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Liaw WJ, Wu TJ, Huang LH, Chen CS, Tsai MC, Lin IC, Liao YH, Shen WC. Effectiveness of Implementing Modified Early Warning System and Rapid Response Team for General Ward Inpatients. J Med Syst 2024; 48:35. [PMID: 38530526 DOI: 10.1007/s10916-024-02046-2] [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: 05/23/2023] [Accepted: 02/10/2024] [Indexed: 03/28/2024]
Abstract
This retrospective study assessed the effectiveness and impact of implementing a Modified Early Warning System (MEWS) and Rapid Response Team (RRT) for inpatients admitted to the general ward (GW) of a medical center. This study included all inpatients who stayed in GWs from Jan. 2017 to Feb. 2022. We divided inpatients into GWnon-MEWS and GWMEWS groups according to MEWS and RRT implementation in Aug. 2019. The primary outcome, unexpected deterioration, was defined by unplanned admission to intensive care units. We defined the detection performance and effectiveness of MEWS according to if a warning occurred within 24 h before the unplanned ICU admission. There were 129,039 inpatients included in this study, comprising 58,106 GWnon-MEWS and 71,023 GWMEWS. The numbers of inpatients who underwent an unplanned ICU admission in GWnon-MEWS and GWMEWS were 488 (.84%) and 468 (.66%), respectively, indicating that the implementation significantly reduced unexpected deterioration (p < .0001). Besides, 1,551,525 times MEWS assessments were executed for the GWMEWS. The sensitivity, specificity, positive predicted value, and negative predicted value of the MEWS were 29.9%, 98.7%, 7.09%, and 99.76%, respectively. A total of 1,568 warning signs accurately occurred within the 24 h before an unplanned ICU admission. Among them, 428 (27.3%) met the criteria for automatically calling RRT, and 1,140 signs necessitated the nursing staff to decide if they needed to call RRT. Implementing MEWS and RRT increases nursing staff's monitoring and interventions and reduces unplanned ICU admissions.
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Affiliation(s)
- Wen-Jinn Liaw
- Medical Quality Center, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tzu-Jung Wu
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Li-Hua Huang
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chiao-Shan Chen
- Medical Quality Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Che Tsai
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - I-Chen Lin
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Han Liao
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wei-Chih Shen
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan.
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Chang GC, Chiu CH, Yu CJ, Chang YC, Chang YH, Hsu KH, Wu YC, Chen CY, Hsu HH, Wu MT, Yang CT, Chong IW, Lin YC, Hsia TC, Lin MC, Su WC, Lin CB, Lee KY, Wei YF, Lan GY, Chan WP, Wang KL, Wu MH, Tsai HH, Chian CF, Lai RS, Shih JY, Wang CL, Hsu JS, Chen KC, Chen CK, Hsia JY, Peng CK, Tang EK, Hsu CL, Chou TY, Shen WC, Tsai YH, Tsai CM, Chen YM, Lee YC, Chen HY, Yu SL, Chen CJ, Wan YL, Hsiung CA, Yang PC. Low-dose CT screening among never-smokers with or without a family history of lung cancer in Taiwan: a prospective cohort study. Lancet Respir Med 2024; 12:141-152. [PMID: 38042167 DOI: 10.1016/s2213-2600(23)00338-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND In Taiwan, lung cancers occur predominantly in never-smokers, of whom nearly 60% have stage IV disease at diagnosis. We aimed to assess the efficacy of low-dose CT (LDCT) screening among never-smokers, who had other risk factors for lung cancer. METHODS The Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) was a nationwide, multicentre, prospective cohort study done at 17 tertiary medical centres in Taiwan. Eligible individuals had negative chest radiography, were aged 55-75 years, had never smoked or had smoked fewer than 10 pack-years and stopped smoking for more than 15 years (self-report), and had one of the following risk factors: a family history of lung cancer; passive smoke exposure; a history of pulmonary tuberculosis or chronic obstructive pulmonary disorders; a cooking index of 110 or higher; or cooking without using ventilation. Eligible participants underwent LDCT at baseline, then annually for 2 years, and then every 2 years up to 6 years thereafter, with follow-up assessments at each LDCT scan (ie, total follow-up of 8 years). A positive scan was defined as a solid or part-solid nodule larger than 6 mm in mean diameter or a pure ground-glass nodule larger than 5 mm in mean diameter. Lung cancer was diagnosed through invasive procedures, such as image-guided aspiration or biopsy or surgery. Here, we report the results of 1-year follow-up after LDCT screening at baseline. The primary outcome was lung cancer detection rate. The p value for detection rates was estimated by the χ2 test. Univariate and multivariable logistic regression analyses were used to assess the association between lung cancer incidence and each risk factor. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LDCT screening were also assessed. This study is registered with ClinicalTrials.gov, NCT02611570, and is ongoing. FINDINGS Between Dec 1, 2015, and July 31, 2019, 12 011 participants (8868 females) were enrolled, of whom 6009 had a family history of lung cancer. Among 12 011 LDCT scans done at baseline, 2094 (17·4%) were positive. Lung cancer was diagnosed in 318 (2·6%) of 12 011 participants (257 [2·1%] participants had invasive lung cancer and 61 [0·5%] had adenocarcinomas in situ). 317 of 318 participants had adenocarcinoma and 246 (77·4%) of 318 had stage I disease. The prevalence of invasive lung cancer was higher among participants with a family history of lung cancer (161 [2·7%] of 6009 participants) than in those without (96 [1·6%] of 6002 participants). In participants with a family history of lung cancer, the detection rate of invasive lung cancer increased significantly with age, whereas the detection rate of adenocarcinoma in situ remained stable. In multivariable analysis, female sex, a family history of lung cancer, and age older than 60 years were associated with an increased risk of lung cancer and invasive lung cancer; passive smoke exposure, cumulative exposure to cooking, cooking without ventilation, and a previous history of chronic lung diseases were not associated with lung cancer, even after stratification by family history of lung cancer. In participants with a family history of lung cancer, the higher the number of first-degree relatives affected, the higher the risk of lung cancer; participants whose mother or sibling had lung cancer were also at an increased risk. A positive LDCT scan had 92·1% sensitivity, 84·6% specificity, a PPV of 14·0%, and a NPV of 99·7% for lung cancer diagnosis. INTERPRETATION TALENT had a high invasive lung cancer detection rate at 1 year after baseline LDCT scan. Overdiagnosis could have occurred, especially in participants diagnosed with adenocarcinoma in situ. In individuals who do not smoke, our findings suggest that a family history of lung cancer among first-degree relatives significantly increases the risk of lung cancer as well as the rate of invasive lung cancer with increasing age. Further research on risk factors for lung cancer in this population is needed, particularly for those without a family history of lung cancer. FUNDING Ministry of Health and Welfare of Taiwan.
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Affiliation(s)
- Gee-Chen Chang
- Department of Internal Medicine, Division of Pulmonary Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Internal Medicine, Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Hua Chiu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Cancer Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; National Taiwan University Hospital, Hsinchu, Taiwan
| | - Yeun-Chung Chang
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Hsuan Chang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan; Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli, Taiwan
| | - Kuo-Hsuan Hsu
- Division of Critical Care and Respiratory Therapy, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chung Wu
- Department of Surgery, Division of Thoracic Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan; Department of Surgery, Division of Thoracic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yi Chen
- Department of Surgery, Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsian-He Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Ting Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Inn-Wen Chong
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ching Lin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Te-Chun Hsia
- Department of Respiratory Therapy, China Medical University, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan; Chang Gung Respirology Center of Excellence, Kaohsiung, Taiwan
| | - Wu-Chou Su
- Department of Oncology, National Cheng Kung University Hospital, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Bin Lin
- Department of Internal Medicine, Division of Chest Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kang-Yun Lee
- Department of Pulmonary Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, Division of Thoracic Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Feng Wei
- Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Gong-Yau Lan
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wing P Chan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kao-Lun Wang
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Mei-Han Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Imaging, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hao-Hung Tsai
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Feng Chian
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ruay-Sheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Liang Wang
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Jui-Sheng Hsu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Radiology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kun-Chieh Chen
- Department of Internal Medicine, Division of Pulmonary Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Internal Medicine, Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan
| | - Chun-Ku Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Cardiopulmonary Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiun-Yi Hsia
- Department of Surgery, Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chung-Kan Peng
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Medical Planning, Medical Affairs Bureau Ministry of National Defense, Taipei, Taiwan
| | - En-Kuei Tang
- Department of Surgery, Division of Thoracic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Chia-Lin Hsu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Pathology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chih Shen
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan
| | - Ying-Huang Tsai
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan; Department of Pulmonary and Critical Care, Xiamen Chang Gung Hospital, Xiamen, China
| | - Chun-Ming Tsai
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Cathay General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chin Lee
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pulmonary Medicine, West Garden Hospital, Taipei, Taiwan
| | - Hsuan-Yu Chen
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Sung-Liang Yu
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Pan-Chyr Yang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
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Lu HJ, Shen CY, Chiu YW, Lin WL, Peng CY, Tseng HC, Hsin CH, Chuang CY, Chen CC, Wu MF, Huang WS, Shen WC. Radiomic biomarkers for platinum-refractory head and neck cancer in the era of immunotherapy. Oral Dis 2024. [PMID: 38178608 DOI: 10.1111/odi.14854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/17/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Immune checkpoint inhibitors (ICI) are recommended as the first-line therapy for platinum-refractory head and neck squamous cell carcinoma (HNSCC), a disease with a poor prognosis. However, biomarkers in this situation are rare. The objective was to identify radiomic features-associated biomarkers to guide the prognosis and treatment opinions in the era of ICI. METHODS A total of 31 platinum-refractory HNSCC patients were retrospectively enrolled. Of these, 65.5% (20/31) received ICI-based therapy and 35.5% (11/31) did not. Radiomic features of the primary site at the onset of recurrent metastatic (R/M) status were extracted. Prognostic and predictive radiomic biomarkers were analysed. RESULTS The median overall survival from R/M status (R/M OS) was 9.6 months. Grey-level co-occurrence matrix-associated texture features were the most important in identifying the patients with or without 9-month R/M death. A radiomic risk-stratification model was established and equally separated the patients into high-, intermittent- and lower-risk groups (1-year R/M death rate, 100.0% vs. 70.8% vs. 27.1%, p = 0.001). Short-run high grey-level emphasis (SRHGE) was more suitable than programmed death ligand 1 (PD-L1) expression in selecting whether patients received ICI-based therapy. CONCLUSIONS Radiomic features were effective prognostic and predictive biomarkers. Future studies are warranted.
