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Shih IL, Yen RF, Chen CA, Cheng WF, Chen BB, Zheng QY, Cheng MF, Chen JLY, Shih TTF. PET/MRI in Endometrial Cancer: Imaging Biomarkers are Associated with Disease Progression and Overall Survival. Acad Radiol 2024; 31:939-950. [PMID: 37714718 DOI: 10.1016/j.acra.2023.08.012] [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: 05/29/2023] [Revised: 07/22/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the association between positron emission tomography (PET)/magnetic resonance imaging (MRI) biomarkers and survival outcomes in patients with endometrial cancer. MATERIALS AND METHODS Between April 2014 and April 2016, 88 patients with newly diagnosed endometrial cancer participated this prospective study and underwent [18F] fluorodeoxyglucose PET/MRI. Sixty-nine patients with measurable tumors on PET/MRI were included in the image analysis. Imaging biomarkers included the minimum and mean apparent diffusion coefficients (ADCmin and ADCmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors. The log-rank test and Cox proportional hazards model were used to assess the relationship between imaging biomarkers and survival. RESULTS After a median follow-up of 80 months, 15 (22%) patients had tumor progression and six (9%) patients died. The results of ADCmin, ADCmean, and SUVmax did not show a significant association with progression-free survival (PFS) and overall survival (OS). Significantly shorter PFS was noted in patients with primary tumors with higher MTV (P < 0.001) and TLG (P < 0.001). Significantly shorter OS was also noted in patients with primary tumors with higher MTV (P = 0.048) and TLG (P = 0.034). In the multivariate analysis, MTV was an independent predictor of PFS (hazard ratio = 10.84, P = 0.033). CONCLUSION PET/MRI biomarkers, particularly MTV and TLG, are associated with PFS and OS in patients with endometrial cancer. MTV was an independent predictor of PFS.
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Affiliation(s)
- I-Lun Shih
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan (I.-L.S., B.-B.C., Q.-Y.Z., T.T.- F.S.); Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.)
| | - Ruoh-Fang Yen
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.); Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan (R.-F.Y., M.-F.C.)
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (C.-A.C., W.-F.C.); Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan (C.-A.C., W.-F.C.)
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan (C.-A.C., W.-F.C.); Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan (C.-A.C., W.-F.C.)
| | - Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan (I.-L.S., B.-B.C., Q.-Y.Z., T.T.- F.S.); Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.)
| | - Quan-Yin Zheng
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan (I.-L.S., B.-B.C., Q.-Y.Z., T.T.- F.S.); Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.)
| | - Mei-Fang Cheng
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.); Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan (R.-F.Y., M.-F.C.)
| | - Jenny Ling-Yu Chen
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.); Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (J.L.-Y.C.)
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan (I.-L.S., B.-B.C., Q.-Y.Z., T.T.- F.S.); Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan (I.-L.S., R.-F.Y., B.-B.C., Q.-Y.Z., M.-F.C., J.L.-Y.C., T.T.-F.S.).
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Chen BB, Huang YS. Editorial for "Amide Proton Transfer-Weighted Imaging and Multiple Models Intravoxel Incoherent Motion Based 18 F-FDG PET/MRI for Predicting Progression-Free Survival in Non-Small Cell Lung Cancer". J Magn Reson Imaging 2023. [PMID: 37792393 DOI: 10.1002/jmri.29039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Radiology, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Yu-Shen Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Radiology, College of Medicine, National Taiwan University, Taipei City, Taiwan
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Lu YS, Chen TW, Lin CH, Yeh DC, Tseng LM, Rau KM, Chen BB, Chao TC, Huang SM, Chang DY, Chen IC, Cheng AL. Anti-tumor efficacy of a bevacizumab preconditioning followed by etoposide and cisplatin regimen in human epidermal growth factor receptor-2-positive breast cancer brain metastasis refractory to whole brain radiotherapy. J Cancer Res Pract 2023. [DOI: 10.4103/ejcrp.ejcrp-d-23-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Peng SH, Chen BB, Kuo TC, Lee JC, Yang SH. Maintenance therapy of low-dose nivolumab, S-1, and leucovorin in metastatic pancreatic adenocarcinoma with a germline mutation of MSH6: A case report. Front Immunol 2022; 13:1077840. [PMID: 36582237 PMCID: PMC9792834 DOI: 10.3389/fimmu.2022.1077840] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) provide substantial benefits to a small subset of patients with advanced cancer with mismatch repair deficiency (MMRD) or microsatellite instability (MSI), including patients with pancreatic ductal adenocarcinoma (PDAC). However, the long duration of ICI treatment presents a considerable financial burden. We present the case of a 63-year-old woman with metastatic PDAC refractory to conventional chemotherapy. Genetic analyses identified an MSH6 germline mutation and a high tumor mutation burden (TMB). Complete response (CR) was achieved after a short course of low-dose nivolumab (20 mg once every 2 weeks) with chemotherapy. CR was maintained for over 1 year with low-dose nivolumab and de-escalated chemotherapy without any immune-related adverse events. This case supports the further exploration of low-dose, affordable ICI-containing regimens in patients with advanced MSI-high/TMB-high cancer.
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Affiliation(s)
- Shang-Hsuan Peng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan,Department of Oncology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Chun Kuo
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Chieh Lee
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Hung Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan,*Correspondence: Shih-Hung Yang,
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You K, Chen BB, Wang P, Bu RG, Xu XW. Intense venous reflux, quantified by a new software to analyze presurgical ultrasound, is associated with unfavorable outcomes of microsurgical varicocelectomy. Asian J Androl 2022; 25:119-125. [PMID: 35899921 PMCID: PMC9933975 DOI: 10.4103/aja202248] [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] [Indexed: 01/19/2023] Open
Abstract
The hemodynamic characteristics of venous reflux are associated with infertility in patients with varicocele; however, an effective method for quantifying the structural distribution of the reflux is lacking. This study aimed to predict surgical outcomes using a new software for venous reflux quantification. This was a retrospective cohort study of a consecutive series of 105 patients (age range: 22-44 years) between July 2017 and September 2019. Venous reflux of the varicocele was obtained using the Valsalva maneuver during scrotal Doppler ultrasonography before microsurgical varicocelectomy. Using this software, the colored reflux signals were segmented, and the gray scale of the color pixels representing the reflux velocity was comprehensively quantified into the mean reflux velocity of the green layer (MRVG) and the reflux velocity standard deviation of the green layer (RVSDG). Spontaneous pregnancy and changes from baseline in the semen parameters were assessed during a 12-month follow-up period. Data were analyzed using logistic regression analysis. An association of the high MRVG group with impaired progressive motility (odds ratio [OR] = 2.868, 95% confidence interval [CI]: 1.133-7.265) and impaired sperm concentration (OR = 2.943, 95% CI: 1.196-7.239) was found during multivariate analysis. High MRVG (OR = 2.680, 95% CI: 1.086-6.614) and high RVSDG (OR = 2.508, 95% CI: 1.030-6.111) were found to be independent predictors of failure to achieve pregnancy following microsurgical repair. In summary, intense venous reflux is an independent predictor of impaired progressive motility, sperm concentration, and pregnancy outcomes after microsurgical varicocelectomy.
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Affiliation(s)
- Kai You
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Bang-Bin Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Peng Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Ren-Ge Bu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China,
Correspondence: Dr. XW Xu () or Dr. RG Bu ()
| | - Xue-Wen Xu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China,
Correspondence: Dr. XW Xu () or Dr. RG Bu ()
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Yang SH, Lee JC, Chen BB, Kuo SH, Hsu C, Bai LY. Case Report: Maintenance Nivolumab in Complete Responder After Multimodality Therapy in Metastatic Pancreatic Adenocarcinoma. Front Immunol 2022; 13:870406. [PMID: 35572526 PMCID: PMC9097224 DOI: 10.3389/fimmu.2022.870406] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
Maintenance therapy is rarely considered in pancreatic ductal adenocarcinoma (PDAC). We describe the case of a 57-year-old man with metastatic PDAC treated with an initially full but subsequently de-escalated dose of combination chemotherapy due to intolerance to neurotoxicity. After a complete response to combined radiofrequency ablation for the liver metastasis and radiotherapy for the pancreatic tumor was achieved, chemotherapy was terminated and maintenance therapy was applied: nivolumab plus cytokine-induced killer cell therapy initially and then a de-escalated dosing interval of nivolumab monotherapy subsequently. No adverse events occurred during nivolumab therapy for more than 2 years, and the patient remains disease-free. To date, this is the first report of maintenance nivolumab after successful multimodality therapy in metastatic PDAC.
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Affiliation(s)
- Shih-Hung Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jen-Chieh Lee
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chiun Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Yuan Bai
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Yang SH, Lu LC, Kao HF, Chen BB, Kuo TC, Kuo SH, Tien YW, Bai LY, Cheng AL, Yeh KH. Negative prognostic implications of splenomegaly in nivolumab-treated advanced or recurrent pancreatic adenocarcinoma. Oncoimmunology 2021; 10:1973710. [PMID: 34595057 PMCID: PMC8477954 DOI: 10.1080/2162402x.2021.1973710] [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] [Indexed: 12/24/2022] Open
Abstract
Immune checkpoint inhibitors have limited efficacy in the treatment of pancreatic ductal adenocarcinoma (PDAC). We investigated prognostic markers for nivolumab-based therapy in advanced or recurrent PDAC. Consecutive patients receiving nivolumab-based therapy at our institution between 2015 and 2020 were evaluated. Overall survival (OS) was analyzed through univariate and multivariate analyses. Spleen volume was estimated from the width, thickness, and length of the spleen. A total of 45 patients were identified. Biweekly nivolumab was administered as monotherapy (n = 5) or in combination with chemotherapy or targeted therapy (n = 40). Among 31 evaluable patients, the response and disease control rates were 7% and 36%, respectively. The baseline median spleen volume was 267 (110–674) mL. Patients with spleens ≥267 mL had significantly shorter median OS (1.9 months, 95% confidence interval [CI], 1.0–2.7) than did those with smaller spleens (8.2 months, 95% CI, 5.6–10.8; P = .003). In the multivariate analysis, spleen volume of <267 mL, ≤2 lines of prior chemotherapy, ECOG performance status of 0–2, add-on nivolumab with stable disease after prior therapy, concomitant or sequential cell therapy, high lymphocyte count, and total bilirubin <1 mg/dL were independent favorable prognostic factors for OS. In the control groups of patients receiving gemcitabine-based chemotherapy (n = 142) or FOLFIRINOX regimen (n = 24), spleen volume exhibited no prognostic significance. In heavily pretreated PDAC, a large spleen may predict poor OS following nivolumab-based immunotherapy. Studies with larger cohorts should confirm the prognostic value of spleen volume.
