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Lin WC, Tai WC, Chang CH, Tu CH, Feng IC, Shieh MJ, Chung CS, Yen HH, Chou JW, Wong JM, Liu YH, Huang TY, Chuang CH, Tsai TJ, Chiang FF, Lu CY, Hsu WH, Yu FJ, Chao TH, Wu DC, Ho AS, Lin HH, Feng CL, Wu KL, Wong MW, Tung CC, Lin CC, Chen CC, Hu HM, Lu LS, Wang HS, Wu IC, Kuo HY, Wu JF, Yao Shih H, Ni YH, Tang SL, Chen PH, Wei SC. Real-World Evidence of Effectiveness and Safety of Vedolizumab for Inflammatory Bowel Disease in Taiwan: A Prospective Nationwide Registry (VIOLET) Study. Inflamm Bowel Dis 2023; 29:1730-1740. [PMID: 36626567 PMCID: PMC10918762 DOI: 10.1093/ibd/izac269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND This nationwide prospective registry study investigated the real-world effectiveness, safety, and persistence of vedolizumab (VDZ) in inflammatory bowel disease (IBD) patients in Taiwan. Disease relapse rates after VDZ discontinuation due to reimbursement restriction were assessed. METHODS Data were collected prospectively (January 2018 to May 2020) from the Taiwan Society of IBD registry. RESULTS Overall, 274 patients (147 ulcerative colitis [UC] patients, 127 Crohn's disease [CD] patients) were included. Among them, 70.7% with UC and 50.4% with CD were biologic-naïve. At 1 year, 76.0%, 58.0%, 35.0%, and 62.2% of UC patients and 57.1%, 71.4%, 33.3%, and 30.0% of CD patients achieved clinical response, clinical remission, steroid-free remission, and mucosal healing, respectively. All patients underwent hepatitis B and tuberculosis screening before initiating biologics, and prophylaxis was recommended when necessary. One hepatitis B carrier, without antiviral prophylaxis due to economic barriers, had hepatitis B reactivation during steroid tapering and increasing azathioprine dosage, which was controlled with an antiviral agent. No tuberculosis reactivation was noted. At 12 months, non-reimbursement-related treatment persistence rates were 94.0% and 82.5% in UC and CD patients, respectively. Moreover, 75.3% of IBD patients discontinued VDZ due to mandatory drug holiday. Relapse rates after VDZ discontinuation at 6 and 12 months were 36.7% and 64.3% in CD patients and 42.9% and 52.4% in UC patients, respectively. CONCLUSIONS The findings demonstrated VDZ effectiveness in IBD patients in Taiwan, with high treatment persistence rates and favorable safety profiles. A substantial IBD relapse rate was observed in patients who had mandatory drug holiday.
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Affiliation(s)
- Wei-Chen Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Hung Tu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Che Feng
- Division of Gastroenterology and Hepatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Jium Shieh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Shuan Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsu-Heng Yen
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Jen-Wei Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jau-Min Wong
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Hwa Liu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chiao-Hsiung Chuang
- Department of Internal Medicine, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tzung-Jiun Tsai
- Division of Gastroenterology and Hepatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Feng-Fan Chiang
- Division of Colon and Rectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Yu Lu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Hsin Chao
- Division of Colon and Rectal Surgery, Department of Surgery, Chiayi and Wangiao Branch, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ai-Sheng Ho
- Division of Gastroenterology, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Lung Feng
- Division of Gastroenterology and Hepatology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ming-Wun Wong
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chien-Chih Tung
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Huang-Ming Hu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huann-Sheng Wang
- Division of Colorectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yu Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Feng Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiang Yao Shih
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Lun Tang
- Takeda Pharmaceuticals Taiwan, Ltd., Taipei, Taiwan
| | | | - Shu-Chen Wei
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Liu MS, Han XY, Qu ZG, Luo QL, Wu KL, Chen J, Wu YJ, Xu WL, Yang XX, Zhu YY. [Rapid promyelocytic blast crisis of chronic myeloid leukemia with PML-RARα fusion gene: a case report and literature review]. Zhonghua Xue Ye Xue Za Zhi 2023; 44:512-515. [PMID: 37550211 PMCID: PMC10450556 DOI: 10.3760/cma.j.issn.0253-2727.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Indexed: 08/09/2023]
Affiliation(s)
- M S Liu
- Yiwu Central Hospital, Yiwu 322099, China
| | - X Y Han
- The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
| | - Z G Qu
- Yiwu Central Hospital, Yiwu 322099, China
| | - Q L Luo
- Yiwu Central Hospital, Yiwu 322099, China
| | - K L Wu
- Yiwu Central Hospital, Yiwu 322099, China
| | - J Chen
- Yiwu Central Hospital, Yiwu 322099, China
| | - Y J Wu
- Yiwu Central Hospital, Yiwu 322099, China
| | - W L Xu
- Yiwu Central Hospital, Yiwu 322099, China
| | - X X Yang
- Yiwu Central Hospital, Yiwu 322099, China
| | - Y Y Zhu
- The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China
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Huang CC, Wu KL, Liu JS, Chang YY. Autonomic impairment in treatment-naive patients with chronic hepatitis B and C infections. Auton Neurosci 2022; 238:102928. [PMID: 35021146 DOI: 10.1016/j.autneu.2021.102928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/16/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Peripheral neuropathy is not an uncommon manifestation in patients with chronic hepatitis. The role of cryoglobulin (CG) in neuropathy in patients with chronic hepatitis remains controversial. There is limited information about the autonomic neuropathy in chronic hepatitis. This study aimed to evaluate autonomic function in treatment-naive patients with chronic hepatitis B or hepatitis C infection and to elucidate the association between autonomic neuropathy and CG in these patients. METHODS A total of 29 treatment-naive patients with chronic, yet mild degrees of hepatitis B or C infection were evaluated for autonomic function, including those in the sympathetic sudomotor, cardiovagal, and adrenergic domains, to compare with the control subjects. The autonomic impairment was graded using the Composite Autonomic Scoring Scale. Then, association analyses between autonomic parameters/scores and CG were performed. RESULTS Patients with chronic hepatitis B or C infection had significantly worse autonomic function than control subjects, especially in the sudomotor and cardiovagal domains. The autonomic manifestations in cases with and without CG were similar. There was no significant difference in autonomic dysfunction between patients with hepatitis B and C infections. CONCLUSION The study demonstrated that autonomic neuropathy was not uncommon in patients with chronic hepatitis B or C infection. There was no association between autonomic neuropathy and CG.
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Affiliation(s)
- Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Jia-Shou Liu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
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Chan YC, Chen CL, Wang CC, Lin CC, Yong CC, Chiu KW, Wu KL. Extremity risk factors of sepsis for gastrointestinal endoscopy in patients with liver cirrhosis. BMC Gastroenterol 2022; 22:54. [PMID: 35139804 PMCID: PMC8826657 DOI: 10.1186/s12876-022-02124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 01/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Liver cirrhosis is a well-known risk factor of sepsis after emergent gastrointestinal (GI) endoscopy. Elective GI endoscopy before living donor liver transplantation (LDLT), however, may also carry the septic risk among these patients. METHODS This retrospective study reviewed the medical records of 642 cirrhotic recipients who underwent GI endoscopy from 2008 to 2016. We analyzed the incidence and risk factors of post-endoscopy sepsis during 2008-2012 (experience cohort). Our protocol changed after 2013 (validation cohort) to include antibiotic prophylaxis. RESULTS In experience cohort, 36 cases (10.5%) of the 342 LDLT candidates experienced sepsis within 48 h after endoscopy. The sepsis rate was significantly higher in patients with hepatic decompensation than patients without (22.2% vs. 9.6% vs. 2.6% in Child C/B/A groups respectively; ×2 = 20.97, P < 0.001). Using multivariate logistic regression analysis, the factors related to post-endoscopy sepsis were the Child score (OR 1.46; 95% CI 1.24-1.71), Child classes B and C (OR 3.80 and 14.13; 95% CI 1.04-13.95 and 3.97-50.23, respectively), hepatic hydrothorax (OR 4.85; 95% CI 1.37-17.20), and use of antibiotic prophylaxis (OR 0.08; 95% CI 0.01-0.64). In validation cohort, antibiotics were given routinely, and all cases of hepatic hydrothorax (n = 10) were drained. Consequently, 4 (1.3%) episodes of sepsis occurred among 300 LDLT candidates, and the incidence was significantly lower than before (1.3% vs. 10.5%, P < 0.001). CONCLUSIONS Patients with decompensated cirrhosis and hepatic hydrothorax have higher risk of sepsis following endoscopy. In advanced cirrhotic patients, antibiotic prophylaxis and drainage of hydrothorax may be required to prevent sepsis before elective GI endoscopy.
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Affiliation(s)
- Yi-Chia Chan
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan.
| | - Chee-Chien Yong
- Liver Transplantation Center, and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, 83303, Kaohsiung, Taiwan
| | - King-Wah Chiu
- Liver Transplantation Center, and Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Liver Transplantation Center, and Department of Internal Medicine, Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Yang SC, Wu CK, Tai WC, Liang CM, Yao CC, Wu KL, Hsu CN, Chuah SK. Risks of adverse events for users of proton-pump inhibitors plus aspirin or clopidogrel in patients with aspirin-related ulcer bleeding. J Gastroenterol Hepatol 2021; 36:1828-1835. [PMID: 33247982 DOI: 10.1111/jgh.15360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/22/2020] [Accepted: 11/21/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIM Clopidogrel is widely prescribed for patients with of aspirin-related upper gastrointestinal bleeding (UGIB) history. This study aimed to compare the risk of a major adverse cardiovascular event (MACE), UGIB, and mortality between aspirin and clopidogrel in patients at risk of bleeding. METHODS We analyzed adult patients at high risk of UGIB following aspirin-related bleeding for secondary MACE prevention between 2000 and 2012. Secondary prevention was for those patients who had ever been hospitalized for cardiovascular disease and reused aspirin or changed to clopidogrel after discharge. Study endpoints were recurrence of MACE, UGIB, and death in 90 days of follow-up. The associations between study outcomes and the use of clopidogrel (vs aspirin) were analyzed. RESULTS Among 947 eligible patients, 653 reused aspirin (in combination with a proton-pump inhibitor), and 294 were treated with clopidogrel (in combination with a proton-pump inhibitor) after discharge for UGIB. Compared with aspirin treatment, clopidogrel showed an increased risk of MACE (adjusted hazard ratio [aHR] 1.65; 95% confidence interval [CI] 0.87-3.12) and UGIB (aHR 1.25; 95% CI 0.66-2.36), but without statistical significance in 90 days' follow-up. Clopidogrel use was associated with greater than four times the risk of any cause of mortality (aHR 4.84; 95% CI 1.59-14.75), but the significance did not hold in propensity score-matched cohort analysis (P = 0.06). CONCLUSIONS A nonsignificant difference between clopidogrel and aspirin for short-term MACE prevention as well as UGIB recurrence was found in the present study. Further research to assess 90-day mortality would assist clinical decision making.
