related immunodeficiency. Infection is a major cause of morbidity and mortality among patients with SLE. Infected Baker's cyst (BC) can occur in patients with trauma, and degenerative or inflammatory arthritis, but is rarely described in SLE patients. We describe the case of a 22-year-old woman with a three-month history of SLE who did not receive any immunosuppressive treatment after diagnosis. Initial manifestations included fever, tachycardia, and hypotension with pain and edema in her left calf. Magnetic resonance imaging revealed a large BC with thickening of the adjacent subcutaneous layer of the calf. Turbid fluids were aspirated from the cyst, and methicillin-susceptible Staphylococcus aureus was cultured. She received antibiotic therapy...

Research paper thumbnail of Significantly Higher Percentage of Circulating CD27 high Plasma Cells in Systemic Lupus Erythematosus Patients with Infection than with Disease Flare-Up

Yonsei Medical Journal, 2010

Research paper thumbnail of Useful biomarkers for assessment of hepatitis C virus infection-associated autoimmune disorders

World Journal of Gastroenterology, 2014

During the course of chronic hepatitis C virus (HCV) infection, various extrahepatic manifestatio... more During the course of chronic hepatitis C virus (HCV) infection, various extrahepatic manifestations of autoimmune disorders may occur, including arthralgia/arthritis, sicca complex, purpura, cutaneous ulcer, and thyroid dysfunction. In addition, the prevalence of circulating autoantibodies is high among patients with HCV infection. Commonly detected autoantibodies in HCVinfected patients include rheumatoid factor, antinuclear antibody, anti-SSA/anti-SSB antibody, cryoglobulin, antineutrophil cytoplasmic antibody, anti-smooth muscle antibody, anti-liver and anti-thyroid autoantibodies.

Research paper thumbnail of Isolated Septic Discitis Associated with Streptococcus bovis Bacteremia

Southern Medical Journal, 2011

Streptococcus bovis is a Gram-positive coccus that can be found in the intestinal flora of health... more Streptococcus bovis is a Gram-positive coccus that can be found in the intestinal flora of healthy people; it is also associated with colon cancer and infective endocarditis. We report on a 79-yearold male who initially presented with acute-onset lower back pain. Streptococcus bovis was detected in repeated blood cultures, and magnetic resonance imaging of the lumbar spine revealed septic discitis of the L2YL3 intervertebral disc. Excision and debridement of the intervertebral disc was performed and a tissue culture tested positive for S. bovis. Repeat echocardiography and colonoscopy showed no signs of vegetation or tumor lesions, respectively. We diagnosed the patient with isolated septic discitis caused by S. bovisinduced bacteremia. The patient was discharged after six weeks of antibiotic therapy.

Research paper thumbnail of Etanercept as a rescue agent in patient with adult onset Still’s disease complicated with congestive heart failure

Rheumatology International, 2008

Adult onset Still&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more Adult onset Still&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AOSD) is an uncommon disorder of unknown cause. The clinical symptoms of AOSD are a spiking fever, a typical rash, arthralgia or arthritis, sore throat, lymphadenopathy, and splenomegaly. Pleuropulmonary and cardiac involvement are rare. We report a patient with a two-year history of AOSD with myocarditis refractory to cyclosporine and glucocorticoid. Significant congestive heart failure due to left ventricle dysfunction and hyperferritinemia developed during the hospital course. After therapy with etanercept, the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinical manifestations recovered and she regained normal left ventricular systolic function.

Research paper thumbnail of Nontyphoid Salmonella-infected mycotic aneurysm in a patient with rheumatoid arthritis

Rheumatology International, 2013

A 60-year-old male presented, and was admitted, to our hospital with a 1-week history of intermit... more A 60-year-old male presented, and was admitted, to our hospital with a 1-week history of intermittent chills and high fever. He has rheumatoid arthritis for 2 years with regular medication of hydroxychloroquine, methotrexate, sulfasalazine, and low-dose prednisolone (5 mg daily). The patient had a history of type 2 diabetes for which he was under regular medication. General malaise and dyspnea would occur during the episode of fever. On admission to our hospital, his blood pressure was 129/74 mm Hg, and his body temperature was 39°C. His heart sounds were normal with no murmur; the lungs were clear to auscultation. The abdomen was soft without palpable masses or tenderness; the liver and spleen were not palpable. The patient had mild back pain. A complete blood count revealed 9,000 leukocytes/lL and 221,000 platelets/uL, with mild anemia (hemoglobin: 9.4 g/dL). The C-reactive protein (CRP) level was 24.1 mg/dL (normal \0.5 mg/dL) and the erythrocyte sedimentation rate (ESR), 64 mm/h (normal \15 mm/h). Urine analysis and culture yielded negative results. Two blood cultures obtained before intravenous antibiotic administration tested positive for salmonella group D. No vegetations or signs of infective endocarditis were detected on transthoracic echocardiography. Computed tomography (CT) showed a saccular aneurysm arising from the abdominal aorta, with fatty stranding, free air-bubbles (arrow indicates air-bubbles and asterisk indicates aneurysm; ) and periaortic fluid accumulation . Mycotic aneurysm was confirmed. The patient received surgical management for debridement of abscess and intravenous ceftriaxone 2 gm daily continuously for 8 weeks. The patient had an excellent clinical response and was discharged 2 months later with no recurrence of fever.