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Affiliation(s)
- Shih-Hung Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Chun Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiang-Fong Kao
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Chun Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Yuan Bai
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
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Chang CK, Shih TTF, Tien YW, Chang MC, Chang YT, Yang SH, Cheng MF, Chen BB. Metabolic Alterations in Pancreatic Cancer Detected by In Vivo 1H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome. Diagnostics (Basel) 2021; 11:diagnostics11091541. [PMID: 34573881 PMCID: PMC8472373 DOI: 10.3390/diagnostics11091541] [Citation(s) in RCA: 3] [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: 07/08/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022] Open
Abstract
Objective: To compare the metabolites of in vivo 1H- MRS in pancreatic cancer with normal pancreas, and correlate these metabolites with Positron Emission Tomography (PET) metabolic activity, clinical stages, and survival outcomes. Methods: The prospective study included 58 patients (mean age 62.7 ± 12.1 years, range 34–81 years; 36 men, 22 women) with pathological proof of pancreatic adenocarcinoma, and all of them received 18F-fluorodeoxyglucose (FDG) PET/MRI before treatment. The single-voxel MRS with a point-resolved selective spectroscopy sequence was used to measure metabolites (creatine, Glx (glutamine and glutamate), N-acetylaspartate (NAA), and lipid) of pancreatic cancer and adjacent normal parenchyma, respectively. FDG-PET parameters included SUVmax, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Non-parametric tests were used to evaluate the differences of MRS metabolites between pancreatic cancer and those in normal pancreas, and their correlation with PET parameters and clinical stages. The correlation with progression-free survival (PFS) and overall survival (OS) was measured using the Kaplan–Meier and Cox proportional hazard models. Results: When compared with normal pancreas, the Glx, NAA, and lipid levels were significantly decreased in pancreatic cancer (all p < 0.05). Creatine, Glx, and lipid levels were all inversely correlated with both MTV (rho = −0.405~−0.454) and TLG (rho = −0.331~−0.441). For correlation with clinical stages, lower lipid levels were found in patients with T4 (vs. <T4, p = 0.038) and lower creatine levels were found in N1 (vs. N0, p = 0.019). Regarding survival outcomes, high TNM stage, low creatine, low Glx, and low lipid levels were associated with both poor PFS and OS (all p < 0.05). Additionally, creatine remained an independent factor for PFS and OS after adjusting for age, sex, tumor size, stages, and other metabolites levels. Conclusions: Decreased MRS metabolites in pancreatic cancer were associated with poor survival outcome, and may be used as prognostic image biomarkers for these patients.
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Affiliation(s)
- Chih-Kai Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-K.C.); (T.T.-F.S.)
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-K.C.); (T.T.-F.S.)
- Department of Radiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Ming-Chu Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (M.-C.C.); (Y.-T.C.)
| | - Yu-Ting Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (M.-C.C.); (Y.-T.C.)
| | - Shih-Hung Yang
- Department of Oncology, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-K.C.); (T.T.-F.S.)
- Department of Radiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-23123456 (ext. 65620); Fax: +886-2-23224552
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Tsai JY, Hung IYJ, Guo YL, Jan YK, Lin CY, Shih TTF, Chen BB, Lung CW. Lumbar Disc Herniation Automatic Detection in Magnetic Resonance Imaging Based on Deep Learning. Front Bioeng Biotechnol 2021; 9:708137. [PMID: 34490222 PMCID: PMC8416668 DOI: 10.3389/fbioe.2021.708137] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 05/13/2021] [Accepted: 07/19/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Lumbar disc herniation (LDH) is among the most common causes of lower back pain and sciatica. The causes of LDH have not been fully elucidated but most likely involve a complex combination of mechanical and biological processes. Magnetic resonance imaging (MRI) is a tool most frequently used for LDH because it can show abnormal soft tissue areas around the spine. Deep learning models may be trained to recognize images with high speed and accuracy to diagnose LDH. Although the deep learning model requires huge numbers of image datasets to train and establish the best model, this study processed enhanced medical image features for training the small-scale deep learning dataset. Methods: We propose automatic detection to assist the initial LDH exam for lower back pain. The subjects were between 20 and 65 years old with at least 6 months of work experience. The deep learning method employed the YOLOv3 model to train and detect small object changes such as LDH on MRI. The dataset images were processed and combined with labeling and annotation from the radiologist's diagnosis record. Results: Our method proves the possibility of using deep learning with a small-scale dataset with limited medical images. The highest mean average precision (mAP) was 92.4% at 550 images with data augmentation (550-aug), and the YOLOv3 LDH training was 100% with the best average precision at 550-aug among all datasets. This study used data augmentation to prevent under- or overfitting in an object detection model that was trained with the small-scale dataset. Conclusions: The data augmentation technique plays a crucial role in YOLOv3 training and detection results. This method displays a high possibility for rapid initial tests and auto-detection for a limited clinical dataset.
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Affiliation(s)
- Jen-Yung Tsai
- Department of Digital Media Design, Asia University, Taichung, Taiwan
| | - Isabella Yu-Ju Hung
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Yue Leon Guo
- Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan
- Graduate Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Chih-Yang Lin
- Department of Electrical Engineering, Yuan Ze University, Chung-Li, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University (NTU) Hospital and NTU College of Medicine, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University (NTU) Hospital and NTU College of Medicine, Taipei, Taiwan
| | - Chi-Wen Lung
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Department of Creative Product Design, Asia University, Taichung, Taiwan
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Hung IYJ, Shih TTF, Chen BB, Guo YL. Prediction of Lumbar Disc Bulging and Protrusion by Anthropometric Factors and Disc Morphology. Int J Environ Res Public Health 2021; 18:ijerph18052521. [PMID: 33806268 PMCID: PMC7967385 DOI: 10.3390/ijerph18052521] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
The relationship between reduced disc height and disc bulging and/or protrusion has been controversial. The purposes of this study were to examine the relationship between disc morphology and disc bulging and protrusion and to establish a model for predicting disc bulging and protrusion. This is a retrospective study. A total of 452 MRI scans from a spine study were analysed, 210 (46.5%) were men. Logistic regression analysis was applied to identify the association between anthropometric factors, disc morphology factors, and outcome. Model 1 was constructed using anthropometric variables to investigate the capacity for predicting outcomes. Model 2 was constructed using anthropometric and disc morphology variables. Age, body weight, body height, disc height, and disc depth were significantly associated with outcome. The area under the curve (AUC) statistics of Model 2 were significantly better than those of Model 1 at the L3-L4 and L4-L5 levels but not at the L5-S1 level. The results showed an association between disc morphology and disc bulging and/or protrusion at the L3-L4, L4-L5, and L5-S1 levels. The model utilizing both anthropometric factors and disc morphology factors had a better capacity to predict disc bulging and/or protrusion compared with the model using only anthropometric factors.
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Affiliation(s)
- Isabella Yu-Ju Hung
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan;
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University (NTU) Hospital and NTU College of Medicine, Taipei 100225, Taiwan; (T.T.-F.S.); (B.-B.C.)
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University (NTU) Hospital and NTU College of Medicine, Taipei 100225, Taiwan; (T.T.-F.S.); (B.-B.C.)
| | - Yue Leon Guo
- National Institute of Environmental Health Sciences, National Health Research Institute (NHRI), Miaoli 35053, Taiwan
- Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei 100225, Taiwan
- Graduate Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100225, Taiwan
- Correspondence:
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Jan IS, Chang MC, Yang CY, Tien YW, Jeng YM, Wu CH, Chen BB, Chang YT. Validation of Indications for Surgery of European Evidence-Based Guidelines for Patients with Pancreatic Intraductal Papillary Mucinous Neoplasms. J Gastrointest Surg 2020; 24:2536-2543. [PMID: 31745906 DOI: 10.1007/s11605-019-04420-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Which patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) should undergo surgical intervention remains a controversial issue. The aim of this retrospective study was to validate the new European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) for the management of IPMNs. METHODS One hundred fifty-eight patients with resected IPMNs at National Taiwan University Hospital between January 1994 and December 2016 were enrolled. Clinical information, including new-onset diabetes mellitus (DM) and preoperative CA 19-9 levels, were collected. All patients were stratified into three groups-absolute, relative indications, and conservative approach-according to EEBGPCN. The performance characteristics of EEBGPCN for high-grade dysplasia (HGD)/invasive carcinoma (IC) of IPMNs were calculated. RESULTS One hundred seven (67.7%) patients with low-grade dysplasia and 51 patients with HGD/IC, including 10 HGD and 41 IC, were analyzed. The missed rate for HGD/IC by EEBGPCN was 1.9% (3/158). The sensitivity, specificity, positive and negative predictive values, and accuracy of the absolute or relative indications for resecting IPMN according to EEBGPCN were 94.1%, 28.0%, 38.4%, 90.9%, and 49.4%. Jaundice, enhancing mural nodule < 5 mm, cyst diameter > 40 mm, increased levels of serum CA 19-9, new-onset DM, and main pancreatic duct dilation were associated with HGD/IC. CONCLUSIONS The missed rate for HGD/IC is low by EEBGPCN. Increased serum CA 19-9 and new-onset DM in EEBGPCN were verified as the indications for the surgical resection of IPMNs.
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Affiliation(s)
- I-Shiow Jan
- Department of Laboratory Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Chu Chang
- Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung Shan South Road, Taipei, 100, Taiwan
| | - Ching-Yao Yang
- Department of Surgery, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yung-Ming Jeng
- Department of Pathology, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pathology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Horng Wu
- Department of Medical Image, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Image, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Image, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Image, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ting Chang
- Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung Shan South Road, Taipei, 100, Taiwan.
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12
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Peng YC, Wu CH, Tien YW, Lu TP, Wang YH, Chen BB. Preoperative sarcopenia is associated with poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy. Eur Radiol 2020; 31:2472-2481. [PMID: 32974690 DOI: 10.1007/s00330-020-07294-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To analyze the effect of preoperative body composition on survival in patients with pancreatic cancer following pancreaticoduodenectomy (PD). METHODS Between October 2005 and August 2018, 116 patients (68 men, 48 women, mean age 66.2 ± 11.9 years) diagnosed with pancreatic adenocarcinoma following PD were retrospectively enrolled. The preoperative CT on vertebral level L3 was assessed for total abdominal muscle area (TAMA), visceral adipose tissue area (VAT), subcutaneous adipose tissue area (SAT), and mean skeletal muscle attenuation (SMD). The clinical data and pathological findings of tumors were collected. The impact of these factors on disease-free survival (DFS) and overall survival (OS) was evaluated by the Kaplan-Meier method and by univariable and multivariable Cox proportional hazards models. RESULTS The 3-year DFS and OS rates were 8% and 25%, respectively. Of 116 patients, 20 (17.2%), 3 (2.6%), and 46 (39.7%) patients were classified as having sarcopenia, sarcopenic obesity, and myosteatosis, respectively. The VAT-TAMA ratio (1.2 ± 0.7 vs 0.9 ± 0.5, p = 0.01) and the visceral to subcutaneous adipose tissue area ratio (1.3 ± 0.7 vs 0.9 ± 0.5, p = 0.04) were higher in sarcopenic patients than in the nonsarcopenic group. Preoperative sarcopenia and sarcopenic obesity were associated with shorter OS (p = 0.012 and p = 0.041, respectively), but not shorter DFS. Myosteatosis was neither associated with DFS nor OS. On multivariable analysis, sarcopenia was the only significant prognostic factor for OS (p = 0.039). CONCLUSIONS Preoperative sarcopenia assessed by CT is a poor prognostic factor for OS in pancreatic cancer patients after PD. KEY POINTS • Sarcopenia and sarcopenic obesity can be evaluated by abdominal CT on L3 level. • Patients with diabetes mellitus (DM) had lower sex-standardized subcutaneous adipose tissue area index and skeletal muscle density and higher visceral to subcutaneous adipose tissue area ratio than did those without DM. • Preoperative sarcopenia, sarcopenic obesity, and new-onset diabetes mellitus may predict poor overall survival in pancreatic cancer patients following pancreaticoduodenectomy.
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Affiliation(s)
- Yan-Chih Peng
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Rd, Taipei City, 10016, Taiwan
| | - Chien-Hui Wu
- Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Tzu-Pin Lu
- Department of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsin Wang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Rd, Taipei City, 10016, Taiwan.