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Affiliation(s)
- Shih-Cheng Yang
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
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Hung KT, Yang SC, Wu CK, Wang HM, Yao CC, Liang CM, Tai WC, Wu KL, Kuo YH, Lee CH, Chuah SK. Eradication Rates for Esomeprazole and Lansoprazole-Based 7-Day Non-Bismuth Concomitant Quadruple Therapy for First-Line Anti- Helicobacter pylori Treatment in Real World Clinical Practice. Infect Drug Resist 2021; 14:1239-1246. [PMID: 33790594 PMCID: PMC8007608 DOI: 10.2147/idr.s304711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/06/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Non-bismuth concomitant quadruple therapy is commonly administered in Taiwan, achieving an acceptable efficacy as a first-line anti-Helicobacter pylori treatment. This study compared the eradication rates between esomeprazole- and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line anti-H. pylori treatment. PATIENTS AND METHODS This study included 206 H. pylori-infected naïve patients between July 2016 and February 2019. The patients were prescribed with either a 7-day non-bismuth containing quadruple therapy (esomeprazole, 40 mg twice daily; amoxicillin, 1 g twice daily; and metronidazole, 500 mg twice daily; and clarithromycin, 500 mg twice daily for 7 days [EACM group]; lansoprazole, 30 mg twice daily; amoxicillin, 1 g twice daily; metronidazole, 500 mg twice daily; and clarithromycin, 500 mg twice daily [LACM group]). Then, the patients were asked to perform urea breath tests 8 weeks later. RESULTS The eradication rates in the EACM group were 86.1% (95% confidence interval [CI], 77.8%-92.2%) and 90.6% (95% CI, 82.9%-95.6%) in the intention-to-treat (ITT) and the per-protocol (PP) analyses, respectively. Moreover, the eradication rates in the LACM group were 90.1% (95% CI, 82.6%-95.2%) and 92.6% (95% CI, 85.5%-96.9%) in the ITT and the PP analyses, respectively. Consequently, the LACM group exhibited more diarrhea patients than the EACM group (7.1% versus 1.0%, p = 0.029), but all symptoms were mild. Univariate analysis in this study showed that metronidazole-resistant strains were the clinical factor affecting the eradications (95.3% versus 78.9%, p = 0.044). Moreover, a trend was observed in dual clarithromycin- and metronidazole-resistant strains (91.5% versus 66.7%, p = 0.155). CONCLUSION The eradication rates between esomeprazole and lansoprazole-based non-bismuth concomitant quadruple therapy for first-line H. pylori treatment were similar in this study. Both could achieve a > 90% report card in the PP analysis.
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Affiliation(s)
- Kuo-Tung Hung
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Hsing-Ming Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yuan-Hung Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chen-Hsiang Lee
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Division of Infectious Disease, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
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Yuan JJ, Li DP, Liu YH, Wu KL, Zhao Y, Wu J, Yao CY, Wang Y. [Application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal or hypopharyngeal cancer]. Zhonghua Zhong Liu Za Zhi 2020; 42:976-979. [PMID: 33256313 DOI: 10.3760/cma.j.cn112152-20200418-00354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To Investigate the application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal and hypopharyngeal cancer. Methods: A total of 60 patients with laryngeal and hypopharyngeal cancer occurred serious postoperative complications, including 31 cases of severe postoperative neck infection, 8 cases of dyspnea, 5 cases of massive hemorrhage and 16 cases of seriously intractable aspiration. The tracheal cannula with inner cannula and outer cuff was immediately worn on these patients and the cuff was inflated. Different treatments were carried out according to different complications. The outer cuffs were inflated for patients with severe neck infections to prevent a large amount of neck secretions inhaled to the trachea. Patients with dyspnea immediately received ventilator-assisted ventilation. For those with massive hemorrhage on the wound, doctors should prevent bleeding and stop bleeding under general anesthesia. Patients with severely coughing should perform eating training to prevent food aspiration. The inner cannula was regularly replaced once a month for all of these patients. Results: Through targeted treatment, the complications of 60 patients with cuffed tracheostomy tube with inner cannula were effectively controlled. After dressing change, the neck wounds of 31 patients with neck infection were shrunk or healed. Finally, all of the patients were replaced with metal tracheal tubes. Eight cases with dyspnea were rescued with the symptomatic and related special treatment, and finally replace by metal tracheal tube. Five cases with massive bleeding in the neck wound were successfully rescued and replaced with metal tracheal cannula. Thirteen patients among 16 cases with intractable aspiration were removed the tracheal cannula and other 3 cases of old and severely ill were replaced with metal tracheal cannula. Conclusions: The cuffed tracheostomy tube with inner cannula is of great value in the treatment of severe postoperative complications of laryngeal or hypopharyngeal cancer. It is strongly recommended that the operators should fully understand and use it reasonably after the operation of laryngeal or hypopharyngeal cancer.
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Affiliation(s)
- J J Yuan
- Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - D P Li
- Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Y H Liu
- Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - K L Wu
- Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Y Zhao
- Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - J Wu
- Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - C Y Yao
- Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Y Wang
- Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Huang TH, Yang SC, Tai WC, Liang CM, Kuo CM, Yao CC, Wu CK, Kuo YH, Chou YP, Lee CH, Wu KL, Chuah SK. The efficacies of non-bismuth containing quadruple therapies in the treatment of first-line anti-Helicobacter pylori across 4-year time interval with changing antibiotics resistance. Biomed J 2020; 44:S275-S281. [PMID: 35292265 PMCID: PMC9068570 DOI: 10.1016/j.bj.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023] Open
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Tai WC, Liang CM, Kuo CM, Huang PY, Wu CK, Yang SC, Kuo YH, Lin MT, Lee CH, Hsu CN, Wu KL, Hu TH, Chuah SK. A 14 day esomeprazole- and amoxicillin-containing high-dose dual therapy regimen achieves a high eradication rate as first-line anti-Helicobacter pylori treatment in Taiwan: a prospective randomized trial. J Antimicrob Chemother 2020; 74:1718-1724. [PMID: 30768161 DOI: 10.1093/jac/dkz046] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The first-line eradication rate of standard triple therapy for Helicobacter pylori infection has declined to <80%, and alternative therapies with >90% success rates are needed. Inconsistent eradication rates were reported for proton pump inhibitor- and amoxicillin-containing high-dose dual therapy. OBJECTIVES We performed a prospective, randomized controlled study to assess the efficacy of esomeprazole- and amoxicillin-containing high-dose dual therapy and investigated the influencing clinical factors. PATIENTS AND METHODS We recruited 240/278 eligible H. pylori-infected patients after exclusion. They were randomly assigned to 14 day high-dose dual therapy (esomeprazole 40 mg three times daily and amoxicillin 750 mg four times daily for 14 days; EA group) or 7 day non-bismuth quadruple therapy (esomeprazole 40 mg twice daily, clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily and metronidazole 500 mg twice daily for 7 days; EACM group). Urea breath tests were followed up 8 weeks later. RESULTS The eradication rates for the EA and EACM groups were 91.7% (95% CI = 85.3%-96.0%) and 86.7% (95% CI = 79.3%-92.2%) (P = 0.21) in ITT analysis; and 95.7% (95% CI = 90.2%-98.6%) and 92.0% (95% CI = 85.4%-96.3%) (P = 0.26) in PP analysis. The adverse event rates were 9.6% versus 23.0% in the two groups (P = 0.01). The H. pylori culture positivity rate was 91.8%. The antibiotic resistance rates were amoxicillin, 0%; clarithromycin, 14.6%; and metronidazole, 33.7%. CONCLUSIONS A 14 day esomeprazole- and amoxicillin-containing high-dose dual therapy achieves a high eradication rate as first-line anti-H. pylori therapy, comparable to that with 7 day non-bismuth quadruple therapy but with fewer adverse events.
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Affiliation(s)
- Wei-Chen Tai
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Mou Kuo
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Pao-Yuan Huang
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yuan-Hung Kuo
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Tsung Lin
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Gang Gung Memorial Hospital, Kaohsiung, Taiwan.,School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Wu TC, Lu CN, Hu WL, Wu KL, Chiang JY, Sheen JM, Hung YC. Tongue diagnosis indices for gastroesophageal reflux disease: A cross-sectional, case-controlled observational study. Medicine (Baltimore) 2020; 99:e20471. [PMID: 32702810 PMCID: PMC7373596 DOI: 10.1097/md.0000000000020471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Traditional Chinese medicine tongue diagnosis can mirror the status of the internal organ, but evidence is lacking regarding the accuracy of tongue diagnosis to gastroesophageal reflux disease (GERD). This study was to investigate the association between GERD and tongue manifestation, and whether tongue imaging could be initial diagnosis of GERD noninvasively.We conducted a cross-sectional, case-controlled observational study at Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2016 to September 2017. Participants aged over 20 years old with GERD were enrolled and control group without GERD were matched by sex. Tongue imaging were acquired with automatic tongue diagnosis system, then followed by endoscope examination. Nine tongue features were extracted, and a receiver operating characteristic (ROC) curve, analysis of variance, and logistic regression were used.Each group enrolled 67 participants. We found that the saliva amount (P = .009) and thickness of the tongue's fur (P = .036), especially that in the spleen-stomach area (%) (P = .029), were significantly greater in patients with GERD than in those without. The areas under the ROC curve of the amount of saliva and tongue fur in the spleen-stomach area (%) were 0.606 ± 0.049 and 0.615 ± 0.050, respectively. Additionally, as the value of the amount of saliva and tongue fur in the spleen-stomach area (%) increased, the risk of GERD rose by 3.621 and 1.019 times, respectively. The tongue fur in the spleen-stomach area (%) related to severity of GERD from grade 0 to greater than grade B were 51.67 ± 18.72, 58.10 ± 24.60, and 67.29 ± 24.84, respectively.The amount of saliva and tongue fur in the spleen-stomach area (%) might predict the risk and severity of GERD and might be noninvasive indicators of GERD. Further large-scale, multi-center, randomized investigations are needed to confirm the results.Trial registration: NCT03258216, registered August 23, 2017.
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Affiliation(s)
- Tzu-Chan Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Cheng-Nan Lu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
- Fooyin University College of Nursing, Kaohsiung
- Kaohsiung Medical University College of Medicine
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine
| | - John Y. Chiang
- Department of Computer Science and Engineering, National Sun Yat-sen University, Taiwan
| | - Jer-Ming Sheen
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
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11
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Cheng Y, Lu W, Wu KL. [Severe facial malformation caused by secondary hyperparathyroidism in uremia: report of 4 cases]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 54:924-927. [PMID: 31887819 DOI: 10.3760/cma.j.issn.1673-0860.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the etiology, characteristics and prevention of severe facial deformity in patients with uremia entering the dialysis stage. Methods: Four cases with uremia in the dialysis stage who presented with severe facial deformity between October 2011 and November 2018 were reviewed, including 3 males and 1 female. The ages were 31, 15, 51 and 61, respectively. The general information, clinical symptoms, biochemical indicators, relevant imaging indicators, diagnoses, treatments and efficacies of the 4 patients admitted to the First Affiliated Hospital of Anhui Medical University were collected. Results: All the 4 patients appeared obviously shorter, accompanied by a certain degree of decline in self-care ability, multiple bone and joint pain and severe facial deformity. They presented with significantly increased serum levels of alkaline phosphatase, calcium, phosphorus and parathyroid hormone, and parathyroid hormone level>2 500 pg/ml.Ultrasonography and (99)Tc(m) radionuclide scan showed in situ or ectopic hyperplasia of parathyroid tissue. Bone radiography showed local decrease of bone mineral density and cystic changes.After parathyroidectomy, the serum levels of alkaline phosphatase, parathyroid hormone, calciumand phosphorus decreased significantly, while bone pain symptoms and facial deformities gradually improved. Conclusion: Secondary hyperparathyroidism is a serious complication in patients with dialysis and few of patients may have severe facial deformity (Sagliker syndrome) affecting their normal life and social activities. Parathyroidectomy can improve the facial deformity and the quality of life of patients.
