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Chen MF, Zhang JF, Ren XL, Liu Y, Huang L. [Retrospective analysis of perioperative anaphylactic shock induced by cefuroxime]. Zhonghua Nei Ke Za Zhi 2024; 63:406-411. [PMID: 38561287 DOI: 10.3760/cma.j.cn112138-20231103-00293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This study investigated the characteristics and frequency of perioperative anaphylactic shock induced by cefuroxime, so as to provide a reference for the safe and rational use of cefuroxime in the perioperative period. Cases of perioperative anaphylactic shock caused by cefuroxime in our hospital from 2011 to 2021 were extracted from the Adverse Drug Reaction Monitoring System. Literature reporting adverse drug reactions (ADR) including cefuroxime-induced anaphylactic shock in perioperative settings was collected from the CNKI, VIP, Wanfang, PubMed, and Web of Science databases from their respective inception to May 2022. Statistical analysis was performed for all cases of cefuroxime-induced perioperative anaphylactic shock. A total of 31 patients were included [13 men (48.1%) and 14 women (51.9%)], most of whom were over 60 years old (n=16, 59.3%); 9 (29.0%) patients had a history of drug allergy; 5 (16.1%) patients had received skin tests, but with negative results; 28 (90.3%) patients received treatment intravenously; 22 (71.0%) patients were treated after anesthesia. For 20 (64.5%) patients the ADR occurred within 10 minutes after anesthesia. The main manifestations were hypotension, dyspnea, rash, and tachycardia. For all patients, symptoms resolved after withdrawal of the drug and active rescue, and there were no deaths. A history of allergy and skin test findings may have limitations in predicting perioperative anaphylactic shock caused by cefuroxime; greater vigilance should be exercised when using cefuroxime in the perioperative period. Close monitoring is recommended for patients undergoing treatment with cefuroxime. Rescue therapy should be administered for allergic shock, and suitable response measures must be taken in a timely manner to ensure the safety of patients.
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Affiliation(s)
- M F Chen
- Department of Infectious Disease, Peking University People's Hospital, Beijing 100044,China
| | - J F Zhang
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China Department of Pharmacy, Tongliao Hospital, Tongliao 028000, China
| | - X L Ren
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
| | - Y Liu
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
| | - L Huang
- Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
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Chen MF, Piotrowska Z, Yu HA. POSing the question: MARIPOSA-2, do the ends justify the means? Ann Oncol 2024; 35:4-6. [PMID: 37972893 DOI: 10.1016/j.annonc.2023.11.005] [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] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- M F Chen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Z Piotrowska
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston
| | - H A Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Department of Medicine, Weill Cornell Medical College, New York, USA.
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Wang YY, Shi ZM, Li GY, Zhang ZX, Jin JF, Chen MF, Han CF, Xu Y, Gao ZC, Guo SM. [Investigation of the chronic respiratory symptoms and pulmonary function of adult residents in Hongtong County, Shanxi Province]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:1571-1580. [PMID: 37859373 DOI: 10.3760/cma.j.cn112150-20221107-01075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Objective: To investigate the chronic respiratory symptoms and pulmonary function of adult residents in 3 towns of Hongtong County, Shanxi Province, and to explore their risk factors. Methods: The investigation of chronic respiratory symptoms and lung function status of adult residents in Hongdong County is based on the regional population of the entire county in Hongdong County. The project was initiated by the Science and Technology Department of Linfen City and coordinated by the Hongdong County Government. The investigation will be conducted in 3 townships in Hongdong County, Linfen City, Shanxi Province from April to November 2021: Demographic characteristics, respiratory symptoms, smoking dust exposure and other personal history were collected through questionnaires. Physical examination, routine blood tests and lung function tests were also performed on each individual. SPSS 22.0 software was used to conduct t test, χ2 test, ANOVA or Kruskal-Wallis test for statistical analysis of the collected information. Results: 10 945 subjects aged 18-102 years were included in the analysis, of whom 3 754 (34.3%) were male, 1 222 (11.2%) had a history of dust exposure, 7 164 (65.5%) had used straw and firewood as cooking fuel, and 3 296 (30.1%) had a history of smoking. Among the participants, 394 (3.6%), 339 (3.1%), and 1 543 (14.1%) had respiratory symptoms such as chronic cough, sputum, and dyspnea. Statistics showed that the population with chronic respiratory symptoms was more elderly and had a smoking history, and the incidence of chronic respiratory symptoms was higher in those who smoked more than 40 packs a year (all P<0.05). Men with a history of dust exposure were more likely to suffer from chronic cough and expectoration, while emaciation and biofuel use for more than 40 years were more likely to suffer from chronic expectoration and dyspnea (all P<0.05). The median values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and FEV1/FVC in 1 second were 2.19 L/s, 3.24 L and 69.16%, respectively. Among them, the lung function of 5 801 (53.0%) respondents was lower than the expected value. The median FEV1/FVC decreased with the increase of age. The FEV1/FVC of people over 40 years old with smoking history was lower, the dust exposure history of people with decreased lung function was more than that of people with normal lung function, and the incidence of chronic expectoration and dyspnea was higher in people with decreased lung function (all P<0.05). The absolute value and ratio of eosinophils in patients with decreased ventilation function over 60 years old were significantly higher than those with normal ventilation function, but the level of body mass index (BMI) was lower (all P<0.05). Conclusion: In Hongdong County, Shanxi Province, grassroots residents have poor medical awareness, low lung function examination rate, chronic respiratory symptoms and lung function decline are associated with more risk factors. Primary medical institutions need to formulate prevention strategies and carry out lung function detection according to the actual situation, focusing on monitoring and follow-up of high-risk groups to achieve early and timely prevention, diagnosis and treatment of chronic obstructive pulmonary disease.
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Affiliation(s)
- Y Y Wang
- Department of Respiratory Medicine, Linfen Central Hospital, Linfen 041000, China
| | - Z M Shi
- Medical Department, Linfen Central Hospital, Linfen 041000, China
| | - G Y Li
- Science and Education Department, Linfen Central Hospital, Linfen 041000, China
| | - Z X Zhang
- Nursing Department, Linfen Central Hospital, Linfen 041000, China
| | - J F Jin
- Department of Respiratory Medicine, Linfen Central Hospital, Linfen 041000, China
| | - M F Chen
- Department of Respiratory Medicine, Linfen Central Hospital, Linfen 041000, China
| | - C F Han
- Department of Respiratory Medicine, Linfen Central Hospital, Linfen 041000, China
| | - Y Xu
- Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, Capital Medical University,Beijing 100035, China
| | - Z C Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - S M Guo
- Nursing Department, Linfen Central Hospital, Linfen 041000, China
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P X, Zz L, Gg J, Lp W, Cm B, Yl W, Chen MF, W L. The role of LRP1 in Aβ efflux transport across the blood-brain barrier and cognitive dysfunction in diabetes mellitus. Neurochem Int 2022; 160:105417. [PMID: 36067928 DOI: 10.1016/j.neuint.2022.105417] [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: 04/02/2022] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The incidence of cognitive dysfunction in diabetes is increasing yearly, which severely affects the quality of life of patients and places a heavy burden on families and society. It has been demonstrated that impaired clearance of cerebral amyloid β-protein (Aβ) is a central event in the initiation and progression of Aβ deposition and cognitive impairment in diabetic patients. However, until now, the molecular mechanism by which diabetes mellitus induces impaired clearance of Aβ has remained unclear. OBJECTIVE To investigate the role and mechanism of lipoprotein receptor-related protein 1 (LRP1) in Aβ clearance impairment and cognitive function damage caused by diabetes. METHODS SPF male C57BL/6 mice were bred, and streptozotocin (STZ) (60 mg/kg/d) was intraperitoneally injected for 5 days to establish a diabetes model. The novel object recognition test and fear conditioning test were used to assess the cognitive function of mice in each group. Western blotting, qRT-PCR, ELISAs, and immunofluorescence staining were used to detect the expression levels of Aβ and Aβ clearance-related proteins in mouse brains. HBMECs were cultured in vitro to establish the blood-brain barrier model. The clearance rate of Aβ and the expression levels of LRP1 were measured under different glucose concentration culture conditions. HBMECs were transfected with lentivirus to overexpress or knock down the LRP1, and then, the changes in Aβ clearance were detected again. We injected adeno-associated virus AAV9-SP-A-LRP1 shRNA into the tail vein of DM mice to selectively knock down LRP1 gene expression in cerebral vascular endothelial cells. Then, the cognitive function and the expression levels of Aβ and Aβ clearance-related proteins in the brains of normal, DM and LRP1 knockdown mice were detected. RESULTS Compared with the controls, diabetic mice showed impaired cognitive performance, increased deposition of Aβ in the brain and decreased expression of LRP1 in the brain microvasculature. In vitro experiments showed that high glucose can downregulate the expression of LRP1 in HBMECs and damage the Aβ clearance across the blood-brain barrier (BBB). The reduction in the clearance rate of Aβ induced by high glucose was reversed by LRP1 overexpression but further substantially decreased when LRP1 was knocked down. CONCLUSION Hyperglycemia can impair Aβ efflux in the brain by downregulating the expression of LRP1 in the brain microvasculature, eventually resulting in cognitive impairment.
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Affiliation(s)
- Xue P
- Department of Geriatrics, Li-Yuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, China
| | - Long Zz
- Xiang Yang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China
| | - Jiang Gg
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wang Lp
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bian Cm
- Department of Geriatrics, The First People's Hospital of Yichang, Three Gorges University, Yichang, 430010, China
| | - Wang Yl
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - M F Chen
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li W
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Chen MF, Zheng CC, Liu Y, Chen F, Xu D. [Choroidal blood flow and visual function in idiopathic macular hole]. Zhonghua Yan Ke Za Zhi 2022; 58:412-419. [PMID: 35692022 DOI: 10.3760/cma.j.cn112142-20210918-00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the choroidal blood flow and visual function in idiopathic macular hole. Methods: In this prospective study, fundus structure and visual function in 22 eyes with macular hole and their fellow eyes and 16 normal eyes were assessed. The best corrected visual acuity and retinal sensitivity were detected by the EDTRS visual chart and MP1. The choroidal blood flow was observed by optical coherence tomography angiography. The choriocapillary blood flow density was measured using MatLab. The thickness of the choroid and the aperture size of macular hole were measured using enhanced depth imaging mode of Heidelberg optical coherence tomography. Results: The best corrected visual acuity and retinal sensitivity of macular hole eyes [1.02±0.20 and (13.03±2.91) dB] were significantly lower than fellow eyes [0.15±0.11, t=17.019, P<0.001 and (17.25±2.03) dB, t=-4.085, P<0.001] and normal eyes [0.04±0.05, t=21.736, P=0.001 and (16.63±2.89) dB, t=-3.134, P=0.004]. The blood flow area of choroidal capillaries in macular hole eyes [(1.33±0.29) mm2] was significantly lower than fellow eyes [(1.98±0.13) mm2; t=-9.424, P<0.001] and normal eyes [(1.93±0.12) mm2; t=-8.707, P<0.001]. The paracentral blood vessel density of the choroid capillary layer in macular hole eyes (48.91%±10.12%) was significantly lower than fellow eyes (58.27%±6.18%; t=-3.502, P=0.001) and normal eyes (55.20%±2.12%; t=-2.830, P=0.020). The subfoveal choroidal thickness of macular hole eyes [(188±21) μm] was significantly lower than fellow eyes [(217±36) μm; t=-3.672, P=0.002] and normal eyes [(229±25) μm; t=-3.304, P<0.001]. The basic diameter of macular hole eyes was correlated with the blood vessel density (r=-0.584, P=0.004), the subfoveal choroidal thickness (r=-0.511, P=0.015) and the retinal sensitivity (r=-0.432, P=0.044). The retinal sensitivity was correlated with the blood vessel density (r=0.450, P=0.035) and the subfoveal choroidal thickness (r=0.429, P=0.046). Conclusions: The retinal sensitivity and fundus blood perfusion of idiopathic macular hole was decreased, and the thickness of paracentral choroid in the contralateral eye tended to become thinner. The reduced visual function in eyes with macular hole may be associated with the decreased choroidal thickness and worse blood flow of fundus microcirculation.