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13
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Shih IL, Yen RF, Chen CA, Cheng WF, Chen BB, Chang YH, Cheng MF, Shih TTF. PET/MRI in Cervical Cancer: Associations Between Imaging Biomarkers and Tumor Stage, Disease Progression, and Overall Survival. J Magn Reson Imaging 2020; 53:305-318. [PMID: 32798280 DOI: 10.1002/jmri.27311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/07/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression-free survival (PFS) and overall survival (OS) merit further investigation. PURPOSE To evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer. STUDY TYPE Prospective cohort study. POPULATION In all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis. FIELD STRENGTH/SEQUENCE 3.0T integrated PET/MRI including diffusion-weighted echo-planar imaging (b = 50 and 1000 s/mm2 ) and [18F]fluorodeoxyglucose PET. ASSESSMENT Two radiologists measured the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean ), maximum standardized uptake value (SUVmax ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors. STATISTICAL TESTS A Mann-Whitney U-test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival. RESULTS In advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADCmin was significantly lower and MTV, TLG, MTV/ADCmin , and TLG/ADCmin were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADCmin was significantly lower and MTV and MTV/ADCmin were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUVmax was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADCmin was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADCmin was a predictor of PFS in stage I disease (P = 0.003), ADCmin (P = 0.038), and MTV (P = 0.020) in stage II, SUVmax (P = 0.006), and TLG (P = 0.006) in stage IV; and ADCmin was a predictor of OS in stage III disease (P = 0.008). DATA CONCLUSION PET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUVmax and ADCmin are independent predictors of PFS and OS, respectively. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: 3.
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Affiliation(s)
- I-Lun Shih
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Rouh-Fang Yen
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsuan Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mei-Fang Cheng
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.,Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Abstract
In recent years, the application of artificial intelligence (AI) in radiology has been growing rapidly, fueled by the availability of large datasets, advances in computing power, and newly developed algorithms. Progress in AI applied to medical imaging analyses has transformed these images into quantitative data, termed radiomics. When combined with patients’ clinical data, these models, when developed by machine learning, have the potential to improve diagnostic, prognostic, and predictive accuracy. Currently, limited literature is available on the use of radiomics for pancreatic disease. Here, we will review recent studies in the application of AI in a variety of pancreatic diseases, mainly involving lesion detection, tumor characterization, tumor grading, response, and prognosis evaluation. Finally, we will also discuss the challenges and prospects in the field of radiomics for pancreatic disease.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei 10016, Taiwan
- Department of Radiology, College of Medicine, National Taiwan University, Taipei 10016, Taiwan
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15
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Chen BB. Will novel imaging approaches predict oligometastases or early liver metastasis in patients with colorectal cancer? Hepatobiliary Surg Nutr 2020; 9:391-393. [PMID: 32509839 PMCID: PMC7262606 DOI: 10.21037/hbsn.2019.10.31] [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: 09/15/2019] [Accepted: 10/24/2019] [Indexed: 08/29/2023]
Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei
- Department of Medical Imaging, College of Medicine, National Taiwan University, Taipei
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16
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Hung IYJ, Shih TTF, Chen BB, Liou SH, Ho IK, Guo YL. The roles of lumbar load thresholds in cumulative lifting exposure to predict disk protrusion in an Asian population. BMC Musculoskelet Disord 2020; 21:169. [PMID: 32178650 PMCID: PMC7077115 DOI: 10.1186/s12891-020-3167-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 02/26/2020] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was to determine whether a specific threshold per lifting movement, the accumulation above which best predicts lumbar disk protrusion, exists or the total lifting load should be considered. Methods This was a retrospective study. Subjects with various lifting exposures were recruited. Disk protrusion was assessed by magnetic resonance imaging. The cumulative lifting load was defined as the sum of the time-weighed lumbar load for each job and was calculated using a biomechanical software system. The effectiveness of accumulation above different thresholds in predicting disk protrusion were compared using four statistical methods. Results A total of 252 men and 301 women were included in the final analysis. For the men, 3000 Newtons for each lifting task was the optimal threshold for predicting L4-S1 disk protrusion, whereas for the women, 2800 Newtons was optimal. Conclusions Our findings suggested that for cumulative lifting exposure, including the total lifting load without defining a minimal exposure limit might not be the optimal method for predicting disk protrusion. The NIOSH 3400 Newton recommended limits do not appear to be the optimal thresholds for preventing disk protrusion. Different lifting thresholds might be needed for men and women in the workplace for their safety.
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Affiliation(s)
- Isabella Y-J Hung
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Tiffany T-F Shih
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University (NTU), College of Medicine, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University (NTU), College of Medicine, Taipei, Taiwan
| | - Saou-Hsing Liou
- National Institute of Environmental Health Sciences, National Health Research Institute (NHRI), Miaoli, Taiwan
| | - Ing-Kang Ho
- Center for Drug Abuse and Addiction, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Yue Leon Guo
- National Institute of Environmental Health Sciences, National Health Research Institute (NHRI), Miaoli, Taiwan. .,Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei, Taiwan. .,Graduate Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University (NTU), Taipei, Taiwan.
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17
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Chen HW, Kuo HY, Chen BB, Tien YW, Kuo SH, Yang SH. S-1-Associated Hypertriglyceridemia in a Patient With Pancreatic Adenocarcinoma. JCO Oncol Pract 2020; 16:45-47. [PMID: 31618087 DOI: 10.1200/jop.19.00204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hsing-Wu Chen
- National Taiwan University Hospital, Taipei City, Taiwan
| | - Hung-Yang Kuo
- National Taiwan University Hospital, Taipei City, Taiwan
- National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Bang-Bin Chen
- National Taiwan University Hospital, Taipei City, Taiwan
| | - Yu-Wen Tien
- National Taiwan University Hospital, Taipei City, Taiwan
| | - Sung-Hsin Kuo
- National Taiwan University Hospital, Taipei City, Taiwan
- National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Shih-Hung Yang
- National Taiwan University Hospital, Taipei City, Taiwan
- National Taiwan University College of Medicine, Taipei City, Taiwan
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18
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Zhan X, Cao ZZ, Chen RR, Chen BB. [Giant teratoma of nasopharynx with cleft palate and lingual hamartoma in the newborn: a case report]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 54:695-697. [PMID: 31550764 DOI: 10.3760/cma.j.issn.1673-0860.2019.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- X Zhan
- Department of Otorhinolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Z Z Cao
- Department of Otorhinolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - R R Chen
- Department of Otorhinolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - B B Chen
- Department of Otorhinolaryngology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
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19
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Chang YT, Tung CC, Chang MC, Wu CH, Chen BB, Jan IS. Age and cystic size are associated with clinical impact of endoscopic ultrasonography-guided fine-needle aspiration on the management of pancreatic cystic neoplasms. Scand J Gastroenterol 2019; 54:506-512. [PMID: 30978145 DOI: 10.1080/00365521.2019.1601254] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: The clinical impact of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) in managing pancreatic cystic neoplasms (PCNs) remains controversial. The aim of this study was to identify which patients with PCNs would benefit from EUS-FNA. Methods: A retrospective study was performed on patients with PCNs who underwent EUS-FNA between January 2009 and June 2018. A discordant or a consistent diagnosis after EUS-FNA was analyzed and was correlated with the clinical demographic data and cystic features. Predictors of the change in the diagnosis after EUS-FNA were analyzed. Results: One hundred eighty-eight cases of PCNs were analyzed. EUS-FNA changed the diagnosis in 45.7% of all patients with PCNs and 54.5% patients with presumed branch ductal type intraductal papillary mucinous neoplasm (BD-IPMN) and impacted the recommendation in 35.6% of patients with PCNs and 50.5% patients with BD-IPMN. Patients with a discordant diagnosis after EUS-FNA were younger in age (54.8 ± 12.6 vs. 61.2 ± 14.2; p=.037) and had a cyst size larger than 3 cm than patients with a consistent diagnosis after EUS-FNA. The only worrisome feature (WF) that differed between patients with a discordant and a consistent diagnosis after EUS-FNA was the main pancreatic duct (MPD) between 5 and 9 mm (p=.013). In multivariate analysis, a cyst size >3 cm and age were independent predictors of diagnostic changes after EUS-FNA (OR: 5.33, 95% CI: 1.79-15.88, p = .003; OR: 0.96, 95% CI: 0.93-0.99, p = .031). Conclusions: EUS-FNA made a significant change in the management of nearly half of the patients with PCNs, especially in younger patients and in patients with a cyst size larger than 3 cm.
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Affiliation(s)
- Yu-Ting Chang
- a Department of Internal Medicine, National Taiwan University Hospital, College of Medicine , National Taiwan University , Taipei , Taiwan.,b Department of Internal Medicine , College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Chien-Chih Tung
- c Department of Integrated Diagnostics and Therapeutics and Internal Medicine , National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Ming-Chu Chang
- a Department of Internal Medicine, National Taiwan University Hospital, College of Medicine , National Taiwan University , Taipei , Taiwan.,b Department of Internal Medicine , College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Chih-Horng Wu
- d Department of Medical Imaging , National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - Bang-Bin Chen
- d Department of Medical Imaging , National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei , Taiwan
| | - I-Shiow Jan
- e Department of Laboratory Medicine , College of Medicine, National Taiwan University , Taipei , Taiwan.,f Department of Laboratory Medicine , National Taiwan University Hospital, College of Medicine, National Taiwan University , Taipei , Taiwan
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20
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Xie ZW, Li JP, Guan YJ, Zhang XY, Guo FX, Chen BB, Pan CQ. [A clinical study of antiviral therapy for patients with compensated hepatitis C cirrhosis]. Zhonghua Gan Zang Bing Za Zhi 2019; 25:827-833. [PMID: 29325276 DOI: 10.3760/cma.j.issn.1007-3418.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: To investigate the effect of antiviral therapy on the progression of liver cirrhosis and related predictive factors through a retrospective analysis of patients with compensated hepatitis C cirrhosis. Methods: The patients with compensated hepatitis C cirrhosis who were treated in our hospital from 2004 to 2015 were divided into sustained virologic response (SVR) group, non-SVR (NSVR) group, and untreated group. The baseline features of patients with or without liver cirrhosis were compared to identify the predictive factors for the progression of liver cirrhosis. The changes in platelet count, spleen sizes, Model for End-Stage Liver Disease (MELD) score, Sequential Organ Failure Assessment (SOFA) score, and Child-Turotte-Pugh (CTP) score were analyzed, and the incidence rate of liver cancer was compared between groups. A one-way analysis of variance, the Kruskal-wallis H test, the two-independent-sample t test, the chi-square test, and a multivariate logistic regression analysis were used for data analysis based on data type. Results: A total of 89 patients with compensated liver cirrhosis were enrolled, among whom 42 received the antiviral treatment with interferon and ribavirin (30 were treated with pegylated interferon-α and 12 were treated with ordinary interferon) and 47 did not receive any antiviral therapy. Among the patients who received the antiviral treatment with interferon and ribavirin, 20 achieved SVR and 22 did not achieve SVR. Compared with baseline values, platelet count in the SVR group and the NSVR group was increased by (44.93 ± 32.66)×10(9)/L and (9.73 ± 28.83)×10(9)/L, respectively, and platelet count in the untreated group was reduced by (19.76 ± 54.5)×10(9)/L; the three groups had a significant change in platelet count (F = 14.731, P < 0.001). Spleen size was reduced by 0.91 ± 1.09 cm in the SVR group and increased by 0.20±0.84 cm and 1.11 ± 1.69 cm in the NSVR group and the untreated group, respectively; the three groups had a significant change in spleen size (F = 14.943, P < 0.001). The three groups had no significant changes in MELD, SOFA, and CTP scores (P > 0.05). One patient (5.00%) in the SVR group, 5 (22.73%) in the NSVR group, and 6 (12.77%) in the untreated group progressed to liver cancer (χ (2) = 13.787, P = 0.001). The univariate analysis showed that SVR, HCV RNA, total bilirubin, and albumin were predictive factors for disease progression, and the multiple logistic regression analysis demonstrated that SVR and total bilirubin were predictive factors for disease progression. Conclusion: Interferon combined with ribavirin has a marked clinical effect in the treatment of compensated hepatitis C cirrhosis with good short- and long-term efficacy.