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Affiliation(s)
- Hsueh-Ju Lu
- Division of Hematology and Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chao-Yu Shen
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Wei Chiu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wea-Lung Lin
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pathology, Chung Shan Medical University and Hospital, Taichung, Taiwan
| | - Chih-Yu Peng
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsien-Chun Tseng
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Han Hsin
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Yi Chuang
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Chia Chen
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Plastic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ming-Fang Wu
- Division of Hematology and Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Shiou Huang
- Division of Hematology and Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wei-Chih Shen
- Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
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Chou YH, Hsia JY, Kao PF, Chang BJ, Lu XP, Liao YH, Chiang KT, Shen WC. Predicting Treatment Response of Esophageal Cancer Treated by Concurrent Chemoradiotherapy Using Pre- and Posttreatment 18F-FDG PET Metabolic Characteristics. Int J Radiat Oncol Biol Phys 2023; 117:e462-e463. [PMID: 37785479 DOI: 10.1016/j.ijrobp.2023.06.1661] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study hypothesizes that metabolic characteristics of esophageal tumors can be used to predict treatment response, which considers changes in the primary tumor and lymph nodes, for patients receiving neoadjuvant concurrent chemoradiotherapy (CCRT). MATERIALS/METHODS This study retrospectively included 60 esophageal cancer patients receiving CCRT followed by surgery. All patients received 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) examinations prior to CCRT and in the interval between CCRT and surgery. On the pre-treatment FDG PET/CT images, the maximum standardized uptake value (SUVMaxPre) within the primary tumor was identified. By computerized methods, the CT images of pre- and post-treatment FDG PET/CT were registered. Then, the coordinates of SUVMaxPre were transformed to the post-treatment FDG PET images and delineated a sphere with a diameter of 5 cm to indicate the tumor position. After excluding air, the sphere was partitioned into several metabolic volumes by the optimal dichotomy of high and low metabolic FDG uptakes. Finally, the volume with the shortest distance to the center was adopted and represented by the maximum standardized uptakes (SUVMaxPost). Two additional features, SUVDiff and SUVDiffR, were defined as SUVMaxPost - SUVMaxPre and (SUVMaxPost - SUVMaxPre) / SUVMaxPre. Besides, for defining treatment response, the patients with and without residual tumors were defined as ypT+ and ESOCR based on the histopathology results of surgery. The ESOCR was further classified into pCR to indicate the absence of lymph node metastasis and LNM for remaining. Finally, the area under the receiver operating characteristic curve analysis (AUC) was conducted to assess the features' ability to differentiate two treatment responses. Kruskal-Wallis test was used to evaluate the differences in features between treatment responses. RESULTS Of the 60 patients, 55 were men (92%), and the mean age was 58. The number of tumors at the esophagus's upper, middle, and lower third were 8, 18, and 34, respectively. Ninety-eight percent of the tumors were squamous cell carcinomas (59/60). The patient numbers of ypT+ and ESOCR were 43 and 17 of which contained 13 pCR and 4 LNM. The SUVDiff and SUVDiffR exhibited a significant ability to identify the ESOCR with AUC = .337 (p = .05) and AUC = .290 (p = .012), respectively. In addition, a statistically significant difference was found among the three groups of ypT+, pCR, and LNM on SUVMaxPre (H = 6.252 and p = .044), SUVDiff (H = 7.948 and p = .019), and SUVDiffR (H = 8.405 and p = .015). In the post-hoc tests corrected by the Bonferroni, the difference between ypT+ and LNM was significant on these features. CONCLUSION The metabolic characteristics extracted from pre- and post-treatment FDG PET/CT images could indicate treatment response and disease progression. Further studies are warranted.
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Affiliation(s)
- Y H Chou
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - J Y Hsia
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - P F Kao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - B J Chang
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - X P Lu
- Department of Nuclear Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y H Liao
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - K T Chiang
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - W C Shen
- Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan
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Tu CH, Lin CL, Yang ST, Shen WC, Chen YH. Hormonal Contraceptive Treatment May Reduce the Risk of Fibromyalgia in Women with Dysmenorrhea: A Cohort Study. J Pers Med 2020; 10:jpm10040280. [PMID: 33327434 PMCID: PMC7768424 DOI: 10.3390/jpm10040280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
Dysmenorrhea is the most common gynecological disorder for women in the reproductive age. Study has indicated that dysmenorrhea might be a general risk factor of chronic pelvic pain and even chronic non-pelvic pain, such as fibromyalgia. We used the Longitudinal Health Insurance Database 2000 from the Taiwan National Health Research Institutes Database to investigate whether women with dysmenorrhea have a higher risk of fibromyalgia and whether treatment of dysmenorrhea reduced the risk of fibromyalgia. The dysmenorrhea cohort was matched with a non-dysmenorrhea cohort at a 1:1 ratio based on gender, age, and the year of entry study by frequency matching. Multivariable Cox proportional hazard regression models were used to assess the risk of fibromyalgia, with controlling for potential confounding variables such as age, comorbidities, and medication use. After controlling confounding variables, results revealed that women with dysmenorrhea have a significantly higher risk of fibromyalgia than women without dysmenorrhea. However, only treatment of dysmenorrhea with hormonal contraceptives reduce the risk of fibromyalgia. These results indicated that dysmenorrhea may be a risk factor of fibromyalgia, whereas personalized medicine for treatment of dysmenorrhea may be the key to reduce the risk of fibromyalgia. Future studies are needed to identify the causes and prevention strategies in detail.
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Affiliation(s)
- Cheng-Hao Tu
- Graduate Institute of Acupuncture Science, China Medical University, Taichung 404333, Taiwan
- Correspondence: (C.-H.T.); (Y.-H.C.); Tel.: +886-4-22053366 (C.-H.T.) (ext. 3336)
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Su-Tso Yang
- Department of Medical Imaging, China Medical University Hospital, Taichung 404332, Taiwan;
- School of Chinese Medicine, China Medical University, Taichung 404333, Taiwan
| | - Wei-Chih Shen
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung 404332, Taiwan;
- Department of Computer Science and Information Engineering, Asia University, Taichung 413305, Taiwan
| | - Yi-Hung Chen
- Graduate Institute of Acupuncture Science, China Medical University, Taichung 404333, Taiwan
- Traditional Chinese Medicine Research Center, China Medical University, Taichung 404333, Taiwan
- Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan
- Correspondence: (C.-H.T.); (Y.-H.C.); Tel.: +886-4-22053366 (C.-H.T.) (ext. 3336)
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Shen WC, Chen SW, Wu KC, Lee PY, Feng CL, Hsieh TC, Yen KY, Kao CH. Predicting pathological complete response in rectal cancer after chemoradiotherapy with a random forest using 18F-fluorodeoxyglucose positron emission tomography and computed tomography radiomics. Ann Transl Med 2020; 8:207. [PMID: 32309354 PMCID: PMC7154452 DOI: 10.21037/atm.2020.01.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/14/2022]
Abstract
Background Neoadjuvant chemoradiotherapy (NCRT) followed by surgery is the standard treatment for patients with locally advanced rectal cancer. This study developed a random forest (RF) model to predict pathological complete response (pCR) based on radiomics derived from baseline 18F-fluorodeoxyglucose ([18F]FDG)-positron emission tomography (PET)/computed tomography (CT). Methods This study included 169 patients with newly diagnosed rectal cancer. All patients received 18F[FDG]-PET/CT, NCRT, and surgery. In total, 68 radiomic features were extracted from the metabolic tumor volume. The numbers of splits in a decision tree and trees in an RF were determined based on their effects on predictive performance. Receiver operating characteristic curve analysis was performed to evaluate predictive performance and ascertain the optimal threshold for maximizing prediction accuracy. Results After NCRT, 22 patients (13%) achieved pCR, and 42 features that could differentiate tumors with pCR were used to construct the RF model. Six decision trees and seven splits were suitable. Accordingly, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 81.8%, 97.3%, 81.8%, 97.3%, and 95.3%, respectively. Conclusions By using an RF, we determined that radiomics derived from baseline 18F[FDG]-PET/CT could accurately predict pCR in patients with rectal cancer. Highly accurate and predictive values can be achieved but should be externally validated.
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Affiliation(s)
- Wei-Chih Shen
- Department of Computer Science and Information Engineering, Asia University, Taichung.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung
| | - Shang-Wen Chen
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung.,Department of Radiation Oncology, China Medical University Hospital, Taichung.,School of Medicine, College of Medicine, China Medical University, Taichung.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Kuo-Chen Wu
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung.,Department of Computer Science and Engineering, National Chung Hsing University, Taichung
| | - Peng-Yi Lee
- Department of Radiation Oncology, China Medical University Hospital, Taichung.,Department of Radiation Oncology, China Medical University Hospital, Yunlin
| | - Chun-Lung Feng
- Division of Hepato-Gastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung
| | - Te-Chun Hsieh
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung.,Department of Biomedical Imaging and Radiological Science, School of Medicine, College of Medicine, China Medical University, Taichung
| | - Kuo-Yang Yen
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung.,Department of Biomedical Imaging and Radiological Science, School of Medicine, College of Medicine, China Medical University, Taichung
| | - Chia-Hung Kao
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung.,Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung
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Lin CY, Harnod T, Lin CL, Shen WC, Kao CH. Differences in Incidence and Risks of Suicide Attempt and Suicidal Drug Overdose between Patients with Epilepsy with and without Comorbid Depression. Int J Environ Res Public Health 2019; 16:ijerph16224533. [PMID: 31731830 PMCID: PMC6887751 DOI: 10.3390/ijerph16224533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022]
Abstract
Objective: To determine the differences in the incidences and risks of suicide attempt (SA) and suicidal drug overdose (SDO) between patients with epilepsy with and without comorbid depression by using data from Taiwan’s National Health Insurance Research Database. Methods: We analyzed data of patients (≥20 years) who had received epilepsy diagnoses between 2000 and 2012; the diagnosis date of epilepsy was defined as the index date. The epilepsy patients were divided into the cohorts, with and without comorbid depression, and compared against a cohort from the non-affected population. We calculated adjusted hazard ratios and the corresponding 95% confidence intervals for SA and SDO in the three cohorts after adjustment for age, sex, and comorbidities. Results: The incidences of SA and SDO in the cohort with epilepsy and depression were 42.9 and 97.4 per 10,000 person-years, respectively. The epilepsy with depression cohort had 21.3 times of SA risk; and 22.9 times of SDO risk than did the comparison cohort had a 6.03-fold increased risk of SA and a 2.56-fold increased risk of SDO than did the epilepsy patients without depression. Moreover, patients’ age <65 years, and female sex would further increase the risk of SA in patients with epilepsy and comorbid depression. Conclusion: Risks of SA and SDO in patients with epilepsy are proportionally increased when depression is coexisted. Our findings provide crucial information for clinicians and the government for suicide prevention and to question whether prescribing a large number of medications to patients with epilepsy and depression is safe.
