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Wu YM, Hu RH, Lai HS, Lee PH. Robotic-assisted minimally invasive liver resection. Asian J Surg 2014; 37:53-7. [PMID: 24642128 DOI: 10.1016/j.asjsur.2014.01.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/24/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Minimally invasive liver resection is feasible for select patients. The flexibility of robotic surgical instruments improves the possibility of minimally invasive liver resection, even in challenging major liver resection. MATERIALS AND METHODS We accumulated 69 patients who underwent pure laparoscopic liver resection from 2007 to 2011, and 52 patients who underwent robotic-assisted minimally invasive liver resection in 2012. The patients' characteristics, surgical procedures, and perioperative parameters were described and compared between these two groups. RESULTS In 2012, we performed 56 robotic hepatobiliary procedures, which included 52 (92%) robotic-assisted minimally invasive liver resection procedures. Under the assistance of a robotic system, we increased the number of patients undergoing minimally invasive liver resection by more than twofold, and we increased the percentage of minimally invasive surgery for patients with fresh hepatocellular carcinoma, compared to our laparoscopic group (44% vs. 15%, respectively). We also increased the percentage of major hepatectomy for minimally invasive liver resection by a robotic approach (39% vs. 15%) with a comparable conversion rate (5%) and morbidity (8%), compared to the laparoscopic group. We can even perform a challenging living donor liver harvest procedure with a robotic-assisted minimally invasive approach. CONCLUSION Robotic assistance increased the percentage of minimally invasive liver resections and the percentage of major minimally invasive liver resections with comparable perioperative results. Robotic-assisted minimally invasive liver resection is feasible, but its role needs more accumulated experience to clarify.
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Hung TM, Ho CM, Liu YC, Lee JL, Liao YR, Wu YM, Ho MC, Chen CH, Lai HS, Lee PH. Up-regulation of microRNA-190b plays a role for decreased IGF-1 that induces insulin resistance in human hepatocellular carcinoma. PLoS One 2014; 9:e89446. [PMID: 24586785 PMCID: PMC3930738 DOI: 10.1371/journal.pone.0089446] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/20/2014] [Indexed: 02/08/2023] Open
Abstract
Background & Aims Insulin-like growth factor, (IGF)-1, is produced mainly by the liver and plays important roles in promoting growth and regulating metabolism. Previous study reported that development of hepatocellular carcinoma (HCC) was accompanied by a significant reduction in serum IGF-1 levels. Here, we hypothesized that dysregulation of microRNAs (miRNA) in HCC can modulate IGF-1 expression post-transcriptionally. Methods The miRNAs expression profiles in a dataset of 29 HCC patients were examined using illumina BeadArray. Specific miRNA (miR)-190b, which was significantly up-regulated in HCC tumor tissues when compared with paired non-tumor tissues, was among those predicted to interact with 3′-untranslated region (UTR) of IGF-1. In order to explore the regulatory effects of miR-190b on IGF-1 expression, luciferase reporter assay, quantitative real-time PCR, western blotting and immunofluorecence analysis were performed in HCC cells. Results Overexpression of miR-190b in Huh7 cells attenuated the expression of IGF-1, whereas inhibition of miR-190b resulted in up-regulation of IGF-1. Restoration of IGF-1 expression reversed miR-190b-mediated impaired insulin signaling in Huh7 cells, supporting that IGF-1 was a direct and functional target of miR-190b. Additionally, low serum IGF-1 level was associated with insulin resistance and poor overall survival in HCC patients. Conclusions Increased expression of miR-190 may cause decreased IGF-1 in HCC development. Insulin resistance appears to be a part of the physiopathologic significance of decreased IGF-1 levels in HCC progression. This study provides a novel miRNA-mediated regulatory mechanism for controlling IGF-1 expression in HCC and elucidates the biological relevance of this interaction in HCC.
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MESH Headings
- Adult
- Apoptosis
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Blotting, Western
- Carcinoma, Hepatocellular/genetics
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/mortality
- Carcinoma, Hepatocellular/pathology
- Case-Control Studies
- Cell Proliferation
- Enzyme-Linked Immunosorbent Assay
- Female
- Fluorescent Antibody Technique
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Humans
- Immunoenzyme Techniques
- Insulin Resistance
- Insulin-Like Growth Factor I/metabolism
- Liver Neoplasms/genetics
- Liver Neoplasms/metabolism
- Liver Neoplasms/mortality
- Liver Neoplasms/pathology
- Male
- MicroRNAs/genetics
- Middle Aged
- Oligonucleotide Array Sequence Analysis
- Prognosis
- RNA, Messenger/genetics
- Real-Time Polymerase Chain Reaction
- Reverse Transcriptase Polymerase Chain Reaction
- Survival Rate
- Tumor Cells, Cultured
- Up-Regulation
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Tsai MK, Lee CY, Yang CY, Yeh CC, Hu RH, Lai HS. Robot-assisted renal transplantation in the retroperitoneum. Transpl Int 2014; 27:452-7. [PMID: 24471482 DOI: 10.1111/tri.12279] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/05/2014] [Accepted: 01/23/2014] [Indexed: 01/13/2023]
Abstract
Minimally invasive surgery for renal transplantation is still under development. We employed the robotic surgical system to perform renal transplantation with a minimally invasive wound. The operation was performed with a Gibson incision and two working ports. The space for the transplantation was created by retroperitoneal dissection with the robot lifting the abdominal wall. Vascular reconstruction was performed with two robotic needle drivers. We successfully performed robot-assisted renal transplantation in five female and five male patients with an average wound length of 7.7 ± 1.04 cm. Nine of the renal allografts functioned immediately, but one with prolonged warm ischemia during the live donor nephrectomy had delayed function. The average creatinine level and estimated glomerular filtration rate at discharge were 1.31 ± 0.31 mg/dl and 58.2 ± 8.1 ml/min, respectively. All the transplants are currently functioning at 6.9 ± 3.9 months after operations. In conclusion, with robot assistance, minimal invasive renal transplantation can be performed successfully in the retroperitoneum.
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Chen KC, Chen HY, Lin JW, Tseng YT, Kuo SW, Huang PM, Hsu HH, Lee JM, Chen JS, Lai HS. Acute thoracic empyema: clinical characteristics and outcome analysis of video-assisted thoracoscopic surgery. J Formos Med Assoc 2014; 113:210-8. [PMID: 24512757 DOI: 10.1016/j.jfma.2013.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/27/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/PURPOSE Acute thoracic empyema is a common clinical problem worldwide, resulting in substantial morbidity and mortality. The objective of this study was to report its clinical characteristics and to evaluate whether thoracoscopic surgery is associated with a lower rate of in-hospital mortality compared with nonoperative drainage. METHODS Between 2001 and 2010, we retrospectively reviewed the clinical characteristics, bacteriological studies, and treatment outcomes of 602 patients with acute thoracic empyema. Thoracoscopic surgery was performed in 417 (69.2%) patients, while the remaining patients underwent nonoperative drainage. After treatment, 77 patients (12.8%) died in the hospital. A propensity score-based process, matched on potential risk factors for in-hospital mortality, was performed to select patients with equalized potential prognostic factors in the thoracoscopy and nonoperative groups. The log-rank test was used to compare the survival time with discharge between the two matched groups. RESULTS Multivariate analysis showed that age, malignancy, chronic lung disease, chronic renal insufficiency, liver cirrhosis, polymicrobial infection, and positive bacterial culture were risk factors for in-hospital mortality. The propensity score-matched analysis showed that the in-hospital mortality difference was significant (p = 0.014) and the Kaplan-Meier survival analysis revealed a higher survival rate to discharge (p < 0.001 by log-rank test), both favoring thoracoscopy over nonoperative drainage. CONCLUSION Acute thoracic empyema carries a high mortality rate, especially in elderly patients with coexisting medical conditions and polymicrobial and positive bacterial cultures. Our study results also showed that thoracoscopy is feasible and might provide better chances for survival in borderline operable patients than nonoperative drainage.