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Affiliation(s)
- Z W Xie
- Department of Hepatology Division II, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510060, China
| | - J P Li
- Department of Hepatology Division II, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510060, China
| | - Y J Guan
- Department of Hepatology Division II, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510060, China
| | - X Y Zhang
- Department of Hepatology Division II, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510060, China
| | - F X Guo
- Department of Hepatology Division II, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510060, China
| | - B B Chen
- Department of Hepatology Division II, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou 510060, China
| | - Calvin Q Pan
- 11355, Division of Gastroenterology and Hepatology, NYU Langone Medical Center New York University School of Medicine, New York 11355, USA
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21
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Chen BB, Lu YS, Yu CW, Lin CH, Chen TWW, Wei SY, Cheng AL, Shih TTF. Imaging biomarkers from multiparametric magnetic resonance imaging are associated with survival outcomes in patients with brain metastases from breast cancer. Eur Radiol 2018; 28:4860-4870. [PMID: 29770848 DOI: 10.1007/s00330-018-5448-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/24/2017] [Revised: 03/02/2018] [Accepted: 03/23/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this study is to investigate the correlation of survival outcomes with imaging biomarkers from multiparametric magnetic resonance imaging (MRI) in patients with brain metastases from breast cancer (BMBC). METHODS This study was approved by the institutional review board. Twenty-two patients with BMBC who underwent treatment involving bevacizumab on day 1, etoposide on days 2-4, and cisplatin on day 2 in 21-day cycles were prospectively enrolled for a phase II study. Three brain MRIs were performed: before the treatment, on day 1, and on day 21. Eight imaging biomarkers were derived from dynamic contrast-enhanced MRI (Peak, IAUC60, Ktrans, kep, ve), diffusion-weighted imaging [apparent diffusion coefficient (ADC)], and MR spectroscopy (choline/N-acetylaspartate and choline/creatine ratios). The relative changes (Δ) in these biomarkers were correlated with the central nervous system (CNS)-specific progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier and Cox proportional hazard models. RESULTS There were no significant differences in the survival outcomes as per the changes in the biomarkers on day 1. On day 21, those with a low ΔKtrans (p = 0.024) or ΔADC (p = 0.053) reduction had shorter CNS-specific PFS; further, those with a low ΔPeak (p = 0.012) or ΔIAUC60 (p = 0.04) reduction had shorter OS compared with those with high reductions. In multivariate analyses, ΔKtrans and ΔPeak were independent prognostic factors for CNS-specific PFS and OS, respectively, after controlling for age, size, hormone receptors, and performance status. CONCLUSIONS Multiparametric MRI may help predict the survival outcomes in patients with BMBC. KEY POINTS • Decreased angiogenesis after chemotherapy on day 21 indicated good survival outcome. • ΔK trans was an independent prognostic factors for CNS-specific PFS. • ΔPeak was an independent prognostic factors for OS. • Multiparametric MRI helps clinicians to assess patients with BMBC. • High-risk patients may benefit from more intensive follow-up or treatment strategies.
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Affiliation(s)
- Bang-Bin Chen
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Wei Yu
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Ching-Hung Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shwu-Yuan Wei
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
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Chen BB, Tien YW, Chang MC, Cheng MF, Chang YT, Yang SH, Wu CH, Kuo TC, Shih IL, Yen RF, Shih TTF. Multiparametric PET/MR imaging biomarkers are associated with overall survival in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging 2018; 45:1205-1217. [PMID: 29476229 DOI: 10.1007/s00259-018-3960-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 10/16/2017] [Accepted: 01/22/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To correlate the overall survival (OS) with the imaging biomarkers of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy, and glucose metabolic activity derived from integrated fluorine 18 fluorodeoxyglucose positron emission tomography (18F-FDG PET)/MRI in patients with pancreatic cancer. METHODS This prospective study was approved by the institutional review board and informed consent was obtained from all participants. Sixty-three consecutive patients (mean age, 62.7 ± 12 y; men/women, 40/23) with pancreatic cancer underwent PET/MRI before treatment. The imaging biomarkers were comprised of DCE-MRI parameters (peak, IAUC 60 , K trans , k ep , v e ), the minimum apparent diffusion coefficient (ADCmin), choline level, standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) of the tumors. The relationships between these imaging biomarkers with OS were evaluated with the Kaplan-Meier and Cox proportional hazard models. RESULTS Seventeen (27%) patients received curative surgery, with the median follow-up duration being 638 days. Univariate analysis showed that patients at a low TNM stage (≦3, P = 0.041), high peak (P = 0.006), high ADCmin (P = 0.002) and low TLG (P = 0.01) had better OS. Moreover, high TLG/peak ratio was associated with poor OS (P = 0.016). Multivariate analysis indicated that ADCmin (P = 0.011) and TLG/peak ratio (P = 0.006) were independent predictors of OS after adjustment for age, gender, tumor size, and TNM stage. The TLG/peak ratio was an independent predictor of OS in a subgroup of patients who did not receive curative surgery (P = 0.013). CONCLUSION The flow-metabolism mismatch reflected by the TLG/peak ratio may better predict OS than other imaging biomarkers from PET/MRI in pancreatic cancer patients.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Yu-Wen Tien
- Department of Surgery, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Ming-Chu Chang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Yu-Ting Chang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Shih-Hung Yang
- Department of Oncology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Ting-Chun Kuo
- Department of Surgery, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - I-Lun Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
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Huang SL, Chen BB, Hsueh IP, Jeng JS, Koh CL, Hsieh CL. Prediction of lower extremity motor recovery in persons with severe lower extremity paresis after stroke. Brain Inj 2018; 32:627-633. [PMID: 29388842 DOI: 10.1080/02699052.2018.1432897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the extent of motor recovery and predict the prognosis of lower extremity (LE) recovery in patients with severe LE paresis after stroke Methods: 137 patients with severe LE paresis after stroke were recruited from a local medical centre. Voluntary LE movement was assessed with the LE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-LE). Univariate and stepwise regression analyses were used to investigate 25 clinical variables (including demographic, neuroimaging, and behavioural variables) for finding the predictors of LE recovery. RESULTS The STREAM-LE at discharge (DCSTREAM-LE) of the participants covered a very wide range (0-19). Specifically, 5.1% of the participants were nearly completely recovered, 11.7% were moderately recovered, 36.5% were slightly recovered, and 46.7% remained severely paralysed. 'Score of STREAM-LE at admission (ADSTREAM-LE)' and 'volume of lesion and oedema') were significant predictors of LE movement at discharge, explaining 25.1% of the variance of the DCSTREAM-LE (p < 0.001). CONCLUSIONS LE motor recovery varied widely in our participants, indicating that patients' recovery might not follow simple rules. The low predictive power (about a quarter) indicates that LE motor recovery in patients with severe LE paresis after stroke was hardly predictive.
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Affiliation(s)
- Sheau-Ling Huang
- a School of Occupational Therapy, College of Medicine , National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| | - Bang-Bin Chen
- c Department of Medical Imaging and Radiology , National Taiwan University College of Medicine and Hospital , Taipei , Taiwan
| | - I-Ping Hsueh
- a School of Occupational Therapy, College of Medicine , National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan
| | - Jiann-Shing Jeng
- d Stroke Center and Department of Neurology , National Taiwan University Hospital , Taipei , Taiwan
| | - Chia-Lin Koh
- a School of Occupational Therapy, College of Medicine , National Taiwan University , Taipei , Taiwan
| | - Ching-Lin Hsieh
- a School of Occupational Therapy, College of Medicine , National Taiwan University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan.,e Department of Occupational Therapy, College of Medical and Health Science , Asia University , Taichung , Taiwan
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Cao ZZ, Zheng XX, Feng BH, Gao JJ, Huang SY, Zhan X, Li BL, Chen BB. [Analysis of the related factors of attention deficit/hyperactivity disorder and allergic rhinitis in children]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:250-255. [PMID: 29798499 DOI: 10.13201/j.issn.1001-1781.2018.04.003] [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] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Indexed: 06/08/2023]
Abstract
Objective:To investigate the association between symptom of attention deficit/hyperactivity disorder (ADHD) and allergic rhinitis (AR) in children with AR at different sexes and different ages. Method:A total of 439 AR children aged 6 to 12 years were enrolled in this study. Basic information (age, gender, medical history, family history and comorbidities) of children with AR was collected. Results of prick tests on children skin were recorded. (TNSS) and Chinese version of the SNAP-Ⅳ scale, children under the guidance of independent completion of children's quality of life of children with nasal conjunctivitis scale (PRQLQ). According to the results of SNAP-Ⅳ, children were divided into AR with ADHD group [attention deficit and hyperactivity symptom score (IHS) >1.25] and AR without ADHD group (IHS≤1.25). The differences between the two groups of children were analyzed using group t-test and χ² test, and the relationship between each parameter and IHS >1.25 was analyzed by binary logistic regression. Result:Using SPSS 22.0 software, among all the included AR children, IHS >1.25 children accounted for 26.4%, IHS >1.25 group AR symptom scores were significantly higher than HIS ≤1.25 groups. Univariate analysis showed that children with age, gender, duration of AR symptoms, skin index and PRQLQ subscales had a correlation with IHS >1.25. After controlling for age and gender, duration of AR symptoms and skin index correlated with IHS >1.25 The estimated OR values are 1.807 (95%CI: 1.350-2.419) and 1.912 (95%CI: 1.320-2.772), respectively. The estimated OR values of PRQLQ subscale and IHS >1.25 were 1.657 (nasal symptom score), 1.324 (eye symptom score), 2.48 (non-eye-nasal symptom score), 1.418 (Behavior problem score) and 2.045 (activity and sleep score). The correlation between IHS>1.25 and the skin index and PRQLQ subscales was mainly found in males with stratification of age and gender, and the association between duration of AR symptoms and HIS >1.25 was statistically significant among all groups reflected. Conclusion:The association between attention deficits and hyperactivity symptoms in AR children was correlated with the severity of AR symptoms, duration, and skin index, and this association was more pronounced in males. In children with AR and ADHD, early management of AR symptoms may improve their ADHD symptoms.
