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Cher GLY, Kuo YT, Peng CL, Wang HP. Lotus sign: The lumen-apposing metal stent that failed to bloom. Endoscopy 2024; 56:E327-E328. [PMID: 38594004 PMCID: PMC11003800 DOI: 10.1055/a-2288-5076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Gabriel Liu Yuan Cher
- Division of Gastroenterology, Department of General Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Kuo
- Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Ling Peng
- Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Cheng YW, Kuo PC, Chen SH, Kuo YT, Liu TL, Chan WS, Chan KC, Yeh YC. Early prediction of mortality at sepsis diagnosis time in critically ill patients by using interpretable machine learning. J Clin Monit Comput 2024; 38:271-279. [PMID: 38150124 DOI: 10.1007/s10877-023-01108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023]
Abstract
This study applied machine learning for the early prediction of 30-day mortality at sepsis diagnosis time in critically ill patients. Retrospective study using data collected from the Medical Information Mart for Intensive Care IV database. The data of the patient cohort was divided on the basis of the year of hospitalization, into training (2008-2013), validation (2014-2016), and testing (2017-2019) datasets. 24,377 patients with the sepsis diagnosis time < 24 h after intensive care unit (ICU) admission were included. A gradient boosting tree-based algorithm (XGBoost) was used for training the machine learning model to predict 30-day mortality at sepsis diagnosis time in critically ill patients. Model performance was measured in both discrimination and calibration aspects. The model was interpreted using the SHapley Additive exPlanations (SHAP) module. The 30-day mortality rate of the testing dataset was 17.9%, and 39 features were selected for the machine learning model. Model performance on the testing dataset achieved an area under the receiver operating characteristic curve (AUROC) of 0.853 (95% CI 0.837-0.868) and an area under the precision-recall curves of 0.581 (95% CI 0.541-0.619). The calibration plot for the model revealed a slope of 1.03 (95% CI 0.94-1.12) and intercept of 0.14 (95% CI 0.04-0.25). The SHAP revealed the top three most significant features, namely age, increased red blood cell distribution width, and respiratory rate. Our study demonstrated the feasibility of using the interpretable machine learning model to predict mortality at sepsis diagnosis time.
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Affiliation(s)
- Yi-Wei Cheng
- Taiwan AI Labs, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Po-Chih Kuo
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Shih-Hong Chen
- Department of Anesthesiology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
| | - Yu-Ting Kuo
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | | | - Wing-Sum Chan
- Department of Anesthesiology, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S Rd, Banqiao District, New Taipei City, 220, Taiwan.
| | - Kuang-Cheng Chan
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan.
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Chung CS, Kuo YT, Chiu YC, Lin YC, Yang CY, Chen KC, Liao SC, Sun CK, Lin YC, Wang HP. Multicenter study of the efficacy and safety of electrocautery-enhanced lumen-apposing metal stents for the internal drainage of pancreatic fluid collections. Sci Rep 2024; 14:5481. [PMID: 38443387 PMCID: PMC10914712 DOI: 10.1038/s41598-024-53785-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Pancreatic fluid collections (PFCs) including pancreatic pseudocyst (PP) and walled-off necrosis (WON) are complications after acute pancreatitis. We aimed to evaluate the efficacy and safety of endoscopic ultrasound (EUS)-guided lumen-apposing metal stent (LAMS) placement to manage PFCs. Between June 2019 and May 2023, patients with symptomatic PFCs who underwent EUS-guided electrocautery-enhanced LAMS drainage were enrolled retrospectively from eight tertiary centers in Taiwan. In total, 33 [14 (42.42%) PP and 19 (57.58%) WON] patients were enrolled. Gallstones (27.27%) and abdominal pain (72.73%) were the most common etiology and indication for drainage. The technical and clinical success rates were 100% and 96.97%, respectively, and the mean procedure time was 30.55 (± 16.17) min. Complications included one (3.03%) case of self-limited bleeding; there were no cases of mortality. Seven (21.21%) patients had recurrence. Patients with disconnected pancreatic duct syndrome (DPDS) had a higher recurrence rate than those without (71.43% vs. 38.46%, p = 0.05). After replacing LAMSs with transmural double-pigtail plastic stents (DPSs) in the DPDS patients, the DPS migration rate was higher in the patients with recurrence (100% vs. 33.33%, p = 0.04). In conclusion, drainage of symptomatic PFCs with EUS-guided electrocautery-enhanced LAMS appears to be efficient and safe. Replacing LAMSs with DPSs in DPDS patients was associated with a lower recurrence rate.
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Affiliation(s)
- Chen-Shuan Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Ting Kuo
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yang-Chao Lin
- Department of Gastroenterology and Hepatology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Chi-Ying Yang
- Department of Internal Medicine, Digestive Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Chih Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Szu-Chia Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheuk-Kay Sun
- Department of Internal Medicine, Shin Kong Wo Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yen-Chih Lin
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Chong CCN, Pittayanon R, Pausawasdi N, Bhatia V, Okuno N, Tang RSY, Cheng TY, Kuo YT, Oh D, Song TJ, Kim TH, Hara K, Chan AWH, Leung HHW, Yang A, Jin Z, Xu C, Lakhtakia S, Wang HP, Seo DW, Teoh AYB, Ho LKY, Kida M. Consensus statements on endoscopic ultrasound-guided tissue acquisition. Guidelines from the Asian Endoscopic Ultrasound Group. Dig Endosc 2024. [PMID: 38433315 DOI: 10.1111/den.14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 01/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This consensus was developed by the Asian EUS Group (AEG), who aimed to formulate a set of practice guidelines addressing various aspects of endoscopic ultrasound-guided tissue acquisition (EUS-TA). METHODS The AEG initiated the development of consensus statements and formed an expert panel comprising surgeons, gastroenterologists, and pathologists. Three online consensus meetings were conducted to consolidate the statements and votes. The statements were presented and discussed in the first two consensus meetings and revised according to comments. Final voting was conducted at a third consensus meeting. The Grading of Recommendations, Assessment, Development, and Evaluation system was adopted to define the strength of the recommendations and quality of evidence. RESULTS A total of 20 clinical questions and statements regarding EUS-TA were formulated. The committee recommended that fine-needle biopsy (FNB) needles be preferred over conventional fine-needle aspiration (FNA) needles for EUS-TA of subepithelial lesions. For solid pancreatic masses, rapid on-site evaluation is not routinely recommended when FNB needles are used. For dedicated FNB needles, fork-tip and Franseen-tip needles have essentially equivalent performance. CONCLUSION This consensus provides guidance for EUS-TA, thereby enhancing the quality of EUS-TA.
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Affiliation(s)
- Charing Ching-Ning Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross, Bangkok, Thailand
| | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Endoscopy Center, Mahidol University, Bangkok, Thailand
| | - Vikram Bhatia
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Nozomi Okuno
- Department of Gastroenterology, Aichi Cancer Center, Aichi, Japan
| | - Raymond Shing-Yan Tang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Institute of Digestive Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tsu-Yao Cheng
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Dongwook Oh
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Jun Song
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Hyeon Kim
- Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center, Aichi, Japan
| | - Anthony Wing-Hung Chan
- Department of Anatomical and Cellular Pathology, Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Howard Ho Wai Leung
- Department of Anatomical and Cellular Pathology, Laboratory of Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Shanghai, China
| | - Can Xu
- Department of Gastroenterology, Changhai Hospital, Shanghai, China
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Dong-Wan Seo
- Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Anthony Yuen-Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Khek-Yu Ho
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, National University Health System, Singapore City, Singapore
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
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Wong WF, Kuo YT, Han ML, Wang HP. Endoscopic ultrasound avoids diagnostic ERCP among the ASGE high-risk group - Experience in an Asian population. J Formos Med Assoc 2024; 123:374-380. [PMID: 37673777 DOI: 10.1016/j.jfma.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND A prediction system for common bile duct (CBD) stones was originally published by the American Society for Gastrointestinal Endoscopy (ASGE) in 2010 and was last revised in 2019. We wanted to investigate its application in an Asian population, who have different etiologies of bile duct stone formation and accessibility to medical service compared to the West. METHODS This is a single center retrospective study. Patients who received endoscopic ultrasound (EUS) for suspected CBD stones were collected from our endoscopic record system over a 10-year period. The accuracy of the revised ASGE criteria was estimated according to the results of EUS. A minimum follow-up of 6 months was required to detect false negative results. RESULTS 142 patients were enrolled, 87 (61%) patients had CBD stones. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the revised ASGE criteria for high-risk patients were 69%, 38%, 64%, 44%, and 57%. 36% of the ASGE-defined high-risk patients negative for CBD stones on EUS. The two significant predictors for CBD stone were CBD dilatation (adjusted OR 3.06, 95% C.I. 1.31-7.17, p = 0.010) and ascending cholangitis (adjusted OR 2.28, 95% C.I. 1.01-5.15, p = 0.047). CONCLUSION ASGE recommends that patients defined as high-risk for choledocholithiasis be considered for direct ERCP without prior need for confirmation imaging. However, our findings indicate a high rate (36%) of patients in that group negative for CBD stones on EUS. Hence, EUS is still be suggested first in selective high-risk patients so that diagnostic ERCP can be avoided in our Asian society.
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Affiliation(s)
- Weng-Fai Wong
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Ting Kuo
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ming-Lun Han
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Kuo YT, Chang TS, Tsai CC, Chang HC, Chia YY. Optimizing nonintubated laryngeal microsurgery: The effectiveness and safety of superior laryngeal nerve block with high-flow nasal oxygen-A prospective cohort study. J Chin Med Assoc 2024; 87:334-339. [PMID: 38305707 DOI: 10.1097/jcma.0000000000001057] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Laryngeal microsurgery (LMS) typically requires intubated general anesthesia (ITGA). Although nonintubated general anesthesia (NIGA) with high-flow nasal oxygen (HFNO) can be applied with LMS, a muscle relaxant is required, which can cause apnea and hypercapnia. This study evaluated the effectiveness of a superior laryngeal nerve block (SLNB) in improving safety during LMS. METHODS This prospective cohort study enrolled a cumulative total of 61 adult patients received LMS under intravenous general anesthesia and allocated to three groups: ITGA group (n = 18), which patients performed intubation; neuromuscular blocking (NMB) group (n = 21), which patients administrated muscle relaxant without intubation and superior laryngeal nerve block (NB) group (n = 22), which patients performed SLNB without intubation or muscle relaxant. RESULTS The average (SD) values of PaCO 2 after surgery in ITGA, NMB, and NB group were 50.8 (7.5), 97.5 (24.9), and 54.8 (8.8) mmHg, respectively. The mean postoperative pH values were 7.33 (0.04), 7.14 (0.07), and 7.33 (0.04), respectively. The results were all p < 0.001, and the average pH value of the NMB group was lower than that of the ITGA and NB groups. During the LMS, the mean heart rate (HR) (93.9 [18.1] bpm) and noninvasive blood pressure systolic (NBPs) (143.5 [28.2] mmHg) in the NMB group were higher than those in the ITGA group (HR = 77.4 [13.5] bpm and NBPs = 132.7 [20.8] mmHg) and NB group (HR = 82.3 [17.4] bpm and NBPs = 120.9 [25.0] mmHg). The results of p value by HR and NBPs are p < 0.001. The PaCO 2 and pH values are similar between ITGA group and NB group. CONCLUSION Our approach of using HFNO with SLNB was successful for performing nonintubated LMS, enabling the patients to maintain spontaneous breathing and effectively eliminate CO 2 . This approach reduces the risks of hypercapnia and acidosis even when the duration of LMS exceeds 30 minutes.
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Affiliation(s)
- Yu-Ting Kuo
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Ting-Shou Chang
- Department of Otolaryngology-Head & Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- School of Medicine, National Defense Medicine Center, Taipei, Taiwan, ROC
| | - Chih-Chi Tsai
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Hsin-Chih Chang
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yuan-Yi Chia
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Defense Medicine Center, Taipei, Taiwan, ROC
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Su HJ, Chen CC, Kuo YT, Han ML, Tsai MC, Liu KL, Wang HP. Clinical outcomes of different types of metallic stents in malignant distal duodenum stenosis: A retrospective study. J Formos Med Assoc 2024:S0929-6646(23)00493-X. [PMID: 38171957 DOI: 10.1016/j.jfma.2023.12.013] [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: 06/18/2023] [Revised: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND/PURPOSE Endoscopic stenting at malignant distal duodenum stenosis (MDDS) is challenging because of the duodenal C-loop configuration, the acute angle of the duodenojejunal junction, and the limited length of the endoscope. Few studies have investigated the clinical outcomes of stenting at the distal duodenum. Therefore, this study aimed to investigate the clinical outcomes of treating MDDS with different types of metallic stents. METHODS From January 2012 to December 2020, fifty-six patients with MDDS who underwent duodenal stenting were enrolled for analysis. Thirty-five patients received uncovered self-expandable metallic stents (UC-SEMS), and twenty-one patients received partially covered self-expandable metallic stents (PC-SEMS). All patients were followed up till death or for 18 months. The clinical success rate, stent dysfunction rate, and stent patency were compared between the groups. Multivariate analysis was conducted to identify factors related to stent dysfunction. RESULTS The clinical success rates were 85.7 % in both the UC-SEMS and PC-SEMS groups. Stent dysfunction rates (UC-SEMS: 34.3 %, PC-SEMS: 38.1 %, p = 0.773) and the average stent patency (UC-SEMS: 117.2 days, PC-SEMS: 100.0 days, p = 0.576) were not statistically different between the groups. Multivariate analysis disclosed the age ≥65 years was significantly related to stent dysfunction (odds ratio: 4.78, p = 0.031). CONCLUSIONS Both UC-SEMS and PC-SEMS are safe and effective treatment options for MDDS. However, stent dysfunction remains a significant issue to overcome, particularly in the elderly. Further research is needed to explore novel strategies that can improve the effectiveness of stent placement and reduce the risk of stent dysfunction.