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Huang APH, Tsai JC, Kuo LT, Lee CW, Lai HS, Tsai LK, Huang SJ, Chen CM, Chen YS, Chuang HY, Wintermark M. Clinical application of perfusion computed tomography in neurosurgery. J Neurosurg 2013; 120:473-88. [PMID: 24266541 DOI: 10.3171/2013.10.jns13103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECT Currently, perfusion CT (PCT) is a valuable imaging technique that has been successfully applied to the clinical management of patients with ischemic stroke and aneurysmal subarachnoid hemorrhage (SAH). However, recent literature and the authors' experience have shown that PCT has many more important clinical applications in a variety of neurosurgical conditions. Therefore, the authors share their experiences of its application in various diseases of the cerebrovascular, neurotraumatology, and neurooncology fields and review the pertinent literature regarding expanding PCT applications for neurosurgical conditions, including pitfalls and future developments. METHODS A pertinent literature search was conducted of English-language articles describing original research, case series, and case reports from 1990 to 2011 involving PCT and with relevance and applicability to neurosurgical disorders. RESULTS In the cerebrovascular field, PCT is already in use as a diagnostic tool for patients suspected of having an ischemic stroke. Perfusion CT can be used to identify and define the extent of the infarct core and ischemic penumbra core, and thus aid patient selection for acute reperfusion therapy. For patients with aneurysmal SAH, PCT provides assessment of early brain injury, cerebral ischemia, and infarction, in addition to vasospasm. It may also be used to aid case selection for aggressive treatment of patients with poor SAH grade. In terms of oncological applications, PCT can be used as an imaging biomarker to assess angiogenesis and response to antiangiogenetic treatments, differentiate between glioma grades, and distinguish recurrent tumor from radiation necrosis. In the setting of traumatic brain injury, PCT can detect and delineate contusions at an early stage. In patients with mild head injury, PCT results have been shown to correlate with the severity and duration of postconcussion syndrome. In patients with moderate or severe head injury, PCT results have been shown to correlate with patients' functional outcome. CONCLUSIONS Perfusion CT provides quantitative and qualitative data that can add diagnostic and prognostic value in a number of neurosurgical disorders, and also help with clinical decision making. With emerging new technical developments in PCT, such as characterization of blood-brain barrier permeability and whole-brain PCT, this technique is expected to provide more and more insight into the pathophysiology of many neurosurgical conditions.
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Chen PD, Tsai MK, Lee CY, Yang CY, Hu RH, Lee PH, Lai HS. Gender differences in renal transplant graft survival. J Formos Med Assoc 2013; 112:783-8. [PMID: 24246256 DOI: 10.1016/j.jfma.2013.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/17/2013] [Accepted: 10/04/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE A long-term retrospective study was conducted to assess the risk factors of renal transplant graft failure focusing on the effects of gender of both the donor and the recipient. METHODS Medical records of primary renal transplantation performed in a single transplant hospital were reviewed. Cases of ABO incompatibility, positive cross-matches, or multiple organ transplants were excluded. A total of 766 patient records were reviewed, and variables were analyzed with Kaplan-Meier survival curves and Cox regression to determine the independent factors associated with graft survival. RESULTS The overall 5-year graft and patient survival rates were 84.7% and 92.2%, respectively. Univariate analysis showed significantly poorer prognosis in male patients and in those with acute rejection, delayed function, or more mismatches in human lymphocyte antigens. Multivariate analysis with step-wise regression identified three independent prognostic factors for poor graft survival (male gender, acute rejection, and delayed function). The 5-year graft survival rates for female and male patients were 87.9% and 81.3%, respectively. The risk ratio of graft failure for male renal transplant recipients was 1.3732, when compared with that for female patients. The risk ratios for those with acute rejection and delayed function were 1.8330 and 1.5422, respectively. CONCLUSION Male gender, in addition to acute rejection and delayed function, was found to be an independent prognostic factor for poor renal transplant survival in this long-term retrospective study.
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Li YI, Hung JS, Yu TY, Liou JM, Wei JN, Kao HL, Chuang LM, Shun CT, Lee PH, Lai HS, Su CY, Li HY, Liang JT. Serum vascular adhesion protein-1 predicts all-cause mortality and cancer-related mortality in subjects with colorectal cancer. Clin Chim Acta 2013; 428:51-6. [PMID: 24211727 DOI: 10.1016/j.cca.2013.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Vascular adhesion protein-1 (VAP-1) participates in inflammation and catalyzes the breakdown of amines to produce aldehyde, hydrogen peroxide, and ammonia. Serum VAP-1 can predict cancer mortality, including colorectal cancer (CRC) mortality, in type 2 diabetic subjects. However, it remains unknown if serum VAP-1 can predict mortality in CRC patients. This prospective cohort study investigates if serum VAP-1 is a novel biomarker for mortality prediction in CRC. METHODS We enrolled 300 CRC patients. Preoperative serum VAP-1 was measured by time-resolved immunofluorometric assay. They were followed until September 2009 or death, which was ascertained by the National Death Registration System. RESULTS The median follow-up period was 4.7 years. Compared with normal counterpart, VAP-1 immunoactivity was upregulated in CRC tissues, especially at the invasion front. Serum VAP-1 can independently predict all-cause mortality (HR: 1.0026, 95% CI: 1.0003-1.0050, P<0.05) and cancer-related mortality (HR: 1.0026, 95% CI: 1.0001-1.0050, P<0.05). A risk score composed of age, gender, carcinoembryonic antigen (CEA) >5 ng/ml, tumor grading, tumor staging, and serum VAP-1 could stratify CRC patients into low-, intermediate-, and high-risk subgroups, with a 5-year mortality rate of 10%, 34%, and 78%, respectively. CONCLUSIONS Serum VAP-1 predicts mortality independently and improves risk stratification in CRC subjects.
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Lin PH, Chao TL, Kuo SW, Wang JT, Hung CC, Lin HC, Yang ZY, Ho SY, Chang CK, Huang MS, Chen HH, Chen YC, Lai HS, Chang SY, Chang SC, Yang PC. Virological, Serological, and Antiviral Studies in an Imported Human Case of Avian Influenza A(H7N9) Virus in Taiwan. Clin Infect Dis 2013; 58:242-6. [DOI: 10.1093/cid/cit638] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Liu TJ, Lin MW, Hsieh MS, Kao MW, Chen KC, Chang CC, Kuo SW, Huang PM, Hsu HH, Chen JS, Lai HS, Lee JM. Video-Assisted Thoracoscopic Surgical Thymectomy to Treat Early Thymoma: A Comparison with the Conventional Transsternal Approach. Ann Surg Oncol 2013; 21:322-8. [DOI: 10.1245/s10434-013-3228-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Indexed: 11/18/2022]
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Yu HJ, Lai HS, Chen KH, Chou HC, Wu JM, Dorjgochoo S, Mendjargal A, Altangerel E, Tien YW, Hsueh CW, Lai F. A sharable cloud-based pancreaticoduodenectomy collaborative database for physicians: emphasis on security and clinical rule supporting. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2013; 111:488-497. [PMID: 23706526 DOI: 10.1016/j.cmpb.2013.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 04/27/2013] [Accepted: 04/29/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is a major operation with high complication rate. Thereafter, patients may develop morbidity because of the complex reconstruction and loss of pancreatic parenchyma. A well-designed database is very important to address both the short-term and long-term outcomes after PD. OBJECTIVE The objective of this research was to build an international PD database implemented with security and clinical rule supporting functions, which made the data-sharing easier and improve the accuracy of data. METHODS The proposed system is a cloud-based application. To fulfill its requirements, the system comprises four subsystems: a data management subsystem, a clinical rule supporting subsystem, a short message notification subsystem, and an information security subsystem. After completing the surgery, the physicians input the data retrospectively, which are analyzed to study factors associated with post-PD common complications (delayed gastric emptying and pancreatic fistula) to validate the clinical value of this system. RESULTS Currently, this database contains data from nearly 500 subjects. Five medical centers in Taiwan and two cancer centers in Mongolia are participating in this study. A data mining model of the decision tree analysis showed that elderly patients (>76 years) with pylorus-preserving PD (PPPD) have higher proportion of delayed gastric emptying. About the pancreatic fistula, the data mining model of the decision tree analysis revealed that cases with non-pancreaticogastrostomy (PG) reconstruction - body mass index (BMI)>29.65 or PG reconstruction - BMI>23.7 - non-classic PD have higher proportion of pancreatic fistula after PD. CONCLUSIONS The proposed system allows medical staff to collect and store clinical data in a cloud, sharing the data with other physicians in a secure manner to achieve collaboration in research.
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Wu YM, Liu CH, Huang MJ, Lai HS, Lee PH, Hu RH, Huang MC. C1GALT1 enhances proliferation of hepatocellular carcinoma cells via modulating MET glycosylation and dimerization. Cancer Res 2013; 73:5580-90. [PMID: 23832667 DOI: 10.1158/0008-5472.can-13-0869] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Altered glycosylation is a hallmark of cancer. The core 1 β1,3-galactosyltransferase (C1GALT1) controls the formation of mucin-type O-glycans, far overlooked and underestimated in cancer. Here, we report that C1GALT1 mRNA and protein are frequently overexpressed in hepatocellular carcinoma tumors compared with nontumor liver tissues, where it correlates with advanced tumor stage, metastasis, and poor survival. Enforced expression of C1GALT1 was sufficient to enhance cell proliferation, whereas RNA interference-mediated silencing of C1GALT1 was sufficient to suppress cell proliferation in vitro and in vivo. Notably, C1GALT1 attenuation also suppressed hepatocyte growth factor (HGF)-mediated phosphorylation of the MET kinase in hepatocellular carcinoma cells, whereas enforced expression of C1GALT1 enhanced MET phosphorylation. MET blockade with PHA665752 inhibited C1GALT1-enhanced cell viability. In support of these results, we found that the expression level of phospho-MET and C1GALT1 were associated in primary hepatocellular carcinoma tissues. Mechanistic investigations showed that MET was decorated with O-glycans, as revealed by binding to Vicia villosa agglutinin and peanut agglutinin. Moreover, C1GALT1 modified the O-glycosylation of MET, enhancing its HGF-induced dimerization and activation. Together, our results indicate that C1GALT1 overexpression in hepatocellular carcinoma activates HGF signaling via modulation of MET O-glycosylation and dimerization, providing new insights into how O-glycosylation drives hepatocellular carcinoma pathogenesis.