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Affiliation(s)
- Z Z Cao
- Department of Otolaryngology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- The Second School of Medicine, Wenzhou Medical University
| | - X X Zheng
- Department of Otolaryngology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- The Second School of Medicine, Wenzhou Medical University
| | - B H Feng
- Department of Otolaryngology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- The Second School of Medicine, Wenzhou Medical University
| | - J J Gao
- Department of Otolaryngology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- The Second School of Medicine, Wenzhou Medical University
| | - S Y Huang
- Department of Otolaryngology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- The Second School of Medicine, Wenzhou Medical University
| | - X Zhan
- Department of Otolaryngology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- The Second School of Medicine, Wenzhou Medical University
| | - B L Li
- Department of Otolaryngology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- The Second School of Medicine, Wenzhou Medical University
| | - B B Chen
- Department of Otolaryngology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- The Second School of Medicine, Wenzhou Medical University
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Chen BB, Hsu CY, Yu CW, Liang PC, Hsu C, Hsu CH, Cheng AL, Ting-Fang Shih T. Dynamic Contrast-enhanced MR Imaging of Advanced Hepatocellular Carcinoma: Comparison with the Liver Parenchyma and Correlation with the Survival of Patients Receiving Systemic Therapy. Radiology 2017; 283:923. [DOI: 10.1148/radiol.2017174012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Huang PH, Chen BB, Lin ZZ, Shen YC, Chao Y, Shao YY, Cheng AL, Hsu C. Using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict efficacy of axitinib for treatment of advanced hepatocellular carcinoma (HCC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15656 Background: Axitinib, a potent inhibitor of vascular endothelial growth factor receptor, has moderate antitumor efficacy for advanced HCC. Vascular response (VR) measured by DCE-MRI has been demonstrated to correlate with efficacy of systemic therapy for advanced HCC. Methods: Patients enrolled into a phase 2 trial of axitinib as second-line therapy for advanced HCC (NCT01273662) with liver tumors evaluable by DCE-MRI were included. Patients must have documented progression on or intolerance to sorafenib and Child-Pugh class A liver function. The primary endpoint was disease stabilization, defined as complete or partial response per RECIST1.1 or stable disease lasting for 8 weeks without progression of tumor-related symptoms. The quantitative parameter Ktrans and semi-quantitative parameter peak, measured by DCE-MRI at baseline and after 2 weeks of axitinib treatment, were used to evaluate VR, defined by a greater than 40% decrease of Ktrans or peak. Results: From April 2011 to March 2016, 40 patients were enrolled at National Taiwan University Hospital and 5 at Taipei Veterans General Hospital, all had documented progression after sorafenib treatment. Disease stabilization rate was 62.2% (95% CI 48.0-76.4). Median progression-free survival (PFS) and overall survival (OS) were 2.2 months (95% CI 0.3-4.1) and 10.1 months (95% CI 3.6-16.5) respectively. 33 patients were evaluable for VR. VR evaluated by peak was significantly associated with better PFS (5.5 vs. 1.8 months, HR 0.41, 95% CI 0.16-1.02, p = 0.04) and OS (13.0 vs. 5.8 months, HR 0.28, 95% CI 0.09-0.85, p = 0.02). Treatment-related adverse events were compatible with previous reports of axitinib. Conclusions: VR measured by DCE-MRI may help identify HCC patients most likely to benefit from axitinib treatment. Clinical trial information: NCT01273662. [Table: see text]
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Affiliation(s)
- Po-Hsiang Huang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Zhong-Zhe Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Chun Shen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yee Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu Yun Shao
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiun Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
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Wang HK, Yu CW, Hsu CY, Chen BB, Chen HC, Chen CY, Lee YH, Shih TTF. Microcirculation at the supraspinatus tendon and shoulder external rotation explosive strength and fatigue are correlated. ISOKINET EXERC SCI 2017. [DOI: 10.3233/ies-160639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan
- Center of Physical Therapy, National Taiwan University Hospital, Taiwan
| | - Chih-Wei Yu
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Chao-Yu Hsu
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
- Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Hsin-Chia Chen
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Chin-Yi Chen
- Department of Athletics, National Taiwan University, Taipei, Taiwan
| | - Yong-Hsiang Lee
- Physical Education Office, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taiwan
- Department of Radiology and Medical Imaging, Taipei City Hospital, Taiwan
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Chang MC, Wu CH, Yang SH, Liang PC, Chen BB, Jan IS, Chang YT, Jeng YM. Pancreatic cancer screening in different risk individuals with family history of pancreatic cancer-a prospective cohort study in Taiwan. Am J Cancer Res 2017; 7:357-369. [PMID: 28337383 PMCID: PMC5336508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/24/2017] [Indexed: 06/06/2023] Open
Abstract
Pancreatic cancer (PC) is usually diagnosed at advanced stage. Our aim was to investigate the risk of malignant and premalignant pancreatic lesions in individuals with family history of PC. Individuals at risk of PC were enrolled prospectively in a screening program in Taiwan. All risk individuals received genetic testing of cationic trypsinogen (PRSS1) gene and the serine protease inhibitor Kazal type 1 (SPINK1) gene. They were stratified into three risk groups (high, moderate, and low) based on the family history and genetic testing. Magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatogram (MRCP) were performed in all screened individuals. A total of three hundred and three risk individuals in 165 families were enrolled with the mean age of 51.1 years, 38.3% of whom were male. A total of 24 of 303 (7.9%) screened individuals had the PRSS1 mutation, and 7/234 (0.3%) had the SPINK1 mutation. Nineteen (6.3%) risk individuals had pancreatic pathology including seven with pancreatic cancer, and four with pancreatic mucinous neoplasms. The earliest age of onset of PC in affected members was an independent factor associated with risk of developing PC in all risk groups. DM was associated with much-increased risk of developing PC in low and moderate risk groups (OR45.8. 95% CI. 13.82-151.64, P=0.001). Combined family history of non-PC malignancy in the family in the low-risk individual was associated with abnormal findings on MRI (OR8.4, 95% CI 3.29-21.88, P < 0.0001). There was no any complication of screening. In summary, pancreatic cancer screening may benefit in risk individuals with family history of pancreatic cancer in our population. The diagnostic yield is similar to prior studies. MRCP as initial screening modality is safe and effective. Future study will be needed to tailor PC screening strategy in different risk populations.
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Affiliation(s)
- Ming-Chu Chang
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityNo.7 Chung Shan South Road, Taipei, Taiwan
| | - Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityNo.7 Chung Shan South Road, Taipei, Taiwan
| | - Shih-Hung Yang
- Department of Oncology, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityNo.7 Chung Shan South Road, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityNo.7 Chung Shan South Road, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityNo.7 Chung Shan South Road, Taipei, Taiwan
| | - I-Shiow Jan
- Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityTaiwan
| | - Yu-Ting Chang
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityNo.7 Chung Shan South Road, Taipei, Taiwan
| | - Yung-Ming Jeng
- Department of Pathology, National Taiwan University Hospital, College of Medicine, National Taiwan UniversityNo.7 Chung Shan South Road, Taipei, Taiwan
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Chen BB, Hsu CY, Yu CW, Liang PC, Hsu C, Hsu CH, Cheng AL, Shih TTF. Early perfusion changes within 1 week of systemic treatment measured by dynamic contrast-enhanced MRI may predict survival in patients with advanced hepatocellular carcinoma. Eur Radiol 2016; 27:3069-3079. [PMID: 27957638 DOI: 10.1007/s00330-016-4670-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To correlate early changes in the parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) within 1 week of systemic therapy with overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC). METHODS Eighty-nine patients with advanced HCC underwent DCE-MRI before and within 1 week following systemic therapy. The relative changes of six DCE-MRI parameters (Peak, Slope, AUC, Ktrans, Kep and Ve) of the tumours were correlated with OS using the Kaplan-Meier model and the double-sided log-rank test. RESULTS All patients died and the median survival was 174 days. Among the six DCE-MRI parameters, reductions in Peak, AUC, and Ktrans, were significantly correlated with one another. In addition, patients with a high Peak reduction following treatment had longer OS (P = 0.023) compared with those with a low Peak reduction. In multivariate analysis, a high Peak reduction was an independent favourable prognostic factor in all patients [hazard ratio (HR), 0.622; P = 0.038] after controlling for age, sex, treatment methods, tumour size and stage, and Eastern Cooperative Oncology Group performance status. CONCLUSIONS Early perfusion changes within 1 week following systemic therapy measured by DCE-MRI may aid in the prediction of the clinical outcome in patients with advanced HCC. KEY POINTS • DCE-MRI is helpful to evaluate perfusion changes of HCC after systemic treatment. • Early perfusion changes within 1 week after treatment may predict overall survival. • High Peak reduction was an independent favourable prognostic factor after systemic treatment.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Chao-Yu Hsu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan.,Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chih-Wei Yu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Chiun Hsu
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Chih-Hung Hsu
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan. .,Department of Medical Imaging, Taipei City Hospital, Taipei City, Taiwan. .,Department of Medical Imaging, National Taiwan University Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
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Chen BB, Hsu CY, Yu CW, Liang PC, Hsu C, Hsu CH, Cheng AL, Ting-Fang Shih T. Dynamic Contrast-enhanced MR Imaging of Advanced Hepatocellular Carcinoma: Comparison with the Liver Parenchyma and Correlation with the Survival of Patients Receiving Systemic Therapy. Radiology 2016; 281:983. [DOI: 10.1148/radiol.2016164030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chen BB, Lu YS, Lin CH, Chen WW, Wu PF, Hsu CY, Yu CW, Wei SY, Cheng AL, Shih TTF. A pilot study to determine the timing and effect of bevacizumab on vascular normalization of metastatic brain tumors in breast cancer. BMC Cancer 2016; 16:466. [PMID: 27412562 PMCID: PMC4944505 DOI: 10.1186/s12885-016-2494-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/28/2016] [Indexed: 12/19/2022] Open
Abstract
Background To determine the appropriate time of concomitant chemotherapy administration after antiangiogenic treatment, we investigated the timing and effect of bevacizumab administration on vascular normalization of metastatic brain tumors in breast cancer patients. Methods Eight patients who participated in a phase II trial for breast cancer-induced refractory brain metastases were enrolled and subjected to 4 dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examinations that evaluated Peak, Slope, iAUC60, and Ktrans before and after treatment. The treatment comprised bevacizumab on Day 1, etoposide on Days 2–4, and cisplatin on Day 2 in a 21-day cycle for a maximum of 6 cycles. DCE-MRI was performed before treatment and at 1 h, 24 h, and 21 days after bevacizumab administration. Results Values of the 4 DCE-MRI parameters reduced after bevacizumab administration. Compared with baseline values, the mean reductions at 1 and 24 h were −12.8 and −24.7 % for Peak, −46.6 and −65.8 % for Slope, −27.9 and −55.5 % for iAUC60, and −46.6 and −63.9 % for Ktrans, respectively (all P < .05). The differences in the 1 and 24 h mean reductions were significant (all P < .05) for all the parameters. The generalized estimating equation linear regression analyses of the 4 DCE-MRI parameters revealed that vascular normalization peaked 24 h after bevacizumab administration. Conclusion Bevacizumab induced vascular normalization of brain metastases in humans at 1 and 24 h after administration, and the effect was significantly higher at 24 h than at 1 h. Trial registration ClinicalTrials.gov, identifier NCT01281696, registered prospectively on December 24, 2010
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Yen-Shen Lu
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Ching-Hung Lin
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Wei-Wu Chen
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Pei-Fang Wu
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Chao-Yu Hsu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan.,Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chih-Wei Yu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Shwu-Yuan Wei
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan. .,Department of Medical Imaging, Taipei City Hospital, Taipei City, Taiwan.
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Chen BB, Hsu CY, Yu CW, Liang PC, Hsu C, Hsu CH, Cheng AL, Shih TTF. Dynamic Contrast-enhanced MR Imaging of Advanced Hepatocellular Carcinoma: Comparison with the Liver Parenchyma and Correlation with the Survival of Patients Receiving Systemic Therapy. Radiology 2016; 281:454-464. [PMID: 27171020 DOI: 10.1148/radiol.2016152659] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose To retrospectively compare the perfusion parameters of advanced hepatocellular carcinoma (HCC) measured with dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging with surrounding liver parenchyma to determine the relationship between these parameters and uncensored overall survival (OS). Materials and Methods This retrospective study had institutional review board approval, and informed consent was waived. DCE MR imaging was performed in 92 patients with advanced HCC before systemic treatment was administered (19 patients received a placebo). Three semiquantitative (peak, slope, and area under the gadolinium concentration-time curve [AUC]) and six quantitative (arterial fraction, arterial flow, portal flow, total blood flow, distribution volume, and mean transit time) parameters were calculated by placing regions of interest in the largest area of the tumor and background liver parenchyma. The DCE MR imaging parameters between the tumor and normal liver were compared with paired Wilcoxon test. By using the Cox proportional hazards model for univariate and multivariate analyses, the association of DCE MR imaging parameters and OS was investigated. Results HCC demonstrated significantly higher peak, slope, AUC, arterial fraction, and arterial flow but lower portal flow, distribution volume, and mean transit time than did the background liver (all P < .05). Patients with high peak in the tumor had longer OS (P = .005) than did those with low peak. Cox multivariate analysis identified peak as an independent predictor of OS (P = .032) after adjusting for age, sex, treatment, tumor size, and portal vein thrombosis. Conclusion DCE MR imaging parameters can be used to differentiate advanced HCC from the background liver, and peak, a semiquantitative parameter, is associated with outcome in patients with advanced HCC before systemic therapy. © RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on July 22, 2016.