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Affiliation(s)
- M F Chen
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - C C Zheng
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Y Liu
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - F Chen
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - D Xu
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
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Chen MF, Liu XT, Zhang F, Wang YL, Mao XJ. [The influencing factors and the effect of myopia control in children treated with orthokeratology]. Zhonghua Yan Ke Za Zhi 2022; 58:259-264. [PMID: 35391512 DOI: 10.3760/cma.j.cn112142-20210801-00360] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To analyze the influencing factors and the effect of myopia control in children treated with orthokeratology. Methods: It was a retrospective case series study. Data of 137 children from June 2016 to July 2020 in the Optometry Hospital of Wenzhou Medical University who were fitted with orthokeratology lenses and kept wearing them for 24 months were retrospectively reviewed. These children were divided into the modeling group (n=91) and verification group (n=46). The baseline conditions were recorded before they wore the orthokeratology lenses, including age, spherical equivalent refractive power (SER) and pupil area. The decentration distance was measured with a tangential difference map. Axial length (AL) changes of all children during 24 months were calculated. The influencing factors and the effect of myopia control were analyzed, and a regression equation was formulated with the modeling group. Then the influencing factors were imported with the verification group to compare the AL change differences between prediction and measurement. Results: There was statistical difference in AL between baseline and after wearing orthokeratology lenses for 24 months both in the modeling group [(25.16±0.90) mm vs. (25.56±0.82) mm; t=-10.119, P<0.001] and verification group [(25.29±0.71) mm vs. (25.67±0.69) mm; t=-8.785, P<0.001]. The AL changes in the modeling group showed significant correlations with baseline age (r=-0.365, P<0.001), baseline SER (r=0.308, P=0.003), pupil area (r=-0.260, P=0.013) and decentration distance (r=-0.352, P=0.001). The regression equation was as follows: y=1.609-0.056a-0.315b-0.009c+0.054d (y: AL changes, a: baseline age, b: decentration distance, c: pupil area, d: baseline SER). There was no statistical difference between prediction and measurement [(0.40±0.20) mm vs. (0.40±0.32) mm; t=-0.036, P=0.971]. Conclusion: Baseline age, decentration distance, baseline SER and pupil area contributed to predict the effect of myopia control after orthokeratology treatment.
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Affiliation(s)
- M F Chen
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases,Wenzhou 325027, China
| | - X T Liu
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases,Wenzhou 325027, China
| | - F Zhang
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases,Wenzhou 325027, China
| | - Y L Wang
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases,Wenzhou 325027, China
| | - X J Mao
- Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases,Wenzhou 325027, China
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Liu B, Cheng YH, Ge YH, He ZL, Chen C, Yang PZ, Chen MF, Zhou LX, Nie SD, Lyu P. [Mucinous adenocarcinoma of the gallbladder: report of 5 cases]. Zhonghua Yi Xue Za Zhi 2021; 101:3506-3508. [PMID: 34775710 DOI: 10.3760/cma.j.cn112137-20210509-01101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The clinical manifestations, laboratory and imaging results, diagnosis and treatment and prognosis of 5 patients with mucinous adenocarcinoma of the gallbladder were analyzed. It was found that the clinical characteristics of mucinous adenocarcinoma of the gallbladder were very similar to that of gallbladder malignant tumor, and it was difficult to differentiate. Ultrasound guided gallbladder needle biopsy can confirm the diagnosis before surgery. Surgery is still the first choice of treatment. Since laparoscopic surgery has obvious advantages over open surgery, it is recommended to be preferentially used. If the tumor is under T2 stage and has no aggressive metastasis, the prognosis is generally good.
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Affiliation(s)
- B Liu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - Y H Cheng
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - Y H Ge
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - Z L He
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - C Chen
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - P Z Yang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - M F Chen
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - L X Zhou
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - S D Nie
- Clinical Trial Research Center, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
| | - P Lyu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha 410005, China
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Wang SY, Hung YL, Hsu CC, Hu CH, Huang RY, Sung CM, Li YR, Kou HW, Chen MY, Chang SC, Lee CW, Tsai CY, Liu KH, Hsu JT, Yeh CN, Yeh TS, Hwang TL, Jan YY, Chen MF. Optimal Perioperative Nutrition Therapy for Patients Undergoing Pancreaticoduodenectomy: A Systematic Review with a Component Network Meta-Analysis. Nutrients 2021; 13:nu13114049. [PMID: 34836308 PMCID: PMC8620471 DOI: 10.3390/nu13114049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
Numerous strategies for perioperative nutrition therapy for patients undergoing pancreaticoduodenectomy (PD) have been proposed. This systematic review aimed to summarize the current relevant published randomized controlled trials (RCTs) evaluating different nutritional interventions via a traditional network meta-analysis (NMA) and component network meta-analysis (cNMA). EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov were searched to identify the RCTs. The evaluated nutritional interventions comprised standard postoperative enteral nutrition by feeding tube (Postop-SEN), preoperative enteral feeding (Preop-EN), postoperative immunonutrients (Postop-IM), preoperative oral immunonutrient supplement (Preop-IM), and postoperative total parenteral nutrition (TPN). The primary outcomes were general, infectious, and noninfectious complications; postoperative pancreatic fistula (POPF); and delayed gastric emptying (DGE). The secondary outcomes were mortality and length of hospital stay (LOS). The NMA and cNMA were conducted with a frequentist approach. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Two primary outcomes, infectious complications and POPF, were positively influenced by nutritional interventions. Preop-EN plus Postop-SEN (OR 0.11; 95% CI 0.02~0.72), Preop-IM (OR 0.22; 95% CI 0.08~0.62), and Preop-IM plus Postop-IM (OR 0.11; 95% CI 0.03~0.37) were all demonstrated to be associated with a decrease in infectious complications. Postop-TPN (OR 0.37; 95% CI 0.19~0.71) and Preop-IM plus Postop-IM (OR 0.21; 95% CI 0.06~0.77) were clinically beneficial for the prevention of POPF. While enteral feeding and TPN may decrease infectious complications and POPF, respectively, Preop-IM plus Postop-IM may provide the best clinical benefit for patients undergoing PD, as this approach decreases the incidence of both the aforementioned adverse effects.
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Affiliation(s)
- Shang-Yu Wang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City 333, Taiwan
| | - Yu-Liang Hung
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Chih-Chieh Hsu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Chia-Hsiang Hu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Ruo-Yi Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Chang-Mu Sung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan;
| | - Yan-Rong Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan;
| | - Hao-Wei Kou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Ming-Yang Chen
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Shih-Chun Chang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Chun-Yi Tsai
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Keng-Hao Liu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Jun-Te Hsu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Chun-Nan Yeh
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
- Correspondence: ; Fax: +886-3-3285818
| | - Ta-Sen Yeh
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Tsann-Long Hwang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Yi-Yin Jan
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
| | - Miin-Fu Chen
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan; (S.-Y.W.); (Y.-L.H.); (C.-C.H.); (C.-H.H.); (R.-Y.H.); (H.-W.K.); (M.-Y.C.); (S.-C.C.); (C.-W.L.); (C.-Y.T.); (K.-H.L.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.); (M.-F.C.)
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9
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Xie WX, Chen MF, Gao L, Feng ZK. A 12-year follow-up study of mucoepidermoid carcinoma-associated membranous nephropathy. J BIOL REG HOMEOS AG 2021; 35:1081-1085. [PMID: 34008398 DOI: 10.23812/20-444-l] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- W X Xie
- Department of Stomatology, Tongcheng People's Hospital, Anhui Province Tongcheng, China
| | - M F Chen
- Department of Stomatology, Tongcheng People's Hospital, Anhui Province Tongcheng, China
| | - L Gao
- Department of Stomatology, Tongcheng People's Hospital, Anhui Province Tongcheng, China
| | - Z K Feng
- Department of Stomatology, Tongcheng People's Hospital, Anhui Province Tongcheng, China
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10
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Xu YH, Chen MF, Lv XP, Yu C, Qi F, Wang HQ. [Analysis on the situation of being supported by the national natural science foundation of China in the field of occupational diseases from 2010 to 2019]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2020; 38:125-128. [PMID: 32306676 DOI: 10.3760/cma.j.issn.1001-9391.2020.02.010] [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 understand the situation supported by the National Natural Science Foundation in the field of occupational diseases (H2402) in China, so as to provide a reference basis for the application and research of scientific researchers in the field of occupational diseases in China. Methods: The information system of scientific and technological achievements was used to search the financial support of the National Natural Science Foundation of China (NSFC) in the field of occupational diseases from 2010 to 2019. Results: From 2010 to 2019, a total of 55 projects were funded under the Occupational Disease code (H2402) , with a total funding of 22.33 million yuan, of which 30 were supported by the Youth Science Foundation, 20 by the Youth Science Foundation and 5 by the Regional Science Foundation. Thirty five items of the research projects focused on pneumoconiosis and other respiratory diseases which accounted for 63.64 per cent. Forty one items of scientific research projects are supported by domestic institutions of higher learning which accounted for 74.55 per cent. Conclusion: The research support of the National Natural Science Foundation of China to the field of occupational diseases (H2402) has increased steadily, but the support of different research directions and supporting units is not balanced. It is suggested that departments concerned strengthen guidance and support for the applicants in less developed areas and weak research directions of the projects in the National Natural Science Foundation.
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Affiliation(s)
- Y H Xu
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention 100050 Beijing, China; School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences. Jinan 250062, China; Shandong First Medical University & Shandong Academy of Medical Sciences. Jinan 250062, China
| | - M F Chen
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention 100050 Beijing, China
| | - X P Lv
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention 100050 Beijing, China
| | - C Yu
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention 100050 Beijing, China
| | - F Qi
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention 100050 Beijing, China
| | - H Q Wang
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention 100050 Beijing, China
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11
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Chan KM, Tsai CY, Yeh CN, Yeh TS, Lee WC, Jan YY, Chen MF. Characterization of intrahepatic cholangiocarcinoma after curative resection: outcome, prognostic factor, and recurrence. BMC Gastroenterol 2018; 18:180. [PMID: 30514231 PMCID: PMC6278092 DOI: 10.1186/s12876-018-0912-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 05/23/2018] [Accepted: 11/21/2018] [Indexed: 12/15/2022] Open
Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is a relatively rare subtype of cholangiocarcinoma. The study herein gathered experience of surgical treatment for ICC, and aimed to analyze the prognosis of patients who had received curative-intent liver resection. Methods A total of 216 patients who had undergone curative-intent liver resection for ICC between January 1977 and December 2014 was retrospectively reviewed. Results Overall, the rates of 5-years recurrence-free survival (RFS) and overall survival (OS) were 26.1 and 33.9% respectively. Based on multivariate analysis, four independent adverse prognostic factors including morphology patterns, maximum tumor size > 5 cm, pathological lymph node involvement, and vascular invasion were identified as affecting RFS after curative-intent liver resection for ICC. Among patients with cholangiocarcinoma recurrence, only 27 (16.9%) were able to receive surgical resection for recurrent cholangiocarcinoma that had a significantly better outcome than the remaining patients. Conclusion Despite curative resection, the general outcome of patients with ICC is still unsatisfactory because of a high incidence of cholangiocarcinoma recurrence after operation. Tumor factors associated with cholangiocarcinoma remain crucial for the prognosis of patients with ICC after curative liver resection. Moreover, aggressive attitude toward repeat resection for the postoperative recurrent cholangiocarcinoma could provide a favorable outcome for patients.
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Affiliation(s)
- Kun-Ming Chan
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305, Taiwan.