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Affiliation(s)
- Hau-Jyun Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ting Kuo
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Lun Han
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chang Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Hong TC, El-Omar EM, Kuo YT, Wu JY, Chen MJ, Chen CC, Fang YJ, Leow AHR, Lu H, Lin JT, Tu YK, Yamaoka Y, Wu MS, Liou JM. Primary antibiotic resistance of Helicobacter pylori in the Asia-Pacific region between 1990 and 2022: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2024; 9:56-67. [PMID: 37972625 DOI: 10.1016/s2468-1253(23)00281-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND We previously showed rising primary antibiotic resistance of Helicobacter pylori during 1990-2015 in the Asia-Pacific region. However, whether primary antibiotic resistance continues to rise is unknown. Therefore, we aimed to assess the latest prevalence of H pylori antibiotic resistance in this region. METHODS We did an updated systematic review and meta-analysis of observational studies and randomised controlled trials published in PubMed, Embase, and Cochrane Library between Jan 1, 1990, and July 12, 2023. Studies investigating primary H pylori resistance to clarithromycin, metronidazole, levofloxacin, amoxicillin, or tetracycline in individuals naive to eradication therapy in the Asia-Pacific region (as defined by the UN geoscheme) were eligible for inclusion. There were no language restrictions. Studies that focused on specific subpopulations (eg, children) were excluded. Using a standardised extraction form, two authors independently reviewed and extracted summary data from all eligible articles. The updated prevalence of antibiotic resistance was generated by meta-analysis under a random-effects model and subgroup analyses were done by countries and periods of study. Between-study variability was assessed by use of I2. The study is registered in PROSPERO, CRD42022339956. FINDINGS A total of 351 studies, including 175 new studies and 176 studies from our previous analysis, were included in this meta-analysis. The overall prevalence of primary antibiotic resistance of H pylori between 1990 and 2022 was 22% (95% CI 20-23; I2=96%) for clarithromycin, 52% (49-55; I2=99%) for metronidazole, 26% (24-29; I2=96%) for levofloxacin, 4% (3-5; I2=95%) for tetracycline, and 4% (3-5; I2=95%) for amoxicillin. Prevalence varied considerably between countries and across study periods. From 1990 to 2022, the prevalence of primary resistance increased for clarithromycin, metronidazole, and levofloxacin but remained stable for amoxicillin and tetracycline. The latest primary resistance prevalences were 30% (95% CI 28-33; I2=93%) for clarithromycin, 61% (55-66; I2=99%) for metronidazole, 35% (31-39; I2=95%) for levofloxacin, 4% (2-6; I2=96%) for tetracycline, and 6% (4-8; I2=96%) for amoxicillin in the Asia-Pacific region. INTERPRETATION Treatment guidelines should be adapted in response to the rising primary resistance of key antibiotics for H pylori eradication. A global policy to control and monitor the antibiotic resistance of H pylori is urgently needed. FUNDING Ministry of Health and Welfare of Taiwan, National Science and Technology Council of Taiwan, and National Taiwan University. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Tzu-Chan Hong
- Department of Internal Medicine, National Taiwan University Cancer Centre, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Emad M El-Omar
- UNSW Microbiome Research Centre, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Yu-Ting Kuo
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jeng-Yih Wu
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Jyh Chen
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chieh-Chang Chen
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Jen Fang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Departments of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, National Taiwan University College of Medicine, Yun-Lin, Taiwan
| | - Alex Hwong Ruey Leow
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hong Lu
- Gastrointestinal Division, Renji Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai Institution of Digestive Disease, Shanghai, China
| | - Jaw-Town Lin
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan; Research Center for Global and Local Infectious Diseases, Oita University, Yufu, Japan; Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jyh-Ming Liou
- Department of Internal Medicine, National Taiwan University Cancer Centre, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Kuo YT, Wang HP. A tent-like sign during endoscopic ultrasound-guided gastroenterostomy: an indication of a misdeployed stent in the peritoneum. Endoscopy 2023; 55:E934-E935. [PMID: 37500085 PMCID: PMC10374396 DOI: 10.1055/a-2106-1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Yu-Ting Kuo
- Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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10
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Lin KY, Kuo YT, Cheng MF, Chen PL, Wang HP, Cheng TY, Chang CH, Kao HF, Yang SH, Li HY, Lin CH, Chou YT, Chung AK, Wu WC, Lu JY, Wang CY, Hsih WH, Wen CY, Yang WS, Shih SR. Traits of Patients With Pituitary Tumors in Multiple Endocrine Neoplasia Type 1 and Comparing Different Mutation Status. J Clin Endocrinol Metab 2023; 108:e1532-e1541. [PMID: 37390813 DOI: 10.1210/clinem/dgad387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/02/2023]
Abstract
CONTEXT Recent studies suggest that the clinical characteristics and biological behavior of pituitary tumors (PITs) in patients with multiple endocrine neoplasia type 1 (MEN1) may not be as aggressive as previously reported. Increased imaging of the pituitary as recommended by screening guidelines identifies more tumors, potentially at an earlier stage. However, it is unknown if these tumors have different clinical characteristics in different MEN1 mutations. OBJECTIVE To assess characteristics of patients with MEN1 with and without PITs, and compare among different MEN1 mutations. METHODS Data of patients with MEN1 in a tertiary referral center from 2010 to 2023 were retrospectively analyzed. RESULTS Forty-two patients with MEN1 were included. Twenty-four patients had PITs, 3 of which were invasive and managed with transsphenoidal surgery. One PIT enlarged during follow-up. Patients with PITs had a higher median age at MEN1 diagnosis than those without PITs. MEN1 mutations were identified in 57.1% of patients, including 5 novel mutations. In patients with PITs, those with MEN1 mutations (mutation+/PIT+ group) had more additional MEN1-associated tumors than those without (mutation-/PIT+ group). The mutation+/PIT+ group had a higher incidence of adrenal tumors and a lower median age at initial manifestation of MEN1 than the mutation-/PIT+ group. The most common neuroendocrine neoplasm was nonfunctional in the mutation+/PIT+ group and insulin-secreting in the mutation-/PIT+ group. CONCLUSION This is the first study comparing characteristics of patients with MEN1 with and without PITs harboring different mutations. Patients without MEN1 mutations tended to have less organ involvement and it might be reasonable for them to receive less intensive follow-up.
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Affiliation(s)
- Kuan-Yu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu City 640203, Taiwan
| | - Yu-Ting Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei 100025, Taiwan
| | - Pei-Lung Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Tsu-Yao Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Department of Laboratory Medicine, National Taiwan University Cancer Center, Taipei 106037, Taiwan
| | - Chia-Hsuin Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Hsiang-Fong Kao
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei 106037, Taiwan
| | - Shih-Hung Yang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Hung-Yuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu 302058, Taiwan
| | - Yuh-Tsyr Chou
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei 100233, Taiwan
| | - An-Ko Chung
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei 100233, Taiwan
| | - Wan-Chen Wu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Jin-Ying Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Chih-Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
| | - Wen-Hui Hsih
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu City 640203, Taiwan
| | - Chen-Yu Wen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu City 640203, Taiwan
| | - Wei-Shiung Yang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
| | - Shyang-Rong Shih
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Center of Anti-Aging and Health Consultation, National Taiwan University Hospital, Taipei 100225, Taiwan
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11
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Liu CH, Kuo YT, Lin CJ, Lin LT. Involvement of cell surface glycosaminoglycans in chebulagic acid's and punicalagin's antiviral activities against Coxsackievirus A16 infection. Phytomedicine 2023; 120:155047. [PMID: 37690230 DOI: 10.1016/j.phymed.2023.155047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Coxsackievirus A16 (CVA16) is responsible for several recent outbreaks of Hand, Foot, and Mouth Disease in the Asia-Pacific region, and there are currently no vaccines or specific treatments available. We have previously identified two tannins, chebulagic acid (CHLA) and punicalagin (PUG), as efficient entry inhibitors against multiple viruses known to engage cell surface glycosaminoglycans (GAGs). Interestingly, these two phytochemicals could also block enterovirus infection by directly inactivating CVA16 virions, which were recently reported to utilize GAGs to mediate its entry. PURPOSE The aim of this study is to evaluate the involvement of GAGs in the anti-CVA16 activities of CHLA and PUG. METHODS To explore a potential mechanistic link, the role of GAGs in promoting CVA16 entry was first confirmed by treating human rhabdomyosarcoma (RD) cells with soluble heparin or GAG lyases including heparinase and chondroitinase. We then performed a combination treatment of CHLA or PUG with the GAG interaction inhibitors to assess whether CHLA's and PUG's anti-CVA16 activities were related to GAG competition. Molecular docking and surface plasmon resonance (SPR) were conducted to analyze the interactions between CHLA, PUG, and CVA16 capsid. Lastly, CRISPR/Cas9 knockout (KO) of the Exostosin glycosyltransferase 1 (EXT1) gene, which encodes a transmembrane glycosyltransferase involved in heparan sulfate biosynthesis, was used to validate the importance of GAGs in CHLA's and PUG's antiviral effects. RESULTS Intriguingly, combining GAG inhibition via heparin/GAG lyases treatments with CHLA and PUG revealed that their inhibitory activities against CVA16 infection were overlapping. Further molecular docking analysis indicated that the predicted binding sites of CHLA and PUG on the CVA16 capsid are in proximity to the putative residues recognized for GAG interaction, thus pointing to potential interference with the CVA16-GAG association. SPR analysis also confirmed the direct binding of CHLA and PUG to CVA16 capsid. Finally, RD cells with EXT1 KO decreased CHLA's and PUG's antiviral effect on CVA16 infection. CONCLUSION Altogether, our results suggest that CHLA and PUG bind to CVA16 capsid and prevent the virus' interaction with heparan sulfate and chondroitin sulfate for its entry. This study provides mechanistic insight into the antiviral activity of CHLA and PUG against CVA16, which may be helpful for the development of antiviral strategies against the enterovirus.
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Affiliation(s)
- Ching-Hsuan Liu
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; Department of Microbiology & Immunology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Chien-Ju Lin
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Liang-Tzung Lin
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
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12
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Chen YY, Liu CF, Shen YT, Kuo YT, Ko CC, Chen TY, Wu TC, Shih YJ. Development of real-time individualized risk prediction models for contrast associated acute kidney injury and 30-day dialysis after contrast enhanced computed tomography. Eur J Radiol 2023; 167:111034. [PMID: 37591134 DOI: 10.1016/j.ejrad.2023.111034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/20/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE This study aimed to develop preprocedural real-time artificial intelligence (AI)-based systems for predicting individualized risks of contrast-associated acute kidney injury (CA-AKI) and dialysis requirement within 30 days following contrast-enhanced computed tomography (CECT). METHOD This single-center, retrospective study analyzed adult patients from emergency or in-patient departments who underwent CECT; 18,895 patients were included after excluding those who were already on dialysis, had stage V chronic kidney disease, or had missing data regarding serum creatinine levels within 7 days before and after CECT. Clinical parameters, laboratory data, medication exposure, and comorbid diseases were selected as predictive features. The patients were randomly divided into model training and testing groups at a 7:3 ratio. Logistic regression (LR) and random forest (RF) were employed to create prediction models, which were evaluated using receiver operating characteristic curves. RESULTS The incidence rates of CA-AKI and dialysis within 30 days post-CECT were 6.69% and 0.98%, respectively. For CA-AKI prediction, LR and RF exhibited similar performance, with areas under curve (AUCs) of 0.769 and 0.757, respectively. For 30-day dialysis prediction, LR (AUC, 0.863) and RF (AUC, 0.872) also exhibited similar performance. Relative to eGFR-alone, the LR and RF models produced significantly higher AUCs for CA-AKI prediction (LR vs. eGFR alone, 0.769 vs. 0.626, p < 0.001) and 30-day dialysis prediction (RF vs. eGFR alone, 0.872 vs. 0.738, p < 0.001). CONCLUSIONS The proposed AI prediction models significantly outperformed eGFR-alone for predicting the CA-AKI and 30-day dialysis risks of emergency department and hospitalized patients who underwent CECT.