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Tsai CF, Hsiao CH, Lee JM, Chen KC, Shieh MJ, Lai HS, Chen JS. Video-assisted thoracoscopic surgery for recurrent pneumothorax in pulmonary lymphangioleimyomatosis with tuberous sclerosis complex. J Cardiothorac Surg 2013; 8:101. [PMID: 23597154 PMCID: PMC3639072 DOI: 10.1186/1749-8090-8-101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 03/26/2013] [Indexed: 11/10/2022] Open
Abstract
Pneumothorax in pulmonary lymphangioleiomyomatosis (LAM) with tuberous sclerosis complex (TSC) is a difficult condition to manage. Video-assisted thoracoscopic surgery (VATS) may play a role in diagnosis and treatment of this situation. We present a case of right recurrent pneumothorax due to LAM with TSC in whom VATS was performed for pathological diagnosis and mechanical pleurodesis. The unique presentation of LAM in TSC was also discussed.
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Chen JS, Chan WK, Tsai KT, Hsu HH, Lin CY, Yuan A, Chen WJ, Lai HS, Yang PC. Simple aspiration and drainage and intrapleural minocycline pleurodesis versus simple aspiration and drainage for the initial treatment of primary spontaneous pneumothorax: an open-label, parallel-group, prospective, randomised, controlled trial. Lancet 2013; 381:1277-82. [PMID: 23489754 DOI: 10.1016/s0140-6736(12)62170-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Simple aspiration and drainage is a standard initial treatment for primary spontaneous pneumothorax, but the rate of pneumothorax recurrence is substantial. We investigated whether additional minocycline pleurodesis after simple aspiration and drainage reduces the rate of recurrence. METHODS In our open-label, parallel-group, prospective, randomised, controlled trial at two hospitals in Taiwan, patients were aged 15-40 years and had a first episode of primary spontaneous pneumothorax with a rim of air greater than 2 cm on chest radiographs, complete lung expansion without air leakage after pigtail catheter drainage, adequate haematological function, and normal renal and hepatic function. After simple aspiration and drainage via a pigtail catheter, patients were randomly assigned (1:1) to receive 300 mg of minocycline pleurodesis or no further treatment (control group). Randomisation was by computer-generated random numbers in sealed envelopes. Our primary endpoint was rate of pneumothorax recurrence at 1 year. This trial is registered with ClinicalTrials.gov (NCT00418392). FINDINGS Between Dec 31, 2006, and June 30, 2012, 214 patients were randomly assigned-106 to the minocycline group and 108 to the control group (intention-to-treat population). Treatment was unsuccessful within 7 days of randomisation in 14 patients in the minocycline group and 20 patients in the control group. At 1 year, pneumothoraces had recurred in 31 of 106 (29·2%) patients in the minocycline group compared with 53 of 108 (49·1%) in the control group (p=0·003). We noted no procedure-related complications in either group. INTERPRETATION Simple aspiration and drainage followed by minocycline pleurodesis is a safe and more effective treatment for primary spontaneous pneumothorax than is simple aspiration and drainage only. Minocycline pleurodesis should be an adjunct to standard treatment for primary spontaneous pneumothorax. FUNDING Department of Health and National Science Council, Taiwan.
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Liang JT, Cheng JCH, Huang KC, Lai HS, Sun CT. Comparison of tumor recurrence between laparoscopic total mesorectal excision with sphincter preservation and laparoscopic abdominoperineal resection for low rectal cancer. Surg Endosc 2013; 27:3452-64. [PMID: 23508815 DOI: 10.1007/s00464-013-2898-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 02/15/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND By traditional open surgery, the tumor recurrence rate of total mesorectal excision with sphincter-preserving procedure was lower than that of abdominoperineal resection (APR) for the treatment of low rectal cancer. The present study aimed to rescrutinize whether the same conclusion can be drawn when both surgical procedures are performed laparoscopically. METHODS We retrospectively reviewed the prospectively recorded clinicopathologic data of 344 consecutive patients with low rectal cancer, in which 170 patients underwent preoperative chemoradiotherapy followed by laparoscopic total mesorectal excision (TME), whereas 174 patients underwent laparoscopic TME directly without chemoradiotherapy. Such patients were further stratified according to the pathologic tumor, node, metastasis stage (stage II or III disease) and surgical strategy (APR or sphincter-preserving operation [SPO]). The surgical procedures are presented in supplemental videos. The disease-free survival, recurrence patterns, and functional recovery of patient groups stratified as appropriate were compared. RESULTS In patients who received preoperative chemoradiotherapy, the estimated recurrence rate were similar between laparoscopic TME with SPO and laparoscopic APR with 10.6%, 7 of 66, versus 18.5%, 5 of 27, in stage II disease (p = 0.811, log-rank test); and 19.3%, 11 of 57, versus 20%, 4 of 20, in stage III disease (p = 0.980). In patients without preoperative chemoradiotherapy, the recurrence rate was significantly higher in laparoscopic APR than in the laparoscopic TME with SPO group of patients with stage III disease (45%, 9 of 20, vs. 19.3%, 16 of 83, p = 0.025), whereas the recurrence rate of the two procedures was similar (21.4%, 3 of 14, vs. 17.5%, 10 of 57, p = 0.702) in stage II disease. CONCLUSIONS When low rectal cancer was operated on by laparoscopic approach, the poorer prognosis of APR compared to SPO was only observed in stage III patients without preoperative chemoradiotherapy.
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Ho CM, Wu CY, Lee PH, Lai HS, Ho MC, Wu YM, Hu RH. Analysis of the Risk Factors of Untransplantable Recurrence After Primary Curative Resection for Patients with Hepatocellular Carcinoma. Ann Surg Oncol 2013; 20:2526-33. [DOI: 10.1245/s10434-013-2940-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Indexed: 12/11/2022]
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Cheng CH, Lin HC, Lai IR, Lai HS. Ischemic Postconditioning Attenuate Reperfusion Injury of Small Intestine. Transplantation 2013; 95:559-65. [DOI: 10.1097/tp.0b013e31827e6b02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Lai HS, Wu YM, Lai SL, Lin WH. Lipocalin-2 gene expression during liver regeneration after partial hepatectomy in rats. Int J Surg 2013; 11:314-8. [PMID: 23481292 DOI: 10.1016/j.ijsu.2013.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/08/2013] [Accepted: 02/14/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Lipocalin-2 (Lcn2) is related to cell proliferation. We studied Lcn2 gene expression during liver regeneration after partial hepatectomy (PH). METHODS Male Wistar rats were sacrificed before and 2, 4, 6, 12, 24, 72 h, 7 days after 70% or 40% PH. The remnant liver weight/body weight (RLW/BW) ratio, Lcn2 gene and mRNA expression in the remnant livers were measured. Hepatocytes and nonparenchymal cells were isolated from the remnant livers. Expression of Lcn2 related protein was detected by Western blot. RESULTS The RLW/BW ratio increased to nearly 90% of the original liver 72 h after PH. Lcn2 gene expression showed upward curves from 4 to 72 h after PH in both 70% and 40% PH rats and peaked at 12 h (8 times vs 0 h). Lcn2 mRNA expression showed parallel upward curves from 2 to 72 h. The peak was significantly higher in 70% PH rats (2(7) times vs 0 h) than in 40% PH rats (2(5) times vs 0 h) 12 h after PH (p < 0.05). Lcn2 related protein in the isolated liver cells was markedly enhanced 24 h after PH, more in hepatocytes than in nonparenchymal cells. CONCLUSION The expressions of Lcn2 gene and mRNA, and its related protein increased markedly after PH. Lcn2 might be important in the genetic regulation of liver regeneration after PH.