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Affiliation(s)
- Y Cheng
- Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022
| | - W Lu
- Department of Nephrology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022
| | - K L Wu
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022
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12
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Tai WC, Liang CM, Bi KW, Kuo CM, Lu LS, Wu CK, Yang SC, Kuo YH, Lee CH, Huang CF, Hsu CN, Hsu PI, Wu DC, Hu TH, Wu KL, Chuah SK. A comparison between dexlansoprazole modified release-based and lansoprazole-based nonbismuth quadruple (concomitant) therapy for first-line Helicobacter pylori eradication: a prospective randomized trial. Infect Drug Resist 2019; 12:2923-2931. [PMID: 31571945 PMCID: PMC6754331 DOI: 10.2147/idr.s213998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/03/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose Steadily maintaining high intra-gastric PH is the major factor for successful Helicobacter pylori (H.pylori) eradication. It is important to search for a stronger PPI. Dexlansoprazole MR is a dual delayed release formulation PPI taken once daily which is capable of maintaining longer duration of high intra-gastric PH. It is very effective in treating gastroesophageal disease but reports on H, pylori eradication is very rare. This study sought to compare dexlansoprazole MR-based concomitant treatment and lansoprazole-based concomitant treatment in H. pylori infection and to investigate the factors that affect the eradication rates. Methods Two hundred two participants with H. pylori infection were included and randomly assigned to seven days of dexlansoprazole MR-based concomitant therapy (dexlansoprazole MR 60 mg once daily, clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily and metronidazole 500 mg twice daily; DACM group) or a seven days of lansoprazole-based concomitant therapy (lansoprazole 30 mg twice daily, clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily, and metronidazole 500 mg twice daily; LACM group). The participants were asked to perform urea breath tests eight weeks later. Results The eradication rates in the DACM group were 86.1% [95% confidence interval (CI): 77.8%–92.2%] in the ITT analysis and 90.6% (95% CI: 82.9%–95.6%) in the PP analysis, respectively, as compared with 90.1% (95% CI: 82.6%–95.2%) and 92.6% (95% CI: 85.5%–96.9%) (p=0.384 and p=0.572, respectively) in the LACM group for the same analyses. The adverse event rates were 11.5% in the DACM group and 10.2% in the LACM group (p=0.779). Conclusion As a first-line H. pylori treatment regimen, dexlansoprazole MR-based concomitant therapy attained a successful eradication rate of 90%, which was non inferior to that of lansoprazole-based concomitant treatment. ClinicalTrials.gov identifier NCT03829150. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/AJ1z88nc4uI
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Affiliation(s)
- Wei-Chen Tai
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuo-Wei Bi
- Division of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Mou Kuo
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yuan-Hung Kuo
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Fang Huang
- Division of Family Physician, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Pin-I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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13
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Wu J, Wu KL, Liu YH, Zhao Y, Wang Y, Wang D. [Surgical treatment of stomal recurrence after tracheotomy]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33:752-756. [PMID: 31446733 DOI: 10.13201/j.issn.1001-1781.2019.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Indexed: 11/12/2022]
Abstract
Objective:The aim of this study is to investigate the perioperative management of stomal recurrence after tracheostomy including the method of surgical resection and repairment of postoperative defect. Method:Fifteen cases of stomal recurrence after tracheostomy, all cases received preoperative neck to chest enhanced CT scan or PET-CT examination to determine the scope of the lesion, electronic gastroscope or esophageal radiography to understand whether the esophageal mucosa is invased. All cases received extended resection and low tracheostomy. Result:Seven cases were repaired with pedicle pectoralis major myocutaneous flap. Five cases were repaired with internal thoracic artery perforator flap. Two cases were chosed approaching the skin and subcutaneous tissue, such as pedicled rotator flap or Z-shaped flap or V-Y advance flap to repaire. 1 case was chosed Stomach lifting instead of esophageal surgery and near skin flap for repairment. In all cases, the operations were completed successfully and none patient died during the perioperative period. All patients received postoperative radiotherapy after surgery. Conclusion:After proper examination, the selected stomal recurrence after tracheostomy can be surgically treated. The key to judgment before surgery is whether the surrounding large vessels can be safely dissected or reconstructed, and whether or not tracheostomy can be performed after resection. The appropriate method of repairing the defect during the operation can successfully complete the operation and extend the lives of some patients. Patients with tracheostomy maintenance should pay special attention to regular follow-up after surgery.
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Affiliation(s)
- J Wu
- Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,230022,China
| | - K L Wu
- Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,230022,China
| | - Y H Liu
- Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,230022,China
| | - Y Zhao
- Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,230022,China
| | - Y Wang
- Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,230022,China
| | - D Wang
- Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei,230022,China
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Kuo CM, Chiu YC, Liang CM, Wu CK, Lu LS, Tai WC, Kuo YH, Wu KL, Chuah SK, Kuo CH. The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones. BMC Gastroenterol 2019; 19:93. [PMID: 31215401 PMCID: PMC6582576 DOI: 10.1186/s12876-019-1017-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The removal of large bile duct stones (> 15 mm) by conventional endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) can be challenging, requiring mechanical lithotripsy (ML) in addition to EST or EPBD. The primary complication of ML is basket and stone impaction, which can lead to complications such as pancreatitis and cholangitis. The present study aims to investigate the efficacy of limited EST plus endoscopic papillary large balloon dilation (EST-EPLBD) for large bile duct stone extraction with an extent of cutting < 1/2 the length of the papillary mound. METHODS We enrolled 185 patients with ≥15 mm bile duct stones who received EST, EPLBD and limited EST-EPLBD treatment from January 1, 2010 to February 28, 2018, at Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan). All patients were categorized into three groups: EST group (n = 31), EPLBD group (n = 96), and limited EST-EPLBD group (n = 58). The primary outcome variables were the success rate of complete stone removal and complications. RESULTS The limited EST-EPLBD group exhibited a higher success rate of the first-session treatment compared with the EST and EPLBD groups (98.3% vs. 83.9% vs. 86.5%; P = 0.032) but required a longer procedure time (32 (12-61) min vs. 23.5 (17-68) min vs. 25.0 (14-60) min; P = 0.001). The need for ML during the procedure was 4 (12.9%) in the EST group, 10 (10.4%) in the EPLBD group and 2 (3.4%) in the limited EST-EPLBD group. Post-procedure bleeding in the EST group was more common than that in the limited EST-EPLBD group (9.7% vs. 0%; P = 0.038). Furthermore, dilated bile duct was the only risk factor for bile duct stone recurrence in the limited EST-EPLBD group. CONCLUSIONS Limited EST-EPLBD exhibits a higher success rate but requires marginally longer procedure time for the first-session treatment. Furthermore, dilated bile duct is the only risk factor for bile duct stone recurrence in patients undergoing limited EST-EPLBD.
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Affiliation(s)
- Chung-Mou Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Yuan-Hung Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan
| | - Chung-Huang Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Sung Dist, 833, Kaohsiung, Taiwan.
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Yao CC, Kuo CM, Hsu CN, Yang SC, Wu CK, Tai WC, Liang CM, Wu KL, Huang CF, Bi KW, Lee CH, Chuah SK. First-line Helicobacter pylori eradication rates are significantly lower in patients with than those without type 2 diabetes mellitus. Infect Drug Resist 2019; 12:1425-1431. [PMID: 31239721 PMCID: PMC6554512 DOI: 10.2147/idr.s194584] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/30/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose: To assess the difference of the first-line therapy for Helicobacter pylori in patients with or without type 2 diabetes (DM) and to investigate the clinical factors influencing treatment outcomes. Patients and methods: In total, 719 patients with H. pylori infection were treated with 7-day standard first-line triple therapy, of whom 182 did and 537 did not have DM. Propensity score matched at a 1:2 ratio - for age, sex and body mass index was performed for the two groups, yielding a DM group with 147 patients and a non-DM group with 249 matched controls for analysis. Urea breath test was performed 6-8 weeks after treatment. Clinical and laboratory parameters were collected for identifying factors associated with failed eradication. Results: H. Pylori was eradicated in 74.1% (95% confidence interval [CI] =66.2-81.0) of the DM group and 85.3% (95% CI =80.8-89.4) of the non-DM group (p=0.005). Of 51 gastric biopsy samples cultured for H. pylori, 41 were positive. In the DM group, the rates of resistance to amoxicillin, clarithromycin, levofloxacin, and tetracycline were 0%, 50.0%, 50.0% and 0%, respectively. In the non-DM group, the comparable proportions were 2.9%, 17.1%, 22.9%, and 0%, respectively. Univariate analysis revealed that DM (Odds ratio [OR], 1.771, 95% CI, 1.167-2.668, p=0.006), clarithromycin resistance (OR, 15.273; 95% CI, 1.687-138.269; p=0.015), and amoxicillin resistance (OR, 4.672; 95% CI, 2.431-8.979; p<0.001) were independently associated with failure to eradicate H. pylori. Multivariate analysis showed that clarithromycin resistance was the major factor independently associated with failure of eradication (OR, 25.472; 95% CI, 1.549-418.956; p=0.023). Conclusions: First-line H. pylori eradication rates in patients with DM were significantly lower than in those without DM, although neither group achieved >90% eradication.
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Affiliation(s)
- Chih-Chien Yao
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung833, Taiwan
| | - Chung-Mou Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung833, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung and School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung833, Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung833, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung833, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung833, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung833, Taiwan
| | - Chih-Fang Huang
- Division of Family physician, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Wei Bi
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung833, Taiwan
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Chiang HH, Wu DC, Hsu PI, Kuo CH, Tai WC, Yang SC, Wu KL, Yao CC, Tsai CE, Liang CM, Wang YK, Wang JW, Huang CF, Chuah SK. Clinical efficacy of 60-mg dexlansoprazole and 40-mg esomeprazole after 24 weeks for the on-demand treatment of gastroesophageal reflux disease grades A and B: a prospective randomized trial. Drug Des Devel Ther 2019; 13:1347-1356. [PMID: 31118571 PMCID: PMC6499145 DOI: 10.2147/dddt.s193559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/12/2019] [Indexed: 12/22/2022]
Abstract
Purpose: Research comparing the clinical efficacy of dexlansoprazole and esomeprazole has been limited. This study aims to compare the clinical efficacy of single doses of dexlansoprazole (modified-release 60 mg) and esomeprazole (40 mg) after 24-week follow-up in patients with mild erosive esophagitis. Methods: We enrolled 86 adult GERD subjects, randomized in a 1:1 ratio to two sequence groups defining the order in which they received single doses of dexlansoprazole (n=43) and esomeprazole (n=43) for 8 weeks as initial treatment. Patients displaying complete symptom resolution (CSR) by the end of initial treatment (8 weeks) were switched to on-demand therapy until the end of 24 weeks. Follow-up endoscopy was performed either at the end of 24 weeks or when severe reflux symptoms occurred. Five patients were lost to follow-up, leaving 81 patients (dexlansoprazole, n=41; esomeprazole, n=40) in the per-protocol analysis. Results: The GERDQ scores at 4-, 8-, 12-, 16-, 20-, and 24-week posttreatment were less than the baseline score. The CSR, rate of symptom relapse, days to symptom resolution, sustained healing rate of erosive esophagitis, treatment failure rate, and the number of tablets taken in 24 weeks were similar in both groups. The esomeprazole group had more days with reflux symptoms than the dexlansoprazole group (37.3±37.8 vs 53.9±54.2; P=0.008). In the dexlansoprazole group, patients exhibited persistent improvement in the GERDQ score during the on-demand period (week 8 vs week 24; P<0.001) but not in the esomeprazole group (week 8 vs week 24; P=0.846). Conclusions: This study suggests that the symptom relief effect for GERD after 24 weeks was similar for dexlansoprazole and esomeprazole. Dexlansoprazole exhibited fewer days with reflux symptoms in the 24-week study period, with better persistent improvement in the GERDQ score in the on-demand period. (ClinicalTrials. gov number: NCT03128736).