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Affiliation(s)
- Bang-Bin Chen
- From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.)
| | - Chao-Yu Hsu
- From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.)
| | - Chih-Wei Yu
- From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.)
| | - Po-Chin Liang
- From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.)
| | - Chiun Hsu
- From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.)
| | - Chih-Hung Hsu
- From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.)
| | - Ann-Lii Cheng
- From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.)
| | - Tiffany Ting-Fang Shih
- From the Department of Medical Imaging and Radiology (B.B.C., C.Y.H., C.W.Y., P.C.L.) and Department of Oncology (C.H., C.H.H., A.L.C.), National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Department of Radiology (C.Y.H.), Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan; and Department of Medical Imaging, Taipei City Hospital, No 7 Chung-Shan South Rd, Taipei 10016, Taiwan (T.T.F.S.)
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Chen BB, Murakami T, Shih TTF, Sakamoto M, Matsui O, Choi BI, Kim MJ, Lee JM, Yang RJ, Zeng MS, Chen RC, Liang JD. Novel Imaging Diagnosis for Hepatocellular Carcinoma: Consensus from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014). Liver Cancer 2015; 4:215-27. [PMID: 26734577 PMCID: PMC4698631 DOI: 10.1159/000367742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Indexed: 02/04/2023] Open
Abstract
Current novel imaging techniques in the diagnosis of hepatocellular carcinoma (HCC), with the latest evidence in this field, was discussed at the Asia-Pacific Primary Liver Cancer Expert (APPLE) meeting held in Taipei, Taiwan, in July 2014. Based on their expertise in a specific area of research, the novel imaging group comprised 12 participants from Japan, South Korea, Taiwan, and China and it included 10 abdominal radiologists, one hepatologist, and one pathologist. The expert participants discussed topics related to HCC imaging that were divided into four categories: (i) detection method, (ii) diagnostic method, (iii) evaluation method, and (iv) functional method. Consensus was reached on 10 statements; specific comments on each statement were provided to explain the rationale for the voting results and to suggest future research directions.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Takamichi Murakami
- Department of Radiology, Kinki University, Faculty of Medicine, Osaka, Japan,*Takamichi Murakami, MD, PhD, Department of Radiology, Kinki University, Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama-City, Osaka 589-8511 (Japan), TEL. +81 72 366 0221, E-Mail
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | | | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine
| | - Jeong Min Lee
- Department of Radiology, Seoul National University, Seoul, Republic of Korea
| | - Ren-jie Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Interventional Therapy, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ran-Chou Chen
- Department of Biomedical Imaging and Radiological Science, National Yang-Ming Medical University, Heping Fuyou Branch, Taipei City Hospital, Taiwan (ROC)
| | - Ja-Der Liang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
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Shih IL, Yen RF, Chen CA, Chen BB, Wei SY, Chang WC, Sheu BC, Cheng WF, Tseng YH, Chen XJ, Chen CH, Wei LH, Chiang YC, Torng PL, Yen ML, Shih TTF. Standardized uptake value and apparent diffusion coefficient of endometrial cancer evaluated with integrated whole-body PET/MR: Correlation with pathological prognostic factors. J Magn Reson Imaging 2015; 42:1723-32. [PMID: 25919115 DOI: 10.1002/jmri.24932] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/14/2015] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To evaluate the correlation between maximum standardized uptake value (SUVmax ) and minimum apparent diffusion coefficient (ADCmin ) of endometrial cancer derived from an integrated positron emission tomography / magnetic resonance (PET/MR) system and to determine their correlation with pathological prognostic factors. MATERIALS AND METHODS This prospective study was approved by the Institutional Review Board of the hospital, and informed consent was obtained. Between April and December 2014, 47 consecutive patients with endometrial cancer were enrolled and underwent simultaneous PET/MR examinations before surgery. Thirty-six patients with measurable tumors on PET/MR were included for image analysis. Pearson's correlation coefficient was used to evaluate the correlation between SUVmax and ADCmin of the tumors. The Mann-Whitney U-test was utilized to evaluate relationships between these two imaging biomarkers and pathological prognostic factors. RESULTS The mean SUVmax and ADCmin were 14.7 ± 7.1 and 0.48 ± 0.13 × 10(-3) mm(2) /s, respectively. A significant inverse correlation was found between SUVmax and ADCmin (r = -0.53; P = 0.001). SUVmax was significantly higher in tumors with advanced stage, deep myometrial invasion, cervical invasion, lymphovascular space involvement, and lymph node metastasis (P < 0.05). ADCmin was lower in tumors with higher grade, advanced stage, and cervical invasion (P < 0.05). The ratio of SUVmax to ADCmin was higher in tumors with higher grade, advanced stage, deep myometrial invasion, cervical invasion, lymphovascular space involvement, and lymph node metastasis (P < 0.05). CONCLUSION SUVmax and ADCmin of endometrial cancer derived from integrated PET/MR are inversely correlated and are associated with pathological prognostic factors.
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Affiliation(s)
- I-Lun Shih
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-An Chen
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shwu-Yuan Wei
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Bor-Ching Sheu
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Hui Tseng
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Xin-Jia Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi-Hau Chen
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lin-Hung Wei
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pao-Ling Torng
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Men-Luh Yen
- Department of Obstetrics & Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Hsu C, Chen BB, Chen CH, Ho MC, Cheng JCH, Kokudo N, Murakami T, Yeo W, Seong J, Jia JD, Han KH, Cheng AL. Consensus Development from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014). Liver Cancer 2015; 4:96-105. [PMID: 26020032 PMCID: PMC4439776 DOI: 10.1159/000367732] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A key mission of the Asia-Pacific Primary Liver Cancer Expert (APPLE) Association is to ensure a coherent view for management of hepatocellular carcinoma (HCC) and to advance new treatment for this difficult disease. At the 5th APPLE meeting, held in July 2014 in Taipei, Taiwan, an APPLE consensus development program was established to facilitate discussion among experts in the Asia-Pacific region on pertinent issues for HCC management, including (1) surgery for intermediate/advanced-stage disease, (2) prevention of HCC recurrence after curative treatment, (3) optimizing imaging diagnosis, (4) radiotherapy: current practice and future clinical trials, and (5) the role of cytotoxic chemotherapy. A pre-congress questionnaire was undertaken with the consensus development committee members to help understand the current practice patterns for HCC in the Asia-Pacific region and to identify issues relating to optimal patient care and further clinical trials for which consensus needs to be developed. In this report, the results of the questionnaire are presented, and the pertinent issues identified by each consensus group for further discussion and consensus development are summarized.
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Affiliation(s)
- Chiun Hsu
- Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC), Japan,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan (ROC),*Chiun Hsu, MD, PhD, Department of Oncology, National Taiwan University Hospital, National, Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan (ROC), Tel. +886 2 2312 3456 ext 67789, E-Mail
| | - Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC), Japan
| | - Chien-Hung Chen
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC), Japan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC), Japan
| | - Jason Chia-Hsien Cheng
- Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC), Japan,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
| | | | - Takamichi Murakami
- Department of Radiology, Kinki University Faculty of Medicine, Osaka, Japan
| | - Winnie Yeo
- Department of Clinical Oncology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, SAR (China)
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Dong Jia
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kwan-Hyub Han
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC), Japan,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan (ROC), Japan,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan (ROC)
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Lu YS, Chen TWW, Lin CH, Yeh DC, Tseng LM, Wu PF, Rau KM, Chen BB, Chao TC, Huang SM, Huang CS, Shih TTF, Cheng AL. Bevacizumab preconditioning followed by Etoposide and Cisplatin is highly effective in treating brain metastases of breast cancer progressing from whole-brain radiotherapy. Clin Cancer Res 2015; 21:1851-8. [PMID: 25700303 DOI: 10.1158/1078-0432.ccr-14-2075] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/19/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE We hypothesized that a window period between bevacizumab and cytotoxic agents may enhance drug delivery into tumor tissue through bevacizumab-induced vascular normalization in patients with brain metastases of breast cancer (BMBC). EXPERIMENTAL DESIGN A single-arm phase II study was conducted in which BMBC patients refractory to whole-brain radiotherapy (WBRT) were enrolled. In a 21-day cycle, patients received bevacizumab (15 mg/kg) on day 1, which, with a 1-day window period, was followed by etoposide (70 mg/m(2)/day; days 2-4) and cisplatin (70 mg/m(2); day 2; BEEP regimen). The BEEP regimen was administered for a maximum of 6 cycles. The primary endpoint was the central nervous system (CNS)-objective response rate according to volumetric response criteria. RESULTS A total of 35 patients were enrolled between January 2011 and January 2013. The median age was 54.3 years (range, 33-75); 19 patients (54.3%) had an Eastern Cooperative Oncology Group performance status of 2 or 3. Twenty-seven patients [77.1%; 95% confidence interval (CI), 59.9-89.6] achieved a CNS-objective response, including 13 patients (37.1%) with a ≥80% volumetric reduction of CNS lesions. With a median follow-up of 16.1 months, the median CNS progression-free survival and overall survival times were 7.3 months (95% CI, 6.5-8.1) and 10.5 months (95% CI, 7.8-13.2), respectively. Common grade 3 or 4 toxicities included neutropenia (30.8%) and infection (21.3%). CONCLUSIONS By administering bevacizumab 1 day before etoposide and cisplatin, the BEEP regimen appeared highly effective in BMBC refractory to WBRT. Further study of vascular normalization window concept is warranted.
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Affiliation(s)
- Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hung Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Dah-Cherng Yeh
- Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ling-Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Fang Wu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kun-Ming Rau
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Chung Chao
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Min Huang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Liu Y, Lear T, Zhao Y, Zhao J, Zou C, Chen BB, Mallampalli RK. F-box protein Fbxl18 mediates polyubiquitylation and proteasomal degradation of the pro-apoptotic SCF subunit Fbxl7. Cell Death Dis 2015; 6:e1630. [PMID: 25654763 PMCID: PMC4669792 DOI: 10.1038/cddis.2014.585] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 01/25/2023]
Abstract
Fbxl7, a subunit of the SCF (Skp-Cul1-F-box protein) complex induces mitotic arrest in cells; however, molecular factors that control its cellular abundance remain largely unknown. Here, we identified that an orphan F-box protein, Fbxl18, targets Fbxl7 for its polyubiquitylation and proteasomal degradation. Lys 109 within Fbxl7 is an essential acceptor site for ubiquitin conjugation by Fbxl18. An FQ motif within Fbxl7 serves as a molecular recognition site for Fbxl18 interaction. Ectopically expressed Fbxl7 induces apoptosis in Hela cells, an effect profoundly accentuated after cellular depletion of Fbxl18 protein or expression of Fbxl7 plasmids encoding mutations at either Lys 109 or within the FQ motif. Ectopic expression of Fbxl18 plasmid-limited apoptosis caused by overexpressed Fbxl7 plasmid. Thus, Fbxl18 regulates apoptosis by mediating ubiquitin-dependent proteasomal degradation of the pro-apoptotic protein Fbxl7 that may impact cellular processes involved in cell cycle progression.