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Affiliation(s)
- Yen-Yu Chen
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Ting Shen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan; Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Precision Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Te-Chang Wu
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan; Department of Medical Sciences Industry, Chang Jung Christian University, Tainan, Taiwan
| | - Yun-Ju Shih
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan; Department of Nursing, Chang Jung Christian University, Tainan, Taiwan.
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Wang PY, Kuo YH, Sheu MJ, Kuo HT, Lee WY, Kuo YT, Wang SH. Lymphocyte-Rich Hepatocellular Carcinoma with Multiple Lymphadenopathy and Positive Epstein-Barr Virus Encoding Region. Case Reports Hepatol 2023; 2023:4797233. [PMID: 37583793 PMCID: PMC10425252 DOI: 10.1155/2023/4797233] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/22/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
Lymphocyte-rich hepatocellular carcinoma (HCC) represents the rarest subtype among the various subgroups of HCC, and limited clinical data are available for this particular subtype. It is commonly observed as a solitary lesion and tends to present at an early stage. Histopathological examination typically reveals tumor cells infiltrated by a lymphocyte-rich background, leading to its designation as lymphoepithelioma-like HCC. Unlike other lymphoepithelioma-like tumors associated with the Epstein-Barr virus (EBV), lymphocyte-rich HCC is predominantly negative for EBV. This subtype is characterized by more favorable clinical outcomes and prognosis compared to conventional HCC. Here, we present a case of lymphocyte-rich hepatocellular carcinoma (HCC) characterized by the presence of bilateral hepatic tumors and concurrent multiple lymphadenopathy. Interestingly, contrary to previous literature, the examination for the Epstein-Barr virus (EBV) revealed a positive result in this particular case.
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Affiliation(s)
- Pin-Yi Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Hsuan Kuo
- Division of Hematology and Oncology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Jen Sheu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Tao Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wen-Ying Lee
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Su-Hung Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
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14
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Liu CH, Tai CJ, Kuo YT, Chang SS, Lin LT. Combination of Oncolytic Measles Virus and Ursolic Acid Synergistically Induces Oncolysis of Hepatocellular Carcinoma Cells. Viruses 2023; 15:1294. [PMID: 37376594 DOI: 10.3390/v15061294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
Hepatocellular carcinoma (HCC) remains a difficult-to-treat cancer due to late diagnosis and limited curative treatment options. Developing more effective therapeutic strategies is essential for the management of HCC. Oncolytic virotherapy is a novel treatment modality for cancers, and its combination with small molecules merits further exploration. In this study, we combined oncolytic measles virus (MV) with the natural triterpenoid compound ursolic acid (UA) and evaluated their combination effect against HCC cells, including those harboring hepatitis B virus (HBV) or hepatitis C virus (HCV) replication. We found that the combination of MV and UA synergistically induced more cell death in Huh-7 HCC cells through enhanced apoptosis. In addition, increased oxidative stress and loss of mitochondrial potential were observed in the treated cells, indicating dysregulation of the mitochondria-dependent pathway. Similar synergistic cytotoxic effects were also found in HCC cells harboring HBV or HCV genomes. These findings underscore the potential of oncolytic MV and UA combination for further development as a treatment strategy for HCC.
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Affiliation(s)
- Ching-Hsuan Liu
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Microbiology & Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Chen-Jei Tai
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Ph.D. Program in Clinical Drug Development of Herbal Medicine, Taipei Medical University, Taipei 100, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Shen-Shong Chang
- Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taipei 111, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Liang-Tzung Lin
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
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15
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Penki VSS, Chang YL, Chen HY, Chu YT, Kuo YT, Dorairaj DP, Sudewi S, Ding SW, Hsu SCN. Denticity governs the formation of β-thioketiminato tri-copper(I) and mono-copper(I) complexes. Dalton Trans 2023. [PMID: 37199716 DOI: 10.1039/d3dt00474k] [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: 05/19/2023]
Abstract
Two classes of β-thioketiminate ligands, SN chelators (HL1 and HL2) and SNN chelators (HL3 and HL4), were prepared to understand their coordination behavior in copper(I) complex formation. The formation of these copper(I) complexes bearing β-thioketiminate ligands and their corresponding adducts toward isocyanide, PPh3, and CO was investigated to address two important issues. First, whether the denticity governs the copper(I) thiolate species formation between SN chelators and SNN chelators. Second, how the length of the pendant pyridyl arm affects the coordination and reactivity behaviors of copper(I) complexes. Based on the characterization results, it was found that the denticity of SN chelators and SNN chelators led to different nuclearity of copper(I)-thiolate species. The coordination modes of the pendant pyridyl arm were confirmed by FTIR measurements, which allow us to conclude that the electron donating ability of the LCu fragment is in the order of SNN-chelator (SNN bound) > SNN-chelators (SN bound) > SN-chelator.
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Affiliation(s)
| | - Yu-Lun Chang
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
| | - Hsing-Yin Chen
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
| | - Yu-Ting Chu
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Yu-Ting Kuo
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Dorothy Priyanka Dorairaj
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
- Department of Chemistry, National Institute of Technology, Tiruchirappalli 620015, India
| | - Sri Sudewi
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
- Department of pharmacy, Faculty of Mathematic and Natural science, Universitas Sam Ratulangi, Manado 95115, Indonesia
| | - Shang-Wu Ding
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Sodio C N Hsu
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
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Wang ML, Kuo YT, Kuo LC, Liang HP, Cheng YW, Yeh YC, Tsai MT, Chan WS, Chiu CT, Chao A, Chou NK, Yeh YC, Ku SC. Early prediction of delirium upon intensive care unit admission: Model development, validation, and deployment. J Clin Anesth 2023; 88:111121. [PMID: 37058755 DOI: 10.1016/j.jclinane.2023.111121] [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: 09/30/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
STUDY OBJECTIVE To develop, validate, and deploy models for predicting delirium in critically ill adult patients as early as upon intensive care unit (ICU) admission. DESIGN Retrospective cohort study. SETTING Single university teaching hospital in Taipei, Taiwan. PATIENTS 6238 critically ill patients from August 2020 to August 2021. MEASUREMENTS Data were extracted, pre-processed, and split into training and testing datasets based on the time period. Eligible variables included demographic characteristics, Glasgow Coma Scale, vital signs parameters, treatments, and laboratory data. The predicted outcome was delirium, defined as any positive result (a score ≥ 4) of the Intensive Care Delirium Screening Checklist that was assessed by primary care nurses in each 8-h shift within 48 h after ICU admission. We trained models to predict delirium upon ICU admission (ADM) and at 24 h (24H) after ICU admission by using logistic regression (LR), gradient boosted trees (GBT), and deep learning (DL) algorithms and compared the models' performance. MAIN RESULTS Eight features were extracted from the eligible features to train the ADM models, including age, body mass index, medical history of dementia, postoperative intensive monitoring, elective surgery, pre-ICU hospital stays, and GCS score and initial respiratory rate upon ICU admission. In the ADM testing dataset, the incidence of ICU delirium occurred within 24 h and 48 h was 32.9% and 36.2%, respectively. The area under the receiver operating characteristic curve (AUROC) (0.858, 95% CI 0.835-0.879) and area under the precision-recall curve (AUPRC) (0.814, 95% CI 0.780-0.844) for the ADM GBT model were the highest. The Brier scores of the ADM LR, GBT, and DL models were 0.149, 0.140, and 0.145, respectively. The AUROC (0.931, 95% CI 0.911-0.949) was the highest for the 24H DL model and the AUPRC (0.842, 95% CI 0.792-0.886) was the highest for the 24H LR model. CONCLUSION Our early prediction models based on data obtained upon ICU admission could achieve good performance in predicting delirium occurred within 48 h after ICU admission. Our 24-h models can improve delirium prediction for patients discharged >1 day after ICU admission.
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Affiliation(s)
- Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Kuo
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Lu-Cheng Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Ping Liang
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Yi-Wei Cheng
- Taiwan AI Labs, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chen Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tao Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wing-Sum Chan
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Ching-Tang Chiu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Anne Chao
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Kuan Chou
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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17
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Kuo YT, Chu YL, Wong WF, Han ML, Chen CC, Jan IS, Cheng WC, Shun CT, Tsai MC, Cheng TY, Wang HP. Randomized trial of contrast-enhanced harmonic guidance versus fanning technique for EUS-guided fine-needle biopsy sampling of solid pancreatic lesions. Gastrointest Endosc 2023; 97:732-740. [PMID: 36509113 DOI: 10.1016/j.gie.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS For EUS-guided fine-needle biopsy sampling (EUS-FNB) of solid pancreatic lesions (SPLs), the role of sampling strategy between targeted biopsy sampling and wide sampling has not been reported. This study aimed to investigate the benefits of the 2 sampling techniques on EUS-FNB using rapid on-site evaluation. METHODS Patients with SPLs were prospectively enrolled and randomly assigned (1:1) to undergo EUS-FNB using either contrast guidance or the fanning technique. The primary outcome was the total number of passes required to establish a diagnosis, and secondary outcomes were overall diagnostic accuracy and adverse event rates. RESULTS One hundred eighteen patients were enrolled from February 2019 to January 2021, with 59 patients assigned to each group. There was no significant difference in the total number of passes required to establish a diagnosis between the contrast and fanning groups (median, 1 [interquartile range, 1-1] vs 1 [interquartile range, 1-2], respectively; P = .629). The sensitivity, specificity, and diagnostic accuracy in the contrast group was 100%, 66.7%, and 98.3% and in the fanning group 100%, 100%, and 100%, respectively (P = 1). An SPL <4 cm (odds ratio, 2.47; 95% confidence interval, 1.05-5.81; P = .037) and macroscopic visible core length >1 cm (odds ratio, 2.89; 95% confidence interval, 1.07-7.84; P = .037) were independently associated with increased cytologic and histologic accuracy. CONCLUSIONS The diagnostic accuracy of EUS-FNB with the fanning technique for SPLs was comparable with the contrast guidance technique. Without additional cost, EUS-FNB with the fanning technique may be preferred for SPLs. (Clinical trial registration number: NCT04924725.).
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Affiliation(s)
- Yu-Ting Kuo
- Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Long Chu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Weng-Fai Wong
- Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Ming-Lun Han
- Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh-Chang Chen
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Shiow Jan
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Department of Laboratory Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wern-Cherng Cheng
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Ming-Chang Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine and Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsu-Yao Cheng
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Department of Laboratory Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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18
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Chen KHS, Hung TK, Chikara RK, Kuo YT, Liu YP, Dong YS, Wu YR, Ko LW, Huang YZ, Chen R. Modulating motor cortical oscillation with coordinated reset multifocal transcranial magnetic stimulation. J Neurophysiol 2023; 129:1061-1071. [PMID: 36922160 DOI: 10.1152/jn.00227.2022] [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] [Indexed: 03/17/2023] Open
Abstract
According to the theory of coordinated reset (CR) stimulation, multifocal bursts of stimuli delivered in a random order with a specific interval may reduce the resonance power of the oscillatory generator in the epicenter. We develop a noninvasive coordinated multifocal burst stimulation (COMBS) with three repetitive transcranial stimulation machines based on CR theory to modulate the target frequency in the primary motor cortex and to assess its effect on motor cortical excitability in separate experiments. Electroencephalography and electromyography were recorded in 16 healthy participants during a finger-tapping task, both before and after the intervention. The resting oscillatory power at the targeted frequency was not changed by COMBS. α- band power was increased in both preparation and movement stages and the low β-band power was increased in the movement stage of the finger tapping task. The extent of low β-band event related desynchronization was reduced by COMBS. There were no changes in reaction time, but there was a trend for a reduced error rate after COMBS. In another 14 healthy participants, there were no significant change in cortical excitability before and after COMBS measured by rest motor threshold, short interval intracortical inhibition, short interval intracortical facilitation and cortical silent period. The result indicate that COMBS may modify the cortical oscillatory power and its perturbation within specific movement stage.