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Lai SL, Yang JC, Wu JM, Lai IR, Chen CN, Lin MT, Lai HS. Combined cholecystectomy in gastric cancer surgery. Int J Surg 2013; 11:305-8. [PMID: 23434939 DOI: 10.1016/j.ijsu.2013.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 02/05/2013] [Accepted: 02/09/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Many studies have described the risk factors of gallstone formation in gastric cancer patients after gastrectomy, but few studies focus on the management of asymptomatic gallstones. Our goal is to examine the rationale of simultaneous cholecystectomy during gastric cancer surgery, and influence of surgical mortality, morbidity and overall survival after combined cholecystectomy and gastrectomy. METHODS We retrospectively reviewed 445 gastric cancer patients and the gallbladders evaluated by abdominal ultrasound or computed tomography preoperatively and postoperatively. Clinicopathologic factors, including surgical morbidity, mortality and overall survival of combined surgery, were compared between patients receiving gastrectomy with simultaneous cholecystectomy and patients receiving gastrectomy only. We also evaluated the risk factors of gallstone formation after gastrectomy and the probability of subsequent cholecystectomy after gastrectomy in gastric cancer patients with or without asymptomatic gallstones. RESULTS Of 445 gastric cancer patients, 52 (11.7%) patients had asymptomatic gallstones upon diagnosis of gastric cancer. Among patients with healthy gallbladders, 15.2% developed gallstones after gastrectomy. Men and older patients (age over 60) had significantly higher risk of gallstone formation. Rate of subsequent cholecystectomy in patients with and without preoperative asymptomatic gallstones was 30.8% and 4.5%, respectively (p = 0.005). The rates of mortality and morbidity were not significantly different between combined surgery (3.4%, 24.2%) and gastrectomy only (3.1%, 22%). There was also no significant difference in 5-year survival between combined surgery (61%) and gastrectomy only (63%) groups. CONCLUSION Combined cholecystectomy for asymptomatic gallstone in gastric cancer surgery may be considered. It was not associated with increased surgical morbidity or mortality, and had no significant effect on overall survival.
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Ho CM, Ho MC, Shau WY, Hu RH, Lai HS, Wu YM, Lee PH. Isolated increase in serum alkaline phosphatase after liver transplantation: risk factors and outcomes analysis. Int J Surg 2012; 11:92-5. [PMID: 23246871 DOI: 10.1016/j.ijsu.2012.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 11/27/2012] [Accepted: 12/03/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Isolated increase in serum alkaline phosphatase (IISAlp) is frequently observed in liver transplant recipients visiting outpatient clinics. However, whether the increase is associated with risk factors or poor survival is unknown. METHODS We retrospectively reviewed the medical records of liver transplant recipients who were followed up during 1999-2009 and had IISAlp 1 month after liver transplantation, which was sustained for at least 6 months. Clinical parameters, survival, and risk factors were analyzed and compared between recipients who survived longer than 6 months after transplantation. RESULTS Among 307 liver transplant recipients, 44 had IISAlp. Compared with the control group, the patients with IISAlp were more frequently of the pediatric population, recipients of female donor or living-related partial liver grafts, and found to have biliary-related pretransplant disorders, lower body weight, and shorter warm ischemic time (P < 0.01). One patient with IISAlp died of acute myeloid leukemia during the follow-up period. The mean time to observation of IISAlp after liver transplantation was 6.3 ± 0.8 months. The mean follow-up duration was 5.5 ± 0.2 years. Stepwise multivariate analysis showed that being a pediatric or living-related liver transplant recipient was an independent risk factor for IISAlp, with adjusted hazard ratios (95% confidence interval) of 5.41 (2.59-11.28) and 3.0 (0.98-9.27), respectively. CONCLUSIONS Therefore, being a pediatric or living-related liver transplant recipient was an independent risk factor for IISAlp. However, IISAlp was not associated with poor survival after liver transplantation. Hence, patients who have undergone liver transplantation do not require frequent routine examination of serum alkaline phosphatase levels.
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Chen YL, Jeng YM, Hsu HC, Lai HS, Lee PH, Lai PL, Yuan RH. Expression of insulin-like growth factor II mRNA-binding protein 3 predicts early recurrence and poor prognosis in intrahepatic cholangiocarcinoma. Int J Surg 2012; 11:85-91. [PMID: 23246869 DOI: 10.1016/j.ijsu.2012.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/26/2012] [Accepted: 11/29/2012] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Insulin-like growth factor-II mRNA-binding protein 3 (IMP3), a newly identified oncofetal RNA-binding protein, plays a pivotal role in the regulation of cell growth and migration during early stages of embryogenesis, and is found to be expressed in various human cancers. In this study, we elucidated the clinicopathological significance of IMP3 expression in intrahepatic cholangiocarcinoma (ICC). METHODS From March 1995 to December 2003, 61 surgically resected, unifocal primary ICCs were studied. IMP3 protein expression was detected by immunohistochemical staining. RESULTS IMP3 protein was expressed in 25 of 61 ICCs (41.0%). In addition to correlating with tumor grade (p = 0.0276), tumor stage (p = 0.0059), lymphovascular invasion (p = 0.0198), serum carbohydrate antigen 19-9 level (p = 0.0146), IMP3 expression predicted early tumor recurrence (ETR) (p = 0.0059) and was a strong indicator of worse disease-free survival (p = 0.0001) and overall survival (p = 0.0007). Even though we did not find that IMP3 expression exerted prognostic impact independent of tumor stage, multivariate analysis confirmed that IMP3 expression was an independent risk factor of high-stage tumor and ETR (p = 0.0170, and p = 0.0052, respectively), and thus it contributed to poor prognosis in ICC patients. CONCLUSIONS IMP3 expression can serve as a novel maker for ETR and prognostic prediction, and may be a target for adjuvant therapy of patients with ICC after tumor resection.
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Wu JF, Kao PC, Chen HL, Lai HS, Hsu HY, Chang MH, Ni YH. A high serum interleukin-12p40 level prior to Kasai surgery predict a favourable outcome in children with biliary atresia. Liver Int 2012; 32:1557-63. [PMID: 22958268 DOI: 10.1111/liv.12001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/31/2012] [Indexed: 02/13/2023]
Abstract
BACKGROUND Biliary atresia (BA) is a paediatric cholestatic disease characterized by a progressive fibro-inflammation of the biliary tree. Current treatment of choice is to establish good bile flow via the Kasai operation. AIMS We aimed to identify outcome-predictive serum biomarkers in BA infant. METHODS Thirty-three BA children recruited from 1986 to 2007 served as the baseline-study group. An additional 11 children recruited from 2008 to 2011 served as the validation group. Serum samples were collected immediately before and 6 months after the Kasai operation for the assessment of serum cytokines, including tumour necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β), interferon-γ (IFN-γ), interleukin-2 (IL-2), IL-10, IL-12p40 and IL-12p70 as the candidate biomarkers. RESULTS Increased serum TGF-β levels indicated a lower Knodell hepatitis activity index at Kasai operation. The serum TGF-β levels declined after the operation. Serum IL-12p40 levels before the Kasai operation were higher in the subjects with a 3-month jaundice-free status than in others (P = 0.001). A serum pre-operative IL-12p40 level of 33 pg/ml was predictive of a 3-month jaundice-free status after surgery (positive predictive value=81.0%; negative predictive value=83.3%). This biomarker was also predictive of a better outcome, in terms of 3-year survival with native liver (risk ratio [RR = 4.00]; P < 0.001), and 3-year jaundice-free survival with native liver (RR = 12.00; P < 0.001). We confirmed the predictive power of a high pre-operative IL-12p40 level on 3-month jaundice-free status in the validation group. CONCLUSIONS The pre-operative IL-12p40 level was a good predictive biomarker of clinical outcome in children with BA undergoing the Kasai operation.
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Yang YW, Wu CH, Ko WJ, Wu VC, Chen JS, Chou NK, Lai HS. Prevalence of acute kidney injury and prognostic significance in patients with acute myocarditis. PLoS One 2012; 7:e48055. [PMID: 23144725 PMCID: PMC3483268 DOI: 10.1371/journal.pone.0048055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/20/2012] [Indexed: 12/12/2022] Open
Abstract
Objective Myocarditis is an inflammation of the myocardium. The condition is commonly associated with rapid disease progression and often results in profound shock. Impaired renal function is the result of impairment in end-organ perfusion and is highly prevalent among critically ill patients. The aim of this study was to evaluate the incidence of acute kidney injury (AKI) and identify the relationship between AKI and the prognosis of patients with acute myocarditis. Design, Measurements and Main Results This retrospective study reviewed the medical records of 101 patients suffering from acute myocarditis between 1996 and 2011. Sixty of these patients (59%) developed AKI within 48 hours of being hospitalized. AKI defined as AKIN stage 3 (p = 0.007) and SOFA score (p = 0.03) were identified as predictors of in-hospital mortality in multivariate analysis. The conditional effect plot of the estimated risk against SOFA score upon admission categorized according to the AKIN stages showed that the risk of in-hospital mortality was highest among patients in AKIN stage 3 with a high SOFA score. Conclusions Among patients with acute myocarditis, AKI defined as AKIN stage 3 and elevated SOFA score were associated with unfavorable outcomes. AKIN classification is a simple, reproducible, and easily applied evaluation tool capable of providing objective information related to the clinical prognosis of patients with acute myocarditis.