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305, Taiwan
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305, Taiwan
| | - Yi-Yin Jan
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305, Taiwan.
| | - Miin-Fu Chen
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Kwei-Shan District, Taoyuan City, 33305, Taiwan
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12
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Lee CW, Tsai HI, Cheng HT, Chen WT, Hsu HY, Chiu CC, Liu YP, Wu TH, Yu MC, Lee WC, Chen MF. Stapleless laparoscopic left lateral sectionectomy for hepatocellular carcinoma: reappraisal of the Louisville statement by a young liver surgeon. BMC Gastroenterol 2018; 18:178. [PMID: 30486797 PMCID: PMC6264597 DOI: 10.1186/s12876-018-0903-y] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Laparoscopic liver resection has been regarded as the standard treatment for liver tumors located at the left lateral liver sector. However, few studies have reported the results of laparoscopic left lateral sectionectomy (LLS) for HCC, not to mention the feasibility of this emerging technique for the less experienced liver surgeons. The current study would reappraise the Louisville statement by examining the outcome of LLS performed by a young liver surgeon. METHODS We retrospectively reviewed two separate groups of patients who underwent open or laparoscopic left lateral sectionectomies at Chung Gung Memorial Hospital, Linkou. All laparoscopic hepatectomies were performed by the index young surgeon following a stepwise stapleless LLS. The surgical results and oncological outcomes of laparoscopic vs. open hepatectomies (LH and OH, respectively) with the surgical indication of HCC at left lateral liver sector were further compared and analyzed. RESULTS 18 of 29 patients in the laparoscopic group and 75 patients in the conventional open group had primary HCC. The demographic data was essentially the same for the two groups. Statistical analysis revealed that the LH group had smaller tumor size, higher blood transfusion requirement, longer duration of inflow control and parenchymal transection, and longer operation time. However, no significant difference was observed in terms of complication rate, mortality rate, and hospital stay between the two groups. After adjusting for tumor size, LH and OH showed no statistical difference in the amount of blood transfusion, operation time and patient survival. CONCLUSIONS This study demonstrated that stapleless LLS is a safe and feasible procedure for less experienced liver surgeons to resect HCC located at the left lateral liver sector. This stepwise stapleless LSS can not only achieve surgical results comparable to OH but also can provide a platform for liver surgeons to apply laparoscopic technique before conducting more complicated liver resections.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Anesthesiology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Hao-Tsai Cheng
- College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Heng-Yuan Hsu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Chien-Chih Chiu
- Department of Nursing, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Yi-Ping Liu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Tsung-Han Wu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Ming-Chin Yu
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China. .,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China. .,Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, China.
| | - Wei-Chen Lee
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Miin-Fu Chen
- Department of Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fuxing St, Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Guishan, Taoyuan, Taiwan, Republic of China
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13
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Huang CC, Chen YH, Hung CS, Lee JK, Hsu TP, Chuang PY, Chen MF, Ho YL. P951Short-term exposure to ambient air pollutants affected home blood pressure in patients with chronic cardiovascular diseases. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p951] [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: 11/14/2022] Open
Affiliation(s)
- C C Huang
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - Y H Chen
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - C S Hung
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - J K Lee
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - T P Hsu
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - P Y Chuang
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - M F Chen
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - Y L Ho
- National Taiwan University Hospital, Taipei, Taiwan ROC
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14
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Chen MF, O'Neill SM, Carey AJ, Conrad RH, Stewart BA, Snekvik KR, Ylitalo GM, Hershberger PK. Infection by Nanophyetus salmincola and Toxic Contaminant Exposure in Out-migrating Steelhead from Puget Sound, Washington: Implications for Early Marine Survival. J Aquat Anim Health 2018; 30:103-118. [PMID: 29710401 DOI: 10.1002/aah.10017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/14/2017] [Indexed: 06/08/2023]
Abstract
Out-migrating steelhead Oncorhynchus mykiss from four Puget Sound rivers and associated marine basins of Puget Sound in Washington State were examined for the parasite, Nanophyetus salmincola in 2014 to determine whether recent trends in reduced marine survival are associated with the presence of this pathogen. A subset of steelhead from three of these river-marine basin combinations was analyzed for the presence of persistent organic pollutants (POPs) to assess whether exposure to these contaminants is a contributing factor to their reduced marine survival. The prevalence and parasite load of N. salmincola were significantly higher in fish from central and southern Puget Sound than in fish from river systems in northern Puget Sound. The proportion of steelhead samples with concentrations of POPs higher than adverse effects thresholds (AETs) or concentrations known to cause adverse effects was also greater in fish from the central and southern regions of Puget Sound than in those from the northern region. Polybrominated diphenyl ether concentrations associated with increased disease susceptibility were observed in 10% and 40% of the steelhead sampled from central and southern Puget Sound regions, respectively, but in none of the fish sampled from the northern region. The AET for polychlorinated biphenyls was exceeded in steelhead collected from marine habitats: 25% of the samples from the marine basins in the central and southern regions of Puget Sound and 17% of samples from northern Puget Sound region. Both N. salmincola and POP levels suggest there are adverse health effects on out-migrating steelhead from one southern and one central Puget Sound river that have lower early marine survival than those from a river system in northern Puget Sound.
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Affiliation(s)
- M F Chen
- Northwest Indian Fisheries Commission, 6730 Martin Way East, Olympia, Washington, 98670, USA
| | - S M O'Neill
- Washington Department of Fish and Wildlife, Post Office Box 43150, Olympia, Washington, 98504-3150, USA
| | - A J Carey
- Washington Department of Fish and Wildlife, Post Office Box 43150, Olympia, Washington, 98504-3150, USA
| | - R H Conrad
- Northwest Indian Fisheries Commission, 6730 Martin Way East, Olympia, Washington, 98670, USA
| | - B A Stewart
- Northwest Indian Fisheries Commission, 6730 Martin Way East, Olympia, Washington, 98670, USA
| | - K R Snekvik
- College of Veterinary Medicine, Washington State University, Pullman, Washington, 99164, USA
| | - G M Ylitalo
- National Oceanic and Atmospheric Administration, National Marine Fisheries Service, Northwest Fisheries Science Center, Environmental and Fisheries Sciences Division, 2725 Montlake Boulevard East, Seattle, Washington, 98112, USA
| | - P K Hershberger
- U.S. Geologic Survey, Western Fisheries Research Center, Marrowstone Marine Field Station, 616 Marrowstone Point Road, Nordland, Washington, 98358, USA
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15
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Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, Kozaka K, Endo I, Deziel DJ, Miura F, Okamoto K, Hwang TL, Huang WSW, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Noguchi Y, Shikata S, Ukai T, Higuchi R, Gabata T, Mori Y, Iwashita Y, Hibi T, Jagannath P, Jonas E, Liau KH, Dervenis C, Gouma DJ, Cherqui D, Belli G, Garden OJ, Giménez ME, de Santibañes E, Suzuki K, Umezawa A, Supe AN, Pitt HA, Singh H, Chan ACW, Lau WY, Teoh AYB, Honda G, Sugioka A, Asai K, Gomi H, Itoi T, Kiriyama S, Yoshida M, Mayumi T, Matsumura N, Tokumura H, Kitano S, Hirata K, Inui K, Sumiyama Y, Yamamoto M. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25:41-54. [PMID: 29032636 DOI: 10.1002/jhbp.515] [Citation(s) in RCA: 497] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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Affiliation(s)
- Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Jiro Hata
- Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Horacio J Asbun
- Department of Surgery, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University, Graduate School of Medical Sciences, Ishikawa, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Daniel J Deziel
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Tsann-Long Hwang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Miin-Fu Chen
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In-Seok Choi
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Dong-Sup Yoon
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Yoshinori Noguchi
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | | | - Tomohiko Ukai
- Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Palepu Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Eduard Jonas
- Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Kui-Hin Liau
- Mt Elizabeth Novena Hospital, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Giulio Belli
- Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Mariano Eduardo Giménez
- Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, DAICIM Foundation, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Avinash Nivritti Supe
- Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Harjit Singh
- Department of Hepato-Pancreato-Biliary Surgery, Hospital Selayang, Selangor, Malaysia
| | - Angus C W Chan
- Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Harumi Gomi
- Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Chemotherapy Research Institute Kaken Hospital, International University of Health and Welfare, Chiba, Japan.,Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan
| | | | | | | | | | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
| | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan
| | | | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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16
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Gomi H, Solomkin JS, Schlossberg D, Okamoto K, Takada T, Strasberg SM, Ukai T, Endo I, Iwashita Y, Hibi T, Pitt HA, Matsunaga N, Takamori Y, Umezawa A, Asai K, Suzuki K, Han HS, Hwang TL, Mori Y, Yoon YS, Huang WSW, Belli G, Dervenis C, Yokoe M, Kiriyama S, Itoi T, Jagannath P, Garden OJ, Miura F, de Santibañes E, Shikata S, Noguchi Y, Wada K, Honda G, Supe AN, Yoshida M, Mayumi T, Gouma DJ, Deziel DJ, Liau KH, Chen MF, Liu KH, Su CH, Chan ACW, Yoon DS, Choi IS, Jonas E, Chen XP, Fan ST, Ker CG, Giménez ME, Kitano S, Inomata M, Mukai S, Higuchi R, Hirata K, Inui K, Sumiyama Y, Yamamoto M. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2018; 25:3-16. [PMID: 29090866 DOI: 10.1002/jhbp.518] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by class-definitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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Affiliation(s)
- Harumi Gomi
- Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Joseph S Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David Schlossberg
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan
| | - Steven M Strasberg
- Section of HPB Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Tomohiko Ukai
- Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Naohisa Matsunaga
- Department of Infection Control and Prevention, Teikyo University, Tokyo, Japan
| | - Yoriyuki Takamori
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tsann-Long Hwang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Giulio Belli
- Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
| | | | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Palepu Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Fumihiko Miura
- Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan
| | - Eduardo de Santibañes
- Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Yoshinori Noguchi
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Avinash Nivritti Supe
- Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.,Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniel J Deziel
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kui-Hin Liau
- Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Miin-Fu Chen
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Keng-Hao Liu
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsi Su
- Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Angus C W Chan
- Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Dong-Sup Yoon
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - In-Seok Choi
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Eduard Jonas
- Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Xiao-Ping Chen
- Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheung Tat Fan
- Liver Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Mariano Eduardo Giménez
- Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, Argentina, DAICIM Foundation, Buenos Aires, Argentina
| | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
| | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan
| | | | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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17
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Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, Gomi H, Solomkin JS, Schlossberg D, Han HS, Kim MH, Hwang TL, Chen MF, Huang WSW, Kiriyama S, Itoi T, Garden OJ, Liau KH, Horiguchi A, Liu KH, Su CH, Gouma DJ, Belli G, Dervenis C, Jagannath P, Chan ACW, Lau WY, Endo I, Suzuki K, Yoon YS, de Santibañes E, Giménez ME, Jonas E, Singh H, Honda G, Asai K, Mori Y, Wada K, Higuchi R, Watanabe M, Rikiyama T, Sata N, Kano N, Umezawa A, Mukai S, Tokumura H, Hata J, Kozaka K, Iwashita Y, Hibi T, Yokoe M, Kimura T, Kitano S, Inomata M, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 2018; 25:31-40. [DOI: 10.1002/jhbp.509] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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18
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Kiriyama S, Kozaka K, Takada T, Strasberg SM, Pitt HA, Gabata T, Hata J, Liau KH, Miura F, Horiguchi A, Liu KH, Su CH, Wada K, Jagannath P, Itoi T, Gouma DJ, Mori Y, Mukai S, Giménez ME, Huang WSW, Kim MH, Okamoto K, Belli G, Dervenis C, Chan ACW, Lau WY, Endo I, Gomi H, Yoshida M, Mayumi T, Baron TH, de Santibañes E, Teoh AYB, Hwang TL, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Higuchi R, Kitano S, Inomata M, Deziel DJ, Jonas E, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25:17-30. [PMID: 29032610 DOI: 10.1002/jhbp.512] [Citation(s) in RCA: 326] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although the diagnostic and severity grading criteria on the 2013 Tokyo Guidelines (TG13) are used worldwide as the primary standard for management of acute cholangitis (AC), they need to be validated through implementation and assessment in actual clinical practice. Here, we conduct a systematic review of the literature to validate the TG13 diagnostic and severity grading criteria for AC and propose TG18 criteria. While there is little evidence evaluating the TG13 criteria, they were validated through a large-scale case series study in Japan and Taiwan. Analyzing big data from this study confirmed that the diagnostic rate of AC based on the TG13 diagnostic criteria was higher than that based on the TG07 criteria, and that 30-day mortality in patients with a higher severity based on the TG13 severity grading criteria was significantly higher. Furthermore, a comparison of patients treated with early or urgent biliary drainage versus patients not treated this way showed no difference in 30-day mortality among patients with Grade I or Grade III AC, but significantly lower 30-day mortality in patients with Grade II AC who were treated with early or urgent biliary drainage. This suggests that the TG13 severity grading criteria can be used to identify Grade II patients whose prognoses may be improved through biliary drainage. The TG13 severity grading criteria may therefore be useful as an indicator for biliary drainage as well as a predictive factor when assessing the patient's prognosis. The TG13 diagnostic and severity grading criteria for AC can provide results quickly, are minimally invasive for the patients, and are inexpensive. We recommend that the TG13 criteria be adopted in the TG18 guidelines and used as standard practice in the clinical setting. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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Affiliation(s)
- Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Jiro Hata
- Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
| | - Kui-Hin Liau
- Mt Elizabeth Novena Hospital Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Keng-Hao Liu
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsi Su
- Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Palepu Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mariano Eduardo Giménez
- General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, Buenos Aires, Argentina.,DAICIM Foundation, Buenos Aires, Argentina
| | | | - Myung-Hwan Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Giulio Belli
- Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
| | | | - Angus C W Chan
- Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Harumi Gomi
- Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.,Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eduardo de Santibañes
- Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Tsann-Long Hwang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Miin-Fu Chen
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In-Seok Choi
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Dong-Sup Yoon
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Masafumi Inomata
- Department of Gastroenterolgical and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Daniel J Deziel
- Department of Surgery, Rush University Medical Center, Chicago, USA
| | - Eduard Jonas
- Surgical Gastroenterology /Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
| | | | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
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19
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Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, Iwashita Y, Hibi T, Pitt HA, Umezawa A, Asai K, Han HS, Hwang TL, Mori Y, Yoon YS, Huang WSW, Belli G, Dervenis C, Yokoe M, Kiriyama S, Itoi T, Jagannath P, Garden OJ, Miura F, Nakamura M, Horiguchi A, Wakabayashi G, Cherqui D, de Santibañes E, Shikata S, Noguchi Y, Ukai T, Higuchi R, Wada K, Honda G, Supe AN, Yoshida M, Mayumi T, Gouma DJ, Deziel DJ, Liau KH, Chen MF, Shibao K, Liu KH, Su CH, Chan ACW, Yoon DS, Choi IS, Jonas E, Chen XP, Fan ST, Ker CG, Giménez ME, Kitano S, Inomata M, Hirata K, Inui K, Sumiyama Y, Yamamoto M. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2017; 25:55-72. [PMID: 29045062 DOI: 10.1002/jhbp.516] [Citation(s) in RCA: 386] [Impact Index Per Article: 55.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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20
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Mayumi T, Okamoto K, Takada T, Strasberg SM, Solomkin JS, Schlossberg D, Pitt HA, Yoshida M, Gomi H, Miura F, Garden OJ, Kiriyama S, Yokoe M, Endo I, Asbun HJ, Iwashita Y, Hibi T, Umezawa A, Suzuki K, Itoi T, Hata J, Han HS, Hwang TL, Dervenis C, Asai K, Mori Y, Huang WSW, Belli G, Mukai S, Jagannath P, Cherqui D, Kozaka K, Baron TH, de Santibañes E, Higuchi R, Wada K, Gouma DJ, Deziel DJ, Liau KH, Wakabayashi G, Padbury R, Jonas E, Supe AN, Singh H, Gabata T, Chan ACW, Lau WY, Fan ST, Chen MF, Ker CG, Yoon YS, Choi IS, Kim MH, Yoon DS, Kitano S, Inomata M, Hirata K, Inui K, Sumiyama Y, Yamamoto M. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2017; 25:96-100. [PMID: 29090868 DOI: 10.1002/jhbp.519] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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Affiliation(s)
- Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Joseph S Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David Schlossberg
- Professor of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,Medical Director, TB Control Program, Philadelphia, PA, USA.,Department of Public Health, Philadelphia, PA, USA
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.,Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan
| | - Harumi Gomi
- Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Horacio J Asbun
- Department of Surgery, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Jiro Hata
- Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tsann-Long Hwang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Giulio Belli
- Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Palepu Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, NC, USA
| | - Eduardo de Santibañes
- Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniel J Deziel
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kui-Hin Liau
- Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Robert Padbury
- Division of Surgical and Specialty Services, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Eduard Jonas
- Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Avinash Nivritti Supe
- Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - Harjit Singh
- Department of Hepato-Pancreato-Biliary Surgery, Hospital Selayang, Selangor, Malaysia
| | | | - Angus C W Chan
- Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sheung Tat Fan
- Director, Liver Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Miin-Fu Chen
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In-Seok Choi
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Myung-Hwan Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Sup Yoon
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
| | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan
| | | | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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21
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Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, Ukai T, Shikata S, Noguchi Y, Teoh AYB, Kim MH, Asbun HJ, Endo I, Yokoe M, Miura F, Okamoto K, Suzuki K, Umezawa A, Iwashita Y, Hibi T, Wakabayashi G, Han HS, Yoon YS, Choi IS, Hwang TL, Chen MF, Garden OJ, Singh H, Liau KH, Huang WSW, Gouma DJ, Belli G, Dervenis C, de Santibañes E, Giménez ME, Windsor JA, Lau WY, Cherqui D, Jagannath P, Supe AN, Liu KH, Su CH, Deziel DJ, Chen XP, Fan ST, Ker CG, Jonas E, Padbury R, Mukai S, Honda G, Sugioka A, Asai K, Higuchi R, Wada K, Yoshida M, Mayumi T, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2017; 25:87-95. [PMID: 28888080 DOI: 10.1002/jhbp.504] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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22
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Hsu HY, Yu MC, Lee CW, Tsai HI, Sung CM, Chen CW, Huang SW, Lin CY, Jeng WJ, Lee WC, Chen MF. RAM score is an effective predictor for early mortality and recurrence after hepatectomy for hepatocellular carcinoma. BMC Cancer 2017; 17:742. [PMID: 29121890 PMCID: PMC5680811 DOI: 10.1186/s12885-017-3748-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 02/23/2017] [Accepted: 11/01/2017] [Indexed: 02/08/2023] Open
Abstract
Background Liver resection had been regarded as a standard treatment for primary hepatocellular carcinoma (HCC). However, early mortality and recurrence after surgery were still of major concern. RAM (Risk Assessment for early Mortality) scoring system is a newly developed tool for assessing early mortality after hepatectomy for HCC. In this study, we compared RAM scoring system with ALBI and MELD scores for their capability of predicting short-term outcome. Methods We retrospectively reviewed patients with hepatocellular carcinoma who were treated with hepatectomy at Chang Gung Memorial Hospital between 1986 and 2015. Their clinical characteristics and perioperative variables were collected. We applied RAM, albumin-bilirubin (ALBI), and model for end-stage liver disease (MELD) scoring systems to predict early mortality and early recurrence in HCC patients after surgery. We investigated the discriminative power of each scoring system by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). Results A total of 1935 patients (78% male) who underwent liver resection for HCC were included in this study. The median follow-up period was 41.9 months. One hundred and forty-nine patients (7.7%) died within 6 months after hepatectomy (early mortality). All the three scoring systems were effective predictor for early mortality, with higher score indicating higher risk of early mortality (AUC of RAM = 0.723, p < 0.001; AUC of ALBI = 0.682, p < 0.001; AUC of MELD = 0.590, p = 0.002). Cox regression multivariate analysis demonstrated that the RAM class was the most significant independent predictor of early mortality after surgery, while MELD grade failed to discriminatively predict early mortality. In addition to early mortality, the RAM score was also predictive of early recurrence in HCC after surgery. Conclusions This study demonstrated that RAM score is an effective and user-friendly bedside scoring system to predict early mortality and early recurrence after hepatectomy for HCC. In addition, the predictive capability of RAM score is superior to ALBI and MELD scores. Further study is warranted to validate our findings.
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Affiliation(s)
- Heng-Yuan Hsu
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Department of Anesthesiology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Chang-Mu Sung
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China.,Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Chun-Wei Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Shu-Wei Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Cheng-Yu Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Wei-Chen Lee
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan, Republic of China.,College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
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23
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Iwashita Y, Hibi T, Ohyama T, Umezawa A, Takada T, Strasberg SM, Asbun HJ, Pitt HA, Han HS, Hwang TL, Suzuki K, Yoon YS, Choi IS, Yoon DS, Huang WSW, Yoshida M, Wakabayashi G, Miura F, Okamoto K, Endo I, de Santibañes E, Giménez ME, Windsor JA, Garden OJ, Gouma DJ, Cherqui D, Belli G, Dervenis C, Deziel DJ, Jonas E, Jagannath P, Supe AN, Singh H, Liau KH, Chen XP, Chan ACW, Lau WY, Fan ST, Chen MF, Kim MH, Honda G, Sugioka A, Asai K, Wada K, Mori Y, Higuchi R, Misawa T, Watanabe M, Matsumura N, Rikiyama T, Sata N, Kano N, Tokumura H, Kimura T, Kitano S, Inomata M, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul-de-sac or the birth pangs of a new technical framework? J Hepatobiliary Pancreat Sci 2017; 24:591-602. [PMID: 28884962 DOI: 10.1002/jhbp.503] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce. Surgeons from Japan, Korea, Taiwan, and the USA, etc. (n = 614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when ≥80% of overall responses were 4 or 5. Response rates for the first- and second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: (1) Effective retraction of the gallbladder, (2) Always obtaining critical view of safety, and (3) Avoiding excessive use of electrocautery/clipping as vital procedures; and (4) Calot's triangle area and (5) Critical view of safety as important landmarks. For (6) Impacted gallstone and (7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated. A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI.
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Affiliation(s)
- Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Steven M Strasberg
- Section of HPB Surgery, Washington University in Saint Louis, St. Louis, MO, USA
| | - Horacio J Asbun
- Department of Surgery, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tsann-Long Hwang
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In-Seok Choi
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Dong-Sup Yoon
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Chemotherapy Research Institute, International University of Health and Welfare, Chiba, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Eduardo de Santibañes
- Department of Surgery, Hospital Italianio, University of Buenos Aires, Buenos Aires, Argentina
| | - Mariano Eduardo Giménez
- Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, Argentina DAICIM Foundation, Buenos Aires, Argentina
| | - John A Windsor
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - O James Garden
- Clinical Surgery, The University of Edinburgh, Edinburgh, UK
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Giulio Belli
- Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
| | | | - Daniel J Deziel
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Eduard Jonas
- Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Palepu Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Avinash Nivritti Supe
- Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - Harjit Singh
- Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kui-Hin Liau
- Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Ping Chen
- Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongi Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Angus C W Chan
- Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sheung Tat Fan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Miin-Fu Chen
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Hwan Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhisa Mori
- Department of Surgery I, Kyushu University, Faculty of Medicine, Fukuoka, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeyuki Misawa
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | | | | | - Taizo Kimura
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
| | | | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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24
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Mukai S, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, Ukai T, Shikata S, Teoh AYB, Kim MH, Kiriyama S, Mori Y, Miura F, Chen MF, Lau WY, Wada K, Supe AN, Giménez ME, Yoshida M, Mayumi T, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci 2017; 24:537-549. [DOI: 10.1002/jhbp.496] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shuntaro Mukai
- Department of Gastroenterology and Hepatology; Tokyo Medical University Hospital; Tokyo Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology; Tokyo Medical University Hospital; Tokyo Japan
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology; University of North Carolina at Chapel Hill; NC USA
| | - Tadahiro Takada
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Steven M. Strasberg
- Section of HPB Surgery; Washington University in St. Louis; St. Louis MO USA
| | - Henry A. Pitt
- Lewis Katz School of Medicine at Temple University; Philadelphia PA USA
| | - Tomohiko Ukai
- Department of Family Medicine; Mie Prefectural Ichishi Hospital; Mie Japan
| | | | | | - Myung-Hwan Kim
- Department of Gastroenterology; University of Ulsan College of Medicine; Seoul Korea
| | - Seiki Kiriyama
- Department of Gastroenterology; Ogaki Municipal Hospital; Gifu Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Fumihiko Miura
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Miin-Fu Chen
- Division of General Surgery; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Wan Yee Lau
- Faculty of Medicine; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Keita Wada
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Avinash Nivritti Supe
- Department of Surgical Gastroenterology; Seth G S Medical College and K E M Hospital; Mumbai India
| | - Mariano Eduardo Giménez
- Chair of General Surgery and Minimal Invasive Surgery “Taquini”; University of Buenos Aires; Argentina DAICIM Foundation; Buenos Aires Argentina
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery; Chemotherapy Research Institute; International University of Health and Welfare; Chiba Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine; School of Medicine; University of Occupational and Environmental Health; Fukuoka Japan
| | - Koichi Hirata
- Department of Surgery; JR Sapporo Hospital; Hokkaido Japan
| | | | - Kazuo Inui
- Department of Gastroenterology; Second Teaching Hospital; Fujita Health University; Aichi Japan
| | - Masakazu Yamamoto
- Department of Surgery; Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan
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25
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Endo I, Takada T, Hwang TL, Akazawa K, Mori R, Miura F, Yokoe M, Itoi T, Gomi H, Chen MF, Jan YY, Ker CG, Wang HP, Kiriyama S, Wada K, Yamaue H, Miyazaki M, Yamamoto M. Optimal treatment strategy for acute cholecystitis based on predictive factors: Japan-Taiwan multicenter cohort study. J Hepatobiliary Pancreat Sci 2017; 24:346-361. [PMID: 28419741 DOI: 10.1002/jhbp.456] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although early laparoscopic cholecystectomy is widely performed for acute cholecystitis, the optimal timing of a cholecystectomy in clinically ill patients remains controversial. This study aims to determine the best practice for the patients presenting with acute cholecystitis focused on disease severity and comorbidities. METHODS An international multicentric retrospective observational study was conducted over a 2-year period. Patients were divided into four groups: Group A: primary cholecystectomy; Group B: cholecystectomy after gallbladder drainage; Group C: gallbladder drainage alone; and Group D: medical treatment alone. RESULTS The subjects of analyses were 5,329 patients. There were statistically significant differences in mortality rates between patients with Charlson comorbidity index (CCI) scores below and above 6 (P < 0.001). The shortest operative time was observed in Group A patients who underwent surgery 0-3 days after admission (P < 0.01). Multiple regression analysis revealed CCI and low body mass index <20 as predictive factors of 30-day mortality in Grade I+II patients. Also, jaundice, neurological dysfunction, and respiratory dysfunction were predictive factors of 30-day mortality in Grade III patients. In Grade III patients without predictive factors, there were no difference in mortality between Group A and Group B (0% vs. 0%), whereas Group A patients had higher mortality rates than that of Group B patients (9.3% vs. 0.0%) in cases with at least one predictive factor. CONCLUSION Even patients with Grade III severity, primary cholecystectomy can be performed safely if they have no predictive factors of mortality. Gallbladder drainage may have a therapeutic role in subgroups with higher CCI or higher disease severity.