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Affiliation(s)
- Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Tzu-Kang Hung
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Rupesh Kumar Chikara
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, United States.,Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
| | - Yu-Ting Kuo
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Yi-Ping Liu
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Yan-Siou Dong
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Li-Wei Ko
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Institute of Electrical and Control Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ying-Zu Huang
- Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Institute of Cognitive Neuroscience, College of Health Science and Technology, Taoyua, Taiwan
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Ontario, Canada
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19
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Cheng MC, See MS, Wang PC, Kuo YT, Ho YS, Chen SC, Tsai MA. Lymphocystis Disease Virus Infection in Clownfish Amphiprion ocellaris and Amphiprion clarkii in Taiwan. Animals (Basel) 2022; 13:ani13010153. [PMID: 36611762 PMCID: PMC9817495 DOI: 10.3390/ani13010153] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Abstract
Lymphocystic disease affects over 150 species of marine and freshwater fish worldwide. In this study, the lymphocystis pathogen was found in 2 (Amphiprion ocellaris and Amphiprion clarkii) of the 9 species of clownfish. Detection of lymphocystis disease virus (LCDV) was based on histopathological study, electron microscope observation of virus particles and gene sequence analysis from the MCP region. Infected A. ocellaris hosts showed sparse, multifocal, white, stiff, papilloma-like nodules on the body, skin, gills and fins; while, on A. clarkia, nodules were found on the operculum skin. Histopathologic study showed lymphocystic cells with an irregular nucleus, enlarged cytoplasm and intracytoplasmic inclusion bodies surrounded by the cell membrane. The viral particle presents virions 180-230 nm in diameter, hexagonal in shape with an inner dense nucleoid under transmission electron micrographs (TEM). From the ML polygenetic tree, the clownfish LCVD genotype was closely related to the LCDV strain from paradise fish, Macropodus opercularis (KJ408271) (pairwise distance: 92.5%) from China, then followed by the strain from Spain (GU320726 and GU320736) (pairwise distance: 90.8-90.5%), Korea (AB299163, AB212999, AB213004, and AB299164) (pairwise distance: 91.5-80.5%) and lastly Canada (GU939626) (pairwise distance: 83%). This is the first report of lymphocystis disease in A. clarkii in Taiwan.
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Affiliation(s)
- Ming-Chung Cheng
- Eastern Marine Biology Center, Fisheries Research Institute, Taitung 961, Taiwan
| | - Ming She See
- Institute of Marine Biotechnology, Universiti Malaysia Terengganu, Kuala Nerus 21300, Terengganu, Malaysia
| | - Pei-Chi Wang
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Yu-Ting Kuo
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Yuan-Shing Ho
- Eastern Marine Biology Center, Fisheries Research Institute, Taitung 961, Taiwan
| | - Shih-Chu Chen
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- International Program in Ornamental Fish Technology and Aquatic Animal Health, International College, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Correspondence: (S.-C.C.); (M.-A.T.)
| | - Ming-An Tsai
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- International Program in Ornamental Fish Technology and Aquatic Animal Health, International College, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Correspondence: (S.-C.C.); (M.-A.T.)
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20
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Kuo YT, Kuo LK, Chen CW, Yuan KC, Fu CH, Chiu CT, Yeh YC, Liu JH, Shih MC. Score-based prediction model for severe vitamin D deficiency in patients with critical illness: development and validation. Crit Care 2022; 26:394. [PMID: 36544226 PMCID: PMC9768894 DOI: 10.1186/s13054-022-04274-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Severe vitamin D deficiency (SVDD) dramatically increases the risks of mortality, infections, and many other diseases. Studies have reported higher prevalence of vitamin D deficiency in patients with critical illness than general population. This multicenter retrospective cohort study develops and validates a score-based model for predicting SVDD in patients with critical illness. METHODS A total of 662 patients with critical illness were enrolled between October 2017 and July 2020. SVDD was defined as a serum 25(OH)D level of < 12 ng/mL (or 30 nmol/L). The data were divided into a derivation cohort and a validation cohort on the basis of date of enrollment. Multivariable logistic regression (MLR) was performed on the derivation cohort to generate a predictive model for SVDD. Additionally, a score-based calculator (the SVDD score) was designed on the basis of the MLR model. The model's performance and calibration were tested using the validation cohort. RESULTS The prevalence of SVDD was 16.3% and 21.7% in the derivation and validation cohorts, respectively. The MLR model consisted of eight predictors that were then included in the SVDD score. The SVDD score had an area under the receiver operating characteristic curve of 0.848 [95% confidence interval (CI) 0.781-0.914] and an area under the precision recall curve of 0.619 (95% CI 0.577-0.669) in the validation cohort. CONCLUSIONS This study developed a simple score-based model for predicting SVDD in patients with critical illness. TRIAL REGISTRATION ClinicalTrials.gov protocol registration ID: NCT03639584. Date of registration: May 12, 2022.
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Affiliation(s)
- Yu-Ting Kuo
- grid.412094.a0000 0004 0572 7815Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City, 10002 Taiwan
| | - Li-Kuo Kuo
- grid.413593.90000 0004 0573 007XDivision of Critical Care Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, Taiwan ,grid.452449.a0000 0004 1762 5613Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, Taiwan
| | - Chung-Wei Chen
- grid.414746.40000 0004 0604 4784Department of Surgical Intensive Care Unit, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, Taiwan
| | - Kuo-Ching Yuan
- grid.412897.10000 0004 0639 0994Department of Critical Care Medicine, Taipei Medical University Hospital, No. 252, Wuxing St, Taipei City, Taiwan
| | - Chun-Hsien Fu
- grid.412094.a0000 0004 0572 7815Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City, 10002 Taiwan ,grid.256105.50000 0004 1937 1063Department of Anesthesiology, Fu Jen Catholic University Hospital, No. 69, Guizi Road, New Taipei City, Taiwan
| | - Ching-Tang Chiu
- grid.412094.a0000 0004 0572 7815Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City, 10002 Taiwan
| | - Yu-Chang Yeh
- grid.412094.a0000 0004 0572 7815Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City, 10002 Taiwan
| | - Jen-Hao Liu
- grid.412094.a0000 0004 0572 7815Department of Anesthesiology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Taipei City, 10002 Taiwan
| | - Ming-Chieh Shih
- grid.260567.00000 0000 8964 3950Department of Applied Mathematics, College of Science and Engineering, National Dong Hwa University, No. 1-12, Sec. 2, University Rd., Hualien County, 974 Taiwan
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21
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Chen YJ, Hsieh HP, Hung KC, Shih YJ, Lim SW, Kuo YT, Chen JH, Ko CC. Deep Learning for Prediction of Progression and Recurrence in Nonfunctioning Pituitary Macroadenomas: Combination of Clinical and MRI Features. Front Oncol 2022; 12:813806. [PMID: 35515108 PMCID: PMC9065347 DOI: 10.3389/fonc.2022.813806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives A subset of non-functioning pituitary macroadenomas (NFMAs) may exhibit early progression/recurrence (P/R) after tumor resection. The purpose of this study was to apply deep learning (DL) algorithms for prediction of P/R in NFMAs. Methods From June 2009 to December 2019, 78 patients diagnosed with pathologically confirmed NFMAs, and who had undergone complete preoperative MRI and postoperative MRI follow-up for more than one year, were included. DL classifiers including multi-layer perceptron (MLP) and convolutional neural network (CNN) were used to build predictive models. Categorical and continuous clinical data were fed into the MLP model, and images of preoperative MRI (T2WI and contrast enhanced T1WI) were analyzed by the CNN model. MLP, CNN and multimodal CNN-MLP architectures were performed to predict P/R in NFMAs. Results Forty-two (42/78, 53.8%) patients exhibited P/R after surgery. The median follow-up time was 42 months, and the median time to P/R was 25 months. As compared with CNN using MRI (accuracy 83%, precision 87%, and AUC 0.84) or MLP using clinical data (accuracy 73%, precision 73%, and AUC 0.73) alone, the multimodal CNN-MLP model using both clinical and MRI features showed the best performance for prediction of P/R in NFMAs, with accuracy 83%, precision 90%, and AUC 0.85. Conclusions DL architecture incorporating clinical and MRI features performs well to predict P/R in NFMAs. Pending more studies to support the findings, the results of this study may provide valuable information for NFMAs treatment planning.
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Affiliation(s)
- Yan-Jen Chen
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan.,Graduate Institute of Electronics Engineering, National Taiwan University, Taipei, Taiwan
| | - Hsun-Ping Hsieh
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yun-Ju Shih
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States.,Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
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22
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Chou YC, Lee WY, Huang SK, Wu RH, Kuo YT. Ten-year follow-up of renal adenomatosis with magnetic resonance imaging: a case report. J Med Case Rep 2022; 16:168. [PMID: 35449090 PMCID: PMC9026678 DOI: 10.1186/s13256-022-03394-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background Renal adenomatosis is a rare disease that presents as multiple papillary adenomas in the bilateral kidneys. Moreover, papillary adenoma is considered a precursor to papillary renal cell carcinoma. Therefore, patients with renal adenomatosis may have higher risk of developing malignancy than patients without this benign condition. Case presentation We present the case of a 62-year-old Asian woman with past history of papillary thyroid cancer. She underwent contrast-enhanced magnetic resonance imaging of the abdomen to screen for metastasis in 2010 and was followed up with computed tomography or magnetic resonance imaging annually. She was found to have a right renal tumor on computed tomography and underwent partial nephrectomy. The pathological diagnosis of the right renal tumor was angiomyolipoma. Renal adenomatosis was also histologically confirmed in the renal parenchyma adjacent to the angiomyolipoma. In this case report, we demonstrate the natural course of renal adenomatosis over 10 years using imaging studies. The benign tumors gradually progressed during the follow-up period. Larger tumor sizes and more hypoenhanced nodules in the bilateral kidneys were observed on follow-up computed tomography and magnetic resonance imaging. Conclusions Due to its malignant potential, the clinical course of renal adenomatosis must be monitored. We present the natural course of renal adenomatosis with magnetic resonance imaging during a 10-year follow-up period.
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Affiliation(s)
- Yi-Chen Chou
- Department of Medical Imaging, Chi Mei Medical Center, 901, Chung-Hwa Road, Yung-Kang, Tainan, 710, Taiwan
| | - Wen-Ying Lee
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pathology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Steven K Huang
- Department of Urology, Chi Mei Medical Center, Tainan, Taiwan
| | - Reng-Hong Wu
- Department of Medical Imaging, Chi Mei Medical Center, 901, Chung-Hwa Road, Yung-Kang, Tainan, 710, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, 901, Chung-Hwa Road, Yung-Kang, Tainan, 710, Taiwan. .,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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23
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Yang CC, Chen CY, Kuo YT, Ko CC, Wu WJ, Liang CH, Yun CH, Huang WM. Radiomics for the Prediction of Response to Antifibrotic Treatment in Patients with Idiopathic Pulmonary Fibrosis: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12041002. [PMID: 35454050 PMCID: PMC9028756 DOI: 10.3390/diagnostics12041002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/19/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 02/06/2023] Open
Abstract
Antifibrotic therapy has changed the treatment paradigm for idiopathic pulmonary fibrosis (IPF); however, a subset of patients still experienced rapid disease progression despite treatment. This study aimed to determine whether CT-based radiomic features can predict therapeutic response to antifibrotic agents. In this retrospective study, 35 patients with IPF on antifibrotic treatment enrolled from two centers were divided into training (n = 26) and external validation (n = 9) sets. Clinical and pulmonary function data were collected. The patients were categorized into stable disease (SD) and progressive disease (PD) groups based on functional or radiologic criteria. From pretreatment non-enhanced high-resolution CT (HRCT) images, twenty-six radiomic features were extracted through whole-lung texture analysis, and six parenchymal patterns were quantified using dedicated imaging platforms. The predictive factors for PD were determined via univariate and multivariate logistic regression analyses. In the training set (SD/PD: 12/14), univariate analysis identified eight radiomic features and ground-glass opacity percentage (GGO%) as potential predicators of PD. However, multivariate analysis found that the single independent predictor was the sum entropy (accuracy, 80.77%; AUC, 0.75). The combined sum entropy-GGO% model improved the predictive performance in the training set (accuracy, 88.46%; AUC, 0.77). The overall accuracy of the combined model in the validation set (SD/PD: 7/2) was 66.67%. Our preliminary results demonstrated that radiomic features based on pretreatment HRCT could predict the response of patients with IPF to antifibrotic treatment.
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Affiliation(s)
- Cheng-Chun Yang
- Department of Medical Imaging, Chi Mei Hospital, Tainan 710, Taiwan; (C.-C.Y.); (C.-Y.C.); (Y.-T.K.); (C.-C.K.)
| | - Chin-Yu Chen
- Department of Medical Imaging, Chi Mei Hospital, Tainan 710, Taiwan; (C.-C.Y.); (C.-Y.C.); (Y.-T.K.); (C.-C.K.)
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Hospital, Tainan 710, Taiwan; (C.-C.Y.); (C.-Y.C.); (Y.-T.K.); (C.-C.K.)
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Hospital, Tainan 710, Taiwan; (C.-C.Y.); (C.-Y.C.); (Y.-T.K.); (C.-C.K.)
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
| | - Wen-Jui Wu
- Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei 104, Taiwan;
| | - Chia-Hao Liang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Chun-Ho Yun
- Department of Radiology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, New Taipei City 252, Taiwan
- Correspondence: (C.-H.Y.); (W.-M.H.)
| | - Wei-Ming Huang
- Department of Radiology, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, New Taipei City 252, Taiwan
- Correspondence: (C.-H.Y.); (W.-M.H.)