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Han YY, Lai SL, Ko WJ, Chou CH, Lai HS. Effects of fish oil on inflammatory modulation in surgical intensive care unit patients. Nutr Clin Pract 2012; 27:91-8. [PMID: 22227725 DOI: 10.1177/0884533611429796] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The benefit of ω-3 fatty acids in fat emulsion remains controversial. This study evaluated the effect of ω-3 fatty acids on immune and inflammatory modulation in surgical intensive care unit (SICU) patients. METHODS Thirty-eight patients admitted to the SICU after major surgery were enrolled in this prospective controlled study and randomized to receive parenteral nutrition (PN) with equal volume and calories from glucose, nitrogen, and fat but different lipid components for 7 postoperative days. Group A (n = 12) received a mixture of soybean and medium-chain triglyceride oils; group B (n = 18) received a fat emulsion with part of the lipid replaced by fish oil. Blood tests, including lipid profile, routine biochemistry, inflammatory cytokines, and lymphocyte subpopulations, were evaluated preoperatively and on postoperative days 4 and 7. RESULTS Both lipid regimens were well tolerated. There was a trend toward reduced serum inflammatory cytokines in group B vs group A with significant differences regarding interleukin (IL)-1, IL-8, and interferon (IFN)-γ on postoperative day 4 (P < .05) and IL-1, IL-8, IFN-γ, IL-6, and tumor necrosis factor-α on postoperative day 7 (P < .05). There was a reduction in postoperative liver dysfunction (A vs B: 50% vs 33.3%) and infection rate (A vs B: 41.7% vs 27.8%) in group B, although this was not statistically significant. There was no mortality in either group. CONCLUSION This study suggests that supplementation of parenteral ω-3 fatty acids in PN is safe and may improve immune and hyperinflammatory response for SICU patients after major surgery.
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Lin BR, Lai HS, Chang TC, Lee PH, Chang KJ, Liang JT. Long-term survival results of surgery alone versus surgery plus UFT (Uracil and Tegafur)-based adjuvant therapy in patients with stage II colon cancer. J Gastrointest Surg 2011; 15:2239-45. [PMID: 21993974 DOI: 10.1007/s11605-011-1722-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 09/30/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is well established that adjuvant chemotherapy with 5-fluouracil and leucovorin (5-FU/LV) improves survival for patients with resected colon cancer; however, the benefits of oral uracil and tegafur (UFT) chemotherapy in these patients are still uncertain. METHODS All patients enrolled in this retrospective study with stage II disease who were treated with surgery or surgery plus UFT were examined to determine the overall survival and disease-free interval. Time-to-event by treatment group was examined using Kaplan-Meier estimates and multivariable Cox regression analysis. RESULTS There were 456 eligible patients-217 (47.5%) patients had surgery and 239 (52.5%) patients had surgery plus UFT. In patients aged ≧65 years, deeper tumor depth and fewer nodes observed were associated with lower survival. The 5-year survival rate was 84.2% in the surgery group and 89.1% in the surgery plus UFT group (P = 0.006). Treatment with UFT after surgery was associated with improved outcome compared with surgery alone: overall survival (HR = 0.611, P = 0.018) and disease-free survival (HR = 0.590, P = 0.032). CONCLUSIONS Oral fluoropyrimidines improve the disease-free rate and the overall survival of patients after resection of stage II colon cancer. These observations support the use of these agents following surgery as it provides a benefit over surgery alone.
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Wu YM, Liu CH, Hu RH, Huang MJ, Lee JJ, Chen CH, Huang J, Lai HS, Lee PH, Hsu WM, Huang HC, Huang MC. Mucin glycosylating enzyme GALNT2 regulates the malignant character of hepatocellular carcinoma by modifying the EGF receptor. Cancer Res 2011; 71:7270-9. [PMID: 21990321 DOI: 10.1158/0008-5472.can-11-1161] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Extracellular glycosylation is a critical determinant of malignant character. Here, we report that N-acetylgalactosaminyltransferase 2 (GALNT2), the enzyme that mediates the initial step of mucin type-O glycosylation, is a critical mediator of malignant character in hepatocellular carcinoma (HCC) that acts by modifying the activity of the epidermal growth factor receptor (EGFR). GALNT2 mRNA and protein were downregulated frequently in HCC tumors where these events were associated with vascular invasion and recurrence. Restoring GALNT2 expression in HCC cells suppressed EGF-induced cell growth, migration, and invasion in vitro and in vivo. Mechanistic investigations revealed that the status of the O-glycans attached to the EGFR was altered by GALNT2, changing EGFR responses after EGF binding. Inhibiting EGFR activity with erlotinib decreased the malignant characters caused by siRNA-mediated knockdown of GALNT2 in HCC cells, establishing the critical role of EGFR in mediating the effects of GALNT2 expression. Taken together, our results suggest that GALNT2 dysregulation contributes to the malignant behavior of HCC cells, and they provide novel insights into the significance of O-glycosylation in EGFR activity and HCC pathogenesis.
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MESH Headings
- Animals
- Carcinoma, Hepatocellular/enzymology
- Carcinoma, Hepatocellular/genetics
- Carcinoma, Hepatocellular/metabolism
- Carcinoma, Hepatocellular/pathology
- Cell Line, Tumor
- Cell Movement/drug effects
- Cell Movement/genetics
- Cell Proliferation/drug effects
- Down-Regulation
- Epidermal Growth Factor/metabolism
- ErbB Receptors/antagonists & inhibitors
- ErbB Receptors/metabolism
- Erlotinib Hydrochloride
- Female
- Gene Knockdown Techniques/methods
- Glycosylation/drug effects
- Hep G2 Cells
- Humans
- Liver Neoplasms/enzymology
- Liver Neoplasms/genetics
- Liver Neoplasms/metabolism
- Liver Neoplasms/pathology
- Mice
- Mice, Inbred BALB C
- Mice, Nude
- Mucins/metabolism
- N-Acetylgalactosaminyltransferases/genetics
- N-Acetylgalactosaminyltransferases/metabolism
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Quinazolines/pharmacology
- RNA, Messenger/genetics
- Polypeptide N-acetylgalactosaminyltransferase
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Chen ST, Jeng YM, Chang CC, Chang HH, Huang MC, Juan HF, Hsu CH, Lee H, Liao YF, Lee YL, Hsu WM, Lai HS. Insulin-like growth factor II mRNA-binding protein 3 expression predicts unfavorable prognosis in patients with neuroblastoma. Cancer Sci 2011; 102:2191-8. [PMID: 21917080 DOI: 10.1111/j.1349-7006.2011.02100.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Insulin-like growth factor II mRNA-binding protein 3 (IMP3) has been reported to enhance proliferation and invasion in various cancers. The role of IMP3 on neuroblastoma (NB) is unknown. We aimed to clarify the prognostic significance of IMP3 expression in patients with NB. By microarray analysis, high IMP3 expression was found in patients with poor outcome. IMP3 expression in 90 NB samples was analyzed by immunohistochemical staining to correlate with clinical stages, histology, and patient outcome. Positive IMP3 expression was detected in 52 of 90 patients, and was significantly correlated with undifferentiated histology, advanced stages, MYCN amplification, and poor outcome. In subgroups, positive IMP3 expression could predict an even worse prognosis in patients with advanced disease, with normal MYCN status, or with MYCN amplification (P = 0.005, P = 0.001, and P = 0.033, respectively). The IMP3 expression decreased by induction of differentiation with retinoid acid treatment in SK-N-DZ and SK-N-SH cells in vitro. The invasion ability of NB cells also decreased as IMP3 knockdown by using RNA interference in vitro. In summary, high expression of IMP3 in NB might contribute to the undifferentiated phenotype and invasive behaviors, leading to a poor prognosis. Determining IMP3 expression in NB could help to improve a personalized therapy.