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Affiliation(s)
- Chi-Yu Lin
- Stroke Care Center and Department of Neurology, Yumin Hospital, Nantou 542, Taiwan;
| | - Tomor Harnod
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- College of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404472, Taiwan;
- College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Wei-Chih Shen
- Department of Computer Science and Information Engineering, Asia University, Taichung 41354, Taiwan;
- Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung 404472, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 404472, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- Correspondence: ; Tel.: +886-4-2205-2121; Fax: +886-4-2233-6174
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Chen SW, Shen WC, Chen WTL, Hsieh TC, Yen KY, Chang JG, Kao CH. Metabolic Imaging Phenotype Using Radiomics of [ 18F]FDG PET/CT Associated with Genetic Alterations of Colorectal Cancer. Mol Imaging Biol 2019; 21:183-190. [PMID: 29948642 DOI: 10.1007/s11307-018-1225-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To understand the association between genetic mutations and radiomics of 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography (PET)/x-ray computed tomography (CT) in patients with colorectal cancer (CRC). PROCEDURES This study included 74 CRC patients who had undergone preoperative [18F]FDG PET/CT. A total of 65 PET/CT-related features including intensity, volume-based, histogram, and textural features were calculated. High-resolution melting methods were used for genetic mutation analysis. RESULTS Genetic mutants were found in 21 KRAS tumors (28 %), 31 TP53 tumors (42 %), and 17 APC tumors (23 %). Tumors with a mutated KRAS had an increased value at the 25th percentile of maximal standardized uptake value (SUVmax) within their metabolic tumor volume (MTV) (P < .0001; odds ratio [OR] 1.99; 95 % confidence interval [CI] 1.37-2.90) and their contrast from the gray-level cooccurrence matrix (P = .005; OR 1.52; 95 % CI 1.14-2.04). A mutated TP53 was associated with an increased value of short-run low gray-level emphasis derived from the gray-level run length matrix (P = .001; OR 243006.0; 95 % CI 59.2-996,872,313). APC mutants exhibited lower low gray-level zone emphasis derived from the gray-level zone length matrix (P = .006; OR < .0001; 95 % CI 0.000-0.22). CONCLUSION PET/CT-derived radiomics can provide supplemental information to determine KRAS, TP53, and APC genetic alterations in CRC.
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Affiliation(s)
- Shang-Wen Chen
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.,Department of Radiology, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chih Shen
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - William Tzu-Liang Chen
- Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Hsieh
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Kuo-Yang Yen
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Jan-Gowth Chang
- Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.,Department of Laboratory Medicine, Chine Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. .,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Shen WC, Chen SW, Wu KC, Hsieh TC, Liang JA, Hung YC, Yeh LS, Chang WC, Lin WC, Yen KY, Kao CH. Prediction of local relapse and distant metastasis in patients with definitive chemoradiotherapy-treated cervical cancer by deep learning from [ 18F]-fluorodeoxyglucose positron emission tomography/computed tomography. Eur Radiol 2019; 29:6741-6749. [PMID: 31134366 DOI: 10.1007/s00330-019-06265-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND We designed a deep learning model for assessing 18F-FDG PET/CT for early prediction of local and distant failures for patients with locally advanced cervical cancer. METHODS All 142 patients with cervical cancer underwent 18F-FDG PET/CT for pretreatment staging and received allocated treatment. To augment the amount of image data, each tumor was represented as 11 slice sets each of which contains 3 2D orthogonal slices to acquire a total of 1562 slice sets. In each round of k-fold cross-validation, a well-trained proposed model and a slice-based optimal threshold were derived from a training set and used to classify each slice set in the test set into the categories of with or without local or distant failure. The classification results of each tumor were aggregated to summarize a tumor-based prediction result. RESULTS In total, 21 and 26 patients experienced local and distant failures, respectively. Regarding local recurrence, the tumor-based prediction result summarized from all test sets demonstrated that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71%, 93%, 63%, 95%, and 89%, respectively. The corresponding values for distant metastasis were 77%, 90%, 63%, 95%, and 87%, respectively. CONCLUSION This is the first study to use deep learning model for assessing 18F-FDG PET/CT images which is capable of predicting treatment outcomes in cervical cancer patients. KEY POINTS • This is the first study to use deep learning model for assessing 18 F-FDG PET/CT images which is capable of predicting treatment outcomes in cervical cancer patients. • All 142 patients with cervical cancer underwent 18 F-FDG PET/CT for pretreatment staging and received allocated treatment. To augment the amount of image data, each tumor was represented as 11 slice sets each of which contains 3 2D orthogonal slices to acquire a total of 1562 slice sets. • For local recurrence, all test sets demonstrated that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71%, 93%, 63%, 95%, and 89%, respectively. The corresponding values for distant metastasis were 77%, 90%, 63%, 95%, and 87%, respectively.
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Affiliation(s)
- Wei-Chih Shen
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - Shang-Wen Chen
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Chen Wu
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - Te-Chun Hsieh
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Ji-An Liang
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan
| | - Yao-Ching Hung
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Lian-Shung Yeh
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Chun Chang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Chou Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Kuo-Yang Yen
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. .,Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Li CC, Fang HY, Lin CY, Shen WC, Chien CR. Outcomes of Localized Esophageal Squamous Cell Carcinoma Patients Treated With Definitive Concurrent Chemoradiotherapy Using Either Standard or High Radiotherapy Dose: A Retrospective Study Controlling for Organ at Risk Dose. Anticancer Res 2019; 39:511-517. [PMID: 30591503 DOI: 10.21873/anticanres.13142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/22/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The optimal radiotherapy dose for localized esophageal squamous cell carcinoma (ESqCC) patients treated with definitive concurrent chemo-radiotherapy (CCRT) is debated. The aim of our study was to compare patient outcomes using either standard or high radiotherapy dose. MATERIALS AND METHODS Eligible patients diagnosed between 2011 and 2015 from the cancer registry of our Institute were identified and a propensity score (PS)-matched cohort (1:1 for high vs. standard dose) was constructed to balance observable potential confounders (including organ at risk dose). The hazard ratio (HR) of death between high and standard dose was compared. RESULTS Our study population included 73/36 patients before/after PS matching. The HR of death at the high dose compared to the standard dose was 0.554 (95% confidence interval (CI)=0.308-0.998, p=0.049). CONCLUSION Definitive CCRT using a high radiotherapy dose showed improved survival outcomes for localized ESqCC patients compared to standard dose.
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Affiliation(s)
- Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Hsin-Yuan Fang
- Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan, R.O.C.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Chen-Yuan Lin
- Division of Hematology and Oncology, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Wei-Chih Shen
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan, R.O.C
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan, R.O.C. .,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, R.O.C.,Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, R.O.C
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Chen SW, Shen WC, Hsieh TC, Liang JA, Hung YC, Yeh LS, Chang WC, Lin WC, Yen KY, Kao CH. Textural features of cervical cancers on FDG-PET/CT associate with survival and local relapse in patients treated with definitive chemoradiotherapy. Sci Rep 2018; 8:11859. [PMID: 30089896 PMCID: PMC6082904 DOI: 10.1038/s41598-018-30336-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 10/13/2017] [Accepted: 07/23/2018] [Indexed: 01/18/2023] Open
Abstract
We retrospectively reviewed the records of 142 patients with stage IB–IIIB cervical cancer who underwent 18F-FDG-PET/CT before external beam radiotherapy plus intracavitary brachytherapy and concurrent chemotherapy. The patients were divided into training and validation cohorts to confirm the reliability of predictors for recurrence. Kaplan–Meier analysis was performed and a Cox regression model was used to examine the effects of variables on overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and pelvic relapse-free survival (PRFS). High gray-level run emphasis (HGRE) derived from gray-level run-length matrix most accurately and consistently predicted the presence of pelvic residual or recurrent tumors for both cohorts. In multivariate analysis, stages IIIA–IIIB (P = 0.001, hazard ratio [HR] = 4.07) and a low HGRE (P < 0.0001, HR = 4.34) were prognostic factors for low OS, whereas a low HGRE (P = 0.001, HR = 2.86) and nonsquamous cell histology (P = 0.003, HR = 2.76) were prognostic factors for inferior PFS. The nonsquamous cell histology (P < 0.0001, HR = 9.19) and a low HGRE (P = 0.001, HR = 4.69) were predictors for low PRFS. In cervical cancer patients receiving definitive chemoradiotherapy, pretreatment textural features on 18F-FDG-PET/CT can supplement the prognostic information.
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Affiliation(s)
- Shang-Wen Chen
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chih Shen
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - Te-Chun Hsieh
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Ji-An Liang
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Yao-Ching Hung
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Lian-Shung Yeh
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Chun Chang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Chou Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Kuo-Yang Yen
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. .,Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Hu D, Zhang HJ, Shen WC, Zhu WF, Li L, Lin XD, Lu JP, Zheng XW, Wang C, Zhou XR. [Microcystic, elongated and fragmented invasive pattern in endometrial adenocarcinoma: a clinicopathologic analysis of 72 cases]. Zhonghua Bing Li Xue Za Zhi 2017; 46:318-322. [PMID: 28468037 DOI: 10.3760/cma.j.issn.0529-5807.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinicopathologic features of microcystic, elongated and fragmented (MELF) pattern invasion of endometrial adenocarcinoma. Methods: HE and immunohistochemistry staining method were used to analysis morphologic features and immunophenotype of 72 patients of endometrial adenocarcinoma with MELF pattern invasion, and chi-square test was used to analysis the clinicopathologic features. Results: The mean age of 72 patients was 54 years (40 to 70 years). Thirty-two patients were pre-menopausal and 40 were post-menopausal. According to the FIGO staging system (2014), 32 cases(44.4%)were at stage Ⅰ, 22 cases(30.6%)at stage Ⅱ, 17 cases(23.6%)at stage Ⅲ and 1 case(1.4%) at stage Ⅳ. Microscopically, MELF invasion showed microcystic, elongated slit-like or fragmented glands in myometrium and their lining cells usually were cube or flat, as well as the single or clusters of eosinophilic tumor cells mimicking histocytes. In addition, a fibromyxoid or inflammatory stromal response was often present.Immunohistochemical staining showed that MELF invasion was positive for p16, CA125 and CA19-9, but negative for ER, PR and p53.Compared with non-MELF pattern invasion, significant differences were noted in menopause pausimenia, FIGO stages, deep invasion into myometrium, lymph metastasis, lymphovascular space invasion (LVSL), serum CA125 and CA19-9 in patients with MELF pattern invasion (all P<0.05). Conclusions: MELF pattern invasion of endometrial adenocarcinoma is characterized by advanced FIGO stage, deep myoinvasion, high metastasis rate to lymph node and LVSL. Pathologists should recognize the MELF invasion and evaluate the depth of myometrium of infiltration and LVSL with special attention to the presence of MELF invasion with necessary immunohistochemistry for more accurate pathological diagnosis.