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Affiliation(s)
- Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsann-Long Hwang
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Kohei Akazawa
- Department of Medical Informatics, Niigata University, Niigata, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Harumi Gomi
- Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan
| | - Miin-Fu Chen
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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26
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Kiriyama S, Takada T, Hwang TL, Akazawa K, Miura F, Gomi H, Mori R, Endo I, Itoi T, Yokoe M, Chen MF, Jan YY, Ker CG, Wang HP, Wada K, Yamaue H, Miyazaki M, Yamamoto M. Clinical application and verification of the TG13 diagnostic and severity grading criteria for acute cholangitis: an international multicenter observational study. J Hepatobiliary Pancreat Sci 2017; 24:329-337. [PMID: 28419764 DOI: 10.1002/jhbp.458] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Tokyo Guidelines 2007 (TG07) first presented the diagnostic and severity grading criteria for acute cholangitis. Subsequently updated in 2013, the Tokyo Guidelines (TG13) have been widely adopted throughout the world as global standard guidelines. We set out to verify the efficacy of these TG13 criteria in an international multicenter study. METHODS We reviewed 6,063 patients who were clinically diagnosed with acute cholangitis in Japan and Taiwan over a 2-year period. The TG13 diagnostic and severity grading criteria were retrospectively applied, and 30-day mortality was investigated. RESULTS A diagnosis of acute cholangitis was made in 5,454 (90.0%) patients on the basis of the TG13 criteria, and in 4,815 (79.4%) patients on the basis of the TG07 criteria. The 30-day mortality rates of patients with Grade III, Grade II, and Grade I were 5.1%, 2.6%, and 1.2%, respectively, and increased significantly along with disease severity. The mortality rate in the 1,272 Grade II cases where urgent or early biliary drainage was performed was 2.0% (n = 25), which was significantly lower than that of 3.7% (n = 28) in the other 748 cases. CONCLUSION By using the TG13 diagnostic and severity grading criteria, more patients with possible acute cholangitis can be diagnosed, and patients whose prognosis can potentially be improved by early biliary drainage can be identified. The TG13 criteria are appropriate and useful for clinical practice.
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Affiliation(s)
- Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsann-Long Hwang
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Kohei Akazawa
- Department of Medical Informatics, Niigata University, Niigata, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Harumi Gomi
- Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan
| | - Rintaro Mori
- Department of Health Policy at National Center for Child Health and Development - National Center for Child Health and Development, Tokyo, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Miin-Fu Chen
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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27
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Gomi H, Takada T, Hwang TL, Akazawa K, Mori R, Endo I, Miura F, Kiriyama S, Matsunaga N, Itoi T, Yokoe M, Chen MF, Jan YY, Ker CG, Wang HP, Wada K, Yamaue H, Miyazaki M, Yamamoto M. Updated comprehensive epidemiology, microbiology, and outcomes among patients with acute cholangitis. J Hepatobiliary Pancreat Sci 2017; 24:310-318. [PMID: 28371094 DOI: 10.1002/jhbp.452] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The international practice guidelines for patients with acute cholangitis and cholecystitis were released in 2007 (TG07) and revised in 2013 (TG13). This study investigated updated epidemiology and outcomes among patients with acute cholangitis on a larger scale for the first time. METHODS This is an international multi-center retrospective observational study in Japan and Taiwan. All consecutive patients older than 18 years of age and given a clinical diagnosis of acute cholangitis by clinicians between 1 January 2011 and 31 December 2012 were enrolled. Those who met the diagnostic criteria of acute cholangitis by TG13 were statistically analyzed. RESULTS A total of 7,294 patients were enrolled and 6,433 patients met the TG13 diagnostic criteria. The severity distribution was Grade I (37.5%), Grade II (36.2%), and Grade III (26.2%). The 30-day all-cause mortality was 2.4%, 4.7%, and 8.4% in Grade I, II, III severity, respectively (P < 0.001). The incidence of liver abscess and endocarditis as complications of acute cholangitis was 2.0% and 0.26%, respectively. CONCLUSIONS This is the first large scale study to investigate patients with acute cholangitis. This study provides the basis to define the best practices to manage patients with acute cholangitis in future studies.
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Affiliation(s)
- Harumi Gomi
- Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsann-Long Hwang
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Kohei Akazawa
- Department of medical informatics, Niigata University, Niigata, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Naohisa Matsunaga
- Department of Infection Control and Prevention, Teikyo University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Miin-Fu Chen
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Yokoe M, Takada T, Hwang TL, Endo I, Akazawa K, Miura F, Mayumi T, Mori R, Chen MF, Jan YY, Ker CG, Wang HP, Itoi T, Gomi H, Kiriyama S, Wada K, Yamaue H, Miyazaki M, Yamamoto M. Validation of TG13 severity grading in acute cholecystitis: Japan-Taiwan collaborative study for acute cholecystitis. J Hepatobiliary Pancreat Sci 2017; 24:338-345. [PMID: 28419779 DOI: 10.1002/jhbp.457] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The collaborative multicenter retrospective study of acute cholecystitis (AC) was performed in Japan and Taiwan. The aim for this study was evaluation of the clinical value of TG13 severity grading for AC. METHOD The study was designed as an international multicenter retrospective study of AC from 2011 to 2013. Based on the data, we investigated the TG13 severity grading by analyzing the correlations between grade and prognosis, surgical procedures, histopathology, and organ dysfunction and prognosis. RESULTS An investigation revealed that 30-day overall mortality rate was 1.1% for Grade I, 0.8% for Grade II, 5.4% for Grade III. The mortality rate for Grade III was significantly higher than lower grades (P < 0.001). The greater the number of organ dysfunction, the higher the mortality rate (P < 0.001). However, the mortality rate varied depending on the number of organ dysfunction (3.1-25%). With respect to the surgical procedures, laparoscopic cholecystectomy was performed for Grade I patients (P < 0.001), and the higher the grade, the more likely open surgery would be selected (P < 0.001). CONCLUSION TG13 severity grading criteria for AC are providing great benefits in actual clinical settings. From this study, the position of each severity grade was obviously confirmed.
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Affiliation(s)
- Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsann-Long Hwang
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Kohei Akazawa
- Department of Medical Informatics, Niigata University, Niigata, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Miin-Fu Chen
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Harumi Gomi
- Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masaru Miyazaki
- Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Itoi T, Takada T, Hwang TL, Endo I, Akazawa K, Miura F, Chen MF, Jan YY, Ker CG, Wang HP, Gomi H, Yokoe M, Kiriyama S, Wada K, Yamaue H, Miyazaki M, Yamamoto M. Percutaneous and endoscopic gallbladder drainage for acute cholecystitis: international multicenter comparative study using propensity score-matched analysis. J Hepatobiliary Pancreat Sci 2017; 24:362-368. [PMID: 28371480 DOI: 10.1002/jhbp.454] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tokyo Guideline 2013 (TG13) proposed three drainage techniques for the treatment of acute cholecystitis. We evaluated the clinical efficacy and adverse events between percutaneous transhepatic intervention (PTGBI) including percutaneous transhepatic gallbladder drainage (PTGBD) and percutaneous transhepatic gallbladder aspiration (PTGBA) and endoscopic transpapillary gallbladder drainage (EGBD). METHODS A cohort study was performed using propensity score matching to reduce treatment selection bias. This involved the analysis of collected data for 1,764 patients who underwent PTGBI and EGBD. RESULTS Propensity score matching extracted 330 pairs of patients. The difference in the clinical success rate within 3 days between PTGBI and EGBD were 62.5% and 69.8%, respectively (P = 0.085). The differences in the suboptimal clinical success rates within 7 days between PTGBI and EGBD were 87.6% and 89.2% (P = 0.579). The differences in the complication rate between PTGBI and EGBD were 4.8% and 8.2% (P = 0.083). The differences in the complication rate among PTGBD, PTGBA and EGBD were 5.6%, 1.6% and 8.2% (P = 0.11). Median required days of PTGBD (3.0 days) was significantly longer than those of PTGBA and EGBD (1.5 and 2.0 days, respectively) (P = 0.001). CONCLUSION The current study showed the PTGBI showed similar clinical efficacy compared with EGBD without significant discrepancy of complication rate for the treatment of acute cholecystitis.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsann-Long Hwang
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Kohei Akazawa
- Department of medical informatics, Niigata University, Niigata, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Miin-Fu Chen
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Lin-Kou Chang Gung Memorial Hospital, Tauyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Harumi Gomi
- Center for Global Health Mito Kyodo General Hospital University of Tsukuba, Ibaraki, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- Emeritus Professor, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Yokoe M, Takada T, Hwang TL, Endo I, Akazawa K, Miura F, Mayumi T, Mori R, Chen MF, Jan YY, Ker CG, Wang HP, Itoi T, Gomi H, Kiriyama S, Wada K, Yamaue H, Miyazaki M, Yamamoto M. Descriptive review of acute cholecystitis: Japan-Taiwan collaborative epidemiological study. J Hepatobiliary Pancreat Sci 2017; 24:319-328. [PMID: 28316140 DOI: 10.1002/jhbp.450] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masamichi Yokoe
- Department of General Internal Medicine; Japanese Red Cross Nagoya Daini Hospital; Aichi Japan
| | - Tadahiro Takada
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Tsann-Long Hwang
- Division of General Surgery; Lin-Kou Chang Gung Memorial Hospital; Tauyuan Taiwan
| | - Itaru Endo
- Department of Gastroenterological Surgery; Yokohama City University Graduate School of Medicine; Kanagawa Japan
| | - Kohei Akazawa
- Department of Medical Informatics; Niigata University; Niigata Japan
| | - Fumihiko Miura
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine; School of Medicine; University of Occupational and Environmental Health; Fukuoka Japan
| | - Rintaro Mori
- Department of Health Policy; National Center for Child Health and Development; Tokyo Japan
| | - Miin-Fu Chen
- Division of General Surgery; Lin-Kou Chang Gung Memorial Hospital; Tauyuan Taiwan
| | - Yi-Yin Jan
- Division of General Surgery; Lin-Kou Chang Gung Memorial Hospital; Tauyuan Taiwan
| | - Chen-Guo Ker
- Department of Surgery; Yuan's General Hospital; Kaohsiung Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine; National Taiwan University Hospital; National Taiwan University College of Medicine; Taipei Taiwan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology; Tokyo Medical University Hospital; Tokyo Japan
| | - Harumi Gomi
- Center for Global Health; Mito Kyodo General Hospital; University of Tsukuba; Ibaraki Japan
| | - Seiki Kiriyama
- Department of Gastroenterology; Ogaki Municipal Hospital; Gifu Japan
| | - Keita Wada
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Hiroki Yamaue
- Second Department of Surgery; Wakayama Medical University; Wakayama Japan
| | - Masaru Miyazaki
- Emeritus Professor; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Masakazu Yamamoto
- Department of Surgery; Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan
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31
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Zheng HR, Li Z, You C, Liu DB, Chen MF. Effects of MgO modified β-TCP nanoparticles on the microstructure and properties of β-TCP/Mg-Zn-Zr composites. Bioact Mater 2017; 2:1-9. [PMID: 29744405 PMCID: PMC5935024 DOI: 10.1016/j.bioactmat.2016.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 02/20/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 11/25/2022] Open
Abstract
The mechanical properties and corrosion resistance of magnesium alloy composites were improved by the addition of MgO surface modified tricalcium phosphate ceramic nanoparticles (m-β-TCP). Mg-3Zn-0.8Zr composites with unmodified (MZZT) and modified (MZZMT) nanoparticles were produced by high shear mixing technology. Effects of MgO m-β-TCP nanoparticles on the microstructure, mechanical properties, electrochemical corrosion properties and cytocompatibility of Mg-Zn-Zr/β-TCP composites were investigated. After hot extrusion deformation and dynamic recrystallization, the grain size of MZZMT was the half size of MZZT and the distribution of m-β-TCP particles in the matrix was more uniform than β-TCP particles. The yield tensile strength (YTS), ultimate tensile strength (UTS), and corrosion potential (Ecorr) of MZZMT were higher than MZZT; the corrosion current density (Icorr) of MZZMT was lower than MZZT. Cell proliferation of co-cultured MZZMT and MZZT composite samples were roughly the same and the cell number at each time point is higher for MZZMT than for MZZT samples. High melt shear mixing technology was used to melt MZZT and MZZMT composites. Formation mechanism and optimum properties of MZZT and MZZMT composites were studied. β-TCP particles can be coated with MgO using chemical precipitation method. Compared with β-TCP, dispersion and size of m-β-TCP nanoparticles is improved. This research equipment is simple, low cost, and easy to operate.