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Tsai MS, Ko YH, Hsu WM, Liang JT, Lai HS, Lee PH, Chang KC. Enhanced Aortic Nerve Growth Factor Expression and Nerve Sprouting in Rats Following Gastric Perforation. J Surg Res 2011; 171:205-11. [DOI: 10.1016/j.jss.2010.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/16/2009] [Accepted: 01/13/2010] [Indexed: 11/28/2022]
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Tseng CW, Yang JC, Chen CN, Huang HC, Chuang KN, Lin CC, Lai HS, Lee PH, Chang KJ, Juan HF. Identification of 14-3-3β in human gastric cancer cells and its potency as a diagnostic and prognostic biomarker. Proteomics Clin Appl 2011. [DOI: 10.1002/prca.201190089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tseng CW, Yang JC, Chen CN, Huang HC, Chuang KN, Lin CC, Lai HS, Lee PH, Chang KJ, Juan HF. Identification of 14-3-3β in human gastric cancer cells and its potency as a diagnostic and prognostic biomarker. Proteomics 2011; 11:2423-39. [PMID: 21598387 DOI: 10.1002/pmic.201000449] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 03/07/2011] [Accepted: 03/08/2011] [Indexed: 02/06/2023]
Abstract
Gastric cancer is the second most common cause of cancer deaths worldwide and due to its poor prognosis, it is important that specific biomarkers are identified to enable its early detection. Through 2-D gel electrophoresis and MALDI-TOF-TOF-based proteomics approaches, we found that 14-3-3β, which was one of the proteins that were differentially expressed by 5-fluorouracil-treated gastric cancer SC-M1 cells, was upregulated in gastric cancer cells. 14-3-3β levels in tissues and serum were further validated in gastric cancer patients and controls. The results showed that 14-3-3β levels were elevated in tumor tissues (n=40) in comparison to normal tissues (n=40; p<0.01), and serum 14-3-3β levels in cancer patients (n=145) were also significantly higher than those in controls (n=63; p<0.0001). Elevated serum 14-3-3β levels highly correlated with the number of lymph node metastases, tumor size and a reduced survival rate. Moreover, overexpression of 14-3-3β enhanced the growth, invasiveness and migratory activities of tumor cells. Twenty-eight proteins involved in anti-apoptosis and tumor progression were also found to be differentially expressed in 14-3-3β-overexpressing gastric cancer cells. Overall, these results highlight the significance of 14-3-3β in gastric cancer cell progression and suggest that it has the potential to be used as a diagnostic and prognostic biomarker in gastric cancer.
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Liang JT, Lai HS, Cheng KW. Video. Laparoscopic dissection of Denonvilliers' fascia and implications for total mesorectal excision for treatment of rectal cancer. Surg Endosc 2010; 25:935-40. [PMID: 20927547 DOI: 10.1007/s00464-010-1264-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 07/05/2010] [Indexed: 11/27/2022]
Abstract
AIM To inspect Denonvilliers' fascia and its relationship with neighboring oncologically and functionally important anatomic structures by laparoscopic approach. METHODS A total of 112 patients with middle or low rectal cancer were successfully treated by laparoscopic total mesorectal excision (TME). Digital versatile disk (DVD) recordings were retrieved for scrutiny of the whole dissection process of Denonvilliers' fascia and its contiguous anatomic structures. RESULTS As highlighted in the attached video footage, for nearly all male patients (91%, n = 58), the boundaries of Denonvilliers' fascia could be clearly recognized by laparoscopy. Denonvilliers' fascia, varying in nature from a fragile translucent fibrous layer to a tough leathery membrane, manifests itself as a trapezoidal "apron" covering the glistening fatty tissues of the anterior mesorectum. Anterior dissection in TME can be efficiently continued downwards "in front of" Denonvilliers' fascia. When the prostate is reached, the natural surgical plane halts, and the dissection plane should be shifted to behind this fascia. In contrast, in female patients, Denonvilliers' fascia was much less obvious as a distinct fibrous layer than in male patients. The most appropriate term for the structure in between the rectum and vagina may be rectovaginal septum, in which there is no natural surgical plane, rather than Denonvilliers' fascia. CONCLUSIONS By laparoscopic approach, the nature of Denonvilliers' fasciae in male and female patients can be better defined and facilitates more precise laparoscopic total mesorectal excision for rectal cancer.
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Ko PJ, Lin HY, Lin WH, Lai HS. Sliding inguinal hernia with incarceration of urinary bladder diverticulum in a child. Int Surg 2010; 95:335-337. [PMID: 21309417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Although inguinal herniorrhaphy is generally safe, certain complications can occur even with an experienced pediatric surgeon. We present a case of sliding right inguinal hernia with incarceration of urinary bladder diverticulum in a 2-year-old boy. A small perforation at the anterior wall of the urinary bladder, peritonitis, and kinking of the sigmoid colon occurred after the herniorrhaphy. He received exploratory laparotomy for repairing the urinary bladder perforation hole and drainage of the ascites. An anal tube was inserted to keep the sigmoid colon patent. The patient recovered from this insult gradually with an uneventful postoperative course 10 months after the operation, until the writing of this study. Surgeons should be aware of the possibility of urinary bladder diverticulum incarceration at the inguinal canal and should perform the operation meticulously.
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Chen Y, Lai HS, Chiang BL, Tseng SH, Chen WJ. Tetrandrine attenuates dendritic cell-mediated alloimmune responses and prolongs graft survival in mice. PLANTA MEDICA 2010; 76:1424-1430. [PMID: 20186657 DOI: 10.1055/s-0029-1240909] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Tetrandrine, a bisbenzylisoquinoline alkaloid, has significant immunosuppressive effects; however, the effects of tetrandrine on dendritic cells (DCs) and the associated immune reactions are unclear. In this study, we investigated the effects of tetrandrine on DCs and the effects of the tetrandrine-treated DCs on alloimmune reactions in vitro and graft survival in vivo. Tetrandrine significantly downregulated the expression of CD80 and CD86 of DCs and increased their secretion of IL-10 (p = 0.0001). Mixed leukocyte reaction showed that tetrandrine inhibited dendritic-cell allo-stimulatory activity, which was reversed by the anti-IL-10 treatment. An in vivo study demonstrated that tetrandrine-treated DCs prolonged the survival time of skin grafts in mice compared to control (p = 0.005) and decreased cellular infiltration of the graft in the histopathological study. The data suggest that tetrandrine-treated DCs cause immunosuppression and protect skin grafts from rejection. The tetrandrine-induced immunosuppression seems to be partially due to increased IL-10 secretion.
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Wu YM, Kao CY, Huang YJ, Yu IS, Lee HS, Lai HS, Lee PH, Lin CN, Lin SW. Genetic modification of donor hepatocytes improves therapeutic efficacy for hemophilia B in mice. Cell Transplant 2010; 19:1169-80. [PMID: 20412633 DOI: 10.3727/096368910x503398] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Hepatocyte transplantation (Tx) holds promise for curing genetic liver diseases. However, a limited number of donor hepatocytes can be transplanted into the host liver. Recipient preconditioning and donor cell engineering are under investigation to improve cell engraftment. In theory, genetically engineered cells secreting therapeutic proteins with superior function could compensate for poor engraftment efficiency. We have generated a bioengineered human coagulation factor IX (FIX) with augmented specific activity (named FIX-Triple). The aim of this study was to evaluate therapeutic efficacy of cell therapy using hemophilia B (HB) as a disease model by transplanting FIX-Triple-secreting hepatocytes. The donor hepatocytes were isolated from FIX-Triple knock-in (KI) or FIX-WT (wild-type) KI mice and transplanted intrasplenically into FIX knock-out (KO) mice. FIX-Triple KI recipients exhibited fourfold higher plasma FIX clotting activity than FIX-WT KI recipients. By repeated Txs, the clotting activity of FIX-Triple KI recipients even increased to more than 10% of normal mouse plasma. The engraftment and FIX production efficiencies of transplanted cells were equivalent between the FIX-WT KI and FIX-Triple KI donors. A hemostatic function assay showed that FIX-Triple KI recipients with repeated Txs had more enhanced clot kinetics and a greater maximum rate of thrombus generation than those with a single Tx. Moreover, FIX inhibitors in these recipients rarely developed. In conclusion, hepatocyte Tx with genetically engineered donor cells is an effective therapeutic strategy for HB.
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Wu TT, Tsai TW, Chang H, Su CC, Li SY, Lai HS, Li C. Polymorphisms of the RET gene in hirschsprung disease, anorectal malformation and intestinal pseudo-obstruction in Taiwan. J Formos Med Assoc 2010; 109:32-8. [PMID: 20123584 DOI: 10.1016/s0929-6646(10)60019-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Mutations in the receptor tyrosine kinase RET gene are associated with Hirschsprung disease (HD), which is also known as congenital intestinal aganglionosis. We found an association with specific alleles in five single nucleotide polymorphism (SNP) sites of the RET gene in our HD patients. METHODS We compared the association of specific RET SNP alleles in patients with severe GI disorders such as anorectal malformation (ARM) or pediatric intestinal pseudo-obstruction (IPO) to that in HD patients. Sixty-four HD, 23 ARM and 35 IPO patients were included. Genomic DNA extracted from blood samples was analyzed by polymerase chain reaction and DNA sequencing analysis. RESULTS The allele distributions of all five RET SNPs in the HD patients deviated from those in the normal population (p < 0.05), whereas those of the ARM patients did not. The allele distributions of these RET SNPs in the IPO patients were all significantly different from those in the HD patients. Allele distributions of exon 2 and 13 in the IPO patients were also significantly different from those of the normal population. The frequencies of all the HD-predominant alleles were lower in the HD patients than the normal population, and were even lower in the IPO patients. CONCLUSION This study strengthens the association of specific RET SNP alleles with typical HD in Taiwan.