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Affiliation(s)
- D Hu
- Department of Pathology, Fujian Provincial Cancer Hospital, the Affiliated Hospital of Fujian Medical University, Fuzhou 350014, China
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Juan YH, Tsay PK, Shen WC, Yeh CS, Wen MS, Wan YL. Comparison of the Left Main Coronary Bifurcating Angle among Patients with Normal, Non-significantly and Significantly Stenosed Left Coronary Arteries. Sci Rep 2017; 7:1515. [PMID: 28473705 PMCID: PMC5431433 DOI: 10.1038/s41598-017-01679-3] [Citation(s) in RCA: 13] [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: 10/31/2016] [Accepted: 03/31/2017] [Indexed: 01/25/2023] Open
Abstract
We evaluated the correlation of the left main coronary bifurcating angle (LCBA) with the severity of coronary atherosclerosis, risk factors of coronary artery disease (CAD) and the feasibility of measuring the LBCA using the axial plane. Coronary Computed tomography angiographies (CTAs) of 313 patients between Nov. 2006 and Oct. 2013 were reviewed and separated into three groups. Group I (211 patients) had significant stenosis (≥50%) of the left anterior descending coronary artery (LAD) and/or left circumflex coronary artery (LCX). Group II (62 subjects) had atherosclerosis without significant stenosis. Group III (40 subjects) had unremarkable coronary CTAs. Both Group I and II patients received conventional catheter angiography to confirm the severities of coronary stenoses. Significant differences were found among the groups with respect to risk factors, such as male gender, hypertension and body mass index. Axial plane measurement was feasible in most patients (82.1%), without significant differences among the groups. The mean LCBA was 84.7° among all patients, and significantly differed among groups I, II and III (87.34°, 81.16° and 75.53°, P < 0.001). The LCBA of group I was significantly higher than group III (P < 0.001) in univariate analysis, but insignificant in multivariate analysis (P = 0.064).
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Affiliation(s)
- Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, (333), Taoyuan, Taiwan
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, (333), Taoyuan, Taiwan
| | - Wei-Chih Shen
- Department of Medical Research, China Medical University Hospital, China Medical University, (40447), Taichung, Taiwan
| | - Chih-Seng Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, (333), Taoyuan, Taiwan
| | - Ming-Shien Wen
- Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, (333), Taoyuan, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, (333), Taoyuan, Taiwan.
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14
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Chen SW, Shen WC, Lin YC, Chen RY, Hsieh TC, Yen KY, Kao CH. Correlation of pretreatment 18F-FDG PET tumor textural features with gene expression in pharyngeal cancer and implications for radiotherapy-based treatment outcomes. Eur J Nucl Med Mol Imaging 2016; 44:567-580. [PMID: 27999896 DOI: 10.1007/s00259-016-3580-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE This study investigated the correlation of the matrix heterogeneity of tumors on 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) with gene-expression profiling in patients with pharyngeal cancer and determined the prognostic factors for radiotherapy-based treatment outcomes. METHODS We retrospectively reviewed the records of 57 patients with stage III-IV oropharyngeal or hypopharyngeal cancer who had completed definitive therapy. Four groups of the textural features as well as 31 indices were studied in addition to maximum standard uptake value, metastatic tumor volume, and total lesion glycolysis. Immunohistochemical data from pretreatment biopsy specimens (Glut1, CAIX, VEGF, HIF-1α, EGFR, Ki-67, Bcl-2, CLAUDIN-4, YAP-1, c-Met, and p16) were analyzed. The relationships between the indices and genomic expression were studied, and the robustness of various textural features relative to cause-specific survival and primary relapse-free survival was analyzed. RESULTS The overexpression of VEGF was positively associated with the increased values of the matrix heterogeneity obtained using gray-level nonuniformity for zone (GLNUz) and run-length nonuniformity (RLNU). Advanced T stage (p = 0.01, hazard ratio [HR] = 3.38), a VEGF immunoreactive score of >2 (p = 0.03, HR = 2.79), and a higher GLNUz value (p = 0.04, HR = 2.51) were prognostic factors for low cause-specific survival, whereas advanced T stage, a HIF-1α staining percentage of ≥80%, and a higher GLNUz value were prognostic factors for low primary-relapse free survival. CONCLUSIONS The overexpression of VEGF was associated with the increased matrix index of GLNUz and RLNU. For patients with pharyngeal cancer requiring radiotherapy, the treatment outcome can be stratified according to the textural features, T stage, and biomarkers.
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Affiliation(s)
- Shang-Wen Chen
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,School of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan
| | - Wei-Chih Shen
- Cancer Center and Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - Ying-Chun Lin
- Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.,The Ph.D. Program for Cancer Biology and Drug Discovery, China Medical University and Academia Sinica, Taichung, Taiwan
| | - Rui-Yun Chen
- Department of Pathology, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Hsieh
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Kuo-Yang Yen
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan. .,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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15
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Shen WC. The Comparison Of Clinical Impact Between Entecavir And Tenofovir In Chronic Hbv Infection. Value Health 2014; 17:A362-A363. [PMID: 27200744 DOI: 10.1016/j.jval.2014.08.798] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- W C Shen
- Taipei Medical University and Wan Fang Hospital, Taipei, Taiwan
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16
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Huang WS, Yang TY, Shen WC, Lin CL, Lin MC, Kao CH. Association between Helicobacter pylori infection and dementia. J Clin Neurosci 2014; 21:1355-8. [PMID: 24629396 DOI: 10.1016/j.jocn.2013.11.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 07/29/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 12/24/2022]
Abstract
Dementia is the severe loss of global cognitive ability in a previously healthy person. This study examined the relationship between Helicobacter pylori infection (HP-I) and non-Alzheimer's dementia (non-AD) using a nationwide population-based dataset. The International Classification of Diseases, Ninth Revision (ICD-9) codes for dementia were used to define dementia patients; in addition, we examined the association of dementia with other comorbidities. Patients aged ≥40years with newly diagnosed HP-I (ICD-9 code 041.86) during 1998-2010 were identified as the HP-I cohort. The comparison cohort consisted of people aged ≥40years without HP-I (non-HP-I) randomly selected from the database at a ratio of 1:4 in the same time period. The controls were frequency matched according to the age (every 5years), sex, and index year of patients in the HP-I cohort. Follow-up was performed for all patients until the date of dementia diagnosis (ICD-9 codes 290.0-290.4, 294.1, 331.0-331.2), date of withdrawal from the Taiwanese National Health Insurance program, date of death, or until December 31 2010. Compared with patients without HP-I, HP-I patients were 1.60-fold (95% confidence interval [CI] 1.32-1.95) more likely to develop non-AD. There was no statistical association between HP-I and AD. The adjusted hazard ratio of dementia increased from 1.48 (95% CI 1.22-1.79) for patients who had HP-I once to 2.19 (95% CI 1.13-4.25) for patients who had HP-I two or more times. Our study revealed that HP-I may be a critical risk factor for the development of non-AD. Further investigation, including clinical trials, to examine the microbe-dementia connection may provide further proof of the association between HP-I and dementia.
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Affiliation(s)
- Wei-Shih Huang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tse-Yen Yang
- Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wei-Chih Shen
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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17
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Shen WC, Liu JC, Shieh SH, Yang ST, Tseng GC, Hsu WH, Chen CY, Yu YH. Density features of screened lung tumors in low-dose computed tomography. Acad Radiol 2014; 21:41-51. [PMID: 24331263 DOI: 10.1016/j.acra.2013.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/25/2013] [Accepted: 09/25/2013] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES Using low-dose computed tomography (LDCT), small and heterogeneous lung tumors are detected in screening. The criteria for assessing detected tumors are crucial for determining follow-up or resection strategies. The purpose of this study was to investigate the capacity of density features in differentiating lung tumors. MATERIALS AND METHODS From July 2008 to December 2011, 48 surgically confirmed tumors (29 malignancies, comprising 17 cases of adenocarcinoma and 12 cases of adenocarcinoma in situ [AdIs], and 19 benignancies, comprising 11 cases of atypical adenomatous hyperplasia [AAH] and eight cases of benign non-AAH) in 38 patients were retrospectively evaluated, indicating that the positive predictive value (PPV) of physicians is 60.4% (29/48). Three types of density features, tumor disappearance rate (TDR), mean, and entropy, were obtained from the CT values of detected tumors. RESULTS Entropy is capable of differentiating malignancy from benignancy but is limited in differentiating AdIs from benign non-AAH. The combination of entropy and TDR is effective for predicting malignancy with an accuracy of 87.5% (42/48) and a PPV of 89.7% (26/29), improving the PPV of physicians by 29.3%. The combination of entropy and mean adequately clarifies the four pathology groups with an accuracy of 72.9% (35/48). For tumors with a mean below -400 Hounsfield units, the criterion of an entropy larger than 5.4 might be appropriate for diagnosing malignancy. For others, the pathology is either benign non-AAH or adenocarcinoma; adenocarcinoma has a higher entropy than benign non-AAH, with the exception of tuberculoma. CONCLUSIONS Combining density features enables differentiating heterogeneous lung tumors in LDCT.
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18
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Chen SC, Yang ST, Yu YH, Chen CY, Shen WC. Pleura detection in chest computed tomography with application for nodule detection. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:2344-2347. [PMID: 24110195 DOI: 10.1109/embc.2013.6610008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper proposes an efficient algorithm for detecting pleural objects that come in contact with a nodule. To reduce complexity, the algorithm recursively performed a curve-fitting method on each slice of the volume of interest to locate the object between the parietal and visceral pleurae surfaces and measured the quality of the fitting curve. When a nodule contacted the surfaces of the chest wall or diaphragm, they were automatically separated using the fitting curve. The algorithm was performed on 864 slices of 40 nodules. The segmentation results were visually inspected by a consensus of attending physicians to search for any segmentation errors. The consensus accepted 93.6% of the segmentation results.