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24
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Tsai YT, Hung KC, Shih YJ, Lim SW, Yang CC, Kuo YT, Chen JH, Ko CC. Preoperative Apparent Diffusion Coefficient Values for Differentiation between Low and High Grade Meningiomas: An Updated Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12030630. [PMID: 35328183 PMCID: PMC8947055 DOI: 10.3390/diagnostics12030630] [Citation(s) in RCA: 3] [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: 02/08/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/01/2023] Open
Abstract
The meta-analysis aimed to compare the preoperative apparent diffusion coefficient (ADC) values between low-grade meningiomas (LGMs) and high-grade meningiomas (HGMs). Medline, Cochrane, Scopus, and Embase databases were screened up to January 2022 for studies investigating the ADC values of meningiomas. The study endpoint was the reported ADC values for LGMs and HGMs. Further subgroup analyses between 1.5T and 3T MRI scanners, ADC threshold values, ADC in different histological LGMs, and correlation coefficients (r) between ADC and Ki-67 were also performed. The quality of studies was evaluated by the quality assessment of diagnostic accuracy studies (QUADAS-2). A χ2-based test of homogeneity was performed using Cochran’s Q statistic and inconsistency index (I2). Twenty-five studies with a total of 1552 meningiomas (1102 LGMs and 450 HGMs) were included. The mean ADC values (×10−3 mm2/s) were 0.92 and 0.79 for LGMs and HGMs, respectively. Compared with LGMs, significantly lower mean ADC values for HGMs were observed with a pooled difference of 0.13 (p < 0.00001). The results were consistent in both 1.5T and 3T MRI scanners. For ADC threshold values, pooled sensitivity of 69%, specificity of 82%, and AUC of 0.84 are obtained for differentiation between LGMs and HGMs. The mean ADC (×10−3 mm2/s) in different histological LGMs ranged from 0.87 to 1.22. Correlation coefficients (r) of mean ADC and Ki-67 ranged from −0.29 to −0.61. Preoperative ADC values are a useful tool for differentiating between LGMs and HGMs. Results of this study provide valuable information for planning treatments in meningiomas.
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Affiliation(s)
- Yueh-Ting Tsai
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-T.T.); (Y.-J.S.); (C.-C.Y.); (Y.-T.K.)
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 710, Taiwan;
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Yun-Ju Shih
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-T.T.); (Y.-J.S.); (C.-C.Y.); (Y.-T.K.)
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi Mei Medical Center, Chiali, Tainan 722, Taiwan;
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan 736, Taiwan
| | - Cheng-Chun Yang
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-T.T.); (Y.-J.S.); (C.-C.Y.); (Y.-T.K.)
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-T.T.); (Y.-J.S.); (C.-C.Y.); (Y.-T.K.)
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, CA 92697, USA;
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung 824, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan; (Y.-T.T.); (Y.-J.S.); (C.-C.Y.); (Y.-T.K.)
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Correspondence:
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25
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Chu YL, Kuo YT, Wang HP. Tip of delivery system of a lumen-apposing metal stent getting stuck in a patient undergoing endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis. Dig Endosc 2022; 34:e20-e21. [PMID: 34761440 DOI: 10.1111/den.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Yu-Long Chu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ting Kuo
- Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
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26
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Chen KW, Chen CW, Yuan KC, Wang IT, Hung FM, Wang AY, Wang YC, Kuo YT, Lin YC, Shih MC, Kung YC, Ruan SY, Chiu CT, Chao A, Han YY, Kuo LK, Yeh YC. Prevalence of Vitamin D Deficiency and Associated Factors in Critically Ill Patients: A Multicenter Observational Study. Front Nutr 2021; 8:768804. [PMID: 34966771 PMCID: PMC8710763 DOI: 10.3389/fnut.2021.768804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/22/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Vitamin D deficiency is common in the general population worldwide, and the prevalence and severity of vitamin D deficiency increase in critically ill patients. The prevalence of vitamin D deficiency in a community-based cohort in Northern Taiwan was 22.4%. This multicenter cohort study investigated the prevalence of vitamin D deficiency and associated factors in critically ill patients in Northern Taiwan. Methods: Critically ill patients were enrolled and divided into five groups according to their length of stay at intensive care units (ICUs) during enrolment as follows: group 1, <2 days with expected short ICU stay; group 2, <2 days with expected long ICU stay; group 3, 3-7 days; group 4, 8-14 days; and group 5, 15-28 days. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25(OH)D) level < 20 ng/ml, and severe vitamin D deficiency was defined as a 25(OH)D level < 12 ng/ml. The primary analysis was the prevalence of vitamin D deficiency. The exploratory analyses were serial follow-up vitamin D levels in group 2, associated factors for vitamin D deficiency, and the effect of vitamin D deficiency on clinical outcomes in critically ill patients. Results: The prevalence of vitamin D deficiency was 59% [95% confidence interval (CI) 55-62%], and the prevalence of severe vitamin D deficiency was 18% (95% CI 15-21%). The median vitamin D level for all enrolled critically ill patients was 18.3 (13.7-23.9) ng/ml. In group 2, the median vitamin D levels were <20 ng/ml during the serial follow-up. According to the multivariable analysis, young age, female gender, low albumin level, high parathyroid hormone (PTH) level, and high sequential organ failure assessment (SOFA) score were significantly associated risk factors for vitamin D deficiency. Patients with vitamin D deficiency had longer ventilator use duration and length of ICU stay. However, the 28- and 90-day mortality rate were not associated with vitamin D deficiency. Conclusions: This study demonstrated that the prevalence of vitamin D deficiency is high in critically ill patients. Age, gender, albumin level, PTH level, and SOFA score were significantly associated with vitamin D deficiency in these patients.
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Affiliation(s)
- Kuo-Wei Chen
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chung-Wei Chen
- Department of Surgical Intensive Care Unit, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Ching Yuan
- Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - I-Ting Wang
- Division of Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ming Hung
- Department of Surgical Intensive Care Unit, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - An-Yi Wang
- Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yin-Chin Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Kuo
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Che Lin
- Department of Environment and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chieh Shih
- Department of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Chung Kung
- Division of Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Tang Chiu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Anne Chao
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Yi Han
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kuo Kuo
- Division of Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Huang YC, Ou SY, Kuo YT, Chia YY. Randomized, Active-Controlled, Parallel-Group Clinical Study Assessing the Efficacy and Safety of FKScope® for Nasotracheal Intubation in Patients Scheduled for Oral and Maxillofacial Surgery Under General Anesthesia. Asian J Anesthesiol 2021; 59:152-160. [PMID: 34979630 DOI: 10.6859/aja.202112_59(4).0003] [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: 06/14/2023]
Abstract
BACKGROUND Most of the reports showed that videolaryngoscopy has better outcomes than direct laryngoscopy for nasotracheal intubation. The FKScope® comprises a semirigid and malleable stylet with a terminal camera and has been used to facilitate orotracheal intubation. However, its efficacy and safety for nasotracheal intubation remain unknown. This study compared FKScope® with Macintosh direct laryngoscopy for nasotracheal intubation. METHODS Sixty-four patients scheduled for oral and maxillofacial surgery requiring nasotracheal intubation were enrolled and randomly assigned to FKScope® (n = 32) or Macintosh group (n = 32). The primary outcome was time to successful intubation during the first attempt. Secondary outcomes included modified nasal intubation difficulty scale (MNIDS) scores; percentage of glottic opening (POGO); immediate postintubation side effects such as mucosal bleeding, dental injury, and lip lacerations; and postoperative side effects including nasal pain, sore throat, hoarseness, dysphagia, and dyspnea. RESULTS The rates of successful first-attempt intubation were 87.5% and 90.6% in the FKScope® and Macintosh group, respectively (P = 0.69). Mean (± standard deviation) total intubation time was 68.7 ± 34.8 s in the FKScope® group compared with 61.5 ± 21.9 s in the Macintosh group (P = 0.35), despite a higher POGO for the FKScope® group (77 ± 27 vs. 41 ± 31, P < 0.01). The MNIDS scores of the FKScope® group were significantly lower (0.8 ± 1.0 vs. 2.8 ± 1.4, P < 0.01). The groups did not differ significantly regarding most postoperative side effects, although the FKScope® group had fewer lip lacerations (P = 0.04). CONCLUSIONS The use of FKScope® improves the view of the glottic opening and is safe for nasotracheal intubation with normal airways. However, secretions and blood can obstruct the camera, and therefore, to select the patient carefully is necessary.
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Affiliation(s)
- Yu-Chi Huang
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shu-Yu Ou
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Ting Kuo
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yuan-Yi Chia
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Defense Medicine Center, Taipei, Taiwan
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Ko CC, Chang CH, Chen TY, Lim SW, Wu TC, Chen JH, Kuo YT. Solid tumor size for prediction of recurrence in large and giant non-functioning pituitary adenomas. Neurosurg Rev 2021; 45:1401-1411. [PMID: 34606021 PMCID: PMC8976796 DOI: 10.1007/s10143-021-01662-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 10/31/2022]
Abstract
A subset of large non-functioning pituitary adenomas (lNFPA) and giant non-functioning pituitary adenomas (gNFPA) undergoes early progression/recurrence (P/R) after surgery. This study revealed the clinical and image predictors of P/R in lNFPA and gNFPA, with emphasis on solid tumor size. This retrospective study investigated the preoperative MR imaging features for the prediction of P/R in lNFPA (> 3 cm) and gNFPA (> 4 cm). Only the patients with a complete preoperative brain MRI and undergone postoperative MRI follow-ups for more than 1 year were included. From November 2010 to December 2020, a total of 34 patients diagnosed with lNFPA and gNFPA were included (median follow-up time 47.6 months) in this study. A total of twenty-three (23/34, 67.6%) patients had P/R, and the median time to P/R is 25.2 months. Solid tumor diameter (STD), solid tumor volume (STV), and extent of resection are associated with P/R (p < 0.05). Multivariate analysis showed large STV is a risk factor for P/R (p < 0.05) with a hazard ratio of 30.79. The cutoff points of STD and STV for prediction of P/R are 26 mm and 7.6 cm3, with AUCs of 0.78 and 0.79 respectively. Kaplan-Meier analysis of tumor P/R trends showed that patients with larger STD and STV exhibited shorter progression-free survival (p < 0.05). For lNFPA and gNFPA, preoperative STD and STV are significant predictors of P/R. The results offer objective and valuable information for treatment planning in this subgroup.
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Affiliation(s)
- Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan. .,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Chin-Hong Chang
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Te-Chang Wu
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, CA, USA.,Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Hu HC, Tsai YH, Chuang YC, Lai KH, Hsu YM, Hwang TL, Lin CC, Fülöp F, Wu YC, Yu SY, Kuo YT, Chang FR. Estrogenic and anti-neutrophilic inflammatory phenanthrenes from Juncus effusus L. Nat Prod Res 2021; 36:3043-3053. [PMID: 34498976 DOI: 10.1080/14786419.2021.1954644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Juncus effusus L. (J. effusus) is a Traditional Chinese Medicine (TCM) that has long been used for dealing with gynaecological disorders, such as relieving insomnia, preventing tinnitus, reducing edema with diuretic effect. In our course of evidence-based medical research focused on this herb, one new phenanthrene, Junfusol B (2), together with seventeen known compounds were isolated and identified. All the structures of these compounds were elucidated by spectroscopic methods. The absolute stereochemistry of compounds 1 and 2 was further determined by comparing their calculated and experimental Electronic Circular Dichroism (ECD) spectra and optical rotation (OR) values. The isolates were evaluated for their estrogenic and anti-inflammatory activities which were considered as relevant etiological factors of insomnia, tinnitus and edema in the ancient TCM theory. The results revealed that most of the obtained phenanthrenes in this work were found exerting agonistic effects on estrogen receptor. This is the first report to declare the exact estrogen-regulating potential among this type of compounds from J. effusus. Moreover, phenanthrenes 3 - 7 exhibited significant inhibitions on superoxide anion generation and elastase release in fMLP/CB-induced human neutrophilic inflammation model. J. effusus may be developed as a complementary agent utilized in menopausal multiple syndromes.
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Affiliation(s)
- Hao-Chun Hu
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Pharmaceutical Chemistry, University of Szeged, Szeged, Hungary
| | - Yi-Hong Tsai
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Che Chuang
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Hung Lai
- Graduate Institute of Pharmacognosy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ming Hsu
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Science & Technology, Meiho University, Pingtung, Taiwan
| | - Tsong-Long Hwang
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, and Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Chan Lin
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ferenc Fülöp
- Institute of Pharmaceutical Chemistry, University of Szeged, Szeged, Hungary.,MTA-SZTE Stereochemistry Research Group Hungarian Academy of Sciences, Szeged, Hungary
| | - Yang-Chang Wu
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.,Chinese Medicine Research and Development Center, China Medical University Hospital, Taichung, Taiwan
| | - Szu-Yin Yu
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Rong Chang
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung Taiwan
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30
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Abstract
Electrical impedance tomography (EIT) is a noninvasive imaging technology used to reconstruct the conductivity distribution in objects and the human body. In recent years, numerous EIT systems and image reconstruction algorithms have been developed. However, most of these EIT systems require conventional electrodes with conductive gels (wet electrodes) and cannot be adapted to different body types, resulting in limited applicability. In this study, a wearable wireless EIT belt with dry electrodes was designed to enable EIT imaging of the human body without using wet electrodes. The specific design of the belt mechanism and dry electrodes provide the advantages of easy wear and adaptation to different body sizes. Additionally, the GaussNewton method was used to optimize the EIT image. Finally, experiments were performed on the phantom and human body to validate the performance of the proposed EIT belt. The results demonstrate that the proposed system can provide accurate location information of the objects in the EIT image and the system can be successfully applied for noninvasive measurement of the human body.