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Lai HS, Lin WH, Chen HA, Fan SZ, Chou HC. Successful laparotomy in a 432 g extremely low-birth-weight infant with focal intestinal perforations. Int Surg 2010; 95:57-59. [PMID: 20480842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Acute intra-abdominal abnormalities requiring emergency laparotomy in extremely low-birth-weight (ELBW) infants may increase morbidity and mortality. Focal intestinal perforations (FIPs) not due to necrotizing enterocolitis (NEC) are increasingly recognized in ELBW infants. We present an ELBW preterm male infant (24 weeks' gestation) with FIP who underwent successful abdominal surgery when the patient weighed 432 g. Three isolated intestinal perforations without any NEC were identified. The patient was stable and weighed 1142 g on the 100th day after surgery. Common morbidities associated with ELBW do not appear to be adversely affected by surgical intervention; however, long-term follow-up is essential to enhance future developmental outcomes upon survival.
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Huang SC, Tsai MS, Lai HS. A new technique to remove a "stuck" totally implantable venous access catheter. J Pediatr Surg 2009; 44:1465-7. [PMID: 19573682 DOI: 10.1016/j.jpedsurg.2009.03.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
Abstract
Removal of a totally implantable venous access device (port) is usually a simple procedure; however, if a catheter has been in place for a very long period, it may adhere firmly to the vessel wall. We report a new technique to facilitate removal of a stuck catheter. A 16-year-old girl was admitted for removal of her port, which had been inserted for chemotherapy 11 years earlier. After her disease was controlled, the catheter could not be pulled out during surgery. To remove the catheter, we inserted a guidewire to straighten the catheter and then applied a "push-in" force to detach the adherence from the central vein. The catheter was then removed successfully. We believe that this is a new and simple method for removing a "stuck" catheter.
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87
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Chiang LL, Lai HS, Ni YH, Hsu WM. Management of sigmoid volvulus based on Ladd's procedure: a case report. Pediatr Neonatol 2009; 50:129-31. [PMID: 19579761 DOI: 10.1016/s1875-9572(09)60049-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sigmoid volvulus is a rare but potentially life-threatening condition in childhood. Colectomy is usually required to prevent recurrent volvulus, which carries a high risk of morbidity and mortality. Here, we report a non-resection method based on the concept of Ladd's procedure to treat a sigmoid volvulus in a 15-year-old boy. After reduction of the volvulus, the distance between the sigmoid-rectal junction and the sigmoid-descending colon junction was widened by dissecting the meso-sigmoid colon along the course of the long axis. No colon resection was performed. The total operation time was less than an hour. The post-operative recovery was uneventful. There was no recurrent volvulus during a follow-up of 1 year. Widening the base of the mesosigmoid according to the concept of Ladd's procedure may be considered as a more simple and safe alternative treatment to prevent recurrent sigmoid volvulus in children.
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Chen CN, Lin JJ, Lee H, Cheng YM, Chang KJ, Hsieh FJ, Lai HS, Chang CC, Lee PH. Association between color doppler vascularity index, angiogenesis-related molecules, and clinical outcomes in gastric cancer. J Surg Oncol 2009; 99:402-8. [DOI: 10.1002/jso.21193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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89
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Wu JF, Ni YH, Chen HL, Hsu HY, Lai HS, Chang MH. Humoral immunogenicity to measles, rubella, and varicella-zoster vaccines in biliary atresia children. Vaccine 2009; 27:2812-5. [DOI: 10.1016/j.vaccine.2009.02.094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 02/13/2009] [Accepted: 02/25/2009] [Indexed: 11/25/2022]
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90
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Huang CC, Tsai MS, Lai HS. Chylous ascites after excision of a choledochal cyst in a child. J Pediatr Surg 2009; 44:e5-7. [PMID: 19433158 DOI: 10.1016/j.jpedsurg.2009.01.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 11/16/2022]
Abstract
We report a case of chylous ascites developing 2 weeks after excision of a choledochal cyst with a Roux-en-Y hepaticojejunostomy. Despite the failure of the initial attempts to resolve the chylous ascites by fasting, subsequently, we successfully treated the patient's chylous ascites with intravenous somatostatin. No obvious adverse side effects occurred during the use of somatostatin. To the best of our knowledge, this is the first report of chylous ascites after choledochal cyst excision in children, which was successfully treated with somatostatin. Somatostatin may be considered as a therapeutic option of managing pediatric postoperative chylous ascites.
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91
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Lai HS, Lin WH, Hsu WM, Chen CN, Chang KJ, Lee PH. Variations in interferon gamma receptor gene expression during liver regeneration after partial hepatectomy in rats. Am Surg 2009; 75:49-54. [PMID: 19213397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cell-mediated immunity, which includes interferon gamma (IFN-gamma) expression, is activated during the process of liver regeneration; however, the genetic pathway of this activation is still unclear. The present study evaluated variations in the interferon gamma receptor (IFN-gamma R) gene and its mRNA expression during liver regeneration after partial hepatectomy (PH). Male Wistar rats weighing approximately 200 g were subjected to PH (70 or 40%). IFN-gamma R gene expression in the remnant liver was measured by cDNA microarray, and mRNA expression was verified by real-time quantitative reverse transcription-polymerase chain reaction (Q-PCR) preoperatively and at 2, 4, 6, 12, 24, and 72 hours and 7 days postoperatively. The ratio of remnant liver weight to body weight increased markedly after 70 per cent PH and more gradually after 40 per cent PH. It reached near 90 per cent of the preoperative level at 72 hours after PH in both groups. The scanned spots of the genomic survey on the cDNA microarray chips were uneven and increased irregularly in number and density after PH. IFN-gamma R gene expression increased markedly in a single peak pattern, up to more than double the preoperative level, at 6 hours after 70 per cent PH. The curve in the 40 per cent PH group was flat and peaked at only 1.6 times the preoperative level. The variations in IFN-gamma R-related mRNA expression were verified by Q-PCR. Elevations in IFN-gamma R gene and mRNA expression were shown during the early stage of liver regeneration after PH. The genetic pathway of IFN-gamma/IFN-gamma R expression is activated during liver regeneration.
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Lai HS, Lin WH, Hsu WM, Chen CN, Chang KJ, Lee PH. Variations in Interferon Gamma Receptor Gene Expression during Liver Regeneration after Partial Hepatectomy in Rats. Am Surg 2009. [DOI: 10.1177/000313480907500111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cell-mediated immunity, which includes interferon gamma (IFN-γ) expression, is activated during the process of liver regeneration; however, the genetic pathway of this activation is still unclear. The present study evaluated variations in the interferon gamma receptor (IFN-γR) gene and its mRNA expression during liver regeneration after partial hepatectomy (PH). Male Wistar rats weighing approximately 200 g were subjected to PH (70 or 40%). IFN-γR gene expression in the remnant liver was measured by cDNA microarray, and mRNA expression was verified by real-time quantitative reverse transcription-polymerase chain reaction (Q-PCR) preoperatively and at 2, 4, 6,12, 24, and 72 hours and 7 days postoperatively. The ratio of remnant liver weight to body weight increased markedly after 70 per cent PH and more gradually after 40 per cent PH. It reached near 90 per cent of the preoperative level at 72 hours after PH in both groups. The scanned spots of the genomic survey on the cDNA microarray chips were uneven and increased irregularly in number and density after PH. IFN-γR gene expression increased markedly in a single peak pattern, up to more than double the preoperative level, at 6 hours after 70 per cent PH. The curve in the 40 per cent PH group was flat and peaked at only 1.6 times the preoperative level. The variations in IFN-γR-related mRNA expression were verified by Q-PCR. Elevations in IFN-γR gene and mRNA expression were shown during the early stage of liver regeneration after PH. The genetic pathway of IFN-γ/IFN-γR expression is activated during liver regeneration.
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Hsu WM, Lee H, Juan HF, Shih YY, Wang BJ, Pan CY, Jeng YM, Chang HH, Lu MY, Lin KH, Lai HS, Chen WJ, Tsay YG, Liao YF, Hsieh FJ. Identification of GRP75 as an Independent Favorable Prognostic Marker of Neuroblastoma by a Proteomics Analysis. Clin Cancer Res 2008; 14:6237-45. [DOI: 10.1158/1078-0432.ccr-07-4181] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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94
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Tsai MS, Su YH, Liang JT, Lai HS, Lee PH. Patient factors predicting the completion of sedation-free colonoscopy. HEPATO-GASTROENTEROLOGY 2008; 55:1606-1608. [PMID: 19102351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND/AIMS Colonoscopy without sedation costs less than sedated colonoscopy. The aim of this study is to identify the patient factors predicting the completion of colonoscopy without sedation. METHODOLOGY Between May and September 2005, a single colorectal surgeon performed 120 consecutive colonoscopies. Patient demographic, clinical and colonoscopy-related data were collected and analyzed. RESULTS Out of 120 colonoscopies performed, 11 were excluded due to obstruction of the colon by a tumor or poor preparation. Therefore, the study group contained 109 patients. Ninety-three (85.3%) colonoscopies were completed. Completion rate (odds ratio for completion [95% confidence interval]) was significantly associated with the male gender (5.03 [1.35-18.86]), high body mass index (4.42 [1.18-16.67]), no previous history of gynecological surgery (6.36 [1.84-22.14]), and previous colonic resection. Previous gynecological surgery was significantly associated with lower completion rates as shown using multivariate analysis. No complications relating to colonoscopy were observed. CONCLUSIONS In the majority of patients, a colorectal surgeon with adequate endoscopy experience can perform sedation-free colonoscopy successfully and safely. Gender, previous gynecological surgery, previous colonic resection, and body mass index were predictive factors for successful colonoscopy without sedation.
