1
|
Chan SL, Chiang CL, Chok KSH, Lee AS, Tang RSY, Lim FMY, Lee KF, Tai AYP, Lee SWM, Lo RCL, Chan AWH, Mok FPT. Hong Kong consensus recommendations on the management of pancreatic ductal adenocarcinoma. Hong Kong Med J 2024; 30:147-162. [PMID: 38590158 DOI: 10.12809/hkmj2210476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
This project was undertaken to develop the first set of consensus statements regarding the management of pancreatic ductal adenocarcinoma (PDAC) in Hong Kong, with the goal of providing guidance to local clinicians. A multidisciplinary panel of experts discussed issues surrounding current PDAC management and reviewed evidence gathered in the local context to propose treatment recommendations. The experts used the Delphi approach to finalise management recommendations. Consensus was defined as ≥80% acceptance among all expert panel members. Thirty-nine consensus statements were established. These statements cover all aspects of PDAC management, including diagnosis, resectability criteria, treatment modalities according to resectability, personalised management based on molecular profiling, palliative care, and supportive care. This project fulfils the need for guidance regarding PDAC management in Hong Kong. To assist clinicians with treatment decisions based on varying levels of evidence and clinical experience, treatment options are listed in several consensus statements.
Collapse
Affiliation(s)
- S L Chan
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C L Chiang
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - K S H Chok
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong SAR, China
| | - R S Y Tang
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - F M Y Lim
- Department of Oncology, Princess Margaret Hospital, Hong Kong SAR, China
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K F Lee
- Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China
| | - A Y P Tai
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - S W M Lee
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - R C L Lo
- Department of Pathology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - A W H Chan
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - F P T Mok
- Department of Surgery and Combined Endoscopy Unit, Caritas Medical Centre, Hong Kong SAR, China
| |
Collapse
|
2
|
Chiang CL, Lee WMA, Choi CWH, Ngan KCR, Ng WT, Lee HFV, Lam TC, Lam KO, Tsang KC, Wong WHJ. Radiosensitivity index as a predictive biomarker for radiotherapy de-intensification in nasopharyngeal carcinoma: abridged secondary publication. Hong Kong Med J 2024; 30 Suppl 1:27-28. [PMID: 38413209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - W M A Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C W H Choi
- Division of Epidemiology and Biostatistics, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K C R Ngan
- Division of Epidemiology and Biostatistics, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - W T Ng
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - H F V Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - T C Lam
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K O Lam
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K C Tsang
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - W H J Wong
- School of Biomedical Science, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
3
|
Chiang CL, Liang HL, Chang KC, Tsai WL, Yu HC, Lin KH, Li MF. Advanced hepatocellular carcinoma with major portal vein invasion: Therapeutic outcomes of hepatic arterial infusion chemotherapy vs concurrent radiotherapy. J Chin Med Assoc 2024; 87:171-178. [PMID: 38099672 DOI: 10.1097/jcma.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with major portal vein invasion (MPVI) presents very poor outcomes. Hepatic artery infusion chemotherapy (HAIC) and radiation therapy (RT) have both been found to be effective for advanced HCC. In this retrospective study, we compared the therapeutic outcomes of our "new" HAIC regimen with and without concurrent RT, before and after propensity score matching (PSM) in treating HCC patients with MPVI. METHODS One hundred forty patients with MPVI received HAIC alone and 35 patients underwent concurrent HAIC and RT during a 16-year period. The left subclavian artery was adopted as the entry site for a temporary catheter placement for a 5-day chemoinfusion. The Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was adopted to assess the objective response rate (ORR). The Kaplan-Meier curve was used to calculate progression-free survival (PFS) and overall survival (OS) between the two groups. Univariate and multivariate analyses by Cox regression model were used to assess hazard ratios. RESULTS Of the 140 patients with Child-Pugh A liver function, the median OS was 17.0 months. In the initial cohort, higher ORR and PFS were found in the concurrent RT group than in the HAIC alone group (80% vs 66.4% and 9 vs 8 months, respectively) but shorter OS (10.5 vs 14.5 months, p = 0.039) was observed. After PSM, the OS was 10 and 15 months ( p = 0.012), respectively. Multivariable Cox regression analysis revealed that the significant factors for adjusting hazard ratios for OS were Child-Pugh classification, alpha fetal protein (AFP) level, and hepatic vein invasion. CONCLUSION HAIC is an effective treatment for advanced HCC patients with MPVI. Concurrent HAIC and full-dose RT were associated with worse clinical outcomes.
Collapse
Affiliation(s)
- Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Kuo-Chen Chang
- Department of Radiotherapy and Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Lun Tsai
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Hsien-Chung Yu
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Kung-Hung Lin
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| |
Collapse
|
4
|
Liang TJ, Liu SI, Chiang CL. How Soda Ingestion Facilitates the Distinction between a Killian-Jamieson Diverticulum and a Malignant Thyroid Nodule. Diagnostics (Basel) 2023; 13:3128. [PMID: 37835871 PMCID: PMC10572788 DOI: 10.3390/diagnostics13193128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
A 66-year-old woman presented with an incidental left thyroid nodule during a health examination. She had no voice change, shortness of breath, cough, or dysphagia. Repeated sonography showed a dynamic change of the lesion, which was more evident following soda consumption. A subsequent esophagography confirmed the diagnosis of a Killian-Jamieson diverticulum. This rare left-sided pharyngoesophageal diverticulum is often asymptomatic. On a sonography, air bubbles in the esophageal lumen can cause a ring-down artifact that mimics microcalcifications, which are characteristic of thyroid malignancy, and misdiagnosis may lead to unnecessary interventions, including fine-needle aspiration or thyroidectomy. A dynamic ultrasound, specifically done during soda consumption, offered a simple diagnostic distinction. No surgical intervention was pursued; the patient was monitored in the clinic.
Collapse
Affiliation(s)
- Tsung-Jung Liang
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan; (T.-J.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Shiuh-Inn Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan; (T.-J.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| |
Collapse
|
5
|
Chang PY, Lee RC, Liang PC, Liu YS, Chuang VP, Wu DK, Cheng YF, Huang JI, Tseng HS, Hung CF, Wu RH, Chern MC, Cheng HM, Wu CH, Cheng SM, Chiang CL, Liang HL. Multidisciplinary Taiwan consensus for the use of conventional TACE in hepatocellular carcinoma treatment. Front Oncol 2023; 13:1186674. [PMID: 37427137 PMCID: PMC10328116 DOI: 10.3389/fonc.2023.1186674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Developed in early 1980s, transarterial chemoembolization (TACE) with Lipiodol was adopted globally after large-scale randomized control trials and meta-analyses proving its effectiveness were completed. Also known as "conventional TACE" (cTACE), TACE is currently the first-line treatment for patients with unresectable intermediate stage hepatocellular carcinoma (HCC) and delivers both ischemic and cytotoxic effects to targeted tumors. Although new technology and clinical studies have contributed to a more comprehensive understanding of when and how to apply this widely-adopted therapeutic modality, some of these new findings and techniques have yet to be incorporated into a guideline appropriate for Taiwan. In addition, differences in the underlying liver pathologies and treatment practices for transcatheter embolization between Taiwan and other Asian or Western populations have not been adequately addressed, with significant variations in the cTACE protocols adopted in different parts of the world. These mainly revolve around the amount and type of chemotherapeutic agents used, the type of embolic materials, reliance on Lipiodol, and the degree of selectiveness in catheter positioning. Subsequently, interpreting and comparing results obtained from different centers in a systematic fashion remain difficult, even for experienced practitioners. To address these concerns, we convened a panel of experts specializing in different aspects of HCC treatment to devise modernized recommendations that reflect recent clinical experiences, as well as cTACE protocols which are tailored for use in Taiwan. The conclusions of this expert panel are described herein.
Collapse
Affiliation(s)
- Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Radiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imagine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Vicent P. Chuang
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Ding-Kwo Wu
- Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jen-I. Huang
- Department of Radiology, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Hsiuo-Shan Tseng
- Department of Radiology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chien-Fu Hung
- Department of Radiology, Chang−Gung Memorial Hospital, Taoyuan, Taiwan
| | - Reng-Hong Wu
- Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Chih Chern
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Hua-Ming Cheng
- Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Horng Wu
- Department of Radiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - She-Meng Cheng
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
6
|
Cheng YC, Chiang CL, Huang CW. IgG4-Related Disease Mimicking Unilateral Urothelial Carcinoma: A Rare Case Report and Literature Review. Clin Med Insights Case Rep 2023; 16:11795476231180481. [PMID: 37332833 PMCID: PMC10272671 DOI: 10.1177/11795476231180481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune-mediated disorder with heterogeneous multiorgan manifestations. Early identification and treatment of IgG4-RD are crucial for organ function recovery. Rarely, IgG4-RD manifests as a unilateral renal pelvic soft tissue mass that may be misdiagnosed as urothelial malignancy, resulting in invasive surgical intervention and organ damage. Here we present a 73-year-old man who had a right ureteropelvic mass with hydronephrosis detected by enhanced computed tomography. Right upper tract urothelial carcinoma and lymph node metastasis was highly suggested based on the image findings. However, IgG4-RD was suspected due to his past history of bilateral submandibular lymphadenopathy, nasolacrimal duct obstruction, as well as a high serum IgG4 level of 861 mg/dL. The ureteroscopy with tissue biopsy showed no evidence of urothelial malignancy. His lesions and symptoms improved after glucocorticoid treatment. Hence, a diagnosis of IgG4-RD was made, with the phenotype of classic Mikulicz syndrome with systemic involvement. The manifestation of IgG4-RD as a unilateral renal pelvic mass is rare and should be kept in mind. A ureteroscopic biopsy and serum IgG4 level measurement can help in the diagnosis of IgG4-RD in patients with a unilateral renal pelvic lesion.
Collapse
Affiliation(s)
- Yu-Chieh Cheng
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Wei Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
7
|
Li MF, Liang HL, Chiang CL, Wu TH. Pulsatility index-adjusted doppler flow measurement of pedal arteries in peripheral artery disease patients. J Chin Med Assoc 2023; 86:98-104. [PMID: 36599144 DOI: 10.1097/jcma.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To examine the feasibility of using pulsatility index-adjusted (PI) flow equations to accurately characterize blood volume flow changes using Doppler technique in patients with peripheral artery disease (PAD) before and after percutaneous transluminal angioplasty (PTA). METHODS PTA was performed on 17 PAD patients (23 target vessels treated, 16 anterior tibial arteries, and 7 posterior tibial arteries). Arterial diameter, peak systolic velocity, PI, time-averaged mean velocity, and measured volume flow (MVF) of dorsalis pedis artery (DPA) and common plantar artery (CPA) were measured with duplex Doppler ultrasound before and after PTA. PI-adjusted volume flows (PIVF) were calculated as part of the MVF/PIVF relative percentage metric. RESULTS Significant changes (p < 0.001) of the MVF (mean: 33.0 mL/min, range: -20.9-102.2 mL/min) and MVF/PIVF relative percentages (mean: 51.8, range: 5.1-127.2%) in the DPA existed between before and after PTA, whereas no significant changes could be found in the CPA (mean:10.9 mL/min, p = 0.148 and mean: 21.3%, p = 0.146, respectively). Of the 7 treated posterior tibial arteries, the increments of the MVF/PIVF (mean: 60.4%, p = 0.033) was significant but not in the MVF (mean: 26.5 mL/min, p = 0.125). The ankle-brachial index also showed non-significant changes (p = 0.081). All PI-adjusted results matched clinical observations after blood flow restoration. CONCLUSION No conclusions can be drawn from the comparison of actual measured volume flow between before and after PTA. However, using the MVF/PIVF relative percentage allows for a more objective framework upon which to base clinical observations and provides clarity in situations where direct measurement provides a counter-intuitive or contradictory picture.
Collapse
Affiliation(s)
- Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Tung-Ho Wu
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| |
Collapse
|
8
|
Hu Y, Zhao C, Ji R, Chen W, Shen Q, Chiang CL, Chan J, Ma L, Yang H, Wong T, Ellsworth S, Lo CM, Dawson LA, Kong FM. The role of stereotactic body radiotherapy in hepatocellular carcinoma: guidelines and evidences. Journal of the National Cancer Center 2022. [DOI: 10.1016/j.jncc.2022.05.002] [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: 10/18/2022] Open
|
9
|
Li MF, Liang HL, Chiang CL, Lin YH. Management of acute lower gastrointestinal bleeding by pharmaco-induced vasospasm embolization therapy. J Chin Med Assoc 2022; 85:233-239. [PMID: 35175244 DOI: 10.1097/jcma.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To report the clinical outcomes of vasospasm embolization technique in treating lower gastrointestinal bleeding (LGIB). METHODS Fifty LGIB patients (32 men and 18 women; mean age, 70.4 years) with positive contrast extravasation on multidetector computed tomography were treated with pharmaco-induced vasospasm embolization by semiselective catheterization technique. Distal rectal bleeding was excluded. The bleedings in three patients were considered to be tumor related. Eighteen underwent regular hemodialysis, and 22 showed unstable hemodynamic at intervention. RESULTS Forty-two bleeders were found in superior mesenteric territory and eight in the inferior mesenteric territory. Successful, immediate hemostasis was achieved in 49 (98%) patients. Early recurrent bleeding (<30 days) was found in 13 (26.5%) patients with 6 local rebleeding (12.2%), 5 new-foci bleeding (10.2%), and 2 uncertain foci bleeding (4.1%). Repeated vasospasm embolization therapy was given to five patients, with successful hemostasis in four. All the three tumor-related bleeding patients undergoing vasospasm embolization had ceased bleeding and discharged. Patient-based primary and overall clinical successes were achieved in 73.5% and 83.7%, and lesion-based primary and overall clinical successes were 83.0% and 86.7%, respectively. The 30-day mortality rate was 21.3%, and the 1- and 2-year survival rates were 51.5% and 43.8%. No major procedure-related complications (eg, bowel ischemia) were encountered. CONCLUSION This study confirmed our prior preliminary conclusion that pharmaco-induced vasospasm embolization is easy, safe, and effective for LGIB. This treatment may be considered the first-line alternative approach for LGIB, especially for patients of advanced age with complex medical problems and/or when vasa rectal embolization isn't feasible.
Collapse
Affiliation(s)
- Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yih-Huie Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| |
Collapse
|
10
|
Lee SF, Vellayappan BA, Wong LC, Chiang CL, Chan SK, Wan EYF, Wong ICK, Lambert PC, Rachet B, Ng AK, Luque-Fernandez MA. Cardiovascular diseases among diffuse large B-cell lymphoma long-term survivors in Asia: a multistate model study. ESMO Open 2022; 7:100363. [PMID: 35026723 PMCID: PMC8760397 DOI: 10.1016/j.esmoop.2021.100363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We modeled the clinical course of a cohort of diffuse large B-cell lymphoma (DLBCL) patients with no prior cardiovascular diseases (CVDs) using a multistate modeling framework. PATIENTS AND METHODS Data on 2600 patients with DLBCL diagnosed between 2000 and 2018 and had received chemotherapy with or without radiotherapy were obtained from a population-wide electronic health database of Hong Kong. We used the Markov illness-death model to quantify the impact of doxorubicin and various risk factors (therapeutic exposure, demographic, comorbidities, cardiovascular risk factors, and lifestyle factors which included smoking) on the clinical course of DLBCL (transitions into incident CVD, lymphoma death, and other causes of death). RESULTS A total of 613 (23.6%) and 230 (8.8%) of 2600 subjects died of lymphoma and developed incident CVD, respectively. Median follow-up was 7.0 years (interquartile range 3.8-10.8 years). Older ages [hazard ratio (HR) for >75 versus ≤60 years 1.88; 95% confidence interval (CI) 1.25-2.82 and HR for 61-75 versus ≤60 years 1.60; 95% CI 1.12-2.30], hypertension (HR 4.92; 95% CI 2.61-9.26), diabetes (HR 1.43; 95% CI 1.09-1.87), and baseline use of aspirin (HR 5.30; 95% CI 3.93-7.16) were associated with an increased risk of incident CVD. In a subgroup of anticipated higher-risk patients (aged 61-75 years, smoked, had diabetes, and received doxorubicin), we found that they remained on average 7.9 (95% CI 7.2-8.8) years in the DLBCL state and 0.1 (95% CI 0.0-0.4) years in the CVD state, if they could be followed up for 10 years. The brief time in the CVD state is consistent with the high chance of death in patients who developed CVD. Other causes of death have overtaken DLBCL-related death after about 5 years. CONCLUSIONS In this Asian population-based cohort, we found that incident CVDs can occur soon after DLBCL treatment and continued to occur throughout survivorship. Clinicians are advised to balance the risks and benefits of treatment choices to minimize the risk of CVD.
Collapse
Affiliation(s)
- S F Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - B A Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - L C Wong
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - C L Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - S K Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - E Y-F Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong
| | - I C-K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong; Research Department of Policy and Practice, School of Pharmacy, University College London, London, UK
| | - P C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - B Rachet
- Department of Non-Communicable Disease Epidemiology, ICON Group, London School of Hygiene and Tropical Medicine, London, UK
| | - A K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M A Luque-Fernandez
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), Andalusian School of Public Health, Granada, Spain.
| |
Collapse
|
11
|
Lam TC, Tsang KC, Choi HC, Lee VH, Lam KO, Chiang CL, So TH, Chan WW, Nyaw SF, Lim F, Lau JO, Chik J, Kong FM, Lee AW. Combination atezolizumab, bevacizumab, pemetrexed and carboplatin for metastatic EGFR mutated NSCLC after TKI failure. Lung Cancer 2021; 159:18-26. [PMID: 34303276 DOI: 10.1016/j.lungcan.2021.07.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Acquired resistance to TKI is an important unmet need in the management of EGFR mutated lung cancer. Recent clinical trial IMPower150 suggested that combination approach with VEGF inhibitor, check point inhibitor immunotherapy and platinum-based chemotherapy was effective in oncogene driven lung cancer. The current trial examined the efficacy of a modified regimen in an EGFR mutated cohort. METHODS An open-labelled, single arm, phase II study was conducted in patients with EGFR mutated NSCLC who had progressed on at least one EGFR TKI. For those with T790M mutation, radiological progression on osimertinib was required for enrolment. Patients were treated with combination atezolizumab (1200 mg), bevacizumab (7.5 mg/kg), pemetrexed (500 mg/m2) and carboplatin (AUC 5) given once every 3 weeks until progression. RESULTS Forty patients were enrolled. Median age was 62 (range 45-76) years. More than one half (23/40, 57.5%) had progressed on osimertinib. PD-L1 expression was < 1% in 52.5%. Median follow-up time was 17.8 months. ORR was 62.5%. Median PFS was 9.4 months (95% CI: 7.6 - 12.1). One year OS was 72.5% (95% CI: 0.56-0.83). Treatment related grade 3 or above adverse events (AE) occurred in 37.5% (15/40). Immune-related AE occurred in 32.5% (13/40) patients. Quality of life measures of function and symptoms did not change significantly throughout the course of treatments. Post-trial rechallenge with EGFR TKI containing regimen resulted in PFS of 5.8 months (95% CI 3.9-10.0 months). CONCLUSION Combination approach of atezolizumab, bevacizumab, pemetrexed and carboplatin achieved promising efficacy in metastatic EGFR mutated NSCLC after TKI failure. The results were comparable with taxane based regimen of IMPower150 while toxicity profile was improved.
Collapse
Affiliation(s)
- T C Lam
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - K C Tsang
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - H C Choi
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - V H Lee
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - C L Chiang
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - T H So
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - W W Chan
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - S F Nyaw
- Tuen Mun Hospital, Hong Kong, China
| | - F Lim
- Princess Margaret Hospital, Hong Kong, China
| | - J O Lau
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - J Chik
- Queen Elizabeth Hospital, Hong Kong, Hong Kong, China
| | - F M Kong
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - A W Lee
- Department of Clinical Oncology, Queen Mary Hospital / Hong Kong University-Shenzhen Hospital, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| |
Collapse
|
12
|
Huang SF, Chiang CL, Lee MH. Suture granuloma mimicking local recurrence of colon cancer after open right hemicolectomy: a case report. Surg Case Rep 2021; 7:164. [PMID: 34259947 PMCID: PMC8280259 DOI: 10.1186/s40792-021-01251-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Foreign body granuloma is a rare surgery-related complication that can masquerade as cancer recurrence during postoperative surveillance. It may therefore deceive clinicians and lead to unnecessary interventions. The case presented herein demonstrates how a foreign body granuloma can be misleading in preoperative radiological studies and why this condition should not be ignored in differential diagnoses during surveillance of patients with previous history of abdominal surgery of any kind. Case presentation We report a case of suture granuloma mistaken for recurrent colon cancer, including the clinical history, imaging data, and histopathological photographs. A 60-year-old man was followed up at our institution after open right hemicolectomy 2 years earlier for ascending colon carcinoma. Contrast-enhanced computed tomography and magnetic resonance imaging revealed an infiltrative heterogeneous soft tissue lesion at the right mesenteric root, adjacent to the ileocolic anastomosis. Local recurrence was therefore suspected. We performed exploratory laparotomy, excised the tumor, and sent it for histopathological examination, which confirmed suture granuloma. Conclusions Foreign body granuloma is a rare surgery-related complication that should be considered during surveillance following colectomy. Its radiological features may mimic recurrent lesions, thus misleading clinicians and causing unnecessary interventions or further complications.
Collapse
Affiliation(s)
- Shih-Feng Huang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Hung Lee
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
| |
Collapse
|
13
|
Ho CHM, Chiang CL, Lee FAS, Chan JCH, Yeung CSY, Choi CKK, Wong FCS, Tung SY. Albumin-bilirubin versus Child-Pugh Grade as a Predictor of Survival after Individualised Hypofractionated Radiotherapy for Hepatocellular Carcinoma. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2016971] [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] [Indexed: 11/05/2022] Open
Affiliation(s)
- CHM Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CL Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong; Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong; Department of Clinical Oncology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - FAS Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - JCH Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Jordan, Hong Kong
| | - CSY Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CKK Choi
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FCS Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - SY Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| |
Collapse
|
14
|
Wong NSM, Chiang CL, Ho CHM, Yip WWL, Yeung CSY, Chan MKH, Lee VWY, Lee FAS, Wong FCS. Prognostic Factors and Survival in Advanced Large Hepatocellular Carcinomas Treated with Combined Transarterial Chemoembolisation and Hypofractionated Image-guided Radiotherapy. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017152] [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] [Indexed: 11/05/2022] Open
Affiliation(s)
- NSM Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CL Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong; Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong; Department of Clinical Oncology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - CHM Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - WWL Yip
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - CSY Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - MKH Chan
- Department of Radiation Physics, University Hospital Essen, Germany
| | - VWY Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FAS Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - FCS Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| |
Collapse
|
15
|
Huang JS, Pan HB, Yang TL, Hung BH, Chiang CL, Tsai MY, Chou CP. Kinetic patterns of benign and malignant breast lesions on contrast enhanced digital mammogram. PLoS One 2020; 15:e0239271. [PMID: 32941537 PMCID: PMC7498093 DOI: 10.1371/journal.pone.0239271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the kinetic patterns of benign and malignant breast lesions using contrast-enhanced digital mammogram (CEDM). Methods Women with suspicious breast lesions on mammography or ultrasound were enrolled. Single-view mediolateral oblique (MLO) CEDM of an affected breast was acquired at 2, 3, 4, 7, and 10 min after injection of contrast agent. Three readers visually and semi-quantitatively analyzed the enhancement of suspicious lesions. The kinetic pattern of each lesion was classified as persistent, plateau, or washout over two time intervals, 2–4 min and 2–10 min, by comparing the signal intensity at the first time interval with that at the second. Results There were 73 malignant and 75 benign lesions in 148 patients (mean age: 52 years). Benign and malignant breast lesions showed the highest signal intensity at 3 min and 2 min, respectively. Average areas under receiver operating characteristic (ROC) curve for diagnostic accuracy based on lesion enhancement at different time points were 0.73 at 2 min, 0.72 at 3 min, 0.69 at 4 min, 0.67 at 7 min, and 0.64 at 10 min. Diagnostic performance was significantly better at 2, 3, and 4 min than at 7 and 10 min (all p < 0.05). A washout kinetic pattern was significantly associated with malignant lesions at 2–4 min and 2–10 min frames according to two of the three readers’ interpretations (all p ≤ 0.001). Conclusion Applications of optimal time intervals and kinetic patterns show promise in differentiation of benign and malignant breast lesions on CEDM.
Collapse
Affiliation(s)
- Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Tsung-Lung Yang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Bao-Hui Hung
- Department of Radiology, Golden Hospital, Pingtung, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Meng-Yuan Tsai
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan, ROC
- * E-mail:
| |
Collapse
|
16
|
Chou CP, Pan HB, Yang TL, Chiang CL, Huang JS, Tsai MY. Impact of the COVID-19 pandemic on the volume of mammography examinations in Southern Taiwan. Breast J 2020; 27:89-91. [PMID: 32815587 PMCID: PMC7461087 DOI: 10.1111/tbj.14019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Tsung-Lung Yang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Meng-Yuan Tsai
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Yang-Ming University, School of Medicine, Taipei, Taiwan
| |
Collapse
|
17
|
Tsai WL, Sun WC, Chen WC, Chiang CL, Lin HS, Liang HL, Cheng JS. Hepatic arterial infusion chemotherapy vs transcatheter arterial embolization for patients with huge unresectable hepatocellular carcinoma. Medicine (Baltimore) 2020; 99:e21489. [PMID: 32769883 PMCID: PMC7593048 DOI: 10.1097/md.0000000000021489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
For the treatment of huge unresectable hepatocellular carcinoma (HCC), transcatheter arterial chemoembolization (TACE) or transcatheter arterial embolization (TAE) generally had poor effects and high complication rates. Our previous study found that Hepatic arterial infusion chemotherapy (HAIC) is a safe procedure and provides better survival than symptomatic treatment for the patients with huge unresectable HCC. The aim of the study is to compare the effect of HAIC vs TAE in patients with huge unresectable HCC.Since 2000 to 2005, patients with huge (size > 8 cm) unresectable HCC were enrolled. Twenty-six patients received HAIC and 25 patients received TAE. Each patient in the HAIC group received 2.5 + 1.4 (range: 1-6) courses of HAIC and in the TAE group received 1.8 + 1.2 (range: 1-5) courses of TAE. Baseline characteristics and survival were compared between the HAIC and TAE group.The HAIC group and the TAE group were similar in baseline characteristics and tumor stages. The overall survival rates at 1 and 2 years were 42% and 31% in the HAIC group and 28% and 24% in the TAE group. The patients in the HAIC group had higher overall survival than the TAE group (P = .077). Cox-regression multivariate analysis revealed that HAIC is the significant factor associated with overall survival (relative risk: 0.461, 95% confidence interval: 0.218-0.852, P = .027). No patients died of the complications of HAIC but three patients (12%) died of the complications of TAE.In conclusion, HAIC is a safe procedure and provides better survival than TAE for patients with huge unresectable HCCs.
Collapse
Affiliation(s)
- Wei-Lun Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- Shool of Medicine, National Yang-Ming University, Taipei
| | - Wei-Chi Sun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- Shool of Medicine, National Yang-Ming University, Taipei
| | - Wen-Chi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- Shool of Medicine, National Yang-Ming University, Taipei
| | - Chia-Ling Chiang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- Shool of Medicine, National Yang-Ming University, Taipei
| | | | - Huei-Lung Liang
- Shool of Medicine, National Yang-Ming University, Taipei
- Department of Radiology, Kaohsiung Veterans General Hospital
| | - Jin-Shiung Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- Shool of Medicine, National Yang-Ming University, Taipei
| |
Collapse
|
18
|
Chiang CL, Lee SF, Lee VW, Yeung CS, Cheung SK, Poon MC, Foo DC, Lo SH, Lam KO, Lee FA, Wong FC, Chan MK. Toxicity outcome of endorectal brachytherapy boost in medically inoperable patients. Strahlenther Onkol 2020; 196:993-997. [PMID: 32313964 DOI: 10.1007/s00066-020-01612-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
AIM This communication reviews results and toxicity of image-guided high-dose-rate endorectal brachytherapy (HDREBT) boost after external beam radiotherapy (ERT) in medically inoperable patients with rectal cancer. MATERIALS AND METHODS A total of 18 patients with rectal cancer and clinical stage T2-4N0‑2 treated with HDREBT boost after ERT were retrospectively reviewed. RESULTS Following treatment with a median total dose (EQD2, α/β = 10) of 66 Gy (range 48-92 Gy), the incidence of early and late rectal grade 3 toxicity was 11% and 19%, respectively. There was no correlation between the occurrence of acute and late toxicity. CONCLUSION With proper technique, a combined approach using EBRT and HDREBT was associated with acceptable toxicity in medically inoperable rectal cancer patients.
Collapse
Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China.
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China.
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Venus Wy Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Cynthia Sy Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Steven Kt Cheung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | | | - Dominic Cc Foo
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - S H Lo
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Francis As Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Frank Cs Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Mark Kh Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
- Clinic for Radiation Oncology, University Hospital Essen, Essen, Germany
| |
Collapse
|
19
|
Yeung CSY, Chiang CL, Wong NSM, Ha SK, Tsang KS, Ho CHM, Wang B, Lee VWY, Chan MKH, Lee FAS. Palliative Liver Radiotherapy (RT) for Symptomatic Hepatocellular Carcinoma (HCC). Sci Rep 2020; 10:1254. [PMID: 31988376 PMCID: PMC6985173 DOI: 10.1038/s41598-020-58108-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
This study aims at evaluating the symptom response, response duration, and toxicity of single dose palliative liver radiotherapy (RT) for symptomatic HCC patients. We reviewed unresectable HCC patients treated with palliative RT in our institution. Eligible patients were unsuitable or refractory to trans-arterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT), with an index symptom of pain or abdominal discomfort. The primary outcome was the percentage of patients with clinical improvement of index symptom at 1 month. Secondary outcomes were response duration, toxicities, alpha-feto protein (AFP) response, and radiological response. Fifty-two patients were included in the study. The index symptom was pain in 34 patients (65.4%), and abdominal discomfort (34.6%) in 18 patients. At 1 month, 51.9% of patients had improvement of symptoms. Median time to symptom progression was 89 days (range: 12–392 days). Treatment was well tolerated with only 2 patients (3.8%) developing grade 3 GI toxicities. AFP response, radiological response rate, and disease control rate at 3 months were 48.6%, 15.1%, and 54.5% respectively. Half of the patients had improvement of index symptoms after receiving palliative liver RT with median response duration of 3 months. The treatment was well tolerated with minimal toxicities.
Collapse
Affiliation(s)
- Cynthia S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China. .,Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China. .,Department of Clinical Oncology, HKU-Shenzhen Hospital, ShenZhen, China.
| | - Natalie S M Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - S K Ha
- Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China
| | - K S Tsang
- Department of Clinical Oncology, University of Hong Kong, Pok Fu Lam, Hong Kong (SAR), China
| | - Connie H M Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - B Wang
- Department of Clinical Oncology, HKU-Shenzhen Hospital, ShenZhen, China
| | - Venus W Y Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| | - Mark K H Chan
- Department of Radiation Physics, Imperial College London NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Francis A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong (SAR), China
| |
Collapse
|
20
|
Chiang CL, Choi HC, Lam KO, Chan BY, Lee SF, Yeung SY, Lau KS, Chan SY, Choy TS, Yuen KK. Real-world treatment patterns and outcomes in refractory metastatic colorectal cancer. Asia Pac J Clin Oncol 2019; 15 Suppl 2:5-13. [PMID: 30887726 DOI: 10.1111/ajco.13114] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To investigate treatment patterns and outcomes of metastatic colorectal cancer (mCRC) patients beyond second progression (PD2) since regorafenib and TAS-102 became available in Hong Kong. METHODS The clinical records of consecutive mCRC patients who were treated beyond PD2 at Department of Clinical Oncology, Queen Mary Hospital between June 2013 and February 2018, were retrospectively reviewed. RESULTS Of 176 PD2 patients (76.7% Eastern Cooperative Oncology Group performance status 0/1 and a median follow-up time of 6.6 [range, 0.4-37.2] months), 104 (59%) underwent palliative care only and 72 (41%) received active third-line (3L) treatment: regorafenib (n = 22), TAS-102 (n = 6), chemotherapy + antiepidermal growth factor receptor (n = 12), chemotherapy + antivascular endothelial growth factor (n = 28) or clinical trials (n = 4). Patients on active 3L treatment had significantly longer OS than those on palliative care only: 11.7 versus 5.5 months (adjusted hazard ratio = 0.41, 95% confidence interval: 0.28-0.61, P < 0.001). For those on active treatment, OS was significantly associated with the time from diagnosis of metastasis to PD2 (P < 0.001) and post-3L treatments (P = 0.009). When analyzing treatment eligibility according to trial criteria, half of the eligible patients (54/109) did not receive active treatment, but both eligible and ineligible patients achieved better OS when receiving active 3L treatment versus palliative care only (P < 0.001 and P = 0.002). No unexpected toxicity was reported. CONCLUSION Active 3L and beyond treatment significantly prolonged OS versus palliative care, even in selected "trial ineligible" patients. Given a high rate of palliation only care in eligible patients, improved patient access to medicine and counseling may be needed to maximize outcomes.
Collapse
Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - H C Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - K O Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - B Y Chan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - S F Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - K S Lau
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - S Y Chan
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - T S Choy
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - K K Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| |
Collapse
|
21
|
Hsiao JH, Chang HT, Tseng YD, Chiang CL, Chen IS, Chen YC, Chang PM, Wang BW. Hepatic Arterial Infusion Chemotherapy Is a Feasible Treatment Option for Breast Cancer with Liver-predominant Metastatic Disease. In Vivo 2019; 32:1635-1641. [PMID: 30348727 DOI: 10.21873/invivo.11425] [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] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with liver metastasis from breast cancer (LMBC) are usually offered systemic therapy. However, for those with progressive liver disease and limited extra-hepatic conditions, local liver management becomes an option. Herein we present our experience with hepatic arterial infusion chemotherapy (HAIC). PATIENTS AND METHODS From 1999 to 2018, 42 patients with LMBC, who had progressive liver metastasis after systemic therapy, were treated with HAIC. A catheter was placed angiographically into the hepatic artery and remained there for 5 consecutive days. One cycle of chemotherapy consisted of mitoxantrone, 5-fluorouracil, folinic acid, and cisplatin. This treatment was repeated at monthly intervals. The medical records were reviewed and analyzed for hepatic tumor response, progression-free survival, overall survival and adverse effects. RESULTS Complete response was observed in two patients (5%), partial response in 18 patients (43%) and stable disease in eight patients (19%). Fourteen patients (33%) had progressive disease after HAIC. The median progression-free survival and overall survival were 8.4 and 19.3 months, respectively. There was no death related to HAIC. The patients with response to the treatment had a significant survival benefit (p<0.005). CONCLUSION HAIC can be an option for those with progressive liver disease who are heavily pretreated while their extra-hepatic conditions are minimal or stable.
Collapse
Affiliation(s)
- Jui-Hu Hsiao
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Hong-Tai Chang
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Yen-Dun Tseng
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - I-Shu Chen
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Yu-Chia Chen
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Po-Ming Chang
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Being-Whey Wang
- Division of Gastroenterologic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C.
| |
Collapse
|
22
|
Chiang CL, Chan MKH, Yeung CSY, Ho CHM, Lee FAS, Lee VWY, Wong FCS, Blanck O. Combined stereotactic body radiotherapy and trans-arterial chemoembolization as initial treatment in BCLC stage B-C hepatocellular carcinoma. Strahlenther Onkol 2018; 195:254-264. [PMID: 30413833 DOI: 10.1007/s00066-018-1391-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/17/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE We retrospectively evaluated the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with trans-arterial chemoembolization (TACE) as initial therapy in Barcelona Clinic Liver Cancer (BCLC) system stage B-C hepatocellular carcinoma (HCC). PATIENTS AND METHODS Seventy-two patients received a single dose of TACE followed by SBRT 4 weeks later. All patients had tumor sizes ≥5 cm, at least 700 ml of disease-free liver, Child-Pugh (CP) score ≤ B7 and tumor nodules ≤5. SBRT dose, ranging from 6 × 5-8 Gy or 5-10 × 4 Gy, was individualized according to normal tissue constraints. No subsequent scheduled treatment was delivered unless disease progression was observed. Local control (LC), overall survival (OS), progression-free survival (PFS), response rate (RR), and toxicity were evaluated. RESULTS The patients' characteristics were: median age 60 years (range 28-87 years); CP score A/B (n = 68/4); BCLC stage B/C (n = 51/21); solitary/multifocal (n = 37/35); portal vein invasion (n = 18). The median tumor size and GTV were 11.2 cm (range 5.0-23.6 cm) and 751 cm3 (range 41-4009 cm3), respectively. The median equivalent dose in 2 Gy per fraction (EQD2, α/β = 10) was 37.3 Gy2 (range, 28-72 Gy2). The median follow-up time was 16.8 months (range, 3-96 months). The objective RR was 68% and the 1‑year LC rate was 93.6% (95% CI, 87.6-100%). The median OS was 19.8 months (95% CI, 11.6-30.6 months). SBRT-related grade 3 or higher adverse gastrointestinal events and treatment-related death occurred in three (2.8%) and one patient (1.4%) respectively. No patient developed classical radiation-induced liver injury. CONCLUSION Our experience suggests that combined TACE and SBRT can be a safe and effective initial therapy for BCLC stage B-C HCC with appropriate patient selection. Further prospective trials are warranted.
Collapse
Affiliation(s)
- C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.,Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Hong Kong, China
| | - Mark K H Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China. .,Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany.
| | - Cynthia S Y Yeung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Connie H M Ho
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Francis A S Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Venus W Y Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Frank C S Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Oliver Blanck
- Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
23
|
Chiang CL, Yeung CSY, Wong MYP, Lee VWY, Lee VHF, Lee FAS, Wong FCS. Stereotactic Body Radiotherapy for Pancreatic Cancer. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716861] [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: 11/05/2022] Open
|
24
|
Chiang CL, Lee FAS, Wong YW, Poon CM, Choi CKK, Wong FCS, Sze WK, Tung SY. Short-course Preoperative Radiotherapy with Delayed Surgery for Locally Advanced Rectal Cancer. Hong Kong J Radiol 2017. [DOI: 10.12809/hkjr1716844] [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: 11/05/2022] Open
|
25
|
Hsiao JH, Tsai CC, Liang TJ, Chiang CL, Liang HL, Chen IS, Chen YC, Chang PM, Chou NH, Wang BW. Adjuvant hepatic arterial infusion chemotherapy is beneficial for selective patients with Hepatocellular carcinoma undergoing surgical treatment. Int J Surg 2017; 45:35-41. [DOI: 10.1016/j.ijsu.2017.07.071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/07/2017] [Accepted: 07/15/2017] [Indexed: 02/06/2023]
|
26
|
Yeo W, Lam KO, Law AL, Chiang CL, Lee CC, Au KH. Authors' reply. Hong Kong Med J 2017; 23:315-316. [PMID: 28572525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- W Yeo
- Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - A Ly Law
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - C L Chiang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - C Cy Lee
- Department of Clinical Oncology, United Christian Hospital, Kwun Tong, Hong Kong
| | - K H Au
- Department of Clinical Oncology, United Christian Hospital, Kwun Tong, Hong Kong
| |
Collapse
|
27
|
Liang HL, Li MF, Chiang CL, Chen MCY, Wu CJ, Pan HB. The use of a Colapinto TIPS Needle under cone-beam computed tomography guidance for true lumen re-entry in subintimal recanalization of chronic iliac artery occlusion. J Chin Med Assoc 2017; 80:371-375. [PMID: 28341575 DOI: 10.1016/j.jcma.2016.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/25/2016] [Accepted: 09/16/2016] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To report the technique and clinical outcome of subintimal re-entry in chronic iliac artery occlusion by using a Colapinto transjugular intrahepatic portosystemic shunt (TIPS) needle under rotational angiography (cone-beam computed tomography; CT) imaging guidance. METHODS Patients with chronic iliac artery occlusion with earlier failed attempts at conventional percutaneous recanalization during the past 5 years were enrolled in our study. In these patients, an ipsilateral femoral access route was routinely utilized in a retrograde fashion. A Colapinto TIPS Needle was used to aid the true lumen re-entry after failed conventional intraluminal or subintimal guidewire and catheter-based techniques. The puncture was directed under rotational angiography cone-beam CT guidance to re-enter the abdominal aorta. Bare metallic stents 8-10 mm in diameter were deployed in the common iliac artery, and followed by balloon dilation. RESULTS Ten patients (9 male; median age, 75 years) were included in our investigation. The average occlusion length was 10.2 cm (range, 4-15 cm). According to the Trans-Atlantic Inter-Society Consensus (TASC) II classification, there were five patients each with Class B and D lesions. Successful re-entry was achieved in all patients without procedure-related complications. The ankle-brachial index (ABI) values increased from 0.38-0.79 to 0.75-1.28 after the procedure. Imaging follow-up (> 6 months) was available in six patients with patency of all stented iliac artery. Thereafter, no complaints of recurrent clinical symptoms occurred during the follow-up period. CONCLUSION The use of Colapinto TIPS needle, especially under cone-beam CT image guidance, appears to be safe and effective to re-enter the true lumen in a subintimal angioplasty for a difficult chronic total iliac occlusion.
Collapse
Affiliation(s)
- Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Defense Medical Center, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Matt Chiung-Yu Chen
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chieh-Jen Wu
- Section of Vascular Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Medical Imaging and Radiological Science, I-Shou University, Kaohsiung, Taiwan, ROC
| |
Collapse
|
28
|
Shiau EL, Liang HL, Lin YH, Li MF, Chiang CL, Chen MCY, Huang JS, Pan HB. The Complication of Hepatic Artery Injuries of 1,304 Percutaneous Transhepatic Biliary Drainage in a Single Institute. J Vasc Interv Radiol 2017; 28:1025-1032. [PMID: 28461005 DOI: 10.1016/j.jvir.2017.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/03/2017] [Accepted: 03/10/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine frequency of and assess risk factors for hepatic artery (HA) injury during percutaneous transhepatic biliary drainage (PTBD) and to discuss the technique and report the clinical outcome of embolization for HA injury. MATERIALS AND METHODS Over a 14-year period (2002-2016), 1,304 PTBD procedures in 920 patients were recorded. The incidence of HA injury was determined, and possible associated risk factors were analyzed. When injury occurred, HA embolization was performed at the site as close to the bleeding point as possible. Clinical outcomes of these patients after embolization were reported. RESULTS Of 1,304 PTBD procedures, a left-sided approach was used in 722 procedures (55.4%), and intrahepatic duct (IHD) puncture under ultrasound guidance was used in 1,161 procedures (90.1%). The IHD was nondilated in 124 (9.5%) patients. The punctured ductal entry site was peripheral in 1,181 (90.6%) patients. In this series, 8 procedures (0.61%) were complicated by HA injury. IHD dilatation status was the only risk factor (P = .017) for HA injury. Embolization was performed with technical and clinical success in all 8 patients. No recurrent hemobilia, intraabdominal bleeding, or other sequelae of HA injury after embolization was noted during 1 week to 84 months of follow-up. CONCLUSIONS HA injury is a relatively rare complication of PTBD. IHD dilatation status was the only risk factor for HA injury in this study. When HA injury occurred, embolization therapy was effective in managing this complication.
Collapse
Affiliation(s)
- En-Li Shiau
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung 813, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung 813, Taiwan; National Defense Medical Center, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yih-Huie Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung 813, Taiwan
| | - Ming-Feng Li
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung 813, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung 813, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung 813, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung 813, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
29
|
Yeo W, Lam KO, Law AL, Lee CC, Chiang CL, Au KH, Mo FK, So TH, Lam KC, Ng WT, Li L. Adjuvant S-1 chemotherapy after curative resection of gastric cancer in Chinese patients: assessment of treatment tolerability and associated risk factors. Hong Kong Med J 2016; 23:54-62. [PMID: 27966431 DOI: 10.12809/hkmj164885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The use of adjuvant chemotherapy with S-1 (tegafur, gimeracil, and oteracil potassium) has been shown to improve the outcome of patients with gastric cancer. There are limited data on the tolerability of S-1 in Chinese patients. In this multicentre retrospective study, we assessed the toxicity profile in local patients. METHODS Patients with stage II-IIIC gastric adenocarcinoma who had undergone curative resection and who had received S-1 adjuvant chemotherapy were included in the study. Patient demographics, tumour characteristics, chemotherapy records, as well as biochemical, haematological, and other toxicity profiles were extracted from medical charts. Potential factors associated with grade 2-4 toxicities were identified. RESULTS Adjuvant S-1 was administered to 30 patients. Overall, 19 (63%) patients completed eight cycles. The most common grade 3-4 adverse events included neutropaenia (10%), anaemia (6.7%), septic episode (16.7%), diarrhoea (6.7%), hyperbilirubinaemia (6.7%), and syncope (6.7%). Dose reductions were made in 22 (73.3%) patients and 12 (40.0%) patients had dose delays. Univariate analyses showed that patients who underwent total gastrectomy were more likely to experience adverse haematological events (P=0.034). Patients with nodal involvement were more likely to report adverse non-haematological events (P=0.031). Patients with a history of regular alcohol intake were more likely to have earlier treatment withdrawal (P=0.044). Lower body weight (P=0.007) and lower body surface area (P=0.017) were associated with dose interruptions. CONCLUSIONS The tolerability of adjuvant S-1 in our patient population was similar to that in other Asian patient populations. The awareness of S-1-related toxicities and increasing knowledge of potential associated factors may enable optimisation of S-1 therapy.
Collapse
Affiliation(s)
- W Yeo
- Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - K O Lam
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - A Ly Law
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - C Cy Lee
- Department of Clinical Oncology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - C L Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - K H Au
- Department of Clinical Oncology, United Christian Hospital, Kwun Tong, Hong Kong
| | - F Kf Mo
- Comprehensive Clinical Trials Unit, Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - T H So
- Department of Clinical Oncology, The University of Hong Kong, Pokfulam, Hong Kong
| | - K C Lam
- Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong
| | - W T Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - L Li
- Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong
| |
Collapse
|
30
|
Chiang CL, Liang HL, Chou CP, Huang JS, Yang TL, Chou YH, Pan HB. Easily recognizable sonographic patterns of ductal carcinoma in situ of the breast. J Chin Med Assoc 2016; 79:493-9. [PMID: 27449723 DOI: 10.1016/j.jcma.2016.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 03/19/2016] [Accepted: 05/24/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is a malignant proliferation of ductal epithelium confined by the basement membrane of the involved breast ducts. The aim of this study was to categorize positive findings of DCIS of the breast on sonography. METHODS From 2007 to 2011, 100 pathologically proven DCIS lesions were evaluated. Four sonographic patterns used to identify DCIS have been characterized as cumulus-type, coral-type, pipe-type, and miscellaneous lesions. RESULTS The lesion numbers of nonhigh-grade and high-grade DCIS were 44 and 56, respectively. The coral type (42%) was the most commonly found lesion, followed by cumulus-type (38%), pipe-type (17%), and miscellaneous (3%) lesions. There was no significant difference between the sonographic pattern and nuclear grades. However, the coral-type group was composed of significantly more high-grade DCIS cases than the other three types (p < 0.05). CONCLUSION Coral-, cumulus-, and pipe-type lesions are three easily recognizable sonographic findings of DCIS. Improving the breast ultrasound technique to better demonstrate the sonographic pattern is necessary to facilitate breast lesion interpretation.
Collapse
Affiliation(s)
- Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tsung-Lung Yang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Hong Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| |
Collapse
|
31
|
Han TS, Chiang HH, McConville D, Chiang CL. A Longitudinal Investigation of Person–Organization Fit, Person–Job Fit, and Contextual Performance: The Mediating Role of Psychological Ownership. Human Performance 2015. [DOI: 10.1080/08959285.2015.1021048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
32
|
Chou CP, Lewin JM, Chiang CL, Hung BH, Yang TL, Huang JS, Liao JB, Pan HB. Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis--Comparison to contrast-enhanced breast MRI. Eur J Radiol 2015; 84:2501-8. [PMID: 26456307 DOI: 10.1016/j.ejrad.2015.09.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 08/03/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of contrast-enhanced digital mammography (CEDM) and contrast-enhanced tomosynthesis (CET) to dynamic contrast enhanced breast MRI (DCE-MRI) using a multireader-multicase study. METHODS Institutional review board approval and informed consents were obtained. Total 185 patients (mean age 51.3) with BI-RADS 4 or 5 lesions were evaluated before biopsy with mammography, tomosynthesis, CEDM, CET and DCE-MRI. Mediolateral-oblique and cranio-caudal views of the target breast CEDM and CET were acquired at 2 and 4 min after contrast agent injection. A mediolateral-oblique view of the non-target breast was taken at 6 min. Each lesion was scored with forced BI-RADS categories by three readers. Each reader interpreted lesions in the following order: mammography, tomosynthesis, CEDM, CET, and DCE-MRI during a single reading session. RESULTS Histology showed 81 cancers and 144 benign lesions in the study. Of the 81 malignant lesions, 44% (36/81) were invasive and 56% (45/81) were non-invasive. Areas under the ROC curve, averaged for the 3 readers, were as follows: 0.897 for DCE-MRI, 0.892 for CET, 0.878 for CEDM, 0.784 for tomosynthesis and 0.740 for mammography. Significant differences in AUC were found between the group of contrast enhanced modalities (CEDM, CET, DCE-MRI) and the unenhanced modalities (all p<0.05). No significant differences were found in AUC between DCE-MRI, CET and CEDM (all p>0.05). CONCLUSION CET and CEDM may be considered as an alternative modality to MRI for following up women with abnormal mammography. All three contrast modalities were superior in accuracy to conventional digital mammography with or without tomosynthesis.
Collapse
Affiliation(s)
- Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung 807, Taiwan, ROC
| | - John M Lewin
- Diversified Radiology of Colorado, Denver, CO, USA
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Bao-Hui Hung
- Department of Radiology, Golden Hospital, Pingtung, Taiwan, ROC
| | - Tsung-Lung Yang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Jia-Bin Liao
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Department of pathology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC; Department of pathology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
| |
Collapse
|
33
|
Pan HB, Wong KF, Yang TL, Hsu GC, Chou CP, Huang JS, Lee SK, Chou YH, Chiang CL, Liang HL. The outcome of a quality-controlled mammography screening program: experience from a population-based study in Taiwan. J Chin Med Assoc 2014; 77:531-4. [PMID: 25103986 DOI: 10.1016/j.jcma.2014.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/04/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A greater policy of emphasis on the early detection and treatment of breast cancer is prevalent among developed countries. To raise the screening performance with a potentially decreased mortality rate, it is crucial to evaluate and analyze the screening outcome after implementation. We report the clinical outcome of an 8-year nationwide mammography screening in Taiwan to help share our statistical information on breast screening worldwide, especially in Asia. METHODS Taiwan has provided nationwide, free, biennial mammographic screening since 2004. A total of 2,392,789 consecutive screening mammography examinations were performed during this study period for women aged 50-69 years (2006-2009) and 45-69 years (from December 2009 onwards). The screening covers 33.2% of the target population in the most recent 2 years. The workload of every screening radiologist, the overall recall rate, positive predictive value (PPV1), cancer detection rate (CDR), cancer incidence rate (CIR) from the screening, 1-year interval cancer, sensitivity, and specificity of the screening mammography are calculated, and compared with the American College of Radiology (ACR) recommendation level and/or those of other screening mammographic series. RESULTS The CDRs (%) and CIRs (%) increased from 3.94-4.08 and 4.80-5.04 to 4.71-5.04 and 5.71 after 2009, implying a high occurrence of breast cancer in the younger age group of 45-49 years. The recall rates (9.3-10.0%) in this review are within the ACR recommendation range (<10%) and the PPV1 has also reached the ACR recommended level (>5%) in the most recent 2 years. The improvement of the screening performance may be attributed to our peer auditing review and education program. The sensitivity of our screening mammography is slightly lower than that of the ACR recommended level (>85%), which is still comparable to the results of the Vermont area in the USA. Although the workload (screenees/screeners) for every radiologist each year has increased from 150 in 2004 to 1360 in 2012, it does not seem to worsen the quality outcome of this screening program. CONCLUSION From the outcome review of this national mammography screening, there is still room to ameliorate our performance through comprehensive and continued education, to improve the competence of cancer detection and decrease false negative (FN) cases.
Collapse
Affiliation(s)
- Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Kam-Fai Wong
- Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan, ROC
| | - Tsung-Lung Yang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Giu-Cheng Hsu
- Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - San-Kan Lee
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yi-Hong Chou
- National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
| |
Collapse
|
34
|
Liang HL, Chiang CL, Chen MCY, Lin YH, Huang JS, Pan HB. Pharmaco-induced vasospasm therapy for acute lower gastrointestinal bleeding: a preliminary report. Eur J Radiol 2014; 83:1811-5. [PMID: 25043985 DOI: 10.1016/j.ejrad.2014.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/04/2014] [Accepted: 06/26/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To report a novel technique and preliminary clinical outcomes in managing lower gastrointestinal bleeding (LGIB). MATERIALS AND METHODS Eighteen LGIB patients (11 men and 7 women, mean age: 66.2 years) were treated with artificially induced vasospasm therapy by semi-selective catheterization technique. Epinephrine bolus injection was used to initiate the vascular spasm, and followed by a small dose vasopressin infusion (3-5 units/h) for 3h. The technical success, clinical success, recurrent bleeding and major complications of this study were evaluated and reported. RESULTS Sixteen bleeders were in the superior mesenteric artery and 2 in the inferior mesenteric artery. All patients achieved successful immediate hemostasis. Early recurrent bleeding (<30 days) was found in 4 patients with local and new-foci re-bleeding in 2 (11.1%) each. Repeated vasospasm therapy was given to 3 patients, with clinical success in 2. Technical success for the 21 bleeding episodes was 100%. Lesion-based and patient-based primary and overall clinical successes were achieved in 89.4% (17/19) and 77.7% (14/18), and 94.7% (18/19) and 88.8% (16/18), respectively. None of our patients had complications of bowel ischemia or other major procedure-related complications. The one year survival of our patients was 72.2 ± 10.6%. CONCLUSIONS Pharmaco-induced vasospasm therapy seems to be a safe and effective method to treat LGIB from our small patient-cohort study. Further evaluation with large series study is warranted. Considering the advanced age and complex medical problems of these patients, this treatment may be considered as an alternative approach for interventional radiologists in management of LGIB.
Collapse
Affiliation(s)
- Huei-Lung Liang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan.
| | - Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - Yih-Huie Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan
| | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan
| | - Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
35
|
Chiang CL, Liang JJ. An evaluation approach for livable urban environments. Environ Sci Pollut Res Int 2013; 20:5229-5242. [PMID: 23370852 DOI: 10.1007/s11356-013-1511-6] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/21/2013] [Indexed: 06/01/2023]
Abstract
This study proposes a method for evaluating livable urban environments using the analytic hierarchy process, a survey of public opinions (n=1,075), and gray relational analysis with a pollutant standards index to estimate the weights of weather, air pollution, and environment aspects and each respective factor. This study investigates the positive or negative correlation of these factors and their effects on livable environment. A value of 100 was designated as the perfect living condition. Results show that the weights of weather, air pollution, and environment aspects were 0.288, 0.395, and 0.317, respectively. The weight ranges of three weather factors, five air pollution factors, and ten environmental factors were 0.311-0.358, 0.191-205, and 0.081-0.116, respectively. The monthly livable index of 28 districts in Taichung City and of 20 cities/counties in Taiwan ranged from 81.1 to 92.4 and from 83.1 to 90.8 in different months, respectively, showing that environmental aspect played a key role. These results demonstrate that the proposed method can provide a quantification index of living conditions in each region, thereby establishing the governmental improvement policy firmly. This study also presents a discussion on improvement strategies, especially on the apportionment rate of governmental construction funds for livable urban environments.
Collapse
Affiliation(s)
- Chia-Ling Chiang
- Department of Environmental Engineering and Science, Feng Chia University, Taichung, Taiwan
| | | |
Collapse
|
36
|
Pan HB, Yang TL, Hsu GC, Chiang CL, Huang JS, Chou CP, Wang YC, Liang HL, Lee SK, Chou YH, Wong KF. Can missed breast cancer be recognized by regular peer auditing on screening mammography? J Chin Med Assoc 2012; 75:464-7. [PMID: 22989543 DOI: 10.1016/j.jcma.2012.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 03/09/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND This study was conducted to investigate whether detectable missed breast cancers could be distinguished from truly false negative images in a mammographic screening by a regular peer auditing. METHODS Between 2004 and 2007, a total of 311,193 free nationwide biennial mammographic screenings were performed for 50- to 69-year-old women in Taiwan. Retrospectively comparing the records in Taiwan's Cancer registry, 1283 cancers were detected (4.1 per 1000). Of the total, 176 (0.6 per 1000) initial mammographic negative assessments were reported to have cancers (128 traditional films and 48 laser-printed digital images). We selected 186 true negative films (138 traditional films and 48 laser-printed ones) as control group. These were seeded into 4815 films of 2008 images to be audited in 2009. Thirty-four auditors interpreted all the films in a single-blind, randomized, pair-control study. The performance of 34 auditors was analyzed by chi-square test. A p value of < 0.05 was considered significant. RESULTS Eight (6 traditional and 2 digital films) of the 176 false negative films were not reported by the auditors (missing rate of 4.5%). Of this total, 87 false negatives were reassessed as positive, while 29 of the 186 true negatives were reassessed as positive, making the overall performance of the 34 auditors in interpreting the false negatives and true negatives a specificity of 84.4% and sensitivity of 51.8%. The specificity and sensitivity in traditional films and laser-printed films were 98.6% versus 43.8% and 41.8% versus 78.3%, respectively. Almost 42% of the traditional false negative films had positive reassessment by the auditors, showing a significant difference from the initial screeners (p < 0.001). The specificity of their reinterpretation of laser-printed films was obviously low. CONCLUSION Almost 42% of the false negative traditional films were judged as missed cancers in this study. A peer auditing should reduce the probability of missed cancers.
Collapse
Affiliation(s)
- Huay-Ben Pan
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Lee AS, Zee BC, Cheung FY, Kwong P, Cheng ACK, Lai M, Kwok C, Chong M, Jolivet J, Chiang CL, Leung KC, Siu S, Lee C, Tung SY. Randomized phase II study of the x-linked inhibitor of apoptosis (XIAP) antisense AEG35156 in combination with sorafenib in patients with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.4105] [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: 11/20/2022] Open
Abstract
4105 Background: XIAP inhibits caspases which are proteases responsible for apoptotic cell death. It is highly expressed in HCC. AEG35156 is a second generation antisense oligonucleotide targeting XIAP mRNA, thus lowers the apoptotic threshold of cancer cells. It also accumulates in the liver. This study is designed to assess the added benefit of combining AEG35156 with sorafenib. Methods: Patients with histologically or clinically diagnosed (AASLD criteria) HCC who had failed or were unsuitable for resection or ablative therapies were randomized (2:1) to receive either weekly injection of AEG35156 300mg in combination with sorefanib 400mg BID or sorefanib alone. The primary end point was progression-free survival (PFS). Other endpoints were overall survival (OS), response rates and safety. Results: 51 patients were recruited. 48 patents were evaluable. There were 31 patients in the combination arm and 17 in the control arm. The median age was 60. 88% of patients were male. 81% of patients were hepatitis B carrier. 90% of patients belong to Child-Pugh class A. The median follow-up was 16.2 months. The PFS for the combination arm was 4.0 months (95% CI: 1.2-4.1) and 2.6 months for control arm. The OS for the combination arm was 6.5 months (95% CI: 3.9-11.5) and 5.4 months for the control arm. There were 3 partial responders (Choi’s criteria) in the combination arm (10%, 95% CI: 3-27%) and none (0%) in the control arm. Patients who had the study treatment interrupted (PFS 4.0, 95% CI: 2.4-5.4) or had dose modification (PFS 4.45, 95% CI: 1.0-6.5) according to protocol did significantly better than those who had no dose reduction (PFS 1.2, 95% CI: 1.2-4.0) and those in the control arm (PFS 2.6, 95% CI: 1.2-5.4). This also applies to OS. Regarding toxicities, there were one AEG35156 related serious adverse event (SAE) of hypersensitivity and two sorafenib related gastrointestinal SAE. Conclusions: AEG35156 in combination with Sorafenib was well tolerated in patients with advanced HCC. Dose reduced AEG35156 in combination with sorafenib have shown more activity than sorafenib alone and warrants further investigation.
Collapse
Affiliation(s)
| | | | | | | | | | - Maria Lai
- Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chloe Kwok
- Chinese University of Hong Kong, Shatin, Hong Kong
| | - Marc Chong
- Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jacques Jolivet
- Aegera Therapeutics (Pharmascience Inc.), Montreal, QC, Canada
| | | | - K C Leung
- Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Steven Siu
- Queen Mary Hospital, North Point, Hong Kong
| | - Conrad Lee
- Princess Margaret Hospital, Kowloon, Hong Kong
| | | |
Collapse
|
38
|
Chiang CL, Tsai MY, Chang WN, Chen CKH. Aberrant femoral torsion presenting with frog-leg squatting mimicking gluteal muscle contracture. Clin Orthop Relat Res 2012; 470:1165-70. [PMID: 21932101 PMCID: PMC3293947 DOI: 10.1007/s11999-011-2084-7] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 08/31/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with frog-leg squatting have restricted internal rotation and adduction of the affected hips during sitting or squatting. In the surgical literature, the cause generally has been presumed to arise from and be pathognomonic for gluteal muscle contracture. However, we have encountered patients with frog-leg squatting but without gluteal muscle contracture. QUESTIONS/PURPOSES We therefore raised the following questions: What are the imaging features of patients with frog-leg squatting? Do conditions other than gluteal muscle contracture manifest frog-leg squatting? PATIENTS AND METHODS We retrospectively reviewed the MR images of 67 patients presenting with frog-leg squatting from April 1998 to July 2010. There were four females and 63 males; their mean age was 22.2 years (range, 4-50 years). During MRI readout, we observed aberrant axes of some femoral necks and obtained additional CT to measure femoral torsion angles in 59 of the 67 patients. RESULTS MR images of 27 (40%) patients had signs of gluteal muscle contracture. Twenty-two (33%) patients (40 femora) had aberrant femoral torsion, including diminished anteversion (range, 6°-0°; average, 3.9°) in 11 femora of eight patients and femoral retroversion (range, < 0° to -31°, average, -7.5°) in 29 femora of 17 patients. The remaining 18 (27%) patients did not have gluteal muscle contracture or aberrant femoral torsion. The observation of aberrant femoral torsion was not anticipated before imaging studies. CONCLUSIONS In addition to gluteal muscle contracture, aberrant femoral torsion can be a cause of frog-leg squatting. LEVEL OF EVIDENCE Level II, diagnostic study. See the guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Meng-Yuan Tsai
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Ning Chang
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Clement Kuen-Huang Chen
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ,Department of Medical Imaging, Chi Mei Medical Center, Number 901, Zhonghua Road, Yongkang District, Tainan City, 71004 Taiwan ,National Yang-Ming University School of Medicine, Taipei, Taiwan
| |
Collapse
|
39
|
Chiang CL, Tsai MY, Chen CKH. MRI diagnosis of fibrolipomatous hamartoma of the median nerve and associated macrodystrophia lipomatosa. J Chin Med Assoc 2010; 73:499-502. [PMID: 20875626 DOI: 10.1016/s1726-4901(10)70107-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 06/08/2010] [Indexed: 11/26/2022] Open
Abstract
Fibrolipomatous hamartoma is an uncommon congenital disorder, which is characterized by disproportionate hyperplasia of adipose tissue infiltrating along the perineurium, the epineurium and the affected nerve trajectory. We present a case of combined fibrolipomatous hamartoma and macrodystrophia lipomatosa of the median nerve. The involved sites included the left palm, wrist and forearm. Part of the patient's middle finger had been amputated due to previous macrodystrophia lipomatosa; however, the lesion continued to enlarge and was accompanied by numbness. Magnetic resonance imaging demonstrated a typical fibrolipomatous hamartoma with high signal intensity of fat on both T1-weighted and T2-weighted images, characteristic coaxial cable appearance on axial images, and spaghetti appearance on sagittal images. A similar skipped lesion at the median nerve of the middle forearm was also noted. To the best of our knowledge, this has not been reported in the English literature.
Collapse
Affiliation(s)
- Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | | |
Collapse
|
40
|
Chiang CL, Yang SW, Tsai MY, Kuen-Huang Chen C. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg 2010; 19:e13-5. [PMID: 20303294 DOI: 10.1016/j.jse.2009.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [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: 08/27/2009] [Revised: 11/23/2009] [Accepted: 12/13/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Chia-Ling Chiang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | | | | |
Collapse
|
41
|
Abstract
To compare the survival functions based on right-truncated data, Lagakos et al. proposed a weighted logrank test based on a reverse time scale. This is in contrast to Bilker and Wang, who suggested a semi-parametric version of the Mann-Whitney test by assuming that the distribution of truncation times is known or can be estimated parametrically. The approach of Lagakos et al. is simple and elegant, but the weight function in their method depends on the underlying cumulative hazard functions even under proportional hazards models. On the other hand, a semi-parametric test may have better efficiency, but it may be sensitive to misspecification of the distribution of truncation times. Therefore, this paper proposes a non-parametric test statistic based on the integrated weighted difference between two estimated survival functions in forward time. The comparative results from a simulation study are presented and the implementation of these methods to a real data set is demonstrated.
Collapse
Affiliation(s)
- Yunchan Chi
- Department of Statistics, National Cheng-Kung University, Tainan, Taiwan, ROC.
| | | | | |
Collapse
|
42
|
Wong GKC, Chiang CL, To KF, Ng HK, Ching SC, Poon WS. Klebsiella meningitis mimicking clinical deterioration from hemorrhage of a complex posterior fossa arteriovenous malformation. Am J Forensic Med Pathol 2006; 27:271-3. [PMID: 16936510 DOI: 10.1097/01.paf.0000221090.03770.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of a 33-year-old male with a history of complex posterior fossa arteriovenous malformation (AVM) with partial resection done in China; at follow-up in our unit, he presented with a 1-day history of acute deterioration of consciousness level after minor head injury. The clinical and radiologic features were compatible with spontaneous hemorrhage from the AVM, and the patient died 1 day after admission. However, postmortem examination revealed the direct cause of death was due to Klebsiella meningitis. The clinical catch is highlighted, and the importance of early and prompt detection of this condition is emphasized.