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Kuo YT, Liu CH, Wong SH, Pan YC, Lin LT. Small molecules baicalein and cinnamaldehyde are potentiators of measles virus-induced breast cancer oncolysis. Phytomedicine 2021; 89:153611. [PMID: 34144429 DOI: 10.1016/j.phymed.2021.153611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/06/2021] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although the breast cancer mortality has slowed down from 2008 to 2017, breast cancer incidence rate continues to rise and thus, new and/or improved treatments are highly needed. Among them, oncolytic virotherapy which has the ability of facilitating the antitumor adaptive immunity, appears as a promising anticancer therapy. Oncolytic measles virus (MV) is particularly suitable for targeting breast cancer due to the upregulation of MV's receptor nectin-4. Nonetheless, with limited clinical success currently, ways of boosting MV-induced breast cancer oncolysis are therefore necessary. Oncolytic virotherapy alone and combined with chemotherapeutic drugs are two strategic areas with intensive development for the search of anticancer drugs. Considering that baicalein (BAI) and cinnamaldehyde (CIN) have demonstrated antitumor properties against multiple cancers including breast cancer, they could be good partners for MV-based oncolytic virotherapy. PURPOSE To assess the in vitro effect of BAI and CIN with MV and assess their combination effects. METHODS We examined the combinatorial cytotoxic effect of oncolytic MV and BAI or CIN on MCF-7 breast cancer cells. Potential anti-MV activities of the phytochemicals were first investigated in vitro to determine the optimal combination model. Synergism of MV and BAI or CIN was then evaluated in vitro by calculating the combination indices. Finally, cell cycle analysis and apoptosis assays were performed to confirm the mechanism of synergism. RESULTS Overall, the viral sensitization combination modality using oncolytic MV to first infect MCF-7 breast cancer cells followed by drug treatment with BAI or CIN was found to produce significantly enhanced tumor killing. Further mechanistic studies showed that the combinations 'MV-BAI' and 'MV-CIN' display synergistic anti-breast cancer effect, mediated by elevated apoptosis. CONCLUSION We demonstrated, for the first time, effective combination of oncolytic MV with BAI or CIN that could be further explored and potentially developed into novel therapeutic strategies targeting nectin-4-marked breast cancer cells.
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Affiliation(s)
- Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 71004, Taiwan.
| | - Ching-Hsuan Liu
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; Department of Microbiology & Immunology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Shu Hui Wong
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yu-Chi Pan
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Liang-Tzung Lin
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
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Yang CC, Chou YC, Kuo TN, Liou JY, Cheng HM, Kuo YT. Prophylactic Intraoperative Uterine Artery Embolization During Cesarean Section or Cesarean Hysterectomy in Patients with Abnormal Placentation: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2021; 45:488-501. [PMID: 34282489 DOI: 10.1007/s00270-021-02921-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of prophylactic intraoperative uterine artery embolization (UAE) performed immediately after fetal delivery during planned cesarean section or cesarean hysterectomy in patients with placenta accreta spectrum disorder or placenta previa. METHODS A systematic search was conducted on Ovid MEDLINE and Embase, PubMed, Web of Science, and Cochrane databases. Studies were selected using the Population/Intervention/Comparison/Outcomes (PICO) strategy. The intraoperative blood loss and the rate of emergent peripartum hysterectomy (EPH) were the primary outcomes, whereas the length of hospital stay and volume of blood transfused were the secondary outcomes. A random-effects model was employed to pool each effect size. The cumulative values of the primary outcomes were calculated using the generic inverse variance method. RESULTS Eleven retrospective cohort studies and five case series were included, recruiting 421 women who underwent prophylactic intraoperative UAE (UAE group) and 374 women who did not (control group). Compared with the control group, the UAE group had significantly reduced intraoperative blood loss (p = 0.020) during cesarean section or cesarean hysterectomy. Furthermore, the EPH rate was also significantly decreased (p = 0.020; cumulative rate: 19.65%), but not the length of hospital stay (p = 0.850) and volume of pRBC transfused (p = 0.140), after cesarean section in the UAE group. The incidence of major complications was low (3.33%), despite two patients with uterine necrosis. CONCLUSION The currently available data provides encouraging evidence that prophylactic intraoperative UAE may contribute to hemorrhage control and fertility preservation in women with abnormal placentation. REGISTRATION PROSPERO registration code: CRD42021230581. https://clinicaltrials.gov/ct2/show/CRD42021230581 LEVEL OF EVIDENCE: Level 2a, systematic review of retrospective cohort studies.
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Affiliation(s)
- Cheng-Chun Yang
- Department of Medical Imaging, Chi Mei Medical Center, NO. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan
| | - Yi-Chen Chou
- Department of Medical Imaging, Chi Mei Medical Center, NO. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan
| | - Tian-Ni Kuo
- Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jyun-Yan Liou
- Department of Medical Imaging, Chi Mei Medical Center, NO. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan
| | - Hua-Ming Cheng
- Department of Medical Imaging, Chi Mei Medical Center, NO. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, NO. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan.
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Abstract
Response Evaluation Criteria in Solid Tumors (RECIST) is the gold standard for assessment of treatment response in solid tumors. Morphologic change of tumor size evaluated by RECIST is often correlated with survival length and has been considered as a surrogate endpoint of therapeutic efficacy. However, the detection of morphologic change alone may not be sufficient for assessing response to new anti-cancer medication in all solid tumors. During the past fifteen years, several molecular-targeted therapies and immunotherapies have emerged in cancer treatment which work by disrupting signaling pathways and inhibited cell growth. Tumor necrosis or lack of tumor progression is associated with a good therapeutic response even in the absence of tumor shrinkage. Therefore, the use of unmodified RECIST criteria to estimate morphological changes of tumor alone may not be sufficient to estimate tumor response for these new anti-cancer drugs. Several studies have reported the low reliability of RECIST in evaluating treatment response in different tumors such as hepatocellular carcinoma, lung cancer, prostate cancer, brain glioma, bone metastasis, and lymphoma. There is an increased need for new medical imaging biomarkers, considering the changes in tumor viability, metabolic activity, and attenuation, which are related to early tumor response. Promising imaging techniques, beyond RECIST, include dynamic contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI), diffusion-weight imaging (DWI), magnetic resonance spectroscopy (MRS), and 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET). This review outlines the current RECIST with their limitations and the new emerging concepts of imaging biomarkers in oncology.
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Affiliation(s)
- Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Lee-Ren Yeh
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jeon-Hor Chen
- Department of Radiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan. .,Tu & Yuan Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, 164 Irvine Hall, Irvine, CA, 92697 - 5020, USA.
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Abstract
BACKGROUND: A two-hospital patient referral problem intends to calculate an optimal value of referral patients between two hospitals and to evaluate whether or not the current number of referral patients is too low. OBJECTIVE: The goal of this study is to develop a simulation-based optimization algorithm to find the optimal referral between two hospitals with the unfixed daily patient referral policy. METHODS: This study applied system simulation and a bat algorithm (BA) to build a simulation model in accordance with the status of the two hospitals case and to calculate an optimal value of daily referral patients. RESULTS: Based on the 20 test instances, we verified the stability of this algorithm. The results show that the average magnetic resonance imaging (MRI) patient wait time reduced from 16 days to eight days. The hospital should increase the average total monthly MRI referral patients to 370 under the limitation of the daily referral patients to 25. CONCLUSIONS: This research investigated the two-hospital patient referral problems. We conducted and analyzed a simulation model and improved the case hospital’s conditions, enhancing the quality of its medical care. The findings of this study can extend to other departments or hospitals.
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Affiliation(s)
- Huan-Chung Yao
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Pei-Jarn Chen
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Chun-Chin Shih
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Xuan-Yin Wang
- Department of Industrial and Systems Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Ping-Shun Chen
- Department of Industrial and Systems Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
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Baez M, Kuo YT, Dias Y, Souza T, Boudichevskaia A, Fuchs J, Schubert V, Vanzela ALL, Pedrosa-Harand A, Houben A. Analysis of the small chromosomal Prionium serratum (Cyperid) demonstrates the importance of reliable methods to differentiate between mono- and holocentricity. Chromosoma 2020; 129:285-297. [PMID: 33165742 PMCID: PMC7665975 DOI: 10.1007/s00412-020-00745-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/13/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022]
Abstract
For a long time, the Cyperid clade (Thurniceae-Juncaceae-Cyperaceae) was considered a group of species possessing holocentromeres exclusively. The basal phylogenetic position of Prionium serratum (Thunb.) Drège (Thurniceae) within Cyperids makes this species an important specimen to understand the centromere evolution within this clade. In contrast to the expectation, the chromosomal distribution of the centromere-specific histone H3 (CENH3), alpha-tubulin and different centromere-associated post-translational histone modifications (H3S10ph, H3S28ph and H2AT120ph) demonstrate a monocentromeric organisation of P. serratum chromosomes. Analysis of the high-copy repeat composition resulted in the identification of two centromere-localised satellite repeats. Hence, monocentricity was the ancestral condition for the Juncaceae-Cyperaceae-Thurniaceae Cyperid clade, and holocentricity in this clade has independently arisen at least twice after differentiation of the three families, once in Juncaceae and the other one in Cyperaceae. In this context, methods suitable for the identification of holocentromeres are discussed.
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Affiliation(s)
- M Baez
- Leibniz Institute of Plant Genetics and Crop Plant Research (IPK), Gatersleben, 06466, Stadt Seeland, Germany.,Laboratory of Plant Cytogenetics and Evolution, Department of Botany, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Y T Kuo
- Leibniz Institute of Plant Genetics and Crop Plant Research (IPK), Gatersleben, 06466, Stadt Seeland, Germany
| | - Y Dias
- Leibniz Institute of Plant Genetics and Crop Plant Research (IPK), Gatersleben, 06466, Stadt Seeland, Germany.,Laboratory of Plant Cytogenetics and Evolution, Department of Botany, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - T Souza
- Leibniz Institute of Plant Genetics and Crop Plant Research (IPK), Gatersleben, 06466, Stadt Seeland, Germany.,Laboratory of Cytogenetics and Plant Diversity, Department of General Biology, Center for Biological Sciences, State University of Londrina, Londrina, Paraná, 86057-970, Brazil
| | - A Boudichevskaia
- Leibniz Institute of Plant Genetics and Crop Plant Research (IPK), Gatersleben, 06466, Stadt Seeland, Germany.,KWS SAAT SE & Co. KGaA, 37574, Einbeck, Germany
| | - J Fuchs
- Leibniz Institute of Plant Genetics and Crop Plant Research (IPK), Gatersleben, 06466, Stadt Seeland, Germany
| | - V Schubert
- Leibniz Institute of Plant Genetics and Crop Plant Research (IPK), Gatersleben, 06466, Stadt Seeland, Germany
| | - A L L Vanzela
- Laboratory of Cytogenetics and Plant Diversity, Department of General Biology, Center for Biological Sciences, State University of Londrina, Londrina, Paraná, 86057-970, Brazil
| | - A Pedrosa-Harand
- Laboratory of Plant Cytogenetics and Evolution, Department of Botany, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - A Houben
- Leibniz Institute of Plant Genetics and Crop Plant Research (IPK), Gatersleben, 06466, Stadt Seeland, Germany.
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Liu YJ, Chang YJ, Kuo YT, Liang PH. Targeting β-tubulin/CCT-β complex induces apoptosis and suppresses migration and invasion of highly metastatic lung adenocarcinoma. Carcinogenesis 2020; 41:699-710. [PMID: 31400757 DOI: 10.1093/carcin/bgz137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/03/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022] Open
Abstract
Metastasis, the movement of cancer cells from one site to another, is responsible for the highest number of cancer deaths, especially in lung cancer patients. In this study, we first identified a prognostic marker of lung adenocarcinoma, TCP-1 β subunit (chaperonin-containing TCP-1β; CCT-β). We showed a compound that disrupted the interaction of CCT-β with β-tubulin killed a highly metastatic non-small cell lung cancer cell line CL1-5 through inducing Endoplasmic reticulum stress and caspases activation. Moreover, at the dosage of EC20, the compound inhibited migration and invasion of the lung cancer cells by suppressing matrix metalloproteinase (MMP)-2/9 and epithelial-mesenchymal transition (EMT)-related proteins through downregulating mitogen-activated protein kinases (MAPKs), Akt/β-catenin and integrin-focal adhesion kinase signaling pathways. Unlike the anticancer drugs, such as Taxol, that target the adenosine triphosphate site of β-tubulin, this study reveals a therapeutic target, β-tubulin/CCT-β complex, for metastatic human lung adenocarcinoma. The study demonstrated CCT-β as a prognostic marker. Targeting β-tubulin/CCT-β complex caused apoptosis and inhibited invasion/migration of CCT-β overexpressed, highly metastatic lung adenocarcinoma.