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Affiliation(s)
- Hung-Hsien Chiang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pin-I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-En Tsai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao-Kuang Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiunn-Wei Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Fang Huang
- Division of Family Physicians, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Yang XG, Wu KL, Xu GH, Zhou S. [Differential analysis of protein profiles of bile from patients with hepatocellular carcinoma and gallstone]. Zhonghua Gan Zang Bing Za Zhi 2019; 27:316-318. [PMID: 31082345 DOI: 10.3760/cma.j.issn.1007-3418.2019.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- X G Yang
- Department of Interventional, Sichuan Caner Hospital, Chengdu 610041, China
| | - K L Wu
- Zhongshan University Ophthalmology Center Laboratory, Guangzhou 510000, China
| | - G H Xu
- Department of Interventional, Sichuan Caner Hospital, Chengdu 610041, China
| | - S Zhou
- Department of Interventional, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China
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Wu KL, Chiu YC, Yao CC, Tsai CE, Hu ML, Kuo CM, Tai WC, Chuah SK, Hsiao CC. Effect of extracorporeal low-energy shock wave on diabetic gastroparesis in a rat model. J Gastroenterol Hepatol 2019; 34:720-727. [PMID: 29966170 DOI: 10.1111/jgh.14368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM Delayed gastric emptying occurs in more than 50% of chronic diabetic patients, and this is associated with significant impairments in quality of life. Traditional therapy for delayed gastric emptying has focused on supportive treatment, and there is no significant effective therapy. The effect of low-energy shock wave on gastric motility is never studied. We investigated low-energy shock wave on gastric motility in a diabetic rat model. METHODS Twenty-eight male Wistar rats were studied and separated in three groups in randomized order as control, diabetic rats received shock wave, and diabetic rats received the sham procedure. Antral area and motility were recorded using the transabdominal ultrasound. Blood was taken for measurement of gastric motility peptides. Subjects were killed for immunohistochemical stain analysis of enteric plexus of the stomach. RESULTS We successfully induced 20 diabetic rats and set ultrasound for measuring rat gastric contract and emptying model and demonstrated that 6 weeks of low-energy shock wave could promote gastric contraction and emptying in diabetic rats. Moreover, we demonstrated that shock wave could increase defecation and feces and decrease serum cholesterol and triglycerol. However, no effect on glycohemoglobin and gastric motility peptides was recorded. In the immunohistochemical staining, shock wave increased expression of gastric myenteric neuron plexus. CONCLUSION Low-energy shock wave can increase gastric contraction and emptying by activating axonal regeneration and increasing myenteric plexus, but not related with motility peptides.
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Affiliation(s)
- Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-En Tsai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ming-Luen Hu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Mou Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Kaohsiung, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Chuah SK, Lim CS, Liang CM, Lu HI, Wu KL, Changchien CS, Tai WC. Bridging the Gap between Advancements in the Evolution of Diagnosis and Treatment towards Better Outcomes in Achalasia. Biomed Res Int 2019; 2019:8549187. [PMID: 30881999 PMCID: PMC6381566 DOI: 10.1155/2019/8549187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/02/2019] [Accepted: 01/20/2019] [Indexed: 02/05/2023]
Abstract
Over the past few decades, there was an encouraging breakthrough in bridging the gap between advancements in the evolution of diagnosis and treatment towards a better outcome in achalasia. The purpose of this review is to provide updated knowledge on how the current evidence has bridged the gap between advancements in the evolution of diagnosis and treatment of esophageal achalasia. The advent of high-resolution manometry and standardization based on the Chicago classification has increased early recognition of the disease. These 3 clinical subtypes of achalasia can predict the outcomes of patients, and the introduction of POEM has revolutionized the choice of treatment. Previous evidence has shown that laparoscopic Heller myotomy (LHM) and anterior fundoplication were considered the most durable treatments for achalasia. Based on the current evidence, POEM has been evolving as a promising strategy and is effective against all 3 types of achalasia, but the efficacy of POEM is based on short- and medium-term outcome studies from a limited number of centers. Types I and II achalasia respond well to POEM, LHM, and PD, while most studies have shown that type III achalasia responds better to POEM than to LHM and PD. In general, among the 3 subtypes of achalasia, type II achalasia has the most favorable outcomes after medical or surgical therapies. The long-term efficacy of POEM is still unknown. The novel ENDOFLIP measures the changes in intraoperative esophagogastric junction dispensability, which enables a quantitative assessment of luminal patency and sphincter distension; however, this technology is in its infancy with little data to date supporting its intraoperative use. In the future, identifying immunomodulatory drugs and the advent of stem cell therapeutic treatments, including theoretically transplanting neuronal stem cells, may achieve a functional cure. In summary, it is important to identify the clinical subtype of achalasia to initiate target therapy for these patients.
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Affiliation(s)
- Seng-Kee Chuah
- Gastrointestinal Motility Unit, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 833 Kaohsiung, Taiwan
| | - Chee-Sang Lim
- Department of Hepatology, Hospital Selayang, Lebuh Raya Selayang-Kepong, Batu Caves, Selangor, Malaysia
| | - Chih-Ming Liang
- Gastrointestinal Motility Unit, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 833 Kaohsiung, Taiwan
| | - Hung-I Lu
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, 833 Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Gastrointestinal Motility Unit, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 833 Kaohsiung, Taiwan
| | - Chi-Sin Changchien
- Gastrointestinal Motility Unit, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 833 Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Gastrointestinal Motility Unit, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 833 Kaohsiung, Taiwan
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20
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Wu KL. Enteral nutrition feeding in burn injury patients. Adv Dig Med 2018. [DOI: 10.1002/aid2.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Keng-Liang Wu
- Division of Gastroenterology & Hepatology, Department of Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
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21
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Ma SY, Li C, Zhao HB, Zhang JY, Zhang HZ, Wu KL, Li M. [Comparison of clinical outcomes of frozen-thawed blastocysts derived from non-pronucleus or two pronucleus zygotes]. Zhonghua Fu Chan Ke Za Zhi 2018; 53:749-754. [PMID: 30453421 DOI: 10.3760/cma.j.issn.0529-567x.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the application value of the blastocysts derived from non-pronucleus (0PN) zygotes by the good quality blastocyst formation rate and the clinical outcomes of frozen-thawed blastocyst transfers. Methods: The good quality blastocyst formation rate derived from 0PN zygotes was compared with that derived from2 pronucleus (2PN) zygotes in in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles from January 2015 to December 2016. In addition, the clinical pregnancy, embryo implantation and live birth rates of frozen-thawed blastocyst transfers with blastocysts derived from 0PN and 2PN zygotes were analyzed on corresponding dates. Results: (1) In IVF cycles, the high quality blastocysts formation rate of 2PN embryos was significantly higher than that of 0PN (46.64% versus 42.42%, P<0.01) . In ICSI cycles, the high quality blastocysts formation rate of 2PN embryos was markedly higher than that of 0PN (41.96% versus 21.73%, P<0.01) . (2) In frozen-thawed embryo transfer cycles for IVF, the clinical pregnancy, implantation and live birth rates of D5 0PN blastocysts were significantly higher than those of D6 2PN (52.64% versus 46.78%, 49.91% versus 41.20%, 46.54% versus 39.56%, all P<0.05) , however, the abortion and newborn abnormal rates of D5 0PN blastocysts were lower than those of D6 2PN blastocysts (17.37% versus 23.36%, 1.31% versus 4.21%, both P<0.05) ; the clinical pregnancy, implantation and livebirth rates of D5 2PN blastocysts were significantly higher than those of D5 0PN (59.73% versus 52.64%, 55.95% versus 49.91%, 53.03% versus 46.54%, all P<0.05) , but newborn abnormal rate was a little higher than that of D5 0PN (3.90% versus 1.31%, P<0.05) ; the clinical pregnancy, implantation and live birth rates of D5 2PN blastocysts were significantly higher than those of D6 2PN (59.73% versus 46.78%, 55.95% versus 41.20%, 53.03% versus 39.56%, all P<0.05) , and the abortion rate of D5 2PN blastocysts was lower than that of D6 2PN blastocysts (18.23% versus 23.36%, P<0.05) . Conclusions: Although the blastocysts derived from 0PN could be transffered, the blastocysts derived from 2PN zygotes are preferred in all cycles. In IVF cycles, the good quality blastocysts derived from 2PN or 0PN zygotes will be transferred.
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Affiliation(s)
- S Y Ma
- IVF Laboratory, Hospital for Reproductive Medicine Affiliated to Shandong University, Jinan 250021, China
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22
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Huang HT, Wang HM, Yang SC, Tai WC, Liang CM, Wu KL, Lee CH, Chuah SK. Efficacy of a 14-day quadruple-therapy regimen for third-line Helicobacter pylori eradication. Infect Drug Resist 2018; 11:2073-2080. [PMID: 30464550 PMCID: PMC6214414 DOI: 10.2147/idr.s185511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To assess the efficacy of amoxicillin, tetracycline, high-dose metronidazole, and a proton-pump inhibitor for third-line Helicobacter pylori eradication. METHODS We enrolled 70 consecutive patients who had registered, failed to respond to two rounds of H. pylori eradication, and undergone endoscopy for H. pylori culture. Seven patients were lost to follow-up. Patients were treated according to the results of antibiotic-susceptibility testing reports (cultured group, n=39). Those who failed the H. pylori culture were prescribed 14-day quadruple therapy containing esomeprazole 40 mg twice daily, amoxicillin 1 g twice daily, tetracycline 500 mg four times daily, and metronidazole 500 mg three times daily (empirical group, n=24). A follow-up urea breath test was performed 8 weeks later. RESULTS Antibiotic-resistance rates were 79.5% (clarithromycin), 94.9% (levofloxacin), 66.7% (metronidazole), 2.6% (amoxicillin), and 0 (tetracycline). Eradication rates attained by the cultured and empirical group were 89.7% (95% CI 72.7%-97.1%) and 58.3% (95% CI 36.6%-77.9%) in per-protocol analysis (P=0.004) and 81.4% (95% CI 66.6%-91.6%) and 51.8% (95% CI 31.9%-71.3%) in intention-to-treat analysis (P=0.014), respectively. Culture-guided therapy was the only clinical factor influencing the efficacy of H. pylori eradication (OR 0.16, 95% CI 0.04-0.60; P=0.006). Despite the high metronidazole-resistance rate (66.7%) after two treatment failures, the eradication rate in patients with this condition was 84%. CONCLUSION Empirical 14-day modified quadruple therapy is not acceptable as an alternative third-line rescue H. pylori treatment. The success rate of third-line susceptibility-guided treatment was near 90%. This report is valuable as a reminder to medical practitioners that rather than a try-and-see approach, susceptibility-guided therapy should always be considered whenever possible for patients who have undergone several treatment failures.