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Affiliation(s)
- H R Zheng
- School of Materials Science and Engineering, Tianjin University of Technology, China
| | - Z Li
- School of Materials Science and Engineering, Tianjin University of Technology, China
| | - C You
- School of Materials Science and Engineering, Tianjin University of Technology, China
| | - D B Liu
- School of Materials Science and Engineering, Tianjin University of Technology, China
| | - M F Chen
- School of Materials Science and Engineering, Tianjin University of Technology, China.,Tianjin Key Laboratory of Display Materials and Photoelectric Devices, China
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Lee CW, Tsai HI, Sung CM, Chen CW, Huang SW, Jeng WJ, Wu TH, Chan KM, Yu MC, Lee WC, Chen MF. Risk factors for early mortality after hepatectomy for hepatocellular carcinoma. Medicine (Baltimore) 2016; 95:e5028. [PMID: 27684875 PMCID: PMC5265968 DOI: 10.1097/md.0000000000005028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 12/16/2022] Open
Abstract
Despite advances in surgical technique and medical care, liver resection for hepatocellular carcinoma (HCC) remains a high-risk major operation. The present study evaluated the risk factors for early mortality after hepatectomy.We retrospectively reviewed records of patients undergoing liver resection for HCC between 1983 and 2015. A point score (Risk Assessment for early Mortality (RAM) score) for hepatectomy was developed based on multivariate analyses.Three hundred eighty-three patients (11.3%) expired within 6 months after the operation. Logistic regression analyses identified that operative duration >270 minutes and blood loss >800 cc were significant predictors of major surgical complications (P = 0.013 and 0.002, respectively). On the other hand, diabetes mellitus, albumin ≤3.5 g/dL, α-fetoprotein (AFP) >200 ng/mL, major surgical procedure, blood loss >800 cc, and major surgical complications were independent risk factors for early mortality after hepatectomy (P = 0.019, <0.001, <0.001, 0.006, 0.018, and <0.001, respectively). Risk Assessment for early Mortality score (RAM score) identified 3 subgroups of patients with distinct 6-month mortality rate, with Class III (score 10) having highest risk of early mortality.Our study demonstrated that meticulous surgical techniques to minimize blood loss and avoid prolonged operative time may help decrease the occurrence of major surgical complications. In addition to major surgical complications, diabetes mellitus, hypoalbuminemia, high AFP, massive blood loss, and major surgical procedure are also associated with early mortality after liver resection. Further study is warranted to validate the utility of RAM score as a bedside scoring system to predict postoperative outcome.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan
- Department of Anesthesiology,Chang Gung Memorial Hospital, Linkou
| | - Chang-Mu Sung
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Chun-Wei Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Shu-Wei Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan (R.O.C.)
| | - Tsung-Han Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
| | - Kun-Ming Chan
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan, Taoyuan
- Correspondence: Ming-Chin Yu, Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan (R.O.C.) (e-mail: )
| | - Wei-Chen Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Guishan, Taoyuan
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Smyth LM, Iyengar NM, Chen MF, Popper SM, Patil S, Wasserheit-Lieblich C, Argolo DF, Singh JC, Chandarlapaty S, Sugarman SM, Comen EA, Drullinsky PR, Traina TA, Troso-Sandoval T, Baselga J, Norton L, Hudis CA, Dang CT. Weekly paclitaxel with trastuzumab and pertuzumab in patients with HER2-overexpressing metastatic breast cancer: overall survival and updated progression-free survival results from a phase II study. Breast Cancer Res Treat 2016; 158:91-97. [PMID: 27306421 DOI: 10.1007/s10549-016-3851-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 01/07/2023]
Abstract
We previously reported progression-free survival (PFS) results on a phase II trial of weekly paclitaxel, trastuzumab, and pertuzumab in patients with human epidermal growth factor receptor 2(HER2)-positive metastatic breast cancer (MBC) treated in the first- and second-line setting. Here, we report results for overall survival (OS) and updated PFS after an additional year of follow-up. Patients with HER2-positive MBC with 0-1 prior treatment were eligible. Treatment consisted of paclitaxel (80 mg/m(2)) weekly, and trastuzumab (loading dose 8 mg/kg → 6 mg/kg) and pertuzumab (loading dose 840 mg → 420 mg) every 3 weeks, all given intravenously. Primary endpoint was 6-month PFS. Secondary endpoints included median PFS, 6-month and median OS. Evaluable patients received at least one full dose of treatment. From January 2011 to December 2013, 69 patients were enrolled: 51 (74 %) and 18 (26 %) treated in first- and second-line metastatic settings, respectively. As of July 1, 2015, the median follow-up was 33 months (range 3-49 months; 67 patients were evaluable for efficacy). The median OS was 44 months (95 % CI 37.5-NR) overall and 44 months (95 % CI 38.3-NR) and 37.5 months (95 % CI 30.3-NR) for patients with 0 and 1 prior metastatic treatment, respectively; 6-month OS was 98 % (95 % CI 90-1). The 6-month PFS was 86 % (95 % CI 75-93) overall and 89 % (95 % CI 76-95) and 78 % (95 % CI 51-91) for patients with 0 and 1 prior therapy, respectively; and median PFS was 21.4 months (95 % CI 14.1-NR) overall and 25.7 months (95 % CI 14.1-NR) and 16.9 months (95 % CI 8.5-NR) for patients with 0-1 prior treatment, respectively. Treatment was well tolerated. Updated analysis demonstrates that weekly paclitaxel, when added to trastuzumab and pertuzumab, is associated with a favorable OS and PFS and offers an alternative to docetaxel-based therapy. http://www.ClinicalTrials.gov NCT0127604.
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Affiliation(s)
- L M Smyth
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA.
| | - N M Iyengar
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - M F Chen
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - S M Popper
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - S Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | | | - J C Singh
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - S Chandarlapaty
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - S M Sugarman
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - E A Comen
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - P R Drullinsky
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - T A Traina
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - T Troso-Sandoval
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - J Baselga
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - L Norton
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - C A Hudis
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
| | - C T Dang
- Breast Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA
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Chang IC, Huang SF, Chen PJ, Chen CL, Chen CL, Wu CC, Tsai CC, Lee PH, Chen MF, Lee CM, Yu HC, Lo GH, Yeh CT, Hong CC, Eng HL, Wang J, Tseng HH, Hsiao CH, Wu HDI, Yen TC, Liaw YF. The Hepatitis Viral Status in Patients With Hepatocellular Carcinoma: a Study of 3843 Patients From Taiwan Liver Cancer Network. Medicine (Baltimore) 2016; 95:e3284. [PMID: 27082566 PMCID: PMC4839810 DOI: 10.1097/md.0000000000003284] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 01/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the leading cancer death in Taiwan. Chronic viral hepatitis infections have long been considered as the most important risk factors for HCC in Taiwan. The previously published reports were either carried out by individual investigators with small patient numbers or by large endemic studies with limited viral marker data. Through collaboration with 5 medical centers across Taiwan, Taiwan liver cancer network (TLCN) was established in 2005. All participating centers followed a standard protocol to recruit liver cancer patients along with their biosamples and clinical data. In addition, detailed viral marker analysis for hepatitis B virus (HBV) and hepatitis C virus (HCV) were also performed. This study included 3843 HCC patients with available blood samples in TLCN (recruited from November 2005 to April 2011). There were 2153 (56.02%) patients associated with HBV (HBV group); 969 (25.21%) with HCV (HCV group); 310 (8.07%) with both HBV and HCV (HBV+HCV group); and 411 (10.69%) were negative for both HBV and HCV (non-B non-C group). Two hundred two of the 2463 HBV patients (8.20%) were HBsAg(-), but HBV DNA (+). The age, gender, cirrhosis, viral titers, and viral genotypes were all significantly different between the above 4 groups of patients. The median age of the HBV group was the youngest, and the cirrhotic rate was lowest in the non-B non-C group (only 25%). This is the largest detailed viral hepatitis marker study for HCC patients in the English literatures. Our study provided novel data on the interaction of HBV and HCV in the HCC patients and also confirmed that the HCC database of TLCN is highly representative for Taiwan and an important resource for HCC research.
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Affiliation(s)
- Il-Chi Chang
- From the Liver Research Unit, Chang Gung Memorial Hospital Linko Branch, Chang-Gung University, Taoyuan, Taiwan (I-CC, C-CH, Y-FL), Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan (I-CC, S-FH, C-CH), Department of Pathology, Chang Gung Memorial Hospital Linko Branch, Taoyuan, Taiwan (S-FH), Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan (P-JC, C-LC), Department of General Surgery, Chang Gung Memorial Hospital Kaohsiung Branch, Chang-Gung University, Kaohsiung, Taiwan (C-LC), Department of General Surgery, Taichung Veteran General Hospital, Taichung, Taiwan (C-CW), Department of General Surgery, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan (C-CT), Department of General Surgery, National Taiwan University Hospital, Taipei, Taiwan (P-HL), Department of General Surgery, Chang Gung Memorial Hospital Linko Branch, Chang-Gung University, Taoyuan, Taiwan (M-FC), Department of Hepato-gastroenterology, Chang Gung Memorial Hospital Kaohsiung Branch, Chang-Gung University, Kaohsiung, Taiwan (C-ML), Department of Hepato-gastroenterology, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan (H-CY, G-HL), Department of Hepato-gastroenterology, Chang Gung Memorial Hospital Linko Branch, Chang-Gung University, Taoyuan, Taiwan (C-TY), Department of Pathology, Chang Gung Memorial Hospital Kaohsiung Branch, Chang-Gung University, Kaohsiung, Taiwan (H-LE), Department of Pathology, Taichung Veteran General Hospital, Taichung, Taiwan (JW), Department of Pathology, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan (H-HT), Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan (C-HH), Department of Applied Mathematics and Institute of Statistics, National Chung-Hsing University, TaiChung, Taiwan (H-DIW, T-CY)
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Iyengar NM, Argolo D, Smyth L, Chen MF, Hudis CA, Dang CT. Abstract OT3-01-09: Phase II study of gemcitabine, trastuzumab, and pertuzumab in the treatment of metastatic HER2-positive breast cancer after prior trastuzumab/pertuzumab- or pertuzumab-based therapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-01-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Despite significant therapeutic advances in the treatment of breast cancers that overexpress human epidermal growth factor receptor-2 (HER2), the large majority of patients (pts) with metastatic disease will experience progression. The development of new HER2 directed therapies has led to improvements in progression free and overall survival; however optimal therapeutic sequencing remains under study. The combination of taxanes with trastuzumab (H) and pertuzumab (P) is active in the first line setting; however the efficacy of continuing dual anti-HER2 therapy with HP after initial progression is unknown.
Trial design: This is a single arm phase II trial of gemcitabine (G) with HP for pts with metastatic HER2-positive breast cancer who have had prior HP-based treatment. G is administered at 1200 mg/m2 on days 1 and 8 of an every 3 week cycle. H is given 8 mg/kg load → 6 mg/kg every 3 weeks or 4 mg/kg load → 2 mg/kg every week. P is given 840 mg load → 420 mg every 3 weeks. All agents will be given intravenously. This trial is currently enrolling pts.
Eligibility criteria: Eligible pts are adults with stage IV HER2-positive (3+ IHC or FISH ≥ 2.0 of primary or metastatic site) breast cancer. Pts may have received prior treatment with HP- or P-based therapy in the (neo)adjuvant, unresectable, locally advanced, or metastatic setting. In the metastatic setting, ≤ 3 prior chemotherapies are permitted. Prior G is allowed only if it was not combined with P. Bone-only non-measurable disease is permitted. Adequate organ and bone marrow function, left ventricular ejection fraction > 50%, and ECOG status ≤ 1 are required. Pts with previously treated brain metastases stable for ≥ 2 months may be enrolled.
Specific aims: The primary objective is to determine the progression free survival (PFS) at 3 months. Secondary objectives include overall survival, safety and tolerability. An exploratory endpoint is to compare PFS determined by RECIST criteria versus 18-F FDG-PET response criteria.
Statistical methods: Based on historical data, the anticipated median PFS in this setting is 3 months. The study will be considered positive if the 3-month PFS is ≥ 70%. A Simon optimal 2-stage design will be used. If 12/21 pts in stage 1 are alive and progression free at 3 months, stage 2 will accrue for a total of 45 pts. If at least 27/45 pts are alive and progression free, the trial will be deemed a success. This design assumes a 10% type I and type II error.
Present accrual and target accrual: 3 out of a planned 45 pts have been enrolled.
Contact information: For more information, please visit clinicaltrials.gov (NCT02252887).
Citation Format: Iyengar NM, Argolo D, Smyth L, Chen MF, Hudis CA, Dang CT. Phase II study of gemcitabine, trastuzumab, and pertuzumab in the treatment of metastatic HER2-positive breast cancer after prior trastuzumab/pertuzumab- or pertuzumab-based therapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-01-09.