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Affiliation(s)
- Yan-Jin Liu
- Institute of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yu-Ju Chang
- Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan
| | - Yu-Ting Kuo
- Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan
| | - Po-Huang Liang
- Institute of Biological Chemistry, Academia Sinica, Taipei, Taiwan.,Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan
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Chen KHS, Keng LT, Kuo YT, Tai YC, Chen R. Ultrasound-Guided Needle Electromyography for Assessing Diaphragmatic Myoclonus. Mov Disord Clin Pract 2020; 7:870-871. [PMID: 33043090 DOI: 10.1002/mdc3.13043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kai-Hsiang S Chen
- Department of Neurology National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Li-Ta Keng
- Department of Internal Medicine National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Yu-Ting Kuo
- Department of Neurology National Taiwan University Hospital Hsin-Chu Branch Hsin-Chu Taiwan
| | - Yi-Cheng Tai
- Department of Neurology E-Da Hospital, I-Shou University Kaohsiung Taiwan
| | - Robert Chen
- Krembil Research Institute University Health Network Toronto Ontario Canada.,Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada.,Edmond J. Safra Program in Parkinson's Disease University Health Network Toronto Ontario Canada
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Kuo YT, Liu CH, Li JW, Lin CJ, Jassey A, Wu HN, Perng GC, Yen MH, Lin LT. Identification of the phytobioactive Polygonum cuspidatum as an antiviral source for restricting dengue virus entry. Sci Rep 2020; 10:16378. [PMID: 33009425 PMCID: PMC7532532 DOI: 10.1038/s41598-020-71849-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/02/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022] Open
Abstract
Dengue virus (DENV) is a mosquito-borne pathogen that is becoming a serious global threat, owing to its rising incidence in inter-tropical regions that yield over 50 million annual infections. There are currently no approved antiviral agents for the management of dengue, and recent shortcomings in its immunization called for immediate action to develop effective drugs with prophylactic ability to better manage its infection. In an attempt to discover novel antiviral sources, we identified the medicinal herb Polygonum cuspidatum (PC) as a bioactive botanical material against DENV infectivity. Specifically, the methanolic extract from PC rhizomes (PCME) potently inhibited DENV infection without causing significant cytotoxicity. Further examination on the viral life cycle demonstrated that PCME particularly targeted the initial stages of DENV infection, while pre- and post-infection treatments had no effect. More importantly, the PCME could efficiently inactivate DENV free virus particles and block the viral attachment and entry/fusion events without apparently influencing viral replication, egress, and cell-to-cell spread. The antiviral effect of PCME was also recapitulated in infection analysis using DENV pseudoparticles displaying viral structural proteins that mediate DENV particle entry. Besides, PCME treatment also inhibited direct DENV entry into several cell types relevant to its infection and reduced viral infectivity of other members of the Flaviviridae family, including the hepatitis C virus (HCV) and Zika virus (ZIKV). Due to its potency against DENV entry, we suggest that the phytobioactive extract from PC is an excellent starting point as an antiviral source material for further development of therapeutic strategies in the prophylactic management of DENV infection.
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Affiliation(s)
- Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Ching-Hsuan Liu
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Microbiology & Immunology, Dalhousie University, Halifax, NS, Canada
| | - Jin-Wei Li
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Ju Lin
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Alagie Jassey
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huey-Nan Wu
- Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan
| | - Guey Chuen Perng
- Department of Microbiology and Immunology & Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Center of Infectious Diseases and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Hong Yen
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Liang-Tzung Lin
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Liang KS, Chen CC, Liao WC, Kuo YT, Tseng LW, He WT, Wang HP. Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan. BMC Gastroenterol 2020; 20:194. [PMID: 32560698 PMCID: PMC7304153 DOI: 10.1186/s12876-020-01323-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/28/2020] [Indexed: 01/24/2023] Open
Abstract
Background Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy (TPS), and needle knife fistulotomy (NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF. Methods A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, success rate of biliary cannulation, and the rate of adverse events were assessed. Results 31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2%) in the TPS group and 39 (83.0%) in the NKF group (P = 0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred. Conclusions Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.
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Affiliation(s)
- Kai-Shun Liang
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Chih Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ting Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Liang-Wei Tseng
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Wen-Tsung He
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Ko CC, Chen TY, Lim SW, Kuo YT, Wu TC, Chen JH. Prediction of recurrence in solid nonfunctioning pituitary macroadenomas: additional benefits of diffusion-weighted MR imaging. J Neurosurg 2020; 132:351-359. [PMID: 30717054 DOI: 10.3171/2018.10.jns181783] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE A subset of benign, nonfunctioning pituitary macroadenomas (NFMAs) has been shown to undergo early progression/recurrence (P/R) during the first years after surgical resection. The aim of this study was to determine preoperative MR imaging features for the prediction of P/R in benign solid NFMAs, with emphasis on apparent diffusion coefficient (ADC) values. METHODS We retrospectively investigated the preoperative MR imaging features for the prediction of P/R in benign solid NFMAs. Only the patients who had undergone preoperative MRI and postoperative MRI follow-ups for more than 1 year (at least every 6-12 months) were included. From November 2010 to December 2016, a total of 30 patients diagnosed with benign solid NFMAs were included (median follow-up time 45 months), and 19 (63.3%) patients had P/R (median time to P/R 24 months). RESULTS Benign solid NFMAs with cavernous sinus invasion, failed chiasmatic decompression, large tumor height and tumor volume, high diffusion-weighted imaging (DWI) signal, and lower ADC values/ratios were significantly associated with P/R (p < 0.05). The cutoff points of ADC value and ADC ratio for prediction of P/R are 0.77 × 10-3 mm2/sec and 1.01, respectively, with area under the curve (AUC) values (0.9 and 0.91) (p < 0.01). In multivariate Cox proportional hazards analysis, low ADC value (< 0.77 × 10-3 mm2/sec) is a high-risk factor of P/R (p < 0.05) with a hazard ratio of 14.07. CONCLUSIONS Benign solid NFMAs with low ADC values/ratios are at a significantly increased risk of P/R, and aggressive treatments accompanied by close follow-up with imaging studies should be considered.
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Affiliation(s)
- Ching-Chung Ko
- 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan
| | - Tai-Yuan Chen
- 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,2Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan
| | - Sher-Wei Lim
- 3Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan.,4Department of Nursing, Min-Hwei College of Health Care Management, Tainan
| | - Yu-Ting Kuo
- 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,5Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Te-Chang Wu
- 1Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan.,6Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei
| | - Jeon-Hor Chen
- 7Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; and.,8Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, California
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Abstract
Case-control studies have shown that noxious thermal stimulation (TS) can improve arm function in patients with stroke. However, the neural mechanisms underlying this improvement are largely unknown. We explored functional neural activation due to noxious and innocuous TS intervention applied to the paretic arm of patients with stroke. Sixteen participants with unilateral cortical infarctions were allocated to one of two groups: noxious TS (8 patients; temperature combination: hot pain 46°C to 47°C, cold pain 7°C-8°C) or innocuous TS (n = 8; temperature combination: hot 40°C-41°C, cold 20°C-21°C). All subjects underwent fMRI scanning before and after 30 min TS intervention and performed a finger tapping task with the affected hand. Immediate brain activation effects were assessed according to thermal type (noxious vs. innocuous TS) and time (pre-TS vs post-TS). Regions activated by noxious TS relative to innocuous TS (P < .05, adjusted for multiple comparisons) were related to motor performance and sensory function in the bilateral primary somatosensory cortices, anterior cingulate cortex, insula, thalamus, hippocampus and unilateral primary motor cortex, secondary somatosensory cortex at the contralateral side of lesion, and unilateral supplementary motor area at the ipsilateral side of lesion. Greater activation responses were observed in the side contralateral to the lesion, suggesting a significant intervention effect. Our preliminary findings suggest that noxious TS may induce neuroplastic changes unconstrained to the local area.Trial registration: NCT01418404.
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Affiliation(s)
- Sharon Chia-Ju Chen
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University
- Department of Medical Research, Kaohsiung Medical University Hospital
| | - Miao-Ju Hsu
- Department of Physical Therapy, Kaohsiung Medical University
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan
- Department of Medical Imaging, Kaohsiung Medical University Chung Ho Memorial Hospital
| | - Ruey-Tay Lin
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ROC
| | - Sing-Kai Lo
- Faculty of Liberal Arts and Social Sciences, Education University of Hong Kong, Hong Kong
| | - Jau-Hong Lin
- Department of Medical Research, Kaohsiung Medical University Hospital
- Department of Physical Therapy, Kaohsiung Medical University
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Yeh YC, Kuo YT, Huang MF, Hwang SJ, Tsai JC, Kuo MC, Chen CS. Association of brain white matter lesions and atrophy with cognitive function in chronic kidney disease. Int J Geriatr Psychiatry 2019; 34:1826-1832. [PMID: 31418471 DOI: 10.1002/gps.5198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/11/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Cognitive impairment is common in patients with chronic kidney disease (CKD), possibly leading to poor outcomes. However, the correlation between brain structural abnormalities and cognitive impairment remains unclear. The aim of this study was to investigate the impairment of specific cognitive domains and their association with brain structural abnormalities. METHODS Patients with CKD of at least stage 3 who were not on hemodialysis were enrolled. All participants underwent comprehensive neuropsychological testing in five cognitive domains. Ventricular atrophy, sulcal atrophy, medial temporal atrophy, and white matter changes were assessed using brain magnetic resonance imaging according to standard protocols. RESULTS Eighty-seven patients and 50 controls were enrolled. Patients with CKD exhibited decreased cognitive function relative to controls. Compared with patients with stage 3 CKD, those with advanced stage (stages 4 or 5) had poorer cognitive performance, more pronounced white matter hyperintensity (WMH) and more severe ventricular atrophy. Among CKD patients, executive function (β = -.23, P = .043) and attention (β = -.29, P = .004) were associated with WMH in controlled analyses. However, no cognitive impairment was associated with ventricular atrophy. CONCLUSION Patients with CKD exhibited cognitive impairment and brain structural abnormalities including WMH and general brain atrophy. Impairment of attention and executive dysfunction were associated with WMH.
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Affiliation(s)
- Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Chi Mei Hospital, Tainan, Taiwan
| | - Mei-Feng Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Chia Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Shih YJ, Kuo YT, Ho CH, Wu CC, Ko CC. Incidence and risk of dialysis therapy within 30 days after contrast enhanced computed tomography in patients coded with chronic kidney disease: a nation-wide, population-based study. PeerJ 2019; 7:e7757. [PMID: 31592348 PMCID: PMC6776070 DOI: 10.7717/peerj.7757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/26/2019] [Indexed: 11/21/2022] Open
Abstract
Background Patients with chronic kidney disease (CKD) are considered at risk of contrast-induced acute kidney injury and possible subsequent need for dialysis therapy. Computed tomography (CT) is the most commonly performed examination requiring intravenous iodinated contrast media (ICM) injection. The actual risk of dialysis in CKD patients undergoing CT with ICM remains controversial. Furthermore, it is also uncertain whether these at-risk patients can be identified by means of administrative data. Our study is conducted in order to determine the incidence and risk of dialysis within 30 days after undergoing contrast enhanced CT in CKD coded patients. Methods This longitudinal, nation-wide, populated-based study is carried out by analyzing the Taiwan National Health Insurance Research Database retrospectively. Patients coded under the diagnosis of CKD who underwent CT are identified within randomly selected one million subjects of the database. From January 2012 to December 2013, 487 patients had undergone CT with ICM. A total of 924 patients who underwent CT without ICM are selected as the control group. Patients with advanced CKD or intensive care unit (ICU) admissions are assigned to the subgroups for analysis. The primary outcome is measured by dialysis events within 30 days after undergoing CT scans. The cumulative incidence is assessed by the Kaplan–Meier method and log-rank test. The risk of 30-day dialysis relative to the control group is analyzed by the Cox proportional hazards model after adjusting for age, sex, and baseline comorbidities. Results The numbers and percentages of dialysis events within 30 days after undergoing CT scans are 20 (4.1%) in the CT with ICM group and 66 (7.1%) in the CT without ICM group (p = 0.03). However, the adjusted hazard ratio (aHR) for 30-day dialysis was 0.84 (95% CI [0.46–1.54], p = 0.57), which is statistically non-significant. In both advanced CKD and ICU admission subgroups, there are also no significant differences in 30-day dialysis risks with the aHR of 1.12 (95% CI [0.38–3.33], p = 0.83) and 0.95 (95% CI [0.44–2.05], p = 0.90), respectively. Conclusions Within 30 days of receiving contrast-enhanced CT scans, 4.1% of CKD coded patients required dialysis, which appear to be lower compared with subjects who received non-contrast CT scans. However, no statistically significant difference is observed after adjustments are made for other baseline conditions. Thereby, the application of administrative data to identify patients with CKD cannot be viewed as a risk factor for the necessity to undergo dialysis within 30 days of receiving contrast-enhanced CT scans.