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Affiliation(s)
- Hsiang Tso Huang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Song District, Kaohsiung 833, Taiwan,
| | - Hsin-Ming Wang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Song District, Kaohsiung 833, Taiwan,
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Song District, Kaohsiung 833, Taiwan,
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Song District, Kaohsiung 833, Taiwan,
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Song District, Kaohsiung 833, Taiwan,
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Song District, Kaohsiung 833, Taiwan,
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Song District, Kaohsiung 833, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Song District, Kaohsiung 833, Taiwan,
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Wu KL, Kuo CM, Huang EY, Pan HM, Huang CC, Chen YF, Hsiao CC, Yang KD. Extracellular galectin-3 facilitates colon cancer cell migration and is related to the epidermal growth factor receptor. Am J Transl Res 2018; 10:2402-2412. [PMID: 30210679 PMCID: PMC6129507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
We previously found that galectin-3 enhanced DLD-1 cell migration through the K-Ras-Raf-Erk1/2 pathway, but the effect of extracellular galectin-3 on cancer cell migration and its interaction with the epidermal growth factor receptor (EGFR) remained unknown. We aimed to determine the effect of extracellular galectin-3 on colon cancer cell migration and its correlation with the EGFR expression. Western blotting was performed to analyze galectin-3 secretion, shRNA was used to stably knock down galectin-3 expression and a migration assay was performed to evaluate colon cancer cell migration. Tissues from eighty patients with four different stages of colon cancer were obtained and compared to normal colon tissue. The galectin-3 knockdown colon cancer cells exhibited decreased migration, which was restored by recombinant galectin-3. An EGFR blocking antibody decreased colon cancer cell migration. The addition of recombinant galectin-3 increased phosphorylated EGFR expression within minutes and enhanced the internalization of the EGFR from the cell membrane to the cytoplasm, particularly upon EGF stimulation. Extracellular galectin-3 increased colon cancer cell migration, which correlated with the EGFR. Targeting galectin-3 may have a synergistic effect on EGFR-targeted therapy.
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Affiliation(s)
- Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial HospitalNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung UniversityNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
| | - Chung-Mou Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial HospitalNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial HospitalNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung UniversityNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
| | - Hui-Mei Pan
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial HospitalNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
| | - Chao-Cheng Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial HospitalNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
| | - Yi-Fan Chen
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial HospitalNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung UniversityNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial HospitalNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
| | - Kuender D Yang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung UniversityNo. 123, Ta-Pei Road, Niao Song Dist, Kaohsiung 83301, Taiwan
- Institute of Clinical Medicine, National Yang Ming UniversityNo. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Institute of Biomedical Sciences, Mackay Medical SchoolNo. 46, Sec. 3, Zhongzheng Road, Sanzhi Dist, New Taipei 252, Taiwan
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Huang PY, Tsai KL, Liang CM, Tai WC, Rau KM, Wu KL, Huang CC, Chuah SK. Prognostic factors of patients with gastroenteropancreatic neuroendocrine neoplasms. Kaohsiung J Med Sci 2018; 34:650-656. [PMID: 30392572 DOI: 10.1016/j.kjms.2018.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 01/30/2023] Open
Abstract
There is an increasing trend in the incidence of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) worldwide. The aim of the present study was to identify the prognostic factors of patients with GEP-NENs. A cross-sectional, retrospective chart review study was conducted among patients with pathologically proven GEP-NENs between January 2003 and December 2016 at Kaohsiung Chung-Gung Memorial Hospital. A total of 97 patients who met the inclusion criteria were included (male/female = 56/41, age: 57.7 ± 15.4 years). The presentation, clinical characteristics, and disease outcomes were reviewed and analyzed. The most common primary site of the GEP-NENs was the rectum (49.5%), followed by the pancreas (17.5%), duodenum (11.3%), stomach (10.3%), colon (6.2%), and appendix (5.2%), and most GEP-NENs were hormonally nonfunctional (94.8%). There were 56 tumors classified as G1 neuroendocrine tumors (NETs), 9 as G2 NETs, and 14 as G3 neuroendocrine carcinoma (NEC). Metastasis was found in 15 patients (15%). Curative treatments, such as surgery or endoscopic resection, were performed in 83.5% of patients (n = 81). The mean overall survival duration was 107.2 ± 7.8 months. The estimated 3- and 5-year overall survival rates for all patients were 84% and 82%, respectively. Logistic regression analysis showed that large tumor size, non-rectal NENs, high histopathological grading, lymphatic metastases and distant metastases were associated with poor survival. This study suggested that the presence of lymphatic or distant metastases at diagnosis is an independent risk factor for poor prognosis in patients with GEP-NENs.
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Affiliation(s)
- Pao-Yuan Huang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kai-Lung Tsai
- Division of Colon and Rectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kun-Ming Rau
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Cheng Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Li GY, Liu YY, Wu KL, Tang ZH. A novel HLA-A*24 allele, A*24:231, was identified by sequence-based typing. HLA 2018; 92:96-97. [PMID: 29790284 DOI: 10.1111/tan.13253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 11/29/2022]
Abstract
HLA-A*24:231 has one nucleotide change from HLA-A*24:02:01:01 at position 784 G>C.
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Affiliation(s)
- G Y Li
- HLA Laboratory, Gansu Red Cross Blood Center, Lanzhou, China
| | - Y Y Liu
- HLA Laboratory, Gansu Red Cross Blood Center, Lanzhou, China
| | - K L Wu
- HLA Laboratory, Gansu Red Cross Blood Center, Lanzhou, China
| | - Z H Tang
- HLA Laboratory, Gansu Red Cross Blood Center, Lanzhou, China
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Huang EY, Chang JC, Chen HH, Hsu CY, Hsu HC, Wu KL. Carcinoembryonic antigen as a marker of radioresistance in colorectal cancer: a potential role of macrophages. BMC Cancer 2018; 18:321. [PMID: 29580202 PMCID: PMC5870371 DOI: 10.1186/s12885-018-4254-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/20/2018] [Indexed: 01/19/2023] Open
Abstract
Background We sought to identify the carcinoembryonic antigen (CEA) as a marker of radioresistance in rectal cancer. Methods From July 1997 to January 2008, 104 patients with stage II or III rectal cancer who were treated with post-operative radiotherapy (PORT) were included in this study. The doses of radiotherapy ranged from 45 to 54.6 Gy. The CEA levels were measured before surgery. We analyzed the actuarial rates of overall survival (OS), distant metastasis (DM), and local recurrence (LR) using Kaplan-Meier curves. Multivariate analyses were performed with Cox regression models. We used THP-1 monocyte cell lines for macrophage differentiation (M0, M1 or M2). The RNA extracted from the macrophages was analyzed via a genomic method in the core laboratory. The radiosensitivities of CEA-rich LS1034 cells were compared between cells with and without the conditioned media from CEA-stimulated macrophages. Results Preoperative CEA levels ≥10 ng/mL were independent predictive factors for OS (p = 0.005), DM (p = 0.026), and LR (p = 0.004). The OS rates among the patients with pretreatment CEA levels < 10 ng/mL and ≥10 ng/mL were 64.5% and 35.9% (p = 0.004), respectively. The corresponding rates of DM were 40.6% and 73.1% (p = 0.024). The corresponding rates of LR were 6.6% and 33.9% (p = 0.002). In the M0 macrophages, exogenous CEA elicited a dose-response relationship with M2 differentiation. In the CEA-stimulated M0 cells, some mRNAs were upregulated by as much as 5-fold, including MMP12, GDF15, and JAG1. In the CEA-stimulated M2 cells, a 4-fold up-regulation of GADD45G mRNA was noted. The conditioned media from the CEA-stimulated M2 cells elicited an increase in the numbers of LS180, SW620, and LS1034 cells after irradiation. CEA caused the M2 differentiation of the macrophages. Conclusion Pretreatment CEA levels ≥10 ng/mL are a significant risk factor for OS, DM, and LR following PORT for rectal cancer. CEA causes radioresistance in the presence of M2 macrophages. More comprehensive examinations prior to surgery and intensive adjuvant therapy are suggested for patients with CEA levels ≥10 ng/mL. Further studies of these mechanisms are needed.
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Affiliation(s)
- Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. .,School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Jen-Chieh Chang
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hong-Hwa Chen
- Division of Colonic and Rectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chieh-Ying Hsu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsuan-Chih Hsu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Tsai CE, Wu KL, Chiu YC, Chuah SK, Tai WC, Hu ML, Liang CM. The incidence and clinical associated factors of interval colorectal cancers in Southern Taiwan. J Formos Med Assoc 2018; 117:185-190. [DOI: 10.1016/j.jfma.2017.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/25/2017] [Accepted: 03/22/2017] [Indexed: 01/22/2023] Open
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Tsai CE, Wu KL. Answer to The incidence and clinical associated factors of interval colorectal cancers in Southern Taiwan: Methodological issues. J Formos Med Assoc 2018; 117:171. [PMID: 29173970 DOI: 10.1016/j.jfma.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023] Open
Affiliation(s)
- Cheng-En Tsai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan.
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Wu KL, Kuo CM, Yao CC, Tai WC, Chuah SK, Lim CS, Chiu YC. The effect of dietary carbohydrate on gastroesophageal reflux disease. J Formos Med Assoc 2018; 117:973-978. [PMID: 29339035 DOI: 10.1016/j.jfma.2017.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/10/2017] [Accepted: 11/02/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Acid changes in gastroesophageal reflux with vary component in the food have less been studied, especially carbohydrate. We plan to clarify the effect of different carbohydrate density on low esophageal acid and reflux symptoms of patients with gastroesophgeal reflux disease. METHODS Twelve patients (52 ± 12 years old; five female) with gastroesophageal reflux disease were recruited for the prospective crossover study. Each patient was invited for panendoscope, manometry and 24 h pH monitor. The two formulated liquid meal, test meal A: 500 ml liquid meal (containing 84.8 g carbohydrate) and B: same volume liquid meal (but 178.8 g carbohydrate) were randomized supplied as lunch or dinner. Reflux symptoms were recorded. RESULTS There are significant statistic differences in more Johnson-DeMeester score (p = 0.019), total reflux time (%) (p = 0.028), number of reflux periods (p = 0.026) and longest reflux (p = 0.015) after high carbohydrate diet than low carbohydrate. Total reflux time and number of long reflux periods more than 5 min are significant more after high carbohydrate diet. CONCLUSION More acid reflux symptoms are found after high carbohydrate diet. High carbohydrate diet could induce more acid reflux in low esophagus and more reflux symptoms in patients with gastroesophageal reflux disease.
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Affiliation(s)
- Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Mou Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chee-Sang Lim
- Department of Hepatology, Hospital Selayang, Lebuh Raya Selayang-kepong, 68100 Batu Caves, Selangor, Malaysia
| | - Yi-Chun Chiu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Wu TC, Wu KL, Hu WL, Sheen JM, Lu CN, Chiang JY, Hung YC. Tongue diagnosis indices for upper gastrointestinal disorders: Protocol for a cross-sectional, case-controlled observational study. Medicine (Baltimore) 2018; 97:e9607. [PMID: 29480863 PMCID: PMC5943858 DOI: 10.1097/md.0000000000009607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Upper gastrointestinal disorders are common in clinical practice, for example, gastritis, peptic ulcer disease, and gastroesophageal reflux disease. Panendoscopy or upper gastrointestinal endoscopy is viewed as the primary tool for examining the upper gastrointestinal mucosa, and permitting biopsy and endoscopic therapy. Although panendoscopy is considered to be a safe procedure with minimal complications, there are still some adverse effects, and patients are often anxious about undergoing invasive procedures. Traditional Chinese medicine tongue diagnosis plays an important role in differentiation of symptoms because the tongue reflects the physiological and pathological condition of the body. The automatic tongue diagnosis system (ATDS), which noninvasively captures tongue images, can provide objective and reliable diagnostic information. METHODS This protocol is a cross-sectional, case-controlled observational study investigating the usefulness of the ATDS in clinical practice by examining its efficacy as a diagnostic tool for upper gastrointestinal disorders. Volunteers over 20 years old with and without upper gastrointestinal symptoms will be enrolled. Tongue images will be captured and the patients divided into 4 groups according to their panendoscopy reports, including a gastritis group, peptic ulcer disease group, gastroesophageal reflux disease group, and healthy group. Nine primary tongue features will be extracted and analyzed, including tongue shape, tongue color, tooth mark, tongue fissure, fur color, fur thickness, saliva, ecchymosis, and red dots. OBJECTIVES The aim of this protocol is to apply a noninvasive ATDS to evaluate tongue manifestations of patients with upper gastrointestinal disorders and examine its efficacy as a diagnostic tool.