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19
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Moon WK, Huang CS, Shen WC, Takada E, Chang RF, Joe J, Nakajima M, Kobayashi M. Analysis of elastographic and B-mode features at sonoelastography for breast tumor classification. Ultrasound Med Biol 2009; 35:1794-1802. [PMID: 19767139 DOI: 10.1016/j.ultrasmedbio.2009.06.1094] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 06/10/2009] [Accepted: 06/20/2009] [Indexed: 05/28/2023]
Abstract
The purpose of this study was to evaluate the accuracy of neural network analysis of elastographic features at sonoelastography for the classification of biopsy-proved benign and malignant breast tumors. Sonoelastography of 181 solid breast masses (113 benign and 68 malignant tumors) was performed for 181 patients (mean age, 47 years; range, 24-75 years). After the manual segmentation of the tumors, five elastographic features (strain difference, strain ratio, mean, median and mode) and six B-mode features (orientation, undulation, angularity, average gradient, gradient variance and intensity variance) were computed. A neural network was used to classify tumors by the use of these features. The Student's t test and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. Area under ROC curve (Az) values of the three elastographic features- mean (0.87), median (0.86) and mode (0.83)-were significantly higher than the Az values for the six B-mode features (0.54-0.69) (p < 0.01). Accuracy, sensitivity, specificity and Az of the neural network for the classification of solid breast tumors were 86.2% (156/181), 83.8% (57/68), 87.6% (99/113) and 0.84 for the elastographic features, respectively, and 82.3% (149/181), 70.6% (48/68), 89.4% (101/113) and 0.78 for the B-mode features, respectively, and 90.6% (164/181), 95.6% (65/68), 87.6% (99/113) and 0.92 for the combination of the elastographic and B-mode features, respectively. We conclude that sonoelastographic images and neural network analysis of features has the potential to increase the accuracy of the use of ultrasound for the classification of benign and malignant breast tumors.
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Affiliation(s)
- Woo Kyung Moon
- Department of Radiology, College of Medicine, Seoul National University, Seoul, Korea
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20
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Shen WC, Chang RF, Moon WK. Computer aided classification system for breast ultrasound based on Breast Imaging Reporting and Data System (BI-RADS). Ultrasound Med Biol 2007; 33:1688-98. [PMID: 17681678 DOI: 10.1016/j.ultrasmedbio.2007.05.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 05/07/2007] [Accepted: 05/18/2007] [Indexed: 05/16/2023]
Abstract
Clinically, the ultrasound findings are evaluated by its sonographic characteristics and then assigned to assessment categories according to the definitions of Breast Imaging Reporting and Data System (BI-RADS) developed by the American College of Radiology. In this study, a computer-aided classification (CAC) system was proposed to classify the masses into assessment categories 3, 4 and 5, which simulated the clinical diagnosis of radiologists. Compared with current computer-aided diagnosis systems, the proposed CAC system classifies the indeterminate cases into BI-RADS category 4 for further diagnosis. Six hundred twenty-six cases were collected from three ultrasound systems and confirmed by pathology and retrospectively classified into categories 3, 4 and 5 by radiologists. The multinomial logistic regression model was trained as the CAC system for predicting the assessment category from the computerized BI-RADS features and from a set of machine-dependent factors. By using the machine-dependent factors to indicate the adopted ultrasound systems, the same regression model could be applied for the cases acquired from different ultrasound systems. A basic CAC system was trained by using the classification result of radiologists. A weighted CAC system, to improve the capacity of the basic CAC system in differentiating benign from malignant lesions, was trained by adding the pathologic result. Between the radiologists and the basic CAC system, a substantial agreement was indicated by Cohen's kappa statistic and the differences in either the performance indices or the A(Z) of receiver operating characteristic (ROC) analysis were not statistically significant. For the weighted CAC system, the performance indices accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73.00% (457 of 626), 98.17% (215 of 219), 59.46% (242 of 407), 56.58% (215 of 380) and 98.37% (242 of 246), respectively; the A(Z) was 0.94; and the correlation with the radiologists was also substantial agreement. The indices accuracy and specificity of weighted CAC system, compared with those of the radiologists, were improved by 5.91% and 8.85%, respectively and the indices of sensitivity and NPV, compared with those of a conventional CAD system, were improved by 10.5% and 5.21%, respectively; all improvements were statistically significant. To classify the mass into BI-RADS assessment categories by the CAC system is feasible. Moreover, the proposed CAC system is flexible because it can be used to diagnose the cases acquired from different ultrasound systems.
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Affiliation(s)
- Wei-Chih Shen
- Department of Computer Science and Information Engineering, National Chung Cheng University, Chiayi, Taiwan, R.O.C
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21
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Shen WC, Chang RF, Moon WK, Chou YH, Huang CS. Breast ultrasound computer-aided diagnosis using BI-RADS features. Acad Radiol 2007; 14:928-39. [PMID: 17659238 DOI: 10.1016/j.acra.2007.04.016] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Revised: 04/20/2007] [Accepted: 04/21/2007] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES Based on the definitions in mass category of Breast Imaging Reporting and Data System developed by American College of Radiology, eight computerized features including shape, orientation, margin, lesion boundary, echo pattern, and posterior acoustic feature classes are proposed. MATERIALS AND METHODS Our experimental database consists of 265 pathology-proven cases including 180 benign and 85 malignant masses. The capacity of each proposed feature in differentiating malignant from benign masses was validated by Student's t test and the correlation between each proposed feature and the pathological result was evaluated by point biserial coefficient. Binary logistic regression model was used to relate all proposed features and pathological result as a computer-aided diagnosis (CAD) system. The diagnostic value of each proposed feature in the CAD system was further evaluated by the feature selection methods. Additionally, the likelihood of malignancy for each individual feature was also estimated by binary logistic regression. RESULTS On each proposed feature, the malignant cases were significantly different from the benign ones. The correlation between the angular characteristic and pathological result was indicated as very high. Three substantial correlations appear in features irregular shape, undulation characteristic, and degree of abrupt interface, but the relationship for orientation feature is low. For the constructed CAD system, the performance indices accuracy, sensitivity, specificity, PPV, and NPV were 91.70% (243 of 265), 90.59% (77 of 85), 92.22% (166 of 180), 84.62% (77 of 91), and 95.40% (166 of 174), respectively, and the area index in the ROC analysis was 0.97. Compared with the significant contribution of angular characteristic, the diagnostic values of posterior acoustic feature and orientation feature were relatively low for the CAD system. When three or more angular characteristics are discovered or the degree of abrupt interface is lower than 18, the likelihood of malignancy could be predicted as greater than 40%. CONCLUSION The computerized BI-RADS sonographic features conform to the sign of malignancy in the clinical experience and efficiently help the CAD system to diagnose the mass.
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Affiliation(s)
- Wei-Chih Shen
- Department of Computer Science and Information Engineering, National Chung Cheng University, Chiayi, Taiwan, ROC
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22
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Schroers HJ, Geldenhuis MM, Wingfield MJ, Schoeman MH, Yen YF, Shen WC, Wingfield BD. Classification of the guava wilt fungus Myxosporium psidii, the palm pathogen Gliocladium vermoesenii and the persimmon wilt fungus Acremonium diospyri in Nalanthamala. Mycologia 2006; 97:375-95. [PMID: 16396346 DOI: 10.3852/mycologia.97.2.375] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Psidium guajava wilt is known from South Africa, Malaysia and Taiwan. The fungus causing this disease, Myxosporium psidii, forms dry chains of conidia on surfaces of pseudoparenchymatous sporodochia, which develop in blisters on bark. Similar sporodochia are characteristic of Nalanthamala madreeya, the type species of Nalanthamala. Nalanthamala, therefore, is the appropriate anamorph genus for Myxosporium psidii, while Myxosporium is a nomen nudum (based on M. croceum). For M. psidii the combination Nalanthamala psidii is proposed. Nalanthamala psidii, the palm pathogen Gliocladium (Penicillium) vermoesenii, another undescribed anamorphic species from palm, two species of Rubrinectria and the persimmon pathogen Acremonium diospyri are monophyletic and belong to the Nectriaceae (Hypocreales) based on partial nuclear large subunit ribosomal DNA (LSU rDNA) analyses. Rubrinectria, therefore, is the teleomorph of Nalanthamala, in which the anamorphs are classified as N. vermoesenii, N. diospyri or Nalanthamala sp. Nalanthamala squamicola, the only other Nalanthamala species, has affinities with the Bionectriaceae and is excluded from this group. Rubrinectria/Nalanthamala species form dimorphic conidiophores and conidia in culture. Fusiform, cylindrical, or allantoid conidia arise in colorless liquid heads on acremonium-like conidiophores; ovoidal conidia with somewhat truncated ends arise in long, persistent, dry chains on penicillate conidiophores. No penicillate but irregularly branched conidiophores were observed in N. diospyri. Conidia of N. psidii that are held in chains are shorter than those of N. madreeya, of which no living material is available. Nalanthamala psidii and N. diospyri are pathogenic specifically to their hosts. They form pale yellow to pale orange or brownish orange colonies, respectively, and more or less white conidial masses. Most strains of Rubrinectria sp., Nalanthamala sp. and N. vermoesenii originate from palm hosts, form mostly greenish or olive-brown colonies and white-to-salmon conidial masses. They form a monophyletic clade to which Nalanthamala psidii and N. diospyri are related based on analyses of the internal transcribed spacer regions and 5.8S rDNA (ITS rDNA), LSU rDNA, and partial beta-tubulin gene. Few polymorphic sites in the ITS rDNA and beta-tubulin gene indicate that Nalanthamala psidii comprises two lineages, one of which has been detected only in South Africa.
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MESH Headings
- Acremonium/classification
- Acremonium/cytology
- Acremonium/genetics
- Acremonium/isolation & purification
- DNA, Fungal/chemistry
- DNA, Fungal/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- DNA, Ribosomal Spacer/chemistry
- DNA, Ribosomal Spacer/genetics
- Geography
- Gliocladium/classification
- Gliocladium/cytology
- Gliocladium/genetics
- Gliocladium/isolation & purification
- Hypocreales/classification
- Hypocreales/cytology
- Hypocreales/genetics
- Hypocreales/isolation & purification
- Microscopy
- Microscopy, Electron, Scanning
- Molecular Sequence Data
- Phylogeny
- Plant Diseases/microbiology
- Plants/microbiology
- Polymorphism, Genetic
- RNA, Ribosomal, 28S/genetics
- RNA, Ribosomal, 5.8S/genetics
- Sequence Analysis, DNA
- Sequence Homology
- Spores, Fungal/cytology
- Tubulin/genetics
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Affiliation(s)
- H J Schroers
- Centraalbureau voor Schimmelcultures, Fungal Biodiversity Centre (CBS), Utrecht, The Netherlands.