Research paper thumbnail of Remitting seronegative symmetrical synovitis with pitting edema following acute intracranial hemorrhage

Rheumatology International, 2011

Research paper thumbnail of Usefulness of erythrocyte-bound C4d as a biomarker to predict disease activity in patients with systemic lupus erythematosus

Rheumatology, 2009

Objective. SLE is an autoimmune disorder characterized by abnormal complement activation. Numerou... more Objective. SLE is an autoimmune disorder characterized by abnormal complement activation. Numerous new biomarkers have recently been used to diagnose or monitor disease activity in patients with SLE. We checked the levels of erythrocyte-bound C4d (E-C4d), an activationderived fragment of C4 that is deposited on the erythrocytes, under different conditions of SLE in order to correlate these levels with disease activity. Methods. We conducted a cross-sectional investigation of three groups of patients: (i) 63 patients with SLE; (ii) 43 patients with other diseases; and (iii) 26 healthy controls. Erythrocytes were analysed by flow cytometry to determine the levels of E-C4d. Results. We found a significant elevation in the mean levels of E-C4d in SLE patients compared with patients with other diseases or healthy controls. In SLE patients, the levels of E-C4d were correlated with the SLEDAI and inversely correlated with serum C3/C4 levels. In the subgroup of SLE patients with haemolytic anaemia (HA), a significantly higher level of E-C4d was observed than that in SLE patients without HA. However, in SLE patients with HA, there was no correlation between the levels of E-C4d and other markers of disease activity, including SLEDAI and levels of anti-dsDNA, C3 and C4.

Research paper thumbnail of Neuropathic pain in hereditary coproporphyria

Pakistan Journal of Medical Sciences, 2013

Acute porphyrias are rare diseases with varying incidences worldwide. These diseases are disorder... more Acute porphyrias are rare diseases with varying incidences worldwide. These diseases are disorders of heme biosynthesis characterized by acute attacks of neurological symptoms. Acute porphyria should be considered in patients with unexplained abdominal pain or neurological damage. Clinical manifestations of acute porphyria are nonspecific and are associated with multiple organ systems. This report examines a rare case of an uncommon type of acute porphyria in a patient with an initial presentation of abdominal pain and progressive polyneuropathy.

Research paper thumbnail of Peripheral Arthritis Caused by Mycobacterium avium-intracellulare in a Patient With Ankylosing Spondylitis

JCR: Journal of Clinical Rheumatology, 2009

Research paper thumbnail of Increased Levels of Circulating Advanced Glycation End-Products in Menopausal Women with Osteoporosis

International Journal of Medical Sciences, 2000

Background: Advanced glycation end-products (AGEs) can accumulate in organs and tissues during ag... more Background: Advanced glycation end-products (AGEs) can accumulate in organs and tissues during ageing and diabetes. Increased levels of AGEs are found in the bone tissue of patients with osteoporosis. The purpose of this study was to evaluate circulating AGEs in patients with osteoporosis. Methods: We evaluated plasma AGEs, osteoporosis-related biomarkers, and bone mass in 82 menopausal women with osteoporosis or osteopenia, 16 young women with osteopenia, and 43 healthy women without osteoporosis or osteopenia. Results: Higher levels of serum AGEs were found in the osteoporosis or osteopenia group compared to healthy women (P < 0.0001). A negative correlation was observed between serum AGEs and lumbar spine bone density (BMD of lumbar spine, r = -0.249, P = 0.028; T-score of lumbar spine, r = -0.261, P = 0.021). Women with a increased level of serum AGEs (> 8.12 U/mL) had a 5.34-fold risk of osteopenia regarding lumbar spine T-score and a 3.31-fold risk of osteopenia regarding the hip T-score. Conclusion: Serum AGEs could be used to monitor the severity and progression of osteoporosis. An increased serum level of AGEs was associated with impaired bone formation and was a risk factor for the development of osteoporosis. Targeting AGEs may represent a novel therapeutic approach for primary or secondary osteoporosis.

Research paper thumbnail of Cecorectal intussusception induced by a cecal hamartoma

Abdominal Imaging, 2011

Cecorectal intussusception, a variant form of intussusception, occurs when the cecum enters throu... more Cecorectal intussusception, a variant form of intussusception, occurs when the cecum enters through the entire course of colon and reaches to the rectum. This condition is rare but often associated with a pathologic lead point. Here, we report a 13-year-old boy, featuring insidious abdominal discomfort and constipation for 1 month, who developed cecorectal intussusception. Before surgical intervention, multi-detector row computed tomography with reconstructed images demonstrated the route of cecorectal intussusception and identified a cecal fatcontaining tumor as the lead point. The patient received surgical reduction with resection of the cecal tumor. Final pathological diagnosis was a hamartoma of the cecum. The relevant literature pertaining to this condition is reviewed, and the possible pathophysiology of the condition discussed.