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Affiliation(s)
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Wen-Long Hu
- Department of Chinese Medicine
- Fooyin University College of Nursing
- Kaohsiung Medical University College of Medicine
| | | | | | - John Y. Chiang
- Department of Computer Science & Engineering, National Sun Yat-sen University
| | - Yu-Chiang Hung
- Department of Chinese Medicine
- School of Chinese Medicine for Post Baccalaureate I-Shou University, Kaohsiung, Taiwan
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Liang CM, Kuo MT, Hsu PI, Kuo CH, Tai WC, Yang SC, Wu KL, Wang HM, Yao CC, Tsai CE, Wang YK, Wang JW, Huang CF, Wu DC, Chuah SK. First-week clinical responses to dexlansoprazole 60 mg and esomeprazole 40 mg for the treatment of grades A and B gastroesophageal reflux disease. World J Gastroenterol 2017; 23:8395-8404. [PMID: 29307999 PMCID: PMC5743510 DOI: 10.3748/wjg.v23.i47.8395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/19/2017] [Accepted: 09/26/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the one-week clinical effects of single doses of dexlansoprazole and esomeprazole on grades A and B erosive esophagitis.
METHODS We enrolled 175 adult patients with gastroesophageal reflux disease (GERD). The patients were randomized in a 1:1 ratio into two sequence groups to define the order in which they received single doses of dexlansoprazole (n = 88) and esomeprazole (n = 87) for an intention-to-treat analysis. The primary end-points were the complete symptom resolution (CSR) rates at days 1, 3, and 7 after drug administration.
RESULTS Thirteen patients were lost to follow-up, resulting in 81 patients in each group for the per-protocol analysis. The CSRs for both groups were similar at days 1, 3 and 7. In the subgroup analysis, the female patients achieved higher CSRs in the dexlansoprazole group than in the esomeprazole group at day 3 (38.3% vs 18.4%, P = 0.046). An increasing trend toward a higher CSR was observed in the dexlansoprazole group at day 7 (55.3% vs 36.8%, P = 0.09). In the esomeprazole group, female sex was a negative predictive factor for CSR on post-administration day 1 [OR = -1.249 ± 0.543; 95%CI: 0.287 (0.099-0.832), P = 0.022] and day 3 [OR = -1.254 ± 0.519; 95%CI: 0.285 (0.103-0.789), P = 0.016]. Patients with spicy food eating habits achieved lower CSRs on day 1 [37.3% vs 21.4%, OR = -0.969 ± 0.438; 95%CI: 0.380 (0.161-0.896), P = 0.027].
CONCLUSION The overall CSR for GERD patients was similar at days 1-7 for both the dexlansoprazole and esomeprazole groups, although a higher incidence of CSR was observed on day 3 in female patients who received a single dose of dexlansoprazole.
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Affiliation(s)
- Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ming-Te Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Pin-I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung 833, Taiwan
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 833, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Hsing-Ming Wang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Chih-Chien Yao
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Cheng-En Tsai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yao-Kuang Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 833, Taiwan
| | - Jiunn-Wei Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 833, Taiwan
| | - Chih-Fang Huang
- Division of Family Physicians, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 833, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
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Zhang YY, Liu YH, Wu KL, Wu J, Zhao Y, Yao CY, Yang Q, Wang Y, Zhang L. [The clinical anatomy of the inferior thyroid arteries and veins and the safety of the modified tracheotomy]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:1815-1818. [PMID: 29798394 DOI: 10.13201/j.issn.1001-1781.2017.23.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 11/12/2022]
Abstract
Objective:To evaluated the clinical anatomy of the inferior thyroid arteries and veins and the safety of clinical application of the modified tracheotomy. Method:Sixty patients who need partial resection or full resection of thyroid cancer and 50 patients with laryngeal or hypopharyngeal cancer required tracheotomy were enrolled in this study. The distribution of the inferior thyroid arteries and veins closely related to tracheotomy is further dissected. The inverted "U" type of tracheal flap tracheotomy was further improved based on anatomical findings. Finally, the further modified tracheotomy was used for clinical practice and compared with the conventional tracheotomy and the inverted "U" type of tracheal flap tracheotomy. Result:Of the 110 cases, the lowest thyroid artery was found in 11 cases, with a rate of 10%. The inferior thyroid vein has 2-4 branches, which originates from the lower lobe or isthmus of the thyroid lateral lobe, descending in the anterior tracheal space. According to the characteristics of the static reflux of the thyroid gland, the lower thyroid vessels are classified into four types: intravenous dry type (28 cases); intravenous double dry without traffic type (43 cases); intravenous double trunk with traffic (28 cases); mixed type (11 cases). At present, the further modified tracheotomy can effectively avoid the rebleeding of the lower thyroid arteries and veins. There were no bleeding and other complications in all cases. Conclusion:It provides a basis for the further modified of tracheotomy based on the clinical anatomy of the inferior thyroid artery and vein, which is closely related to tracheotomy. The further modified tracheotomy has certain advantages than the conventional tracheotomy and the inverted "U" type of tracheal flap tracheotomy.
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Affiliation(s)
- Y Y Zhang
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Y H Liu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - K L Wu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - J Wu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Y Zhao
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - C Y Yao
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Q Yang
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Y Wang
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - L Zhang
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
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Cai Q, Liu YH, Wu KL, Wu J, Zhao Y, Yao CY. [Preoperative airway management and perioperative period asphyxia prevention in patients with tumors invasion in the cervical tracheal]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:1806-1809. [PMID: 29798392 DOI: 10.13201/j.issn.1001-1781.2017.23.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the effect of preoperative airway treatment and postoperative asphyxiation preventive measures in patients with tumors invasion in the cervical tracheal. Method:The clinical date of 35 patients with different degree of tumors invasion in the cervical tracheal were analyzed retrospectively. Anesthesia including normal endotracheal intubation anesthesia, awake intubation anesthesia with visual laryngoscope assisted after topical anesthesia, intubation anesthesia with preoperative tracheotomy, intubation anesthesia after transection of trachea and anesthesia with extracoporeal circulation was selected according to the patient's situation such as whether exist forced position, or the extent of dyspnea, or the range of recurrent tumor. Preventive tracheotomy or fistulization was performed according to the patients' tracheal involvement and the choice of operation and general condition during the operation. Result:All 35 patients were successfully anesthetized, 17 of whom had no dyspnea or forced position, this kind patients were all anesthesia successfully, and 3 of them underwent prophylactic tracheotomy. Sixteen cases of nonrecurrent tumor with forced position, 15 patients were accepted awake anesthesia successfully with visual laryngoscope assisted after topical anesthesia, 1 patient who cannot be intubated or done tracheotomy is completed with extracorporeal circulation; prophylactic tracheotomy or tracheostomy was performed in this group. Of 2 cases of recurrent tumor with forced posture, preoperative tracheal intubation failed, 1 case was intubated after emergency transection of trachea, 1 case was successfully intubated by emergency tracheotomy before operation and 2 cases received postoperative tracheostomy. In this study, no serious complications such as massive bleeding, asphyxia and cardiovascular accident occurred after the operation. Conclusion:The preoperative airway management of patients whose tumors involves the cervical tracheal and whether tracheotomy or ostomy need to prevent asphyxia or not should be based on the nature of the tumor such as whether is recurrent, the extent of trachea involvement and whether to merge the OSAHS. Only by considering the various factors that affect the airway synthetically, an effective method can be adopted to ensure the safety of the operation.
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Affiliation(s)
- Q Cai
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Y H Liu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - K L Wu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - J Wu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Y Zhao
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - C Y Yao
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
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Zhang L, Liu YH, Wu KL, Wu J, Zhao Y, Yao CY, Yang Q, Zhang L, Wang Y. [A study of 16 cases on the island pectoralis major muscle flap in repair for the defects after the laryngeal function reserved operation of hypopharyngeal carcinoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:1575-1578. [PMID: 29797953 DOI: 10.13201/j.issn.1001-1781.2017.20.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Indexed: 11/12/2022]
Abstract
Objective:To explore the application about island pectoralis major muscle flap in repair for the defects after the laryngeal function reserved operation of hypopharyngeal carcinoma.Method:A retrospective analysis about 16 patients who underwent hypopharyngeal carcinoma surgery using pedicle island pectoralis major myocutaneous flap to repair, including 14 cases whose primary tumors located in the piriform fossa, and 2 cases in pharynx posterior wall.Result:All 16 cases' pectoralis major muscle flap survived, 2 of patient appeared to have a pharyngeal fistula, but recovered after transition. Of the 16 cases, 14 cases were removed the trachea tube in 1-3 months, 2 cases survive with tube, and all patients were satisfied with their appearance and the function. In 16 cases, 2 of them survived 3 and a half years, died of lung metastasis; 2 cases survived for four years, 1 died of local recurrence of tumor and another died of heart disease; 1 survived for four and a half years and died of lung metastasis; the remaining 11 cases were still in follow-up.Conclusion:The application in the surgical defect repair of pharyngeal carcinoma with pedicle island pectoralis major myocutaneous flap is safe and effective.
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Affiliation(s)
- L Zhang
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Y H Liu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - K L Wu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - J Wu
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Y Zhao
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - C Y Yao
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Q Yang
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - L Zhang
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Y Wang
- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
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Wu KL, Huang EY, Yeh WL, Hsiao CC, Kuo CM. Synergistic interaction between galectin-3 and carcinoembryonic antigen promotes colorectal cancer metastasis. Oncotarget 2017; 8:61935-61943. [PMID: 28977916 PMCID: PMC5617476 DOI: 10.18632/oncotarget.18721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022] Open
Abstract
In this study, we investigated the role of galectin-3 and carcinoembryonic antigen (CEA) in metastasis and survival of colorectal cancer (CRC) patients. CEA interacted with galectin-3 at the cell surface and cytoplasm of Caco2 and DLD1 CRC cells. Knocking down galectin-3 did not affect CEA expression in CRC cells. However, there was a dose-dependent increase in CRC cell migration upon addition of small amounts of exogenous CEA (≤1ng/ml). Galectin-3 knockdown blocked induction of CRC cell migration by CEA, suggesting interaction between galectin-3 and CEA was necessary for CRC cell migration. Exogenous CEA and galectin-3 synergistically promoted migration of galectin-3 knockdown DLD1 cells. Immunohistochemical analysis showed that CEA co-localized with galectin-3 in CRC patient tissues. In additon, advanced stage CRC patients had higher serum galectin-3 and CEA levels than early stage CRC patients. High serum CEA and galectin-3 levels correlated with advanced N stage and poor survival in CRC patients. These findings suggest interaction between galectin-3 and CEA promotes CRC migration and metastasis, and correlates with poor survival of CRC patients. Thus combinatorial therapy targeting galectin-3 and CEA may improve outcomes for advanced stage CRC patients.