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23
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Widera A, Beloussow K, Kim KJ, Crandall ED, Shen WC. Phenotype-dependent synthesis of transferrin receptor in rat alveolar epithelial cell monolayers. Cell Tissue Res 2003; 312:313-8. [PMID: 12739130 DOI: 10.1007/s00441-002-0663-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2002] [Accepted: 10/22/2002] [Indexed: 11/29/2022]
Abstract
The iron carrier protein transferrin plays a prominent antioxidant and anti-bacterial role in the lower respiratory tract and is present at elevated concentrations in lung epithelial lining fluid relative to plasma. The level of transferrin receptor synthesis in primary cultures of rat alveolar epithelial cells (AECs) was investigated. Transferrin receptor was found to be synthesized early in AEC cultures with the alveolar type II cell-like phenotype. Cell-surface receptor localization was attenuated upon apparent transdifferentiation to the alveolar type I cell-like phenotype later in culture. Binding of (125)I-labeled transferrin to the receptor indicated that surface and total cellular transferrin receptor levels were decreased in the type I-like cells. Inclusion of keratinocyte growth factor (KGF) in culture media (10 ng/ml) resulted in retention of transferrin receptor localized to the basolateral surface. Transferrin-receptor-specific internalization of (59)Fe-transferrin was also limited to the basolateral surface of KGF-treated monolayers. These data suggest that alveolar type II (but not type I) cells express functional transferrin receptor in adult rat alveolar epithelium.
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Affiliation(s)
- A Widera
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA 90033, USA
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24
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Lin JJ, Lin GY, Shih C, Shen WC. Presentation of striatal hyperintensity on T1-weighted MRI in patients with hemiballism-hemichorea caused by non-ketotic hyperglycemia: report of seven new cases and a review of literature. J Neurol 2001; 248:750-5. [PMID: 11596778 DOI: 10.1007/s004150170089] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recent studies have shown unique clinicoradiologic characteristics in patients with hemiballism-hemichorea (HB-HC) caused by non-ketotic hyperglycemia; however, there is still a limited number of patients being reported. We report 7 patients (3 males and 4 females) with this type of dyskinesia, whose ages ranged from 60 to 84 years. Brain CT of these patients showed hyperdensity in the contralateral striatum, corresponding with MRI studies that showed an increased signal intensity on T1-weighted images and a decreased signal on T2-weighted images. After metabolic control had been achieved, the hyperkinetic state of these patients abruptly ceased. Follow-up neuroimaging studies in 2 patients documentied complete resolution of the striatal hyperintensity on brain CT and MRI after 3 months and 6 months, respectively. A review of patients with HB-HC caused by non-ketotic hyperglycemia reported formerly and in the present study shows that the dyskinesia tends to occur in aged diabetic patients. The age of patients with dyskinesia secondary to cerebral infarction is generelly much lower. We also found that 86% (30 out of 35 cases) patients reported with HB-HC caused by non-ketotic hyperglycemia were Asians. The prognosis of the dyskinesia was excellent, and the radiological abnormalities are completely reversible.
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Affiliation(s)
- J J Lin
- Department of Neurology, Chushang Show-Chwan Hospital, Chushang Jenn, Nantou, Taiwan.
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25
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Gladysheva IP, Polekhina OV, Karmakova TA, Nemtsova ER, Yakubovskaya RI, Shen WC, Kennedy AR, Larionova NI. Potential of block copolymer- and immuno-conjugates for tumor-targeted delivery of Bowman-Birk soybean proteinase inhibitor. J Control Release 2001; 74:303-8. [PMID: 11489510 DOI: 10.1016/s0168-3659(01)00337-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present work reports the effect of conjugation of the anticarcinogenic and antitumor soybean Bowman-Birk protease inhibitor (BBI) with amphiphilic block copolymer of ethylene oxide and propylene oxide (PEO-PPO) as well as with monoclonal antibody via clinical dextran (D) on tumor-targeted delivery of BBI.
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Affiliation(s)
- I P Gladysheva
- Lomonosov Moscow State University, 119899, Moscow, Russia.
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26
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Chen JH, Ho YJ, Shen WC. Asymptomatic arterio-biliary fistula after transarterial chemoembolization of metastatic liver tumors. Hepatogastroenterology 2001; 48:842-3. [PMID: 11462937] [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: 02/20/2023]
Abstract
Arterio-biliary fistula is a rare clinical condition resulting from various causes such as iatrogenic injury and ischemic change of the bile duct. Serious clinical symptoms occur due to the shunting of high-pressure blood from the hepatic artery into the bile duct. Here we report a case of arterio-biliary fistula demonstrated by angiographic examinations. The communication appeared after repeat transarterial chemoembolization of metastatic liver tumors. The interesting point of this case was that the patient did not have any obvious clinical symptoms related to the fistula. The mechanisms responsible for this rare manifestation are discussed.
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Affiliation(s)
- J H Chen
- Department of Radiology, China Medical College Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan.
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27
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Du X, Beloussow K, Shen WC. Bowman-Birk protease inhibitor and its palmitic acid conjugate prevent 7,12-dimethylbenz[a]anthracene-induced transformation in cultured mouse mammary glands. Cancer Lett 2001; 164:135-41. [PMID: 11179827 DOI: 10.1016/s0304-3835(01)00381-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The chemopreventive effects of Bowman-Birk protease inhibitor (BBI), a soybean polypeptide, and its palmitic acid conjugate, Pal-BBI, on 7,12-dimethylbenz[a]anthracene (DMBA)-induced transformation were investigated by using an in vitro whole organ culture system of mouse mammary glands. The transformation incidence was measured as the number of glands containing nodule-like alveolar lesions (NLAL). Both BBI and Pal-BBI were effective in preventing DMBA-induced transformation, especially when added to the medium during the developing period after the exposure of mammary glands to DMBA, i.e. 35.9 and 53.4% prevention, respectively. However, when only present in the medium before the promotion period, Pal-BBI was effective in decreasing the transformation incidence (32.2%) while BBI was not (10.3%). This difference could possibly be due to the high lipophilicity and tissue retention of Pal-BBI in mammary gland cultures.
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Affiliation(s)
- X Du
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089-9121, USA
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28
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Xia CQ, Shen WC. Tyrphostin-8 enhances transferrin receptor-mediated transcytosis in Caco-2- cells and inreases hypoglycemic effect of orally administered insulin-transferrin conjugate in diabetic rats. Pharm Res 2001; 18:191-5. [PMID: 11405290 DOI: 10.1023/a:1011032502097] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To investigate the effect of tyrphostin 8 (T-8), a GTPase inhibitor, on transferrin receptor (TfR)-mediated transcytosis of insulin-transferrin (In-Tf) conjugate in cultured enterocyte-like Caco-2 cells and on gastrointestinal (GI) absorption of In-Tf in streptozotocin (STZ)-induced diabetic rats. METHODS Caco-2 cells and diabetic rats were used as in vitro and in vivo models, respectively. TfR-mediated transcytosis was measured using 125I-In-Tf. The absorption of insulin in diabetic rats was demonstrated by the hypoglycemic effect. Rat blood glucose level was determined using a ONE TOUCH blood glucose monitoring system. RESULTS T-8 increased apical-to-basolateral transport of In-Tf conjugate by enhancing TfR-mediated transcytosis in filter-grown Caco-2 cell monolayer, and this enhancement was higher and faster than the previously reported brefeldin A (BFA)-induced effect. The measurement of transepithelial electrical resistance (TEER) during the transport study showed that T-8 was less destructive on the cell tight junction than BFA. The GI absorption of In-Tf was evaluated by its hypoglycemic effect after oral administration in STZ-induced diabetic rats. The glucose-lowering effect of orally administered In-Tf in STZ-induced diabetic rats was improved by either T-8 or BFA. However, the effect of T-8 was more potent than that of BFA, especially at 7 h after administration. Either non-conjugated insulin or insulin-human serum albumin (In-HSA) conjugate by itself or in combination with T-8 did not show any hypoglycemic effect after oral administration, indicating that T-8-enhanced hypoglycemic activity of In-Tf was due to a selective enhancement of TfR-mediated transcytosis. CONCLUSIONS Our data indicated that T-8 could be used to increase the GI absorption of insulin as a transferrin conjugate. T-8, as an enhancer of TfR-mediated transcytosis, is better than the previously reported BFA. T-8 produces a higher increase on the transport of In-Tf and a lower toxicity on epithelial cells. Our findings provide an alternative approach to promote the GI absorption of insulin, as well as other peptide or protein drugs.
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Affiliation(s)
- C Q Xia
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles 90089-9121, USA
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Abstract
OBJECTIVE Antley-Bixler syndrome (ABS) is a rare disorder characterized by multiple malformations of cartilage and bone including multisynostotic osteodysgenesis, midface hypoplasia, choanal atresia or stenosis, femoral bowing, neonatal fractures and multiple joint contractures and, occasionally, urogenital, gastrointestinal or cardiac defects. Since the first report in 1975, at least 34 cases (including this report) have been described. We present 2 cases of congenital hydrocephalus, suggesting the cause of craniosynostosis and midface hypoplasia is associated with ABS. CLINICAL PRESENTATION The first case was a 1-day-old female with Arnold-Chiari malformation, multiple cranial synostosis, obstructive hydrocephalus and radioulnahumeral synostosis. Ventriculoperitoneal (V-P) shunting was performed when she was 7 days old. She died 42 days later due to cardiopulmonary failure. The second case was a 2-month-old female with bilateral coronal synostosis, obstructive hydrocephalus and brachycephaly. V-P shunting was done soon after her admission, and bilateral lateral canthal advancement with the floating forehead procedure was performed 1 month later. She is still alive with good development. DISCUSSION The main anomalies of the ABS can be divided into 4 categories: craniofacial, skeletal, extremity and urogenital anomalies. They may be the result of mutation in the fibroblast growth factor receptor 2 (Ser351Cys) gene, which was confirmed in our case 2. Craniosynostosis combined with hydrocephalus created congenital increased intracranial pressure (IICP). Early V-P shunt implantation and surgical release of the closed suture and lateral canthal advancement should be done as soon as possible, ideally when the patient is younger than 3 months. CONCLUSION Early correction of craniosynostosis was feasible and safe for one of our patients. We offer our experience in the treatment of hydrocephalus and correction of craniosynostosis to relieve IICP.