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Affiliation(s)
- NM Iyengar
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - D Argolo
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - L Smyth
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - MF Chen
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - CA Hudis
- Memorial Sloan Kettering Cancer Center, NY, NY
| | - CT Dang
- Memorial Sloan Kettering Cancer Center, NY, NY
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Lee CW, Tsai HI, Lin YS, Wu TH, Yu MC, Chen MF. Intrahepatic biliary mucinous cystic neoplasms: clinicoradiological characteristics and surgical results. BMC Gastroenterol 2015; 15:67. [PMID: 26058559 PMCID: PMC4460858 DOI: 10.1186/s12876-015-0293-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/22/2015] [Indexed: 12/20/2022] Open
Abstract
Background Intrahepatic biliary mucinous cystic neoplasms are rare hepatic tumors and account for less than 5% of intrahepatic cystic lesions. Accurate preoperative diagnosis is difficult and the outcome differs among various treatment modalities.The aim of this study is to investigate the clinico-radiological characteristics of intrahepatic biliary mucinous cystic neoplasms and to establish eligible diagnostic and treatment suggestions. Methods Nineteen patients with intrahepatic biliary cystadenomas and two patients with biliary cystadenocarcinomas were retrospectively reviewed. Their clinico-radiological variables and survival outcome were analyzed. Results Of the 19 patients with biliary cystadenoma, 16 (84.2 %) were female. 11 (57.9 %) patients had symptoms before operation with the most common presenting symptom being abdominal pain. Among the patients with available data, serum and cystic fluid CA 19–9 levels were invariably elevated and the CA 19–9 level in the cystic fluid was significantly higher than that in the serum. Loculations (84.2 %) and septations (63.2 %) were the most common radiologic findings. For treatment, 11 (57.9 %) patients received radical resection by either enucleation or hepatic resection, while the remaining 8 (42.1 %) patients underwent only fenestration of liver cysts. Radical resection provided a significantly better clinical outcome than fenestration in terms of tumor recurrence (p = 0.018). The only two male patients with biliary cystadenocarcinoma received radical hepatic resection and achieved a disease-free survival of 16.5 months and 33 months, respectively. Conclusion Intrahepatic biliary mucinous cystic neoplasms are rare and preoperative diagnosis is difficult. Internal septations and loculations on radiologic examinations should raise some suspicion of this diagnosis. Complete tumor excision is the standard treatment that may provide patients with better long term results after the operation.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
| | - Hsin-I Tsai
- Department Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Tsung-Han Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
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Chen LT, Jeng LB, Hsiao CF, Wu CC, Lee WC, Wang TE, Lee PH, Chen CL, Chen IS, Lee KT, Hsieh CB, Hwang WS, Yang MD, Yang YS, Lin DY, Chen MF, Chen PJ. Randomized, phase III trial of adjuvant adeforvir vs. therapeutic lamivudine in post-operative BCLC stage 0 or A HBV-related HCC: The Taiwan Cooperative Oncology Group T1206 study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.4101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan City, Taiwan
| | | | - Chin-Fu Hsiao
- Institute of Public Health and Bioinformatics, Health Research Institutes, Miaoli, Taiwan
| | | | | | | | - Po-Huang Lee
- National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Long Chen
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - I-Su Chen
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - King-Teh Lee
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | - Mei-Due Yang
- China Medical University Hospital, Taichung, Taiwan
| | - Yang-Sen Yang
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Deng-Yn Lin
- Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Pei-Jer Chen
- National Taiwan University Hospital, Taipei, Taiwan
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Chiang KC, Yeh CN, Lin KJ, Su LJ, Yen TC, Pang JHS, Kittaka A, Sun CC, Chen MF, Jan YY, Chen TC, Juang HH, Yeh TS. Chemopreventive and chemotherapeutic effect of dietary supplementation of vitamin D on cholangiocarcinoma in a Chemical-Induced animal model. Oncotarget 2015; 5:3849-61. [PMID: 24939880 PMCID: PMC4116525 DOI: 10.18632/oncotarget.2000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is an aggressive cancer. Vitamin D supplementation is getting popular due to its anti-tumor functions after conversion to its active form, 1α,25(OH)2D. Here, we show that dietary supplementation with 6 IU/g of vitamin D greatly suppressed ICC initiation and progression without apparent toxicity in a chemically induced rat model. Microarray analysis of rat ICC tissues showed vitamin D supplementation modulated the expressions of several unique genes, including lipocalin 2 (Lcn2), confirmed by RT-qPCR and immunohistochemical (IHC) staining. Further, 53 of 80 human ICC specimens (66%) exhibited high LCN2 expression and LCN2 knockdown in SNU308 cells decreased cell growth and migration, suggesting LCN2 be an oncogene in human ICC. As human ICC SNU1079 cells were treated by 1α,25(OH)2D3, LCN2 expression and cell proliferation were attenuated. The downregulation of LCN2 expression was blunted when vitamin D receptor (VDR) was knocked down, implicating that the in vivo Lcn2 downregulation is a direct consequence of vitamin D supplementation Our results support the prevailing concept that vitamin D status is negatively associated with cancer incidence and mortality and suggest LCN2 may be a potential target against ICC. Further studies of application of vitamin D or its analogs against ICC are warranted.
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Affiliation(s)
- Kun-Chun Chiang
- General Surgery Department, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | | | | | | | | | | | | | | | | | | | - Tai C Chen
- Boston University School of Medicine, Boston, MA, USA
| | - Horng-Heng Juang
- Department of Anatomy, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan, R.O.C
| | - Ta-Sen Yeh
- General Surgery Department, Chang Gung Memorial Hospital, Linkoul, Taoyuan, Taiwan, ROC
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Liu YY, Tsai CY, Yeh CN, Chiang KC, Wang SY, Cheng CT, Liao CH, Hsu JT, Yeh TS, Jan YY, Chen MF. Gastric cancer patients with end-stage renal disease who underwent radical gastrectomy. Anticancer Res 2015; 35:2263-2268. [PMID: 25862888] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Radical gastrectomy (RG) with lymph node (LN) dissection is a standard procedure for gastric cancer (GC). Patients with end-stage renal disease (ESRD) usually have high risk for any operative procedure. However, information for ESRD on RG for GC is limited. PATIENTS AND METHODS A total of 2,021 GC patients who underwent RG with LN dissection were retrospectively reviewed. Among them, 26 patients had ESRD. The clinicopathological features and surgical outcomes were compared between GC with ESRD (ESRD-GC group) and GC without ESRD (GC group). RESULTS ESRD-GC patients could be independently differentiated from GC patients by lower hemoglobin, negative lymph node (LN) involvement and higher postoperative complications. The overall survival rate of ESRD-GC group seemed better than that of GC group patients. Lesser depth of tumor invasion, LN metastasis and lymphatic invasion and early-staged tumor contributed to favorable prognosis of ESRD-GC group of patients. CONCLUSION RG might be beneficial for GC-ESRD patients especially for early-stage disease; however, RG for GC patients with ESRD should be more cautiously performed, otherwise the benefit might be compromised by higher postoperative complications and even mortality.
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Affiliation(s)
- Yu-Yin Liu
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Chun-Yi Tsai
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Chun-Nan Yeh
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C.
| | - Kun-Chun Chiang
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Shang-Yu Wang
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Chi-Tung Cheng
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Chien-Hung Liao
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Ju-Te Hsu
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Ta-Sen Yeh
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Yi-Yin Jan
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
| | - Miin-Fu Chen
- Gastric Cancer Team, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C
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Yeh CN, Hsieh FJ, Chiang KC, Chen JS, Yeh TS, Jan YY, Chen MF. Clinical effect of a positive surgical margin after hepatectomy on survival of patients with intrahepatic cholangiocarcinoma. Drug Des Devel Ther 2014; 9:163-74. [PMID: 25552905 PMCID: PMC4277120 DOI: 10.2147/dddt.s74940] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several unfavorable prognostic factors have been proposed for peripheral cholangiocarcinoma (PCC) in patients undergoing hepatectomy, including gross type of tumor, vascular invasion, lymph node metastasis, a high carbohydrate antigen 19-9 level, and a positive resection margin. However, the clinical effect of a positive surgical margin on the survival of patients with PCC after hepatectomy still needs to be clarified due to conflicting results. METHODS A total of 224 PCC patients who underwent hepatic resection with curative intent between 1977 and 2007 were retrospectively reviewed. Eighty-nine patients had a positive resection margin, with 62 having a microscopically positive margin and 27 a grossly positive margin (R2). The clinicopathological features, outcomes, and recurrence pattern were compared with patients with curative hepatectomy. RESULTS PCC patients with hepatolithiasis, periductal infiltrative or periductal infiltrative mixed with mass-forming growth, higher T stage, and more advanced stage tended to have higher positive resection margin rates after hepatectomy. PCC patients who underwent curative hepatectomy had a significantly higher survival rate than did those with a positive surgical margin. When PCC patients underwent hepatectomy with a positive resection margin, the histological grade of the tumor, nodal positivity, and chemotherapy significantly affected overall survival. Locoregional recurrence was the most common pattern of recurrence. CONCLUSION A positive resection margin had an unfavorable effect on overall survival in PCC patients undergoing hepatectomy. In these patients, the prognosis was determined by the biology of the tumor, including differentiation and nodal positivity, and chemotherapy increased overall survival.
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Affiliation(s)
- Chun-Nan Yeh
- Department of General Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Jen Hsieh
- Department of General Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Chun Chiang
- Department of General Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Shi Chen
- Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Department of General Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Miin-Fu Chen
- Department of General Surgery, Chang Gung University, Taoyuan, Taiwan
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Chiang KC, Lee CH, Yeh CN, Ueng SH, Hsu JT, Yeh TS, Jan YY, Hwang TL, Chen MF. A novel role of the tumor size in pancreatic cancer as an ancillary factor for predicting resectability. J Cancer Res Ther 2014; 10:142-6. [PMID: 24762501 DOI: 10.4103/0973-1482.131464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pancreatic adenocarcinoma (PCA) is a devastating disease. Only surgery can provide effective treatment. The resectability of pancreatic cancer is mainly determined by image studies. However, half of the patients deemed as operable, radiologically, are found to be inoperable during surgery. Previously, we have showed that both CA 19-9 and tumor size could predict PCA resectability, independently. Here, we aimed to determine the cut-off value for tumor size permitting PCA resectability by receiver operating characteristic (ROC) curve analysis. MATERIALS AND METHODS We retrospectively reviewed 372 patients undergoing surgery for histopathologically proven PCA. We compared tumor sizes of patients in resectable and unresectable groups and analyzed them by the ROC curve. RESULTS The tumor size in unresectable groups is significantly larger than that in the resectable group. The area under the ROC curve was 0.73 (95% confidence interval [CI], 0.665-0.789), which represented a good correlation between the tumor size and pancreatic cancer resectability. The PCA patients with a tumor diameter of > 4.8 cm had a 5.043-fold higher chance of unresectability than did those with a tumor diameter < 4.8 cm (odds ratio, 5.043; 95% CI, 3.221-7.894). CONCLUSIONS A tumor diameter > 4.8 cm is a potential ancillary parameter for determining the resectability of PCA in addition to traditional image studies. Diagnosis laparoscopy may be indicated for radiologically resectable PCA patients with tumor size > 4.8 cm to prevent unnecessary laparotomy.
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Affiliation(s)
| | | | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan 333, R.O.C, Taiwan
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Jiang SS, Huang SF, Huang MS, Chen YT, Jhong HJ, Chang IC, Chen YT, Chang JW, Chen WL, Lee WC, Chen MF, Yeh CT, Matsuura I. Dysregulation of the TGFBI gene is involved in the oncogenic activity of the nonsense mutation of hepatitis B virus surface gene sW182*. Biochim Biophys Acta Mol Basis Dis 2014; 1842:1080-7. [DOI: 10.1016/j.bbadis.2014.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/05/2014] [Accepted: 03/09/2014] [Indexed: 01/14/2023]
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Yeh CN, Tsai CY, Cheng CT, Wang SY, Liu YY, Chiang KC, Hsieh FJ, Lin CC, Jan YY, Chen MF. Pain relief from combined wound and intraperitoneal local anesthesia for patients who undergo laparoscopic cholecystectomy. BMC Surg 2014; 14:28. [PMID: 24886449 PMCID: PMC4026815 DOI: 10.1186/1471-2482-14-28] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
Background Laparoscopic cholecystectomy (LC) has become the treatment of choice for gallbladder lesions, but it is not a pain-free procedure. This study explored the pain relief provided by combined wound and intraperitoneal local anesthetic use for patients who are undergoing LC. Methods Two-hundred and twenty consecutive patients undergoing LC were categorized into 1 of the following 4 groups: local wound anesthetic after LC either with an intraperitoneal local anesthetic (W + P) (group 1) or without an intraperitoneal local anesthetic (W + NP) (group 2), or no local wound anesthetic after LC either with intraperitoneal local anesthetic (NW + P) (group 3) or without an intraperitoneal local anesthetic (NW + NP) (group 4). A visual analog scale (VAS) was used to assess postoperative pain. The amount of analgesic used and the duration of hospital stay were also recorded. Results The VAS was significantly lower immediately after LC for the W + P group than for the NW + NP group (5 vs. 6; p = 0.012). Patients in the W + P group received a lower total amount of meperidine during their hospital stay. They also had the shortest hospital stay after LC, compared to the patients in the other groups. Conclusion Combined wound and intraperitoneal local anesthetic use after LC significantly decreased the immediate postoperative pain and may explain the reduced use of meperidine and earlier discharge of patients so treated.