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Affiliation(s)
- Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Kaohsiung, Taiwan.,Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Ling Yeh
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Kaohsiung, Taiwan.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Mou Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Chang Gung University, College of Medicine, Kaohsiung, Taiwan
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Wang HM, Liang CM, Wu CK, Chiu YC, Chou YP, Wu KL, Huang CC, Chuah SK, Tai WC, Lu LS. Metachronous duodenal neuroendocrine neoplasms after endoscopic mucosal resection. Advances in Digestive Medicine 2017. [DOI: 10.1002/aid2.12071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Hsin-Ming Wang
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Chih-Ming Liang
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Yeh-Pin Chou
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Keng-Liang Wu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Chao-Cheng Huang
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
- Department of Pathology; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Biobank and Tissue Bank; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Wei-Chen Tai
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-gastroenterology; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
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Hu ML, Wu KL, Changchien CS, Chuah SK, Chiu YC. Endosonographic surveillance of 1-3 cm gastric submucosal tumors originating from muscularis propria. World J Gastroenterol 2017; 23:2194-2200. [PMID: 28405147 PMCID: PMC5374131 DOI: 10.3748/wjg.v23.i12.2194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/16/2016] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria (SMTMPs).
METHODS By reviewing the computerized medical records over a period of 14 years (2000-2013), patients with 1-3 cm gastric SMTMPs who underwent at least two endoscopic ultrasound (EUS) examinations were enrolled. Tumor progression was defined as a ≥ 1.2 times enlargement in tumor diameter observed during EUS surveillance. All patients were divided into stationary and progressive subgroups and further analyzed. We also reviewed the patients in the progressive subgroup again in 2016.
RESULTS A total of 88 patients were studied, including 25 in the progressive subgroup. The mean time of EUS surveillance was 24.6 mo in the stationary subgroup and 30.7 mo in the progressive subgroup. Risk factors for tumor progression included larger tumor size and irregular border. Initial tumor size > 14.0 mm may be considered a cut-off size for predicting tumor progression. Seventeen patients underwent surgery, of whom 13 had gastrointestinal stromal tumors (GISTs) and 4 had leiomyomas. Tumor progression was found only in patients with GISTs. All of the tumors exhibited benign behaviors without metastasis until 2016.
CONCLUSION Most 1-3 cm gastric SMTMPs (71.6%) are indolent. Tumor progression was found only in GISTs, and it is a good predictor for differentiating GISTs from leiomyomas. Predictors of tumor progression include larger tumor size (> 14.0 mm) and irregular border.
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Wu J, Liu YH, Wu KL, Li XH, Gao CB, Zhao Y. [Lymphadenectomy using dissection and protection of carotid sheath and main nerves in surgery for benign diseases in the neck]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 52:53-56. [PMID: 28104017 DOI: 10.3760/cma.j.issn.1673-0860.2017.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the significance of lymphadenectomy using dissection and protection of carotid sheath and main nerves in treating complex benign disease of neck. Methods: A total of 54 cases with benign diseases in neck who received the protective surgical treatments were reviewed. There were 25 cases of recurrent branchial fistula, 15 cases of lymphoid tuberculosis, 5 cases of cystic hygroma, 5 cases of racemose angioma, and 4 cases of Madelung's disease. According to the location and extent of disease, all cases received operation with dissection and protection of carotid sheath and main nerves to removal lesions with lymphoid tissue and fat-connective tissue. Results: All cases recovered well, and no recurrence occurred with follow-up of 3 to 65 months. There was no other complication except for occurring of Horner syndrome in 1 patient. Conclusion: The protective surgical method has certain application value in the treatment of benign neck diseases that have no indefinite boundary and widely distribute.
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Affiliation(s)
- J Wu
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Y H Liu
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - K L Wu
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - X H Li
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - C B Gao
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Y Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Wang Q, Liu YH, Wu KL, Gao CB, Zhao Y, Wu J, Zhang L, Yao CY, Yang Q. [The application of high tracheotomy in forced posture]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:74-76. [PMID: 29774692 DOI: 10.13201/j.issn.1001-1781.2017.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Indexed: 11/12/2022]
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Xuan XJ, Xu C, Zhao YR, Wu KL, Chen T, Zhang HB, Li X, Su SZ, Ma G, Tang R, Sheng Y, Ma JL. [Application of spontaneous acrosome reaction of sperm in prediction of outcome of in-vitro fertilization and embryo transfer]. Zhonghua Yi Xue Za Zhi 2016; 96:1285-8. [PMID: 27122463 DOI: 10.3760/cma.j.issn.0376-2491.2016.16.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the clinical application of spontaneous acrosome reaction (AR) rate of sperm in predicting the outcome of in-vitro fertilization and embryo transfer (IVF-ET). METHODS The spontaneous AR rate of the sperm of patients who underwent IVF-ET treatment in our center during the period from November to December 2014 were studied. The cut-off value from 6% to 12% were set and analyzed its association between the IVF-ET outcomes (including fertility rates, normal fertilization rates and high-quality embryo rates). For those who underwent fresh embryo transplantation, the rates of chemical pregnancy and clinical pregnancy were calculated, and compared the spontaneous AR rates and quantity of acrosomal enzyme according to the pregnancy outcome. RESULTS There were 202 patients in this study and the mean spontaneous AR rate was 5.99%±5.18%. For patients with the spontaneous AR rate ≥9% versus <9%, the fertility rate, normal fertilization rate and high-quality embryo rate were 81.33% vs 83.85%, 60.53% vs 60.99%, and 51.10% vs 59.67%, respectively, with statistically significant difference in the high-quality embryo rate (P=0.02). For patients who underwent fresh embryo transplantation, when comparison was made between those with spontaneous AR rate ≥8% and those <8%, the rate of chemical pregnancy and clinical pregnancy were 48.57% (17/35) vs 69.64% (78/112) and 37.14% (13/35) vs 63.39% (71/112), respectively, both with statistically significant difference (P=0.02 and P<0.01). The patients with clinical pregnancy had lower spontaneous AR rate than those without clinical pregnancy (5.41%±3.87% vs 7.40%±6.79%, P=0.04), while the quantity of acrosomal enzyme showed no significant difference [(131.79±68.50) vs (153.62±59.59) μU/10(6,) P=0.06]. Logistic regression analysis demonstrated association between spontaneous AR rates and clinical pregnancy (OR=0.93, 95%CI: 0.87-0.99, P=0.03). CONCLUSIONS The spontaneous AR rate of sperm may have clinical significance in predicting the outcome of IVF-ET, as it is reversely correlated with IVF high-quality embryo rate and pregnancy rate. The quantity of acrosomal enzyme may not have significant predictive value for the outcome of IVF.
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Affiliation(s)
- X J Xuan
- Department of Urology and Andrology, Reproductive Hospital Affiliated to Shandong University, Jinan 250021, China
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Wu J, Wu KL, Liu YH. [Repeated carotid blowout's rescue experience of a postoperative patient with hypopharyngeal carcinoma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 51:846-849. [PMID: 27938612 DOI: 10.3760/cma.j.issn.1673-0860.2016.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J Wu
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - K L Wu
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Y H Liu
- Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Jiang MY, Liu YH, Gao CB, Wu KL, Zhao Y, Wu J, Tong BS, Li YF, Wang Y. [Safety analysis of head and neck surgery for short-necked obese patients accompanied by sleep-disordered breathing]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:1246-1248. [PMID: 29798341 DOI: 10.13201/j.issn.1001-1781.2016.15.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Indexed: 11/12/2022]
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Liu CL, Wu CK, Shi HY, Tai WC, Liang CM, Yang SC, Wu KL, Chiu YC, Chuah SK. Medical expenses in treating acute esophageal variceal bleeding: A 15-year nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4215. [PMID: 27428225 PMCID: PMC4956819 DOI: 10.1097/md.0000000000004215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Acute variceal bleeding in patients with cirrhosis is related to high mortality and medical expenses. The purpose of present studies was to analyze the medical expenses in treating acute esophageal variceal bleeding among patients with cirrhosis and potential influencing clinical factors.A total of 151,863 patients with cirrhosis with International Classification of Diseases-9 codes 456.0 and 456.20 were analyzed from the Taiwan National Health Insurance Research Database from January 1, 1996 to December 31, 2010. Time intervals were divided into three phases for analysis as T1 (1996-2000), T2 (2001-2005), and T3 (2006-2010). The endpoints were prevalence, length of hospital stay, medical expenses, and mortality rate.Our results showed that more patients were <65 years (75.6%) and of male sex (78.5%). Patients were mostly from teaching hospitals (90.8%) with high hospital volume (50.9%) and high doctor service load (51.1%). The prevalence of acute esophageal variceal bleeding and mean length of hospital stay decreased over the years (P < 0.001), but the overall medical expenses increased (P < 0.001). Multiple regression analysis showed that older age, female sex, Charlson comorbidity index (CCI) score >1, patients from teaching hospitals, and medium to high or very high patient numbers were independent factors for longer hospital stay and higher medical expenses. Aged patients, female sex, increased CCI score, and low doctor service volume were independent factors for both in-hospital and 5-year mortality. Patients from teaching hospitals and medium to high or very high service volume hospitals were independent factors for in-hospital mortality, but not 5-year mortality.Medical expenses in treating acute esophageal variceal bleeding increased despite the decreased prevalence rate and length of hospital stay in Taiwan. Aged patients, female sex, patients with increased CCI score from teaching hospitals, and medium to high or very high patient numbers were the independent factors for increased medical expenses.
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Affiliation(s)
- Chueh-Ling Liu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital
| | - Cheng-Kun Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital
- Correspondence: Seng-Kee Chuah, and Cheng-Kun Wu, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung 833, Taiwan (e-mail: and )
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital
- Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Chih-Ming Liang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital
| | - Shih-Cheng Yang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital
- Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Yi-Chun Chiu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital
- Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital
- Chang Gung University, College of Medicine, Taipei, Taiwan
- Correspondence: Seng-Kee Chuah, and Cheng-Kun Wu, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-sung Hsiang, Kaohsiung 833, Taiwan (e-mail: and )
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Tsai CE, Liang CM, Lee CH, Kuo YH, Wu KL, Chiu YC, Tai WC, Chuah SK. First-line Helicobacter pylori eradication among patients with chronic liver diseases in Taiwan. Kaohsiung J Med Sci 2016; 32:397-402. [PMID: 27523452 DOI: 10.1016/j.kjms.2016.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/20/2016] [Accepted: 05/26/2016] [Indexed: 02/08/2023] Open
Abstract
Helicobacter pylori eradication in patients with chronic liver diseases (CLDs) and liver cirrhosis is seldom reported. This study aimed to assess the efficacy of 7-day standard triple therapy in patients with CLD including cirrhosis and to investigate the clinical factors influencing the success of eradication. A total of 592 H. pylori-infected patients, who received 7-day standard first-line triple therapy between January 1, 2014, and December 31, 2014, were recruited. Patients were divided into two groups: CLD group (N=136) and non-CLD group (N=456). The eradication rates attained by the CLD and non-CLD groups were 86.0% and 84.2%, respectively, in the per-protocol analysis (p=0.606). The eradication rates of liver cirrhosis and noncirrhosis CLD were 88.5% and 84.3%, respectively (p=0.783). The adverse events were similar between the two groups (8.8% vs. 9.2%, p=0.891). Compliance between the two groups was good (99.3% vs. 99.6%, p=0.670). The univariate analysis showed male sex to be the significant clinical factor in the non-CLD group (p=0.001) and alcohol consumption to be the significant clinical factor influencing H. pylori eradication rate in patients with CLD (p=0.022). Alcohol consumption was the only significant factor influencing H. pylori eradication in multivariate analysis (odds ratio=3.786, p=0.031). The results of this study suggest that H. pylori eradication rates in patients with CLD may be comparable with non-CLD patients. Alcohol consumption was the significant factor influencing H. pylori eradication in patients with CLD.