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Affiliation(s)
- H J Lee
- Department of Neurosurgery, China Medical College Hospital Taichung, Taiwan, ROC
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Lengeler KB, Davidson RC, D'souza C, Harashima T, Shen WC, Wang P, Pan X, Waugh M, Heitman J. Signal transduction cascades regulating fungal development and virulence. Microbiol Mol Biol Rev 2000; 64:746-85. [PMID: 11104818 PMCID: PMC99013 DOI: 10.1128/mmbr.64.4.746-785.2000] [Citation(s) in RCA: 647] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cellular differentiation, mating, and filamentous growth are regulated in many fungi by environmental and nutritional signals. For example, in response to nitrogen limitation, diploid cells of the yeast Saccharomyces cerevisiae undergo a dimorphic transition to filamentous growth referred to as pseudohyphal differentiation. Yeast filamentous growth is regulated, in part, by two conserved signal transduction cascades: a mitogen-activated protein kinase cascade and a G-protein regulated cyclic AMP signaling pathway. Related signaling cascades play an analogous role in regulating mating and virulence in the plant fungal pathogen Ustilago maydis and the human fungal pathogens Cryptococcus neoformans and Candida albicans. We review here studies on the signaling cascades that regulate development of these and other fungi. This analysis illustrates both how the model yeast S. cerevisiae can serve as a paradigm for signaling in other organisms and also how studies in other fungi provide insights into conserved signaling pathways that operate in many divergent organisms.
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Affiliation(s)
- K B Lengeler
- Departments of Genetics, Pharmacology and Cancer Biology, Microbiology, and Medicine, Howard Hughes Medical Institute, Duke University Medical Center, Durham, North Carolina 27710, USA
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Lengeler KB, Davidson RC, D'souza C, Harashima T, Shen WC, Wang P, Pan X, Waugh M, Heitman J. Signal transduction cascades regulating fungal development and virulence. Microbiol Mol Biol Rev 2000. [PMID: 11104818 DOI: 10.1023/a:1024123915158] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Cellular differentiation, mating, and filamentous growth are regulated in many fungi by environmental and nutritional signals. For example, in response to nitrogen limitation, diploid cells of the yeast Saccharomyces cerevisiae undergo a dimorphic transition to filamentous growth referred to as pseudohyphal differentiation. Yeast filamentous growth is regulated, in part, by two conserved signal transduction cascades: a mitogen-activated protein kinase cascade and a G-protein regulated cyclic AMP signaling pathway. Related signaling cascades play an analogous role in regulating mating and virulence in the plant fungal pathogen Ustilago maydis and the human fungal pathogens Cryptococcus neoformans and Candida albicans. We review here studies on the signaling cascades that regulate development of these and other fungi. This analysis illustrates both how the model yeast S. cerevisiae can serve as a paradigm for signaling in other organisms and also how studies in other fungi provide insights into conserved signaling pathways that operate in many divergent organisms.
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Affiliation(s)
- K B Lengeler
- Departments of Genetics, Pharmacology and Cancer Biology, Microbiology, and Medicine, Howard Hughes Medical Institute, Duke University Medical Center, Durham, North Carolina 27710, USA
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Xia CQ, Wang J, Shen WC. Hypoglycemic effect of insulin-transferrin conjugate in streptozotocin-induced diabetic rats. J Pharmacol Exp Ther 2000; 295:594-600. [PMID: 11046093] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Transferrin (Tf) receptor-mediated transcytosis of insulin-transferrin conjugate (In-Tf) has been demonstrated in cultured human enterocyte-like Caco-2 cells. In the present report, oral delivery of insulin as a Tf conjugate in streptozotocin (STZ)-induced diabetic rats was investigated. Human insulin was conjugated at a 1:1 molar ratio to iron-loaded human Tf by a disulfide linkage. The stability of In-Tf and the free insulin released from In-Tf was studied in the presence of rat liver slices by using radioimmunoassay. The release of free insulin involved a disulfide reduction reaction that was inhibited by the pretreatment of the liver slice with a sulfhydryl-reactive reagent N-ethylmaleimide. A protease inhibitor cocktail also showed a partial inhibition of insulin degradation. The biological activity of the conjugate was tested in STZ-induced diabetic rats with s.c. administration, and the conjugate exhibited a slow but prolonged hypoglycemic effect compared with that of the native human insulin. In-Tf also displayed a slow but prolonged hypoglycemic effect after oral administration in fasted STZ-induced diabetic rats in a dose-dependent manner. Furthermore, In-Tf was detected in the serum of rats at 4 h after oral administration of the conjugate, indicating that In-Tf can overcome the barriers in the gastrointestinal tract and be absorbed as an intact conjugate. These results demonstrate that transepithelial transport via TfR-mediated transcytosis is a feasible approach for developing the oral delivery of insulin, as well as other peptide drugs.
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Affiliation(s)
- C Q Xia
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Southern California, Los Angeles, California, USA
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Shen WC. Emerging targeting concepts membrane-associated protein thiol-disulfide interchange activity: a potential target for anti-viral and anti-tumor drug design. J Drug Target 2000; 6:387-9. [PMID: 10937284 DOI: 10.3109/10611869908996845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Bowman-Birk protease inhibitor (BBI) was modified with a reversible lipidizing agent. The palmitoylated product, Pal-BBI, and BBI were iodinated and orally administered to mice using a gavage needle. A prolonged retention of Pal-BBI was found in the stomach. Furthermore, a significant amount of Pal-BBI was detected as intact polypeptide in the stomach of mice fed with Pal-BBI, while only degradation products were detected with BBI. There was also a significant increase of radioactivity in the blood and liver in mice 1.5 h post-administration of Pal-BBI. These results indicate that lipidized polypeptide can have a longer retention and lower digestion in the stomach. They also suggest that the Pal-BBI may have a higher gastrointestinal absorption than the original polypeptide.
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Affiliation(s)
- J Wang
- Department of Pharmaceutical Sciences, University of Southern California School of Pharmacy, Los Angeles 90033, USA
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35
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Chow KC, Lee CC, Lin TY, Shen WC, Wang JH, Peng CT, Lee CC. Congenital enterovirus 71 infection: a case study with virology and immunohistochemistry. Clin Infect Dis 2000; 31:509-12. [PMID: 10987713 DOI: 10.1086/313975] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/1999] [Revised: 02/02/1999] [Indexed: 11/03/2022] Open
Abstract
Previously reported enterovirus 71 (EV71) infections associated with hand-foot-mouth disease, aseptic meningitis, encephalitis, polio-like myelitis, and paralysis all have involved young children. We report a 28-year-old woman who possibly contracted EV71 infection during pregnancy. Obstetric ultrasonograms at 25 weeks of gestation revealed an abnormal placenta, as well as hepatosplenomegaly, liver calcification, excessive ascites, and mild hydrocephalus of the fetus. Presence of EV71 was determined by immunodot blotting, virus culture, and partial sequencing of the amplified product of nested reverse transcription-polymerase chain reaction. Postmortem immunohistochemistry further identified EV71 in the fetal midbrain and liver. The findings indicate that intrauterine EV71 infection is possible during pregnancy.
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Affiliation(s)
- K C Chow
- Departments of Medical Research, China Medical College Hospital, Taichung, Taiwan.
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36
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Chen JH, Shen WC. Rectal carcinoma with stercoral ulcer perforation. Hepatogastroenterology 2000; 47:1018-9. [PMID: 11020868] [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: 04/15/2023]
Abstract
We report a case of ruptured stercoral ulceration due to chronic constipation which is caused by rectal carcinoma. This case suffered from difficulty of stool passage for 5 months. Periumbilical pain and current-jelly stool were experienced before his admission. Physical examination revealed diffuse abdominal rebounding pain and laboratory data showed leukocytosis. Computed tomography demonstrated marked dilatation of the sigmoid colon with stool impaction due to neoplastic growth in the rectosigmoid junction. Thickening and edematous change of the colonic wall were noted. There was amorphous material with gas in the mesocolon, which indicated fecal peritonitis. Emergent operation with Hartman's procedure and left colostomy was performed. Diffuse pressure gangrene of the sigmoid colon wall with a perforating hole was identified. Pathologically, the resected colon specimen showed non-specific-acute and chronic inflammatory change. The perforating hole was surrounded by a necrotic border of ulcerative mucosa. After the operation, pelvic drainage was undertaken for 1 month and then the patient was discharged uneventfully.
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Affiliation(s)
- J H Chen
- Department of Radiology, China Medical College Hospital, Taichung, Taiwan
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Abstract
An 18-year-old girl who had severe headaches in the left temporal and facial regions was found to have a small enhanced dural-based parietal convexity mass. On magnetic resonance imaging (MRI), this mass was homogeneously enhanced with "dural tail sign," and was similar to a meningioma. This mass was completely removed surgically, and pathology proved it to be a cavernous angioma without previous hemorrhages. The patient's facial pain was dramatically relieved after surgery. A small dural mass causing severe facial pain is an unusual situation. The lack of hemosiderin in the extra-axial cavernous angioma often leads to the preoperative diagnosis of meningioma.
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Affiliation(s)
- W C Shen
- Department of Radiology, China Medical College Hospital, Taichung, Taiwan, R.O.C
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Affiliation(s)
- H C Lin
- Department of Pediatrics, China Medical College Hospital, Taichung, Taiwan
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Lee TI, Causton HC, Holstege FC, Shen WC, Hannett N, Jennings EG, Winston F, Green MR, Young RA. Redundant roles for the TFIID and SAGA complexes in global transcription. Nature 2000; 405:701-4. [PMID: 10864329 DOI: 10.1038/35015104] [Citation(s) in RCA: 285] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The transcription factors TFIID and SAGA are multi-subunit complexes involved in transcription by RNA polymerase II. TFIID and SAGA contain common TATA-binding protein (TBP)-associated factor (TAF(II)) subunits and each complex contains a subunit with histone acetyltransferase activity. These observations have raised questions about whether the functions of the two complexes in vivo are unique or overlapping. Here we use genome-wide expression analysis to investigate how expression of the yeast genome depends on both shared and unique subunits of these two complexes. We find that expression of most genes requires one or more of the common TAF(II) subunits, indicating that the functions of TFIID and SAGA are widely required for gene expression. Among the subunits shared by TFIID and SAGA are three histone-like TAF(II)s, which have been proposed to form a sub-complex and mediate a common function in global transcription. Unexpectedly, we find that the histone-like TAF(II)s have distinct roles in expression of the yeast genome. Most importantly, we show that the histone acetylase components of TFIID and SAGA (TAF(II)145 and Gcn5) are functionally redundant, indicating that expression of a large fraction of yeast genes can be regulated through the action of either complex.