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Affiliation(s)
- Y Liu
- Department of Medicine, the Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - T Lear
- Department of Medicine, the Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Zhao
- Department of Medicine, the Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Zhao
- Department of Medicine, the Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Zou
- Department of Medicine, the Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - B B Chen
- Department of Medicine, the Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
| | - R K Mallampalli
- Department of Medicine, the Acute Lung Injury Center of Excellence, University of Pittsburgh, Pittsburgh, PA, USA
- Medical Specialty Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Lu YS, Chen BB, Lin CH, Chen WW, Wu PF, Cheng AL, Shih TTF. Abstract 2984: Normalization of tumor vasculature by anti-angiogenesis therapy in metastatic tumor: A clinical study to determine the timing and effect. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Clinically, combination of anti-angiogenic agents with chemotherapeutic agents demonstrated better antitumor efficacy. Instead of merely effect on vasculature regression, careful use of anti-angiogenic therapy may cause the grossly abnormal structure and function of tumor blood vessels to return to a more normal state. Treatment with anti-angiogenic agents can primarily improve chemotherapy efficacy by normalizing tumor vasculature, decrease the intra-tumor interstitial pressure, thereby leading to a more effective drug delivery. We planned to investigate the timing and effect of tumor vascular normalization in human after the administration of anti-angiogenic agent. It may help determine the appropriate timing of administration of chemotherapeutic agents after anti-angiogenic treatment.
Materials and methods: This study enrolled the last 8 consecutive patients who participated in a phase II trial for treatment of refractory brain metastases from breast cancer (Eur J Can 49:2s, 2013 suppl; abstr 1878). The protocol treatment consists of bevacizumab 15mg/kg on day 1, chemotherapy of etoposide and cisplatin on day 2 (24 hours after administration of bevacizumab), in 21-day cycles. These 8 patients specifically received four dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examinations. DCE-MRI was performed before treatment, 1 hour after the end of bevacizumab infusion (i.e., 2.5 hours after starting bevacizumab infusion), 24 hours and 21 days after bevacizumab infusion. This study was registered with ClinicalTrials.gov, identifier NCT01281696, and was approved by the ethical review board.
Results: Clinically, all the 8 patients achieved partial remission at central nervous system. All of the 4 DCE-MRI parameters decreased after bevacizumab infusion. Compared to baseline values, the mean reductions at 1 hour and 24 hours were -12.8% and -24.7% for Peak, -46.6% and -65.8% for Slope, -27.9% and -55.5% for iAUC60, -46.6% and -63.9% for Ktrans, respectively (all P values <0.05). The differences between 1 hour and 24 hours reached statistical significance (all P values <0.05) for all the parameters. However, the differences in the mean percentage change between 24 hours and 21 days did not reach significance in any of the four parameters
Conclusion: Normalization of tumor vasculature induced by bevacizumab was clearly demonstrated in brain metastases in human at 1 hour after completion of bevacizumab infusion, but significantly became more obvious at 24 hours after bevacizumab administration.
Citation Format: Yen-Shen Lu, Bang-Bin Chen, Ching-Hung Lin, Wei-Wu Chen, Pei-Fang Wu, Ann-Lii Cheng, Tiffany Ting-Fang Shih. Normalization of tumor vasculature by anti-angiogenesis therapy in metastatic tumor: A clinical study to determine the timing and effect. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2984. doi:10.1158/1538-7445.AM2014-2984
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Affiliation(s)
- Yen-Shen Lu
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Wei-Wu Chen
- National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Fang Wu
- National Taiwan University Hospital, Taipei, Taiwan
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Ding YS, Chen BB, Glielmi C, Friedman K, Devinsky O. A pilot study in epilepsy patients using simultaneous PET/MR. Am J Nucl Med Mol Imaging 2014; 4:459-470. [PMID: 25143864 PMCID: PMC4138140] [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] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/27/2014] [Indexed: 06/03/2023]
Abstract
Integrated PET/MR with simultaneous acquisition may improve the identification of pathologic findings in patients. This pilot study evaluated metabolic activity differences between epilepsy patients and healthy controls and directly correlated FDG uptake with MR regional abnormality. Epilepsy patients (n=11) and controls (n=6) were imaged on a whole-body simultaneous PET/MR scanner. After FDG injection, simultaneous images were acquired for 60 minutes. Statistical analyses on SUV values (over 117 brain regions, including left and right, for 96 cortical and 21 subcortical regions) derived from three normalization methods, by individual subject's mean cortical, white matter or global brain, were compared between groups. The asymmetry was compared. T2, T1 and PET co-registered images were also used for lesion detection and correlation of PET and MR regional abnormality. Left and right postcentral gyri were found to be consistently hypermetabolic regions, while right temporal pole and planum polare were consistently hypometabolic regions by all three normalization methods. Using the asymmetry index (AI > 10% or SUV ratios > 1.2), more metabolic asymmetry regions were detected in patients than in controls, with 96.2% agreement. The presence of hippocampal abnormalities or cortical tubers detected via T2 FLAIR in patients correlated well with the hypometabolism detected via FDG-PET. Our results showed specific patterns of metabolic abnormality and asymmetry over 117 brain regions in epilepsy patients, as compared to controls, suggest that simultaneous PET/MR imaging provides a useful tool to help understand etiopathogenesis and localize seizure foci.
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Affiliation(s)
- Yu-Shin Ding
- Department of Radiology, New York University School of MedicinNew York, NY, USA
- Department of Psychiatry, New York University School of MedicinNew York, NY, USA
| | - Bang-Bin Chen
- Medical College and Hospital, National Taiwan UniversityTaipei, Taiwan
| | | | - Kent Friedman
- Department of Radiology, New York University School of MedicinNew York, NY, USA
| | - Orrin Devinsky
- Department of Neurology, New York University School of MedicinNew York, NY, USA
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Lin YH, Hwang RM, Chen BB, Hsu CY, Yu CW, Kao JH, Lee HS, Liang PC, Wei SY, Shih TTF. Vascular and hepatic enhancements at MR imaging: comparison of Gd-EOB-DTPA and Gd-DTPA in the same subjects. Clin Imaging 2014; 38:287-91. [DOI: 10.1016/j.clinimag.2014.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/19/2013] [Accepted: 01/06/2014] [Indexed: 12/14/2022]
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Chen BB, Shih TTF. DCE-MRI in hepatocellular carcinoma-clinical and therapeutic image biomarker. World J Gastroenterol 2014; 20:3125-3134. [PMID: 24695624 PMCID: PMC3964384 DOI: 10.3748/wjg.v20.i12.3125] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/26/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables tumor vascular physiology to be assessed. Within the tumor tissue, contrast agents (gadolinium chelates) extravasate from intravascular into the extravascular extracellular space (EES), which results in a signal increase on T1-weighted MRI. The rate of contrast agents extravasation to EES in the tumor tissue is determined by vessel leakiness and blood flow. Thus, the signal measured on DCE-MRI represents a combination of permeability and perfusion. The semi-quantitative analysis is based on the calculation of heuristic parameters that can be extracted from signal intensity-time curves. These enhancing curves can also be deconvoluted by mathematical modeling to extract quantitative parameters that may reflect tumor perfusion, vascular volume, vessel permeability and angiogenesis. Because hepatocellular carcinoma (HCC) is a hypervascular tumor, many emerging therapies focused on the inhibition of angiogenesis. DCE-MRI combined with a pharmacokinetic model allows us to produce highly reproducible and reliable parametric maps of quantitative parameters in HCC. Successful therapies change quantitative parameters of DCE-MRI, which may be used as early indicators of tumor response to anti-angiogenesis agents that modulate tumor vasculature. In the setting of clinical trials, DCE-MRI may provide relevant clinical information on the pharmacodynamic and biologic effects of novel drugs, monitor treatment response and predict survival outcome in HCC patients.
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Chen BB, Shih IL, Wu CH, Hsu C, Chen CH, Shih TTF, Liu KL, Liang PC. Comparison of characteristics and transarterial chemoembolization outcomes in patients with unresectable hepatocellular carcinoma and different viral etiologies. J Vasc Interv Radiol 2014; 25:371-8. [PMID: 24468045 DOI: 10.1016/j.jvir.2013.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/11/2013] [Accepted: 10/12/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine any differences in patient characteristics and outcomes after transarterial chemoembolization between different viral etiologies of hepatocellular carcinoma (HCC). METHODS This retrospective study consisted of 201 patients undergoing first-time transarterial chemoembolization for unresectable HCC from January to December 2009. The patients were divided into four groups: hepatitis B virus (HBV) only (n = 104), hepatitis C virus (HCV) only (n = 63), HBV and HCV (n = 10), and no viral hepatitis (n = 24). The clinical and laboratory data were obtained from electronic medical records, and imaging findings obtained before transarterial chemoembolization were analyzed. Kaplan-Meier analyses were used to assess the impact of HBV or HCV status, clinical characteristics, and imaging results on overall survival. RESULTS After a median follow-up of 28.3 months ± 16.2, the 1-, 2-, and 3-year overall survival rates were 74.1%, 59.7%, and 53.2%. Patients with HBV had a significant association with younger age (P = .001), higher male-to-female ratio (P = .003), lower alanine aminotransferase levels (P = .018), higher albumin levels (P = .009), and multifocal tumors at diagnosis (P = .04) compared with patients with HCV. Patients with both HBV and HCV had significantly higher serum bilirubin levels compared with the other groups (P = .002). No significant difference was found in overall survival among the different hepatitis groups (P = .943). Multivariate analysis showed that statistically significant determinants for overall survival were Child-Pugh class (P = .002), Barcelona Clinic Liver Cancer stage (P < .001), tumor size (P < .001), and distribution (P < .001). CONCLUSIONS Viral etiology has no correlation with the outcome of patients with HCC undergoing transarterial chemoembolization.
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Affiliation(s)
- Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - I-Lun Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Chih-Horng Wu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Chiun Hsu
- Department of Oncology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Chien-Hung Chen
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Kao-Lang Liu
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100
| | - Po-Chin Liang
- Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No. 7 Chung-Shan S. Road, Taipei, Taiwan 100.
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Chen BB, Glasser JR, Coon TA, Mallampalli RK. Skp-cullin-F box E3 ligase component FBXL2 ubiquitinates Aurora B to inhibit tumorigenesis. Cell Death Dis 2013; 4:e759. [PMID: 23928698 PMCID: PMC3763433 DOI: 10.1038/cddis.2013.271] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/10/2013] [Accepted: 06/19/2013] [Indexed: 12/17/2022]
Abstract
Aurora B kinase is an integral regulator of cytokinesis, as it stabilizes the intercellular canal within the midbody to ensure proper chromosomal segregation during cell division. Here we identified that the ubiquitin E3 ligase complex SCFFBXL2 mediates Aurora B ubiquitination and degradation within the midbody, which is sufficient to induce mitotic arrest and apoptosis. Three molecular acceptor sites (K102, K103 and K207) within Aurora B protein were identified as important sites for its ubiquitination. A triple Lys mutant of Aurora B (K102/103/207R) exhibited optimal resistance to SCFFBXL2-directed polyubiquitination, and overexpression of this variant resulted in a significant delay in anaphase onset, resulting in apoptosis. A unique small molecule F-box/LRR-repeat protein 2 (FBXL2) activator, BC-1258, stabilized and increased levels of FBXL2 protein that promoted Aurora B degradation, resulting in tetraploidy, mitotic arrest and apoptosis of tumorigenic cells, and profoundly inhibiting tumor formation in athymic nude mice. These findings uncover a new proteolytic mechanism targeting a key regulator of cell replication that may serve as a basis for chemotherapeutic intervention in neoplasia.