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Affiliation(s)
- Cheng-En Tsai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Hsiang Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yuan-Hung Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wu J, Liu YH, Wu KL, Zhao Y, Tong BS, Gao CB, Li YF, Wang Y. [Different treatments of maxillary and mandible in management of para-pharynx and cranial base surgery]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:911-914. [PMID: 29797941 DOI: 10.13201/j.issn.1001-1781.2016.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 11/12/2022]
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Chuah SK, Liang CM, Lee CH, Chiou SS, Chiu YC, Hu ML, Wu KL, Lu LS, Chou YP, Chang KC, Kuo CH, Kuo CM, Hu TH, Tai WC. A Randomized Control Trial Comparing 2 Levofloxacin-Containing Second-Line Therapies for Helicobacter pylori Eradication. Medicine (Baltimore) 2016; 95:e3586. [PMID: 27175657 PMCID: PMC4902499 DOI: 10.1097/md.0000000000003586] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Summary of Trial Design.Lengthy exposure to quinolone-containing triple therapy in Helicobacter pylori eradication leads to the development of drug resistance. Sequential therapy with a quinolone and metronidazole -containing regimen appears to be an effective treatment option. This randomized controlled trial aimed to compare the efficacy of 5-plus 5 days' levofloxacin and metronidazole-containing sequential therapy (EALM) with that of 10-day levofloxacin-containing triple therapy (EAL) in second-line H pylori eradication treatment.One hundred and sixty-four patients who had failed the H pylori eradication attempts using the standard triple therapy (proton pump inhibitor bid, clarithromycin 500 mg bid, amoxicillin 1 g bid × 7 days) were randomly assigned to either an EALM therapy group (n = 82; esomeprazole 40 mg bid and amoxicillin 1 g bid for 5 days, followed by esomeprazole 40 mg bid, levofloxacin 500 mg qd, and metronidazole 500 mg tid, for 5 days) or a 10-day EAL therapy group (n = 82; levofloxacin 500 mg qd, amoxicillin 1 g bid, and esomeprazole 40 mg bid). One patient was lost to follow-up in each group. Follow-up for H pylori status was performed 4 to 8 weeks later.Eradication rates for the EALM and EAL groups were 90.2% (74/82, 95% confidence interval [CI] = 83.7%-96.8%) and 80.5% (66/82, 95% CI = 71.7%-89.2%, P = 0.077) in the intention-to-treat analysis; and 91.4% (74/81, 95% CI = 85.1%-97.6%) and 81.5% (66/81, 95% CI = 72.8%-90.1%, P = 0.067) in the per-protocol analysis. The adverse events for the EALM and EAL groups were 23.5% versus 11.1%, P = 0.038 but were all very mild and were well tolerated except for 1 patient with poor compliance. The compliances were 98.8% and 100%, respectively, between the 2 groups. An antibiotic resistance to levofloxacin was the clinical factor influencing the efficacy of H. pylori eradication therapy in the EAL group, and dual resistance to levofloxacin and metronidazole in the EALM group.Levofloxacin and metronidazole-containing sequential therapy achieved a >90% eradication rate as a second-line H pylori therapy. Dual antibiotic resistance to levofloxacin and metronidazole was the clinical factor influencing the efficacy of H pylori eradication therapy in the sequential therapy (ClinicalTrials.gov number: NCT02596620).
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Affiliation(s)
- Seng-Kee Chuah
- From the Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital (S-KC, C-ML, S-SC, Y-CC, M- LH, K-LW, L-SL, Y-PC, K-CC, C-HK, C-MK, T-HH, W-CT); Chang Gung University, College of Medicine, Kaohsiung, Taiwan. (S-KC, C-HL, Y-CC, K-LW, K-CC, T-HH, W- CT); Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital (C-HL)
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Tsai CE, Chiu CT, Rayner CK, Wu KL, Chiu YC, Hu ML, Chuah SK, Tai WC, Liang CM, Wang HM. Associated factors in Streptococcus bovis bacteremia and colorectal cancer. Kaohsiung J Med Sci 2016; 32:196-200. [PMID: 27185602 DOI: 10.1016/j.kjms.2016.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 02/07/2023] Open
Abstract
Reports suggest that between 25% and 80% of patients with Streptococcus bovis/gallolyticus bacteremia have concomitant colorectal tumors. This retrospective study was aimed to identify associations between clinical characteristics and a finding of colorectal neoplasm in patients with S. bovis bacteremia who had colonoscopy examination. We retrospectively reviewed the records of patients with S. bovis bacteremia from Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, between January 2004 and January 2014. Clinical data including age, sex, comorbidities, blood culture, and colonoscopy findings were collected and their relationship to a finding of colorectal cancer was examined. A total of 107 patients with S. bovis bacteremia were identified, of whom 49 (72% male; age 65 ± 12 years) were investigated with colonoscopy; 15 of these patients (30.6%) had colorectal adenocarcinoma. Female sex (p = 0.014) and a history of noncolorectal malignancy (p = 0.004) were associated with a finding of colorectal adenocarcinoma. There were no associations with age, percentage of blood cultures, or the presence of diabetes mellitus, chronic liver disease, heart disease, or end-stage renal disease. Our results show that S. bovis bacteremia is associated with the presence of colorectal adenocarcinoma, especially in female patients, and concomitant existence of other malignancies.
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Affiliation(s)
- Cheng-En Tsai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Tang Chiu
- Division of Hepatogastroenterology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Christopher K Rayner
- Discipline of Medicine, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chung Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
| | - Yi-Chun Chiu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chung Gung University, Taoyuan, Taiwan
| | - Ming-Luen Hu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chung Gung University, Taoyuan, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chung Gung University, Taoyuan, Taiwan
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chung Gung University, Taoyuan, Taiwan
| | - Chih-Ming Liang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chung Gung University, Taoyuan, Taiwan
| | - Hsin-Ming Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Liang CM, Cheng JW, Kuo CM, Chang KC, Wu KL, Tai WC, Chiu KW, Chiou SS, Lin MT, Hu TH, Chuah SK. Levofloxacin-containing second-line anti-Helicobacter pylori eradication in Taiwanese real-world practice. Biomed J 2015; 37:326-30. [PMID: 25163495 DOI: 10.4103/2319-4170.125650] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Quinolone-containing triple therapy is recommended as an option for non-bismuth containing second-line Helicobacter pylori eradication. Current available Taiwanese reports in the literature used 7-day quinolone-containing triple therapy. As a result, some physicians still prescribe 7-day regimens in real-world practice in Taiwan. This study aimed to further assess the appropriateness of 7-day levofloxacin-containing triple therapy as second-line therapy. METHODS We enrolled 61 patients who failed H. pylori eradication using the standard triple therapy for 7 days and were prescribed levofloxacin-containing second-line triple therapy (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily). Routine follow-up with either endoscopy or urea breath test was done 8 weeks later to assess treatment response. RESULTS The eradication rates were 78.7% in the intention-to-treat analysis and 81% in the per-protocol analysis. The incidence of adverse events was 6.6%. Drug compliance was 95.1%. Antibiotic resistance showed the following results: Amoxicillin (0%), levofloxacin (23.5%), clarythromycin (35.3%), metronidazole (17.6%), and tetracycline (0%). CONCLUSION The 7-day levofloxacin-containing triple therapy provides an unacceptable per-protocol report card as the second-line treatment for anti-H. pylori eradication in Taiwan and should be modified by either extending the duration to 10-14 days or seeking other regimens.
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Affiliation(s)
| | | | | | | | | | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Chien TL, Rau KM, Chung WJ, Tai WC, Wang SH, Chiu YC, Wu KL, Chou YP, Wu CC, Chen YH, Chuah SK. Trousseau’s syndrome in a patient with advanced stage gastric cancer. World J Gastroenterol 2015; 21:10049-10053. [PMID: 26379411 PMCID: PMC4566376 DOI: 10.3748/wjg.v21.i34.10049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/09/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
Patients with cancer are at high risk for thrombotic events, which are known collectively as Trousseau’s syndrome. Herein, we report a 66-year-old male patient who was diagnosed with terminal stage gastric cancer and liver metastasis and who had an initial clinical presentation of upper gastrointestinal bleeding. Acute ischemia of the left lower leg that resulted in gangrenous changes occurred during admission. Subsequent angiography of the left lower limb was then performed. This procedure revealed arterial thrombosis of the left common iliac artery with extension to the external iliac artery, the left common iliac artery, the posterior tibial artery, and the peroneal artery, which were occluded by thrombi. Aspiration of the thrombi demonstrated that these were not tumor thrombi. The interesting aspect of our case was that the disease it presented as arterial thrombotic events, which may correlate with gastric adenocarcinoma. In summary, we suggested that the unexplained thrombotic events might be one of the initial presentations of occult malignancy and that thromboprophylaxis should always be considered.
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Tai WC, Lee CH, Chiou SS, Kuo CM, Kuo CH, Liang CM, Lu LS, Chiu CH, Wu KL, Chiu YC, Hu TH, Chuah SK. The clinical and bacteriological factors for optimal levofloxacin-containing triple therapy in second-line Helicobacter pylori eradication. PLoS One 2014; 9:e105822. [PMID: 25141137 PMCID: PMC4139398 DOI: 10.1371/journal.pone.0105822] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/24/2014] [Indexed: 01/10/2023] Open
Abstract
Quinolone has the disadvantage of easily acquired drug resistance. It is important to prescribe it wisely for a high eradication rate. The current study aimed to determine the clinical and bacteriological factors for optimal levofloxacin-containing triple therapies in second-line H. pylori eradication. We enrolled a total of 158 H. pylori-infected patients who failed H. pylori eradication using the 7-day standard triple therapy (proton-pump inhibitor [PPI] twice daily, 500 mg clarithromycin twice daily, and 1 g amoxicillin twice daily). They were prescribed with either a 10-day (group A) or 14-day (group B) levofloxacin-containing triple therapy group (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily for 10 days) by their clinicians. Follow-up studies to assess treatment responses were carried out 8 weeks later. The eradication rates attained by groups A and B were 73.6% (95% confidence interval [CI] = 63.9–85.3%) and 90.5% (95% CI = 84.5–98.1%), respectively in the per protocol analysis (P = 0.008 in the per protocol analysis) and 67.1% (95% CI = 56.6–78.5%) and 84.8% (95% CI = 76.8–93.4%), respectively, in the intention-to-treat analysis (P = 0.009). The subgroup analysis revealed that H. pylori eradication rates for group A patients with levofloxacin-susceptible strains were 92.9% (13/14) but it dropped to 12.5% (1/8) when levofloxacin-resistant strains existed. H. pylori was eradicated among all the group B patients with levofloxacin-susceptible strains, but only half of patients with levofloxacin-resistant strains were successfully eradicated. In conclusion, this study confirms the effectiveness of 14-day treatment. Importantly, the results imply that 10-day treatment duration should be optimal if a culture can be performed to confirm the existence of susceptible strains. The duration of H. pylori eradication and levofloxacin resistance were the influencing factors for successful treatment. This study suggests that tailored levofloxacin-containing therapy should be administered only for patients with susceptible strains because it can achieve >90% success rates.
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Affiliation(s)
- Wei-Chen Tai
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shue-Shian Chiou
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Mou Kuo
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Huang Kuo
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Hua Chiu
- Division of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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