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Affiliation(s)
- T I Lee
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts 02142, USA
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Affiliation(s)
- Y T Chang
- Department of Paediatrics, China Medical College Hospital, Taichung, Taiwan
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Shen WC. A case of cleidocranial dysplasia confirmed by 3D CT of the cranium. AJNR Am J Neuroradiol 2000; 21:609. [PMID: 10730665 PMCID: PMC8174994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Abstract
We report two boys diagnosed as having herpangina and hand-foot-mouth disease complicated by monoplegia during the outbreak enterovirus infection in Taiwan in 1998. Enterovirus 71 was identified in the stool and throat swab; neither polio nor Coxsackie viruses was identified. MRI showed unilateral lesions in the anterior horns of the spinal cord at T11-12 and C2-5. Although the MRI findings and sites of these lesions were similar to those of poliovirus-associated poliomyelitis, the virological data indicated that these boys were infected with enterovirus type 71.
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Affiliation(s)
- W C Shen
- Department of Radiology, and School of Medicine, China Medical College, China Medical College Hospital, No. 2 Yuh-Der Road, 407 Taichung, Taiwan, Republic of China.
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Abstract
We describe a 5 year-old girl who had a skin dimple of the back of her upper neck. MRI showed a dermal sinus tract in the upper cervical spine, associated with an intramedullary dermoid cyst at C 2-3, and spina bifida. A laminectomy was performed, the dermoid cyst and the sinus tract were completely removed. This congenital complex is very rare.
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Affiliation(s)
- W C Shen
- Department of Radiology, and School of Medicine, China Medical College, China Medical College Hospital, No. 2 Yuh-Der Road, 407 Taichung, Taiwan, Republic of China.
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44
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Affiliation(s)
- H C Wu
- Department of Urology, China Medical College Hospital, Taichung, Taiwan
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Wang J, Shen D, Shen WC. Preparation, purification, and characterization of a reversibly lipidized desmopressin with potentiated anti-diuretic activity. Pharm Res 1999; 16:1674-9. [PMID: 10571271 DOI: 10.1023/a:1018929312715] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE . To prepare and characterize a reversibly lipidized dipalmitoyl desmopressin (DPP), and to compare its anti-diuretic efficacy and biodistribution with that of unmodified desmopressin (DDAVP). METHODS Dithiothreitol (DTT) was used to reduce the intramolecular disulfide bond in DDAVP, and the reduced DDAVP was treated with a thiopyridine-containing disulfide lipidization reagent, Pal-CPD. The product, DPP, was purified by acid precipitation and, subsequently, by size-exclusion chromatography. Reversed-phase HPLC was used to analyze the purity and to evaluate the hydrophobicity of the product. Mass spectrometry was employed to characterize its molecular structure. The biological activity of DPP was demonstrated by the antidiuretic effects in vasopressin-deficient Brattleboro rats. Preliminary pharmacokinetic and biodistribution studies of intravenously injected DDAVP and DPP were carried out in CF-1 mice. RESULTS DDAVP was readily reduced by a 2-fold molar excess of DTT at 37 degrees C for 0.5 hr. DPP was formed by the reaction of reduced DDAVP with Pal-CPD. Each DPP molecule contains two palmitic acid moieties, which link to the peptide via two disulfide bonds. After acid precipitation and size-exclusion chromatography, the purity was found to be approximately 95%, and the overall yield was 57%. When DPP was administered subcutaneously to Brattleboro rats, the potency of the anti-diuretic activity of DDAVP was enhanced to more than 250-fold. The plasma concentration of intravenously injected DDAVP in mice decreased rapidly during the first 20 min and followed by a slow elimination rate. However, in DPP administered mice, the plasma concentration actually increased in the first 20 min, followed by a slow elimination with a rate similar to that in DDAVP-injected mice. The regeneration of DDAVP was detected in the plasma of mice treated with DPP. Studies of the organ distribution in mice indicated that the liver retention of DPP was longer than that of DDAVP. On the other hand, the intestinal excretion of DPP was significantly less than that of DDAVP. CONCLUSIONS The 250-fold increase of the anti-diuretic potency in DPP is most likely due to a slow elimination and prolonged tissue retention, together with the regeneration of active DDAVP, in the animals. Our results indicate that reversible lipidization is a simple and effective approach for improving the efficacy of many peptide drugs.
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Affiliation(s)
- J Wang
- Department of Pharmaceutical Sciences, University of Southern California School of Pharmacy, Los Angeles 90033, USA
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Shen WC, Chiu HH, Chow KC, Tsai CH. MR imaging findings of enteroviral encephaloymelitis: an outbreak in Taiwan. AJNR Am J Neuroradiol 1999; 20:1889-95. [PMID: 10588115 PMCID: PMC7657785] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND PURPOSE An outbreak of enterovirus infection occurred in Taiwan from late spring to early fall of 1998. Most of the pediatric infections presented as hand-foot-mouth disease (HFMD) and herpangina. A small portion of patients had symptoms of polio-like encephalitis and paralysis. The purpose of this study was to review the MR imaging findings in CNS involvement of enterovirus infection. METHODS Twenty patients who had HFMD and clinical encephalitis were examined with MR imaging. T1-weighted and T2-weighted MR images were obtained. From the rectum, throat, CSF, and peripheral blood, the presence of enterovirus 71 (EV 71) was determined by virus culture, immunofluorescent microscopy, immunologic dot blotting, and reverse-transcription polymerase chain reaction. RESULTS MR imaging studies of 20 patients showed hyperintensity in the brain stem and spinal cord in 15 patients, as seen on T2-weighted images. The major CNS lesions were in the medulla oblongata, pons, midbrain, and the dentate nuclei of the cerebellum. In some cases, the lesions involved the spinal cord (three cases) as well as the thalamus (two cases) and putamina (one case). Five patients had normal MR imaging results. After the appropriate management for tachycardia and tachypnea, 18 patients recovered within 1 to 2 weeks. In the follow-up MR imaging examination of five patients, the lesions completely disappeared within 2 weeks to 2 months. In two patients who were still respirator-dependent, MR imaging showed the tissue destruction in the posterior portions of the medulla, pons, and the ventral horns of cervical spinal cord. In one patient, most of midbrain was damaged. The presence of EV 71 was detected in specimens from 18 patients. CONCLUSION Because EV 71 was identified in 18 patients, and no other virus was detected, EV 71 was determined to be the major causative agent of this encephalomyelitis. Brain stem and cervical spinal cord involvement are characteristic findings of enteroviral encephalomyelitis.
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Affiliation(s)
- W C Shen
- Department of Radiology, China Medical College Hospital and School of Medicine, Taichung, Taiwan
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Abstract
This study reports 10 aneurysms found in the bifurcation of the middle cerebral arteries (MCA) of seven patients, diagnosed by computed tomography angiography (CTA) and confirmed by digital subtraction angiography and surgery. Six of the 10 aneurysms bled and caused subarachnoid hemorrhage (SAH): the SAH was predominant in the Sylvian fissure where the aneurysms located. Eight aneurysms had a saccular pattern, while two had a fusiform pattern. Nine aneurysms were larger than 8 mm and were easily detected by CTA, while one aneurysm was 6 mm in diameter and was missed initially. It was found, however, after the direction of the CTA was readjusted. In conclusion, the hemorrhages of aneurysm in the bifurcation of the MCA predominated in the Sylvian fissure, and the size of the aneurysm is often big, and thus easily detected by CTA.
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Affiliation(s)
- W C Shen
- Department of Radiology, China Medical College Hospital and School of Medicine, China Medical College, Taichung, Taiwan, ROC.
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Shen WC. Frontiers of drug development. 26-28 July 1999, Pasadena, CA, USA. IDrugs 1999; 2:1002-4. [PMID: 16118708] [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: 05/04/2023]
Abstract
This conference on the Frontiers of Drug Development was co-sponsored by the University of Southern California (USC) and three Japanese universities: Tokyo University of Pharmacy & Life Science (TUPLS), Nagoya City University (NCU), and Meijo University (MU). A major focus of the meeting was to present research activities from these four universities in the area of drug development in conventional, as well as in complementary, therapy. Speakers were also invited from universities other than the sponsoring institutions. The intention was to present a comprehensive coverage of drug development processes, from molecular design to pharmacoeconomic considerations.
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Affiliation(s)
- W C Shen
- School of Pharmacy, University of Southern California, 1985 Zonal Avenue, PSC 404BB, Los Angeles, CA 90033, USA.
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Chen JH, Chai JW, Shen WC. Magnetization transfer contrast imaging of liver cirrhosis. Hepatogastroenterology 1999; 46:2872-7. [PMID: 10576364] [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: 02/14/2023]
Abstract
BACKGROUND/AIMS To test the feasibility of magnetization transfer contrast (MTC) imaging in the evaluation of liver cirrhosis. METHODOLOGY Three normal volunteers and 22 cirrhotic liver patients (13 of them harbored hepatoma) were prospectively studied with on-resonance binomial pulsed MTC imaging using a 1.0 Tesla MR scanner. Both MTC and non-MTC images were acquired. The magnetization transfer (MT) effect (defined as: 1-signal intensity of MTC/signal intensity of non-MTC), was used as an indicator and was correlated with different disease status. Lesion-to-liver contrast of non-MTC versus MTC imaging was also compared. RESULTS Chronic hepatitis and early fibrosis had a MT effect similar to that of the normal group. Frank cirrhosis had the strongest MT effect. Cirrhosis, when infiltrated by diffuse hepatoma, showed a significantly weaker MT effect than that of the normal group (p<0.05), early cirrhosis (P<0.005), and frank cirrhosis (p<0.05). Overall, the MT effects in these 22 patients were widely variable. There was no significant improvement in lesion contrast of MTC imaging when compared to that of non-MTC imaging due to complex signal attenuation behavior of either the background liver tissue or the tumor itself. CONCLUSIONS The complex pathological change of the cirrhotic liver tissue may account for the wide variation of the MT effect and the compromised lesion contrast in cirrhotic patients. Caution should be taken when cirrhotic tissue has an unusually weak MT effect. Then, the possibility of a mixed disease process such as fatty metamorphosis or diffuse hepatoma should be highly suspected. Our experience shows that MTC imaging plays a potential role in the evaluation of the multi-facets of cirrhotic tissue change.
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Affiliation(s)
- J H Chen
- Department of Radiology, China Medical College Hospital, Taichung, Taiwan.
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Affiliation(s)
- H F Lu
- China Medical College Hospital, Taichung, Taiwan
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