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Affiliation(s)
- Chun-Nan Yeh
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
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Huang SF, Chen YT, Lee WC, Chang IC, Chiu YT, Chang Y, Tu HC, Yuh CH, Matsuura I, Shih LY, Lai MW, Wu HDI, Chen MF, Yeh CT. Identification of transforming hepatitis B virus S gene nonsense mutations derived from freely replicative viruses in hepatocellular carcinoma. PLoS One 2014; 9:e89753. [PMID: 24587012 PMCID: PMC3933656 DOI: 10.1371/journal.pone.0089753] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/23/2014] [Indexed: 01/21/2023] Open
Abstract
Background & Aims The correlation between chronic hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC) has been well-established. But the roles of viral factor remain uncertain. Only HBV X gene and nonsense mutations of S gene (C-terminal truncation of HBV surface protein) have been demonstrated to have transforming activity. Whether they play a significant role in hepatocarcinogenesis is still uncertain. Methods Twenty-five HBV-related HCC patients were positive for hepatitis B core antigen (HBcAg) in the cancerous parts of their HCC liver tissues by immunohistochemistry studies, and had available tissue for whole HBV genome sequence analysis. The results were compared with 25 gender and age-matched HBcAg negative HCCs. Plasmids encoding HBV S gene nonsense mutations identified from HBcAg (+) HCC tissue were constructed to investigate their cell proliferation, transformation activity and the oncogenic potentials by xenograft study and in vivo migration assay. Results HBcAg (+) HCC patients were significantly associated with cirrhosis and small tumor size (≦2 cm) when compared with HBcAg (−) HCC patients. Southern blot analyses revealed freely replicative forms of HBV in the cancerous parts of HBcAg(+) HCC. Three nonsense mutations of S gene (sL95*, sW182*, and sL216*) were identified in the HBcAg(+) HCC tumor tissues. sW182* and sL216* were recurrently found in the 25 HBcAg (−) HCC tumor tissue, too. Functional studies of the above 3 non-sense mutations all demonstrated higher cell proliferation activities and transformation abilities than wild type S, especially sW182*. Tumorigenicity analysis by xenograft experiments and in vitro migration assay showed potent oncogenic activity of sW182* mutant. Conclusions This study has demonstrated potent oncogenic activity of nonsense mutations of HBV S gene, suggesting they may play an important role in hepatocarcinogenesis.
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Affiliation(s)
- Shiu-Feng Huang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
- Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pathology, Tzu-Chi General Hospital, Taipei Branch, Tzu-Chi University School of Medicine, Hualien, Taiwan
- * E-mail: (SFH); (CTY)
| | - Ya-Ting Chen
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Il-Chi Chang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Yu-Ting Chiu
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Yu Chang
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Hsiao-Chen Tu
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Chiou-Hwa Yuh
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Isao Matsuura
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Liang-Yu Shih
- Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pathology, Tzu-Chi General Hospital, Dalin Branch, Chiayi, Taiwan
| | - Ming-Wei Lai
- Department of Pediatrics, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Hong-Dar Isaac Wu
- Department of Applied Mathematics and Institute of Statistics, National Chung-Hsing University, Taichung, Taiwan
| | - Miin-Fu Chen
- Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Chau-Ting Yeh
- Liver Research Center, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail: (SFH); (CTY)
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Chen MF, Zhu HS, Zhu HJ. Segmentation of liver in ultrasonic images applying local optimal threshold method. The Imaging Science Journal 2013. [DOI: 10.1179/1743131x12y.0000000028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Gomi H, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF, Dervenis C, Chan ACW, Supe AN, Liau KH, Kim MH, Kim SW. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013. [PMID: 23307001 DOI: 10.1007/s00534-012- 0561-3] [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: 11/24/2022]
Abstract
Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteria. The diagnostic criteria of TG07 do not have enough sensitivity and specificity, and its severity assessment criteria are unsuitable for clinical use. A working team for the revision of TG07 was organized in June, 2010, and these criteria have been updated through clinical implementation and its assessment by means of multi-center analysis. The diagnostic criteria of acute cholangitis have been revised as criteria to establish the diagnosis where cholestasis and inflammation demonstrated by clinical signs or blood test in addition to biliary manifestations demonstrated by imaging are present. The diagnostic criteria of the updated Tokyo Guidelines (TG13) have high sensitivity (87.6 %) and high specificity (77.7 %). TG13 has better diagnostic capacity than TG07. Severity assessment is classified as follows: Grade III: associated with organ failure; Grade II: early biliary drainage should be conducted; Grade1: others. As for the severity assessment criteria of TG07, separating Grade II and Grade I at the time of diagnosis was impossible, so they were unsuitable for clinical practice. Therefore, the severity assessment criteria of TG13 have been revised so as not to lose the timing of biliary drainage or treatment for etiology. Based on evidence, five predictive factors for poor prognosis in acute cholangitis--hyperbilirubinemia, high fever, leukocytosis, elderly patient and hypoalbuminemia--have been extracted. Grade II can be diagnosed if two of these five factors are present. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan.
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Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Gomi H, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF, Dervenis C, Chan ACW, Supe AN, Liau KH, Kim MH, Kim SW. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013; 20:24-34. [PMID: 23307001 DOI: 10.1007/s00534-012-0561-3] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteria. The diagnostic criteria of TG07 do not have enough sensitivity and specificity, and its severity assessment criteria are unsuitable for clinical use. A working team for the revision of TG07 was organized in June, 2010, and these criteria have been updated through clinical implementation and its assessment by means of multi-center analysis. The diagnostic criteria of acute cholangitis have been revised as criteria to establish the diagnosis where cholestasis and inflammation demonstrated by clinical signs or blood test in addition to biliary manifestations demonstrated by imaging are present. The diagnostic criteria of the updated Tokyo Guidelines (TG13) have high sensitivity (87.6 %) and high specificity (77.7 %). TG13 has better diagnostic capacity than TG07. Severity assessment is classified as follows: Grade III: associated with organ failure; Grade II: early biliary drainage should be conducted; Grade1: others. As for the severity assessment criteria of TG07, separating Grade II and Grade I at the time of diagnosis was impossible, so they were unsuitable for clinical practice. Therefore, the severity assessment criteria of TG13 have been revised so as not to lose the timing of biliary drainage or treatment for etiology. Based on evidence, five predictive factors for poor prognosis in acute cholangitis--hyperbilirubinemia, high fever, leukocytosis, elderly patient and hypoalbuminemia--have been extracted. Grade II can be diagnosed if two of these five factors are present. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan.
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Liao MN, Chen SC, Chen SC, Lin YC, Chen MF, Wang CH, Hsu YH, Hung HC, Jane SW. Change and predictors of symptom distress in breast cancer patients following the first 4 months after diagnosis. J Formos Med Assoc 2013; 114:246-53. [PMID: 23871549 DOI: 10.1016/j.jfma.2013.06.009] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND/PURPOSE Breast cancer patients may encounter a wide range of physical and psychosocial distress symptoms during diagnosis, while awaiting treatment, and during treatment. This study of newly diagnosed breast cancer patients explores: (1) changes in symptom distress over 4 months; and (2) factors predicting changes in symptom distress. METHODS A prospective longitudinal design was used to collect data from breast cancer patients in northern Taiwan. A set of questionnaires was used to measure anxiety, symptom distress, social support, and demographic and treatment-related characteristics. Repeated measures analysis of variance (RM-ANOVA) with least significant difference (LSD) was used to examine differences in symptom distress, state anxiety, and social-support levels across four time-points. Generalized estimating equation (GEE) is used to determine predictors for the change in symptom distress. RESULTS Participants showed mild overall symptom distress during treatment that increased from cancer diagnosis to treatment phases, with a peak at 4 months after diagnosis. Insomnia was the most commonly identified distressful symptom over time. Changes in overall symptom distress were significantly predicted by state anxiety, health professional support, and time since cancer diagnosis. CONCLUSION Change in symptom distress following the first 4 months after diagnosis was predicted by state anxiety, health professional support, and time. Patients should receive social support and be trained in problem-solving skills to relieve distressful symptoms from diagnosis through treatment.
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Affiliation(s)
- Mei-Nan Liao
- Administration Center of Medical Research Department, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Ching Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shin-Cheh Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chang Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Miin-Fu Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Hui Wang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ya-Hui Hsu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsueh-Chih Hung
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sui-Whi Jane
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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Lee CW, Kuo WL, Yu MC, Chen TC, Tsai CN, Lee WC, Chen MF. The expression of cytokeratin 19 in lymph nodes was a poor prognostic factor for hepatocellular carcinoma after hepatic resection. World J Surg Oncol 2013; 11:136. [PMID: 23758804 PMCID: PMC3708812 DOI: 10.1186/1477-7819-11-136] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 06/01/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The expression of CK19 in primary hepatocellular carcinoma (HCC) is associated with a poor outcome. However, few studies have investigated the expression profile of CK19 in regional lymph nodes (LNs) of HCC after hepatic resection. The purpose of this study was to evaluate the expression of CK19 in primary liver tumor and regional LNs of HCC with and without lymph node metastasis (LNM). METHODS The expression of CK19 in patients with (n = 16) and without LNM (n = 26) was examined using immunohistochemical staining. Both the primary tumor and LN specimen were studied for their CK19 expression. Clinico-pathological variables and prognostic significance were analyzed. RESULTS Immunopositivity of CK19 in primary liver tumor was significantly correlated with LNM (P = 0.005) and tumor non-encapsulation (P <0.005). Univariate analysis showed that CK19 expression in primary liver tumor, CK19 expression in regional LN, vascular invasion, daughter nodules, positive resection margin and American Joint Committee on Cancer (AJCC) tumor stage significantly decreased overall survival. Multivariate analysis demonstrated that daughter nodules (P = 0.001) and CK19 expression in regional LN (P = 0.002) were independent prognostic factors for overall survival. CONCLUSIONS This study showed that CK19 expression in regional LN of HCC was associated with LNM and an extremely poor outcome after operation. It is of clinical significance to identify these patients at risk for more aggressive HCC, and multi-modality treatment could be helpful to improve their dismal outcome.
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Affiliation(s)
- Chao-Wei Lee
- The Department of Surgery, Chang Gung Memorial Hospital, No 5 Fusing Street, Taoyuan County, Gueishan 333, Taiwan
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Yeh CN, Weng WH, Lenka G, Tsao LC, Chiang KC, Pang ST, Chen TW, Jan YY, Chen MF. cDNA microarray profiling of rat cholangiocarcinoma induced by thioacetamide. Mol Med Rep 2013; 8:350-60. [PMID: 23754683 DOI: 10.3892/mmr.2013.1516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/14/2013] [Indexed: 11/06/2022] Open
Abstract
Cholangiocarcinoma (CCA) is a malignant neoplasm affecting thousands of individuals worldwide. CCA develops through a multistep process. In the current study, an oral thioacetamide (TAA)‑induced model of rat CCA was established which generates the histological progression of human CCA, particularly the mass‑forming type. Seven male Sprague‑Dawley rats were treated with TAA for 24 weeks to induce CCA. Following the generation of the rat CCA model, whole rat genomic oligo microarray was performed to examine gene expression profiles in CCA and non‑cancerous liver samples. In brief, 10,427 genes were found to be differentially expressed (8,318 upregulated and 3,489 downregulated) in CCA compared with non‑tumor liver tissue. The top 50 genes (upregulated or downregulated) were selected and their functional involvement in various pathways associated with cancer progression was analyzed, including cell proliferation, apoptosis, metabolism and the cell cycle. In addition, increased expression of CLCA3, COL1A2, DCN, GLIPr2 and NID1, and decreased expression of CYP2C7 and SLC10A1 were validated by quantitative real‑time PCR. Immunohistochemical analysis was performed to determine the protein expression levels of GLIPr2 and SLC10A1. The gene expression profiling performed in this study provides a unique opportunity for understanding the carcinogenesis of TAA‑induced CAA. In addition, expression profiling of a number of specific genes is likely to provide important novel biomarkers for the diagnosis of CCA and the development of novel therapeutic strategies for CCA.
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Affiliation(s)
- Chun-Nan Yeh
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou 333, Taiwan, R.O.C
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