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Affiliation(s)
- B B Chen
- Department of Medicine, Pulmonary, Allergy and Critical Care Medicine, UPMC Montefiore, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Huang SY, Chen BB, Lu HY, Lin HH, Wei SY, Hsu SC, Shih TTF. Correlation among DCE-MRI measurements of bone marrow angiogenesis, microvessel density, and extramedullary disease in patients with multiple myeloma. Am J Hematol 2012; 87:837-9. [PMID: 22718413 DOI: 10.1002/ajh.23256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 04/26/2012] [Accepted: 04/28/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Shang-Yi Huang
- Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
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Lu YS, Chen WW, Lin CH, Tseng LM, Yeh DC, Wu PF, Chen BB, Chao TC, Tsai YF, Huang SM, Shih TTF, Cheng AL. Bevacizumab, etoposide, and cisplatin (BEEP) in brain metastases of breast cancer progressing from radiotherapy: Results of the first stage of a multicenter phase II study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1079 Background: With a general prolongation of survival, brain metastasis (BM) has become a common complication of breast cancer. However, management of BM remains a severe challenge. We hypothesized that bevacizumab (BE) could significantly enhance drug delivery of etoposide (E) and cisplatin (P), two of the cytotoxic agents that have moderate activity in BM of breast cancer, to brain tumors and thereby improve the efficacy. Methods: Breast cancer patients (pts) with BM progression after whole brain radiotherapy (WBRT) were enrolled. Pts received BE 15 mg/kg day 1, and E 70 mg/m2/day, days 2-4, P 70 mg/m2/day, day 2, every 21 days for a maximum of 6 cycles. The primary endpoint was a centrally assessed CNS objective response (CNS-OR) defined as a ≥50% reduction in the volumetric sum of all measurable CNS lesions in the absence of increasing steroid use, development of new CNS lesion, or progressive neurologic symptoms. Using a Simon’s optimal two-stage design with 15% as a minimum interest in CNS-OR rate (by intent to treat analysis), 11 pts were needed at the first stage; and a total of 31 evaluable for the whole study. Results: Among 16 pts enrolled from Jan 2011 to Jan 2012, 12 pts were evaluable for treatment response at the time of abstract submission. Median age was 55 (range 34-66); 1 pt was ER+HER2-, 5 pts were HER2+, and 6 pts were ER-HER2-. The median treatment cycles were 4.5 (range 1-6). Nine of 12 pts (75%; 95%CI 42.8-94.5) achieved CNS-OR including 6 pts (50%) with ≥80% and 3 pts (25%) with 50-80% CNS volumetric reduction, respectively. Two pts had non-CNS disease progression while CNS tumors remained under control. The median CNS progression free survival was 6.6 months (95% CI 0.8-12.4). Grade 3 /4 toxicities included neutropenia, leukopenia, anemia, and platelet in 13 (25.5%), 6 (11.8%), 2 (3.9%), and 2 (3.9%) cycles, respectively. Seven pts (58.3%) had received dose reduction to E 60 mg/m2 and P 60 mg/m2. Early reporting of this study was approved by Data and Safety Monitoring Committeedue to an extremely promising result. Conclusions: BEEP regimen has a significant anti-tumor effect for BM of breast cancer which progresses after WBRT.
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Affiliation(s)
- Yen-Shen Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Wu Chen
- National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hung Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Dah-Cherng Yeh
- Department of Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Pei-Fang Wu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Bang-Bin Chen
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Chung Chao
- Division of Hematology-Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Fang Tsai
- Division of General Surgery, Department of Surgery, Taipei-Veterans General Hospital, Taipei, Taiwan
| | - Shu-Min Huang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, National Taiwan University Hospital, Taipei, Taiwan
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Chiu HT, Wang YH, Jeng JS, Chen BB, Pan SL. Effect of Functional Status on Survival in Patients With Stroke: Is Independent Ambulation a Key Determinant? Arch Phys Med Rehabil 2012; 93:527-31. [DOI: 10.1016/j.apmr.2011.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 10/15/2011] [Accepted: 10/29/2011] [Indexed: 11/25/2022]
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Zhang PJ, Run WW, P L, Wang CB, Deng XX, Wang BB, Chen BB, J J, Liu HY, Dong ZN, Zhang XJ, Tian YP. Peripheral blood mRNA expression patterns to differentiate hepatocellular carcinoma from other hepatic diseases. Front Biosci (Elite Ed) 2012; 4:620-30. [PMID: 22201899 DOI: 10.2741/e404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Peripheral blood genes expressions profiling (GeXP) have been convinced to be more specific for the diagnosis of cancer and other diseases, and the GeXP system provides an ideal method to analyze multiple genes expression in one normalized and equable system. We aim to differentiate hepatocellular carcinoma from other hepatic diseases based on peripheral blood and the GeXP system. Fifteen selected hepatic diseases related genes with two house-keeping genes for normalization were detected by the GeXP system. The diagnosis model was based on K nearest neighbor classifier and cross validation, and software based on MATLAB software was built for differential diagnosis of hepatic diseases. Eight hepatic related genes were demonstrated to show an obvious statistic difference in expressions while the K nearest neighbors classifier showed that the accuracy for normal controls, hepatitis B, liver cirrhosis, hepatocellular carcinoma and the Other group was separately 80.57 %, 78.17 %, 84.48 %, 73.24 % and 85.85 %. The set of validation has been carried out to assess the accuracy of Model Two and the accuracy was even higher than the set of building for the model, except for the hepatitis B (HBV) group. A sensitive and specific GeXP system of eight genes has been developed for the accurate differential diagnosis of hepatic disease.
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Affiliation(s)
- P J Zhang
- Department of Clinical Biochemistry, Chinese PLA General Hospital, Beijing, China
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Zhang PJ, Run WW, P L, Wang CB, Deng XX, Wang BB, Chen BB, J J, Liu HY, Dong ZN, Zhang XJ, Tian YP. Peripheral blood mRNA expression patterns to differentiate hepatocellular carcinoma from other hepatic diseases. Front Biosci (Elite Ed) 2012. [PMID: 22201899 DOI: 10.2741/404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Peripheral blood genes expressions profiling (GeXP) have been convinced to be more specific for the diagnosis of cancer and other diseases, and the GeXP system provides an ideal method to analyze multiple genes expression in one normalized and equable system. We aim to differentiate hepatocellular carcinoma from other hepatic diseases based on peripheral blood and the GeXP system. Fifteen selected hepatic diseases related genes with two house-keeping genes for normalization were detected by the GeXP system. The diagnosis model was based on K nearest neighbor classifier and cross validation, and software based on MATLAB software was built for differential diagnosis of hepatic diseases. Eight hepatic related genes were demonstrated to show an obvious statistic difference in expressions while the K nearest neighbors classifier showed that the accuracy for normal controls, hepatitis B, liver cirrhosis, hepatocellular carcinoma and the Other group was separately 80.57 %, 78.17 %, 84.48 %, 73.24 % and 85.85 %. The set of validation has been carried out to assess the accuracy of Model Two and the accuracy was even higher than the set of building for the model, except for the hepatitis B (HBV) group. A sensitive and specific GeXP system of eight genes has been developed for the accurate differential diagnosis of hepatic disease.
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Affiliation(s)
- P J Zhang
- Department of Clinical Biochemistry, Chinese PLA General Hospital, Beijing, China
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Chen BB, Glasser JR, Coon TA, Mallampalli RK. F-box protein FBXL2 exerts human lung tumor suppressor-like activity by ubiquitin-mediated degradation of cyclin D3 resulting in cell cycle arrest. Oncogene 2011; 31:2566-79. [PMID: 22020328 PMCID: PMC3266958 DOI: 10.1038/onc.2011.432] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dyregulated behavior of cell cycle proteins and their control by ubiquitin E3 ligases is an emerging theme in human lung cancer. Here we identified and characterized the activity of a novel F box protein, termed FBXL2, belonging to the SCF (Skip-Cullin1-F-box protein) E3 ligase family. Ectopically expressed FBXL2 triggered G2/M phase arrest, induced chromosomal anomalies, and increased apoptosis of transformed lung epithelia by mediating polyubiquitination and degradation of the mitotic regulator, cyclin D3. Unlike other F box proteins that target phosphodegrons within substrates, FBXL2 uniquely recognizes a canonical calmodulin-binding motif within cyclin D3 to facilitate its polyubiquitination. Calmodulin bound and protected cyclin D3 from FBXL2 by direct intermolecular competition with the F box protein for access within this motif. The chemotherapeutic agent vinorelbine increased apoptosis of human lung carcinoma cells by inducing FBXL2 expression and cyclin D3 degradation, an effect accentuated by calmodulin knockdown. Depletion of endogenous FBXL2 stabilized cyclin D3 levels, accellerated cancer cell growth, and increased cell viability after vinorelbine treatment. Last, ectopic expression of FBXL2 significantly inhibited the growth and migration of tumorogenic cells and tumor formation in athymic nude mice. These observations implicate SCFFBXL2 as an indispensible regulator of mitosis that serves as a tumor suppressor.
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Affiliation(s)
- B B Chen
- Department of Medicine, Acute Lung Injury Center of Excellence, The University of Pittsburgh, Pittsburgh, PA, USA
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Hsu CY, Shen YC, Yu CW, Hsu C, Hu FC, Hsu CH, Chen BB, Wei SY, Cheng AL, Shih TTF. Dynamic contrast-enhanced magnetic resonance imaging biomarkers predict survival and response in hepatocellular carcinoma patients treated with sorafenib and metronomic tegafur/uracil. J Hepatol 2011; 55:858-65. [PMID: 21338641 DOI: 10.1016/j.jhep.2011.01.032] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [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: 08/05/2010] [Revised: 01/14/2011] [Accepted: 01/18/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Sorafenib plus metronomic tegafur/uracil therapy can induce tumor stabilization in advanced hepatocellular carcinoma (HCC) patients. This study evaluated the correlation of vascular response measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the clinical outcome. METHODS DCE-MRI was performed in advanced HCC patients treated with sorafenib (800 mg/d) plus tegafur/uracil (250 mg/m(2)/d based on tegafur) at baseline and after 14 days of treatment. An operator-defined region of interest was placed in the most strongly enhanced area of the tumor to measure the pharmacokinetic parameter K(trans). Changes in K(trans) after treatment were correlated with the best tumor response and survival. RESULTS Thirty-one patients were evaluable. There were one partial response (PR), 18 stable disease (SD), and 12 progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors (RECIST). Baseline K(trans) was higher in patients with PR or SD (median 1215.2 × 10(-3)/min, range 582.5-4555.3 × 10(-3)/min) than patients with PD (median 702.0 × 10(-3)/min, range 375.2-1938.0 × 10(-3)/min, p = 0.008). After 14 days of study treatment, the median K(trans) change was -47.1% (range -87.0 to -18.0%) in patients with PR or SD, and 9.6% (range -44.8 to +81%) in those with PD (p<0.001). A vascular response, defined by a 40% or greater decrease in K(trans) after 14 days of study treatment, correlated with longer progression-free survival (median 29.1 vs. 8.7 weeks, p = 0.033) and overall survival (median 53.0 vs. 14.9 weeks, p = 0.016). Percentage of K(trans) change after treatment is an independent predictor of tumor response, progression-free survival, and overall survival. CONCLUSIONS K(trans) measured by DCE-MRI correlated well with tumor response and survival in HCC patients who received sorafenib plus metronomic tegafur/uracil therapy.
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Affiliation(s)
- Chao-Yu Hsu
- Department of Radiology, College of Medicine, National Taiwan University, Taipei, Taiwan
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