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Wu JF, Ni YH, Chen HL, Hsu HY, Lai HS, Chang MH. Inadequate humoral immunogenicity to recombinant hepatitis B virus vaccine in biliary atresia children. Pediatr Res 2008; 64:100-4. [PMID: 18344901 DOI: 10.1203/pdr.0b013e3181732908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study aimed to investigate the primary immunogenicity and the long-term efficacy of recombinant hepatitis B virus (HBV) vaccine in biliary atresia (BA) children. Fifty BA infants (age, 11 +/- 3.9 mo), and 23 BA patients at childhood (age, 8.5 +/- 0.22 y) were included for the evaluation of HBV surface antibody (anti-HBs) levels after three doses of recombinant HBV vaccine immunization. Age- and gender-matched healthy infants (n = 50) and children (n = 23) were enrolled as the control group. Serum samples of the study populations were collected for HBV seromarkers determination. In the absence of hepatitis B virus core antibody and HBV surface antigen, serum anti-HBs level above 10 IU/L was considered adequate immunogenicity to HBV vaccine. The prevalence of adequate anti-HBs levels after recombinant HBV vaccine in BA infants was significantly lower than those of the controls (p = 0.006). There was no difference in the prevalence between childhood BA patients and their matched controls (p = 0.538). In conclusion, adequate primary humoral immunity after the standard doses of recombinant HBV vaccine in BA infants is hard to establish. However, once immunity is acquired, BA children have adequate anti-HBs titer in the long run.
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Lu YY, Lai HS, Hsieh WS, Hsu WM. Ischemic gallbladder perforation in a premature infant. J Pediatr Surg 2008; 43:E31-2. [PMID: 18558162 DOI: 10.1016/j.jpedsurg.2008.02.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 02/20/2008] [Accepted: 02/20/2008] [Indexed: 11/28/2022]
Abstract
Gallbladder perforation is an extremely rare condition in infants. We present a premature infant who had congestive heart failure and renal failure owing to complex congenital heart disease and developed gallbladder perforation at 60 days of age. The patient showed neither signs of peritonitis nor impaired liver function; however, we found bile drainage from the peritoneal dialysis tube. Emergent laparotomy revealed a 3-mm perforation with surrounding tissue necrosis over the gallbladder neck. Cholecystectomy was performed after patent common bile duct was demonstrated using intraoperative cholangiography. No stones were noted in the gallbladder. Further histologic examinations of the perforation site showed ischemic changes. There were no biliary complications after surgery. Nevertheless, the patient died of multiple organ failure at 120 days old.
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Chen HL, Liu YJ, Chen HL, Wu SH, Ni YH, Ho MC, Lai HS, Hsu WM, Hsu HY, Tseng HC, Jeng YM, Chang MH. Expression of hepatocyte transporters and nuclear receptors in children with early and late-stage biliary atresia. Pediatr Res 2008; 63:667-73. [PMID: 18327154 DOI: 10.1203/pdr.0b013e318170a6b5] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To investigate how the liver adapts to chronic obstructive cholestasis, liver samples from infants with early- and late-stage cholestasis were analyzed for changes in the levels of hepatocyte transporters and nuclear receptors. At early-stage cholestasis, most canalicular transporters and sinusoidal uptake transporters were downregulated, including bile salt export pump (BSEP, ABCB11), multidrug resistant protein 3 (MDR3, ABCB4), multidrug-resistant associated protein 2 (MRP2, ABCC2), sodium-dependent taurocholate cotransporting polypeptide (NTCP, SLC10A1), organic anion transporter (OATP, SLCO1A2), and nuclear receptor farnesoid X receptor (FXR, NR1H4). At late-stage cholestasis, FXR-BSEP levels returned to normal, MDR3 and MDR1 (ABCB1) were upregulated, and MRP-2 was downregulated. In addition, alternative sinusoidal efflux transporters, organic solute transporter alpha/beta (OSTalpha/beta) and MRP4 were upregulated, and pregnane X receptor (PXR, NR1I2) levels decreased. Cytochrome enzyme P450 7A1 was markedly downregulated at both early and late-stage cholestasis. An analysis of the long-term prognosis of 18 patients revealed lower PXR and constitutive androstane receptor (CAR, NR1I3) levels in the poor prognosis group. In conclusion, at long-term cholestasis, hepatocyte bile efflux was through sinusoidal and canalicular transporters, with FXR-BSEP levels maintained and PXR downregulated. Low PXR and CAR levels were associated with poor prognosis.
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Liang JT, Lai HS, Lee PH, Chang KJ. Laparoscopic pelvic autonomic nerve-preserving surgery for sigmoid colon cancer. Ann Surg Oncol 2008; 15:1609-16. [PMID: 18365285 PMCID: PMC2373867 DOI: 10.1245/s10434-008-9861-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 12/19/2007] [Accepted: 02/04/2008] [Indexed: 11/18/2022]
Abstract
Background To test the feasibility of laparoscopic approach in performing the simultaneous pelvic autonomic nerve preservation during standard anterior resection of sigmoid colon cancer. Methods Patients meeting appropriate eligibility criteria were recruited for the present study. The surgical procedures are shown in the video. The genitourinary function was evaluated on the basis of validated questionnaires including International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), and Female Sexual Function Index (FSFI). Results A total of 112 patients (tumor, node, metastasis system stage I, n = 8; stage II, n = 54; stage III, n = 50; male, n = 58; female, n = 54; age [mean ± standard deviation], 55.8 ± 6.4 years) with good baseline genitourinary function were operated on with the intent of total preservation of pelvic autonomic nerves and curative resection of sigmoid colon cancer. The patients were prospectively followed (median time of follow-up, 18 months; range, 6–30 months). In patients with a successful nerve-preserving surgery (96.4%, n = 108), 104 patients completed the evaluation of urinary function. The median duration for indwelling urine Foley catheter was 3.0 days (range, 1.0–7.0 days). The voiding function after removal of the urine Foley catheter was good (IPSS, 0–7) in 98 (94.2%) patients, fair (IPSS, 8–14) in 5 (4.8%), and poor (IPSS, 15–35) in 1 (1.0%). Before and after nerve-preserving surgery, there were no significant changes of IPSS scores (3.20 ± 1.72 vs. 3.68 ± 2.82, P = .075, paired t-test) in the present patient series. Forty-four male patients completed the postoperative evaluation of sexual function, and ejaculation was ranked as good in 40 (90.9%), fair (decrease in ejaculatory amounts) in 3 (6.8%), and poor (retrograde ejaculation, failure of ejaculation) in 1 (2.3%), whereas the potency was good (IIEF, 60–75) in 41 (93.2%), fair (IIEF, 44–59) in 2 (4.5%), and poor (IIEF, 5–43) in 1 (2.3%). Moreover, before and after a successful nerve-preserving operation, there were no significant changes of IIEF scores (72.4 ± 4.6 vs. 70.3 ± 8.4, P = .082, paired t-test). For female patients (n = 42), the postoperative sexual function was ranked as good (FSFI score, 76–95) in 36 (85.7%), fair (FSFI, 58–75) in 4 (9.5%), and poor (FSFI, 4–57) in 2 (4.8%). Furthermore, there were no significant changes of FSFI scores (89.0 ± 9.2 vs. 85.4 ± 16.4, P = .122, paired t-test) before and after successful nerve-preserving surgery. Conclusions Under laparoscopy, we can clearly identify and preserve the pelvic autonomic nerves to retain genitourinary function in most patients undergoing oncologic resection of sigmoid colon cancer. Electronic supplementary material The online version of this article (doi:10.1245/s10434-008-9861-x) contains supplementary material, which is available to authorized users.
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Chen ST, Lai HS, Shih JC, Shun CT. Congenital immature teratoma originating from the jejunum. J Pediatr Surg 2007; 42:1600-3. [PMID: 17848256 DOI: 10.1016/j.jpedsurg.2007.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A small bowel teratoma has never been reported in English literature. We present a case of congenital immature teratoma originating from the jejunum, along with a discussion of its pathophysiologic features and the clinical course.
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Kuo PH, Lai HS, Huang SY, Liu KL. Focal nodular hyperplasia of the liver in an 8-year-old boy. Surgery 2007; 142:422-3. [PMID: 17723898 DOI: 10.1016/j.surg.2006.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Accepted: 10/15/2006] [Indexed: 10/23/2022]
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