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Affiliation(s)
- Yun-Ju Shih
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chia-Chun Wu
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan.,Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Zhang Y, Chen JH, Chen TY, Lim SW, Wu TC, Kuo YT, Ko CC, Su MY. Radiomics approach for prediction of recurrence in skull base meningiomas. Neuroradiology 2019; 61:1355-1364. [PMID: 31324948 DOI: 10.1007/s00234-019-02259-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/04/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE A subset of skull base meningiomas (SBM) may show early progression/recurrence (P/R) as a result of incomplete resection. The purpose of this study is the implementation of MR radiomics to predict P/R in SBM. METHODS From October 2006 to December 2017, 60 patients diagnosed with pathologically confirmed SBM (WHO grade I, 56; grade II, 3; grade III, 1) were included in this study. Preoperative MRI including T2WI, diffusion-weighted imaging (DWI), and contrast-enhanced T1WI were analyzed. On each imaging modality, 13 histogram parameters and 20 textural gray level co-occurrence matrix (GLCM) features were extracted. Random forest algorithms were utilized to evaluate the importance of these parameters, and the most significant three parameters were selected to build a decision tree for prediction of P/R in SBM. Furthermore, ADC values obtained from manually placed ROI in tumor were also used to predict P/R in SBM for comparison. RESULTS Gross-total resection (Simpson Grades I-III) was performed in 33 (33/60, 55%) patients, and 27 patients received subtotal resection. Twenty-one patients had P/R (21/60, 35%) after a postoperative follow-up period of at least 12 months. The three most significant parameters included in the final radiomics model were T1 max probability, T1 cluster shade, and ADC correlation. In the radiomics model, the accuracy for prediction of P/R was 90%; by comparison, the accuracy was 83% using ADC values measured from manually placed tumor ROI. CONCLUSIONS The results show that the radiomics approach in preoperative MRI offer objective and valuable clinical information for treatment planning in SBM.
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Affiliation(s)
- Yang Zhang
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Jeon-Hor Chen
- Department of Radiological Sciences, University of California, Irvine, CA, USA.,Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care, Management, Tainan, Taiwan
| | - Te-Chang Wu
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.,Department of of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan. .,Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, CA, USA
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Affiliation(s)
- Kuan-Chih Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Ting Kuo
- Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Division of Endoscopy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Ligresti D, Baraldo S, Chavan R, Keane MG, Kuo YT, Saleem S, Seo DW. Endoscopic ultrasound-guided biliary drainage in a novel radiofrequency ablation-based swine biliary dilatation model. Endoscopy 2019; 51:E162-E163. [PMID: 30939612 DOI: 10.1055/a-0867-9348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Stefano Baraldo
- Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil
| | - Radhika Chavan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Yu-Ting Kuo
- Division of Endoscopy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Shaimaa Saleem
- Gastroenterology and Endoscopy Department, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Chou YC, Lao IH, Hsieh PL, Su YY, Mak CW, Sun DP, Sheu MJ, Kuo HT, Chen TJ, Ho CH, Kuo YT. Gadoxetic acid-enhanced magnetic resonance imaging can predict the pathologic stage of solitary hepatocellular carcinoma. World J Gastroenterol 2019; 25:2636-2649. [PMID: 31210715 PMCID: PMC6558433 DOI: 10.3748/wjg.v25.i21.2636] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although important for determining long-term outcome, pathologic stage of hepatocellular carcinoma (HCC) is difficult to predict before surgery. Current state-of-the-art magnetic resonance imaging (MRI) using gadoxetic acid provides many imaging features that could potentially be used to classify single HCC as pT1 or pT2.
AIM To determine which gadoxetic acid-enhanced MRI (EOB-MRI) findings predict pathologic stage T2 in patients with solitary HCC (cT1).
METHODS Pre-operative EOB-MRI findings were reviewed in a retrospective cohort of patients with solitary HCC. The following imaging features were examined: Hyperintensity in unenhanced T2-weighted images, hypointensity in unenhanced T1-weighted images, arterial enhancement, corona enhancement, washout appearance, capsular appearance, hypointensity in the tumor tissue during the hepatobiliary (HB) phase, peritumoral hypointensity in the HB phase, hypointense rim in the HB phase, intratumoral fat, hyperintensity on diffusion-weighted imaging, hypointensity on apparent diffusion coefficient map, mosaic appearance, nodule-in-nodule appearance, and the margin (smooth or irregular). Surgical pathology was used as the reference method for tumor staging. Univariate and multivariate analyses were performed to identify predictors of microvascular invasion or satellite nodules.
RESULTS There were 39 (34.2%; 39 of 114) and 75 (65.8%; 75 of 114) pathological stage T2 and T1 HCCs, respectively. Large tumor size (≥ 2.3 cm) and two MRI findings, i.e., corona enhancement [odds ratio = 2.67; 95% confidence interval: 1.101-6.480] and peritumoral hypointensity in HB phase images (odds ratio = 2.203; 95% confidence interval: 0.961-5.049) were associated with high risk of pT2 HCC. The positive likelihood ratio was 6.25 (95% confidence interval: 1.788-21.845), and sensitivity of EOB-MRI for detecting pT2 HCC was 86.2% when two or three of these MRI features were present. Small tumor size and hypointense rim in the HB phase were regarded as benign features. Small HCCs with hypointense rim but not associated with aggressive features were mostly pT1 lesions (specificity, 100%).
CONCLUSION Imaging features on EOB-MRI could potentially be used to predict the pathologic stage of solitary HCC (cT1) as pT1 or pT2.
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Affiliation(s)
- Yi-Chen Chou
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan
| | - I-Ha Lao
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan
- Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Pei-Ling Hsieh
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Ying-Ying Su
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Chee-Wai Mak
- Department of Medical Imaging, Chi Mei Medical Center, Tainan 710, Taiwan
| | - Ding-Ping Sun
- Department of Surgery, Chi Mei Medical Center, Tainan 710, Taiwan
- Department of Food Science and Technology, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - Ming-Jen Sheu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan 710, Taiwan
- Department of Medicinal Chemistry, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - Hsing-Tao Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan 710, Taiwan
- Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - Tzu-Ju Chen
- Department of Pathology, Chi-Mei Medical Center, Tainan 710, Taiwan
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan 717, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan 710, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Ko CC, Chen TY, Lim SW, Kuo YT, Wu TC, Chen JH. Prediction of Recurrence in Parasagittal and Parafalcine Meningiomas: Added Value of Diffusion-Weighted Magnetic Resonance Imaging. World Neurosurg 2019; 124:e470-e479. [PMID: 30610981 DOI: 10.1016/j.wneu.2018.12.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Parasagittal and parafalcine (PSPF) meningiomas recur more frequently than other intracranial meningiomas owing to the difficulty in achieving gross total resection. The present study investigated the preoperative magnetic resonance imaging (MRI) features for the prediction of progression/recurrence (P/R) in benign PSPF meningiomas with an emphasis on the apparent diffusion coefficient (ADC) values. METHODS We retrospectively investigated the preoperative MRI features for the prediction of P/R in benign (World Health Organization grade I) PSPF meningiomas. Only patients who had undergone preoperative and postoperative MRI follow-up studies for ≥1 year were included. From October 2006 to December 2015, 48 patients with a diagnosis of benign PSPF meningioma were included (median follow-up period, 42.5 months). Of these 48 patients, 12 (25%) developed P/R (median time to P/R, 23 months). RESULTS PSPF meningiomas in male patients, subtotal resection, large tumor diameter, high diffusion-weighted imaging signal, and lower ADC values or ratios were significantly associated with P/R (P < 0.05). The cutoff points of the ADC value and ADC ratio for the prediction of P/R were 0.83 × 10-3 mm2/second and 0.99, with an area under the curve of 0.82 and 0.83, respectively (P = 0.001). On multivariate Cox proportional hazards analysis, male sex and low ADC values (<0.83 × 10-3 mm2/second) were high-risk factors for P/R, with a hazard ratio of 12.37 and 30.2, respectively (P < 0.05). Kaplan-Meier analysis showed that lower ADC values and ratios predicted for significantly shorter progression-free survival (P < 0.05). CONCLUSIONS The preoperative ADC values and ratios for the prediction of P/R offer additional valuable information for the treatment planning for PSPF meningiomas.
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Affiliation(s)
- Ching-Chung Ko
- Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Tai-Yuan Chen
- Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan; Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yu-Ting Kuo
- Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan; Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Chang Wu
- Section of Neuroradiology, Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Jeon-Hor Chen
- Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan; Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, California, USA
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Abstract
Background and Objectives EUS training is recognized to have a substantial learning curve. To date, few dedicated training programs for EUS have been described. The swine model has been highlighted as a realistic tool to enhance EUS training. Studies extensively describing EUS swine anatomy are lacking in the current literature. The article aims to describe both radial and linear EUS pancreatobiliary swine anatomy. Materials and Methods Four live pigs were endoscoped under general anesthesia using both radial and linear array echoendoscopes. Relevant images and videos were recorded. Results It was possible to effectively image aorta, crus of the diaphragm, celiac trunk, superior mesenteric artery, pancreas, common bile duct, gallbladder, portal vein, kidneys, spleen, and hepatic hilum. Images were comparable to human EUS findings, with some remarkable differences. The pancreas was relatively larger in swine and in contrast to humans has three segments (duodenal, splenic, and connecting lobe). Conclusions The swine model was a highly realistic teaching model for linear and radial pancreatobiliary EUS and a useful tool for training in the setting of in vivo hands-on sessions.
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Affiliation(s)
- Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Specialized Advanced Therapies), Palermo, Italy
| | - Yu-Ting Kuo
- Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, National Taiwan University College of Medicine, Taipei, Taiwan, China
| | - Stefano Baraldo
- Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil
| | - Radhika Chavan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Margaret Geri Keane
- Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shaimaa Seleem
- Department of Gastroenterology and Endoscopy, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Wang SC, Lin LC, Kuo YT, Lin YW. Radiographic Number of Positive Pelvic Lymph Nodes as a Prognostic Factor in Cervical Cancer Treated With Definitive Concurrent Chemoradiotherapy or Intensity-Modulated Radiotherapy. Front Oncol 2018; 8:546. [PMID: 30555798 PMCID: PMC6284041 DOI: 10.3389/fonc.2018.00546] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background: This study aims to assess the prognostic significance of radiographic numbers of positive pelvic lymph nodes (PLNs) in patients with cervical cancer treated with definitive concurrent chemoradiotherapy (CCRT) or intensity-modulated radiotherapy (IMRT). Methods: We conducted a retrospective study that included 164 eligible adult patients with cervical cancer who were treated with definitive CCRT or IMRT at our institution from 2009 to 2016. After exclusion of 50 patients, a total of 114 patients whose clinicopathological data and follow-up were finally analyzed. The radiographic numbers of positive PLNs were assessed by pretreatment magnetic resonance imaging (MRI) or computed tomography (CT). The criterion for a positive lymph node was defined as a short-axis diameter >1 cm. Using the Kaplan–Meier method and the Cox proportional hazards regression model, we assessed the overall survival (OS), cancer-specific survival (CSS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS). Results: The median follow-up duration was 40 (range: 2–100) months. For patients with 0, 1–2, and ≥3 positive PLNs, the estimated 3-year OS were 85.4% vs. 82.4% vs. 59.7% (p = 0.035), CSS were 90.1% vs. 86.1% vs. 62.9% (p = 0.010), DMFS were 89.4% vs. 91.3% vs. 49.6% (p < 0.001), and LRFS were 77.8% vs. 73.4% vs. 70% (p = 0.690). Per the multivariate Cox regression, positive PLNs ≥3 (HR, 2.51; 95% CI: 1.09–5.80; p = 0.031) and non-squamous cell carcinoma type (HR, 2.82; 95% CI: 1.19–6.69; p = 0.018) were unfavorable factors for the OS. Besides, positive PLNs ≥3 was the independent factor for the CSS (HR, 3.38; 95% CI: 1.32–8.67; p = 0.011) and DMFS (HR, 6.83; 95% CI: 2.62–17.83; p < 0.001). The patients that were treated without intracavitary brachytherapy exhibited inferior LRFS (HR, 13.15; 95% CI: 2.66–65.10; p = 0.002). Conclusions: The radiographic number of positive PLNs (≥ 3) is an independent prognostic factor for OS, CSS, and DMFS in patients treated with definitive CCRT or IMRT.
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Affiliation(s)
- Shih-Chang Wang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Li-Ching Lin
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yu-Ting Kuo
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yu-Wei Lin
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
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