Collapse
Affiliation(s)
- George K C Wong
- Division of Neurosurgery, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | | | | | | | | | | |
Collapse
|
43
|
Hwang TL, Chiang CL, Wang PN. Parenteral nutrition support after bone marrow transplantation: comparison of total and partial parenteral nutrition during the early posttransplantation period. Nutrition 2001; 17:773-5. [PMID: 11527677 DOI: 10.1016/s0899-9007(01)00628-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Bone marrow transplantation (BMT) usually is indicated if the patient's malignant disease involves the marrow or if hazard to the normal marrow is the limiting factor in the aggressive treatment of disease. The success of BMT depends on a complete team with all the resources needed to ensure optimal results. Aggressive nutrition support after BMT is very important. Adequate parenteral nutrition, total (TPN) or partial, followed by enteral nutrition according to the patient's gastrointestinal function is the important principle. METHODS Between 1996 and 2000, 60 patients, 46 male and 14 female, received BMT in Chang Gung Memorial Hospital. Their ages ranged from 6 to 54 y. Standard TPN was used in 40 patients after BMT, and partial parenteral nutrition was used in the remaining 20 patients. TPN was enriched with branched-chain amino acids (BCAA) when the patient's liver functions were impaired, and cyclic TPN was shifted when the patient's liver functions persistently deteriorated. RESULTS Most patients improved their nutrition status and increased their body weights, especially those receiving TPN. The patients receiving partial parenteral nutrition decreased their visceral proteins significantly during the course of parenteral nutrition. The BCAA-TPN can maintain a patient's visceral protein better than standard TPN. Only two patients expired because of graft rejection and sepsis; their body weights and nutrition status showed deterioration despite aggressive nutrition support. CONCLUSIONS We conclude that the nutrition support for patients with BMT is related to the success of marrow transplantation. Parenteral nutrition support, especially with TPN, is important because of frequent gastrointestinal dysfunction during the posttransplantational period, and it is better at maintaining the nutrition status and body weights of patients after BMT. An oral diet can be resumed after the patient's gastrointestinal function has improved and it can be tolerated.
Collapse
Affiliation(s)
- T L Hwang
- Department of Nutritional Therapy, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
| | | | | |
Collapse
|
44
|
Abstract
Stable anisotropic gold nanoparticles were prepared by the reduction of tetrachloroauric acid with hydrazine in mixed reverse micelles formed with anionic surfactant Aerosol-OT and nonionic surfactant sorbitan monooleate (Span80) in isooctane. It was found that the Span80 serves not only as a structure modifier but also as a stabilizer for Au particles, to prevent their further growth and precipitation. The control of particle size, shape, and degree of dispersion was achieved by varying the process variables, such as molar ratio of reduction agent to metal salt, size of water droplets (omega(o)), concentration of metal salt, and sequence of addition of metal salt into the mixed reverse micelles. When the HAuCl(4) was injected directly into the mixed reversed micelles containing hydrazine, nonspherical gold nanoparticles, such as rods and cubes, were obtained at the molar ratio of hydrazine to HAuCl(4) of less than 1.0. The nonspherical Au particles were preferably formed at larger omega(o) value and lower gold salt loading. By the analyses of high-resolution electron microscope, electron diffraction pattern, and energy-dispersive X-ray analysis (EDX), the resultant particles have been found to be pure gold of face-centered cubic structure. Copyright 2000 Academic Press.
Collapse
Affiliation(s)
- CL Chiang
- Department of Chemical Engineering, Southern Taiwan University of Technology, 710 Yung-Kang City, Tainan Hsien, Taiwan, Republic of China
| |
Collapse
|
45
|
Liu DW, Tsao YP, Hsieh CH, Hsieh JT, Kung JT, Chiang CL, Huang SJ, Chen SL. Induction of CD8 T cells by vaccination with recombinant adenovirus expressing human papillomavirus type 16 E5 gene reduces tumor growth. J Virol 2000; 74:9083-9. [PMID: 10982354 PMCID: PMC102106 DOI: 10.1128/jvi.74.19.9083-9089.2000] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2000] [Accepted: 07/14/2000] [Indexed: 11/20/2022] Open
Abstract
The potential of the E5 protein as a tumor vaccine candidate has not been explored yet. In this study, we evaluate the human papillomavirus type 16 (HPV-16) E5 protein delivered by an adenovirus vector as a tumor vaccine for cervical lesions. The results demonstrate that a single intramuscular injection of a recombinant adenovirus carrying the HPV-16 E5 gene into syngeneic animals can reduce the growth of tumors which contain E5 gene expression. Moreover, the E5 vaccine-induced tumor protection occurs through CD8 T cells but not through CD4 T cells in in vitro assays. In addition, our studies using knockout mice with distinct T-cell deficiencies confirm that cytotoxic T-lymphocyte-induced tumor protection is CD8 dependent but CD4 independent. Hence, HPV-16 E5 can be regarded as a tumor rejection antigen.
Collapse
Affiliation(s)
- D W Liu
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Lin SC, Chung TC, Ueng TH, Lin YH, Hsu SH, Chiang CL, Lin CC. The hepatoprotective effects of Solanum alatum Moench. on acetaminophen-induced hepatotoxicity in mice. Am J Chin Med 2000; 28:105-14. [PMID: 10794122 DOI: 10.1142/s0192415x00000131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Solanum alatum Moench. has been shown to have a protective effect against carbon tetrachloride (CCl4)-induced liver injury. Solanum alatum treatment (100 mg/kg, p.o.) decreased the elevation of serum alanine aminotransferase (ALT; GPT) and aspartate aminotransferase (AST; GOT) induced by acetaminophen (paracetamol) (600 mg/kg, i.p.) administration. It also decreased the extent of visible necrosis in liver tissue. In addition, Solanum alatum treatment restored hepatic glutathione (GSH) depletion induced by acetaminophen (600 mg/kg, i.p.) administration. Microsomal enzyme levels such as P-450, reductase, and aniline hydroxylation enzyme were also restored to normal levels after Solanum alatum administration. The hepatoprotective mechanism may function through direct binding with acetaminophen toxic metabolites, decreasing the attraction of acetaminophen metabolites for other cellular GSH or thiol protein. Additionally, Solanum alatum treatment increased the concentration of hepatic GSH and maintained a high level activity of GSTase, which led to acceleration of the excretion of toxic acetaminophen metabolites.
Collapse
Affiliation(s)
- S C Lin
- Department of Pharmacology, Taipei Medical College, Taiwan
| | | | | | | | | | | | | |
Collapse
|
47
|
Lin SC, Chung CY, Chiang CL, Hsu SH. The influence of propolis ethanol extract on liver microsomal enzymes and glutathione after chronic alcohol administration. Am J Chin Med 1999; 27:83-93. [PMID: 10354820 DOI: 10.1142/s0192415x99000112] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Propolis designates a series of gums, resins and balms of viscous consistency, which are gathered by honeybees from certain parts, mainly the buds and barks of plants, especially those found on coniferous trees. Bees bring propolis back to the hive, where it is modified and mixed with other substances including the bees' own wax and salivary secretions. In this study, the influences of propolis ethanol extract on chronic alcohol induced liver microsomal enzyme changes were investigated. Three grams of alcohol was added to rats' daily diet for four weeks to induce chronic alcohol liver injuries, and two different doses of propolis ethanol extract were p.o. administrated three times per day on the 28th, 29th, and 30th day. During the period of propolis administration, the ethanol diet was continued. After sacrifice, the rat livers were excised for assay of microsomal enzymes activity, glutathione (GSH) concentration, glutathione-S-transferase (GSTase) and gamma-glutamylcysteine synthetase (gamma-GCSase) activity. It was found that 30 mg/kg of propolis ethanol extract significantly prevented the elevations of total cytochrome P-450 enzymes, NADPH-dependent cytochrome C reductase, aniline hydroxylation, 7-ethoxyresorufin hydroxylation (7-ERH), 7-penthoxyresorufin hydroxylation (7-PRH), and lipid peroxidation induced by chronic ethanol administration. Additionally, propolis ethanol extract (100 mg/kg) also induced GSTase and gamma-GCSase activities and decreased glutathione levels in the liver.
Collapse
Affiliation(s)
- S C Lin
- Department of Pharmacology, Taipei Medical College, Taiwan
| | | | | | | |
Collapse
|
48
|
Abstract
This is the second of two reports on a study of the durations related to marriage. Divorce and death of one's spouse, the main causes of dissolution of marriage, are two of the most important events in a person's life. In the United States in 1994, 30.7 million, or 16.2%, of the adult population were either divorced or widowed. Among the widowed, the female to male ratio was 5 to 1! In this paper duration of separation due to divorce and duration of widowhood are the main variables under study. Algebraic formulas are derived and computer programs are written for estimating these durations for husbands and wives, and for living couples of any age. Relations with the duration of marriage, the expectation of life, and the family life cycle are also presented.
Collapse
Affiliation(s)
- C L Chiang
- School of Public Health, University of California, Berkeley, California, 94720, USA
| | | | | | | |
Collapse
|
49
|
Abstract
In the functional analysis described by Iwata, Dorsey, Slifer, Bauman, and Richman (1982/1994), reinforcer duration varied across conditions (e.g., brief attention vs. 30 s of escape); this may result in unequal exposure to the establishing operations for aberrant behavior. In this study, we compared the effects of unequal and equal reinforcer duration during a functional analysis. The results showed that reinforcer duration affects the rate of aberrant behavior and may potentially alter functional analysis interpretation.
Collapse
Affiliation(s)
- W W Fisher
- Neurobehavioral Unit, Kennedy Krieger Institute, Baltimore, Maryland 21205, USA
| | | | | |
Collapse
|
50
|
Tsai SW, Wei HJ, Chiang CL. Action of lipolytical enzymes in biphasic organic-aqueous systems: dynamics of the irreversible Michaelis-Menten reaction. Biotechnol Bioeng 1993; 41:603-11. [PMID: 18609595 DOI: 10.1002/bit.260410602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Through simple model analysis, the mass action kinetic model for lipolytic enzymes in biphasic aqueous-organic systems can be simplified using the quasi-steady state assumption (or the quasi-equilibrium state assumption) for the adsorbed enzyme E* or the enzyme-substrate complex E*S. Some parameter combinations leading to the above assumptions are derived confirmed by full numerical integration of the whole enzymatic process. The results may be classified into three categories: (1) the quasi-equilibrium state assumption for E*, (2) the quasi-steady state assumption for E*, and (3) the quasi-steady state assumption for E*S. Further simplification for both E* and E*S is also discussed.
Collapse
Affiliation(s)
- S W Tsai
- Department of Chemical Engineering, National Cheng Kung University, Tainan, Taiwan, Republic of China
| | | | | |
Collapse
|