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Lee J, Lin JB, Weng CS, Chen SJ, Chen TC, Chen YJ. Impact of reduced margin pelvic radiotherapy on gastrointestinal toxicity and outcome in gynecological cancer. Clin Transl Radiat Oncol 2023; 43:100671. [PMID: 37692995 PMCID: PMC10482739 DOI: 10.1016/j.ctro.2023.100671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/09/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose To investigate the effect of reduced margin pelvic radiotherapy on gastrointestinal toxicity and outcomes in gynecological cancer. Materials and methods This retrospective study analyzed data of 590 patients who underwent hysterectomy and adjuvant pelvic radiotherapy between 2010 and 2020 at two tertiary centers. The pelvic nodal region was delineated based on a reduced margin definition or the Radiation Therapy Oncology Group (RTOG) guidelines. All patients were treated with intensity-modulated radiotherapy with imaging guidance. Gastrointestinal toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) and the Patient-Reported Outcome version (PRO-CTCAE). Results Overall, 352 (59.7%) and 238 (40.3%) patients underwent RTOG and reduced margin pelvic radiotherapy, respectively. Median follow-up was 6.4 years (IQR: 3.7-9.6). Reduced margin pelvic radiotherapy significantly lowered the radiation dose to the small bowel. For CTCAE grade ≥ 2 or 3, acute gastrointestinal toxicity was lower in the reduced margin group than in the RTOG group (16.4% vs. 33.5%, p < 0.001; 2.9% vs. 8.5%, p < 0.001). The reduced margin group reported less severe acute gastrointestinal toxicity (PRO-CTCAE score ≥ 3) than the RTOG group (12.5% vs. 28.7%, p < 0.001). Late grade 3 gastrointestinal toxicity was lower in the reduced margin group than in the RTOG group (0.8% vs. 4.8%, p = 0.006). The 5-year pelvic recurrence-free survival and disease-free survival in the RTOG and reduced margin pelvic radiotherapy groups were 97.4% and 97.9% (p = 0.55) and 80.7% and 83.5% (p = 0.18), respectively. Conclusion Reduced margin pelvic radiotherapy decreased acute and late gastrointestinal toxicity and achieved favorable outcomes.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Sue-Jar Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tze-Chien Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Huang MY, Weng CS, Kuo HL, Su YC. Using a chatbot to reduce emergency department visits and unscheduled hospitalizations among patients with gynecologic malignancies during chemotherapy: A retrospective cohort study. Heliyon 2023; 9:e15798. [PMID: 37206031 PMCID: PMC10189172 DOI: 10.1016/j.heliyon.2023.e15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
Background A chatbot is an automatic text-messaging tool that creates a dynamic interaction and simulates a human conversation through text or voice via smartphones or computers. A chatbot could be an effective solution for cancer patients' follow-up during treatment, and could save time for healthcare providers. Objective We conducted a retrospective cohort study to evaluate whether a chatbot-based collection of patient-reported symptoms during chemotherapy, with automated alerts to clinicians, could decrease emergency department (ED) visits and hospitalizations. A control group received usual care. Methods Self-reporting symptoms were communicated via the chatbot, a Facebook Messenger-based interface for patients with gynecologic malignancies. The chatbot included questions about common symptoms experienced during chemotherapy. Patients could also use the text-messaging feature to speak directly to the chatbot, and all reported outcomes were monitored by a cancer manager. The primary and secondary outcomes of the study were emergency department visits and unscheduled hospitalizations after initiation of chemotherapy after diagnosis of gynecologic malignancies. Multivariate Poisson regression models were applied to assess the adjusted incidence rate ratios (aIRRs) for chatbot use for ED visits and unscheduled hospitalizations after controlling for age, cancer stage, type of malignancy, diabetes, hypertension, chronic renal insufficiency, and coronary heart disease. Result Twenty patients were included in the chatbot group, and 43 in the usual-care group. Significantly lower aIRRs for chatbot use for ED visits (0.27; 95% CI 0.11-0.65; p = 0.003) and unscheduled hospitalizations (0.31; 95% CI 0.11-0.88; p = 0.028) were noted. Patients using the chatbot approach had lower aIRRs of ED visits and unscheduled hospitalizations compared to usual-care patients. Conclusions The chatbot was helpful for reducing ED visits and unscheduled hospitalizations in patients with gynecologic malignancies who were receiving chemotherapy. These findings are valuable for inspiring the future design of digital health interventions for cancer patients.
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Affiliation(s)
- Ming-Yuan Huang
- Department of Emergency, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsiao-Li Kuo
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
- School of Nursing, Chang Gung University, New Taipei City, Taiwan
| | - Yung-Cheng Su
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Corresponding author.
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Lee J, Weng CS, Chang CL, Hsu WH, Jan YT, Wu KP. Association of prognostic nutritional index with muscle loss and survival in patients with ovarian cancer treated with primary debulking surgery and chemotherapy. Support Care Cancer 2023; 31:267. [PMID: 37058264 DOI: 10.1007/s00520-023-07719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Sarcopenia is prevalent in ovarian cancer and contributes to poor survival. This study is aimed at investigating the association of prognostic nutritional index (PNI) with muscle loss and survival outcomes in patients with ovarian cancer. METHODS This retrospective study analyzed 650 patients with ovarian cancer treated with primary debulking surgery and adjuvant platinum-based chemotherapy at a tertiary center from 2010 to 2019. PNI-low was defined as a pretreatment PNI of < 47.2. Skeletal muscle index (SMI) was measured on pre- and posttreatment computed tomography (CT) at L3. The cut-off for the SMI loss associated with all-cause mortality was calculated using maximally selected rank statistics. RESULTS The median follow-up was 4.2 years, and 226 deaths (34.8%) were observed. With a median duration of 176 days (interquartile range: 166-187) between CT scans, patients experienced an average decrease in SMI of 1.7% (P < 0.001). The cut-off for SMI loss as a predictor of mortality was - 4.2%. PNI-low was independently associated with SMI loss (odds ratio: 1.97, P = 0.001). On multivariable analysis of all-cause mortality, PNI-low and SMI loss were independently associated with all-cause mortality (hazard ratio: 1.43, P = 0.017; hazard ratio: 2.27, P < 0.001, respectively). Patients with both SMI loss and PNI-low (vs. neither) had triple the risk of all-cause mortality (hazard ratio: 3.10, P < 0.001). CONCLUSIONS PNI is a predictor of muscle loss during treatment for ovarian cancer. PNI and muscle loss are additively associated with poor survival. PNI can help clinicians guide multimodal interventions to preserve muscle and optimize survival outcomes.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| | - Chia-Sui Weng
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Long Chang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wen-Han Hsu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Ting Jan
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kun-Pin Wu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Weng CS, Cope AG, Mara KC, Schoolmeester JK, Khan Z, Burnett TL. Association Between Laparoscopic Appearance of Superficial Endometriosis, Positive Histology, and Systemic Hormone Use. J Minim Invasive Gynecol 2022; 29:1339-1343. [PMID: 36154901 DOI: 10.1016/j.jmig.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To assess the association between laparoscopic appearance of superficial endometriosis lesions, histopathology, and systemic hormone use. DESIGN Retrospective study. SETTING Tertiary care academic medical center. PATIENTS We identified 266 women who underwent laparoscopic surgery at an endometriosis center with excision of lesions consistent with possible superficial endometriosis between September 2015 and November 2018. INTERVENTIONS Appearance of the peritoneal lesions was confirmed with review of surgical videos and correlated with each pathology specimen. Lesions were dichotomized on positive or negative pathology assessment. All pathology-positive lesions were further dichotomized by hormone use within 1 month of surgery. MEASUREMENTS AND MAIN RESULTS A total of 841 lesions were biopsied from included subjects during the study period. Of those, 251 biopsies were negative, and 590 were positive for endometriosis on pathology assessment. Lesions had significantly higher odds of positive histology when they were red (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.17-2.48), white (OR, 1.99; 95% CI, 1.47-2.70), blue/black (OR, 2.98; 95% CI, 2.00-4.44), or puckering (OR, 9.78; 95% CI, 2.46-38.91) in appearance. The following combined characteristics had significantly higher odds of positive histology: white and blue (OR, 5.98; 95% CI, 2.97-12.02), red and white (OR, 2.22; 95% CI, 1.38-3.56), red and blue (OR, 4.11; 95% CI, 1.83-9.24), and clear and white (OR, 8.77; 95% CI, 1.17-66.02). Among positive biopsies, those with hormone exposure were more likely to have clear lesions than those without hormone use (OR, 3.36; 95% CI, 1.54-7.34) and were 2.89 times more likely to have clear and white lesions (95% CI, 1.07-7.85). CONCLUSION Although lesions suspicious for endometriosis may have differing rates of positive pathology based on appearance, no lesion characteristic was able to exclude the possibility of endometriosis. In addition, hormone use may influence lesion appearance at the time of surgery, with clear lesions more prevalent. These data have implications for appropriate identification of endometriosis at the time of laparoscopy to ensure accurate diagnosis and complete treatment of disease.
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Affiliation(s)
- Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan (Dr. Weng)
| | - Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota (Dr. Cope)
| | - Kristin C Mara
- Department of Research Services, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - J Kenneth Schoolmeester
- Department of Laboratory Medicine and Pathology (Dr. Schoolmeester), Mayo Clinic, Rochester, Minnesota
| | - Zaraq Khan
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan (Dr. Weng)
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan (Dr. Weng).
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Kobayashi Y, Komatsu H, Isobe M, Meena J, Weng CS, Kim SI, Wong JJL, Kwok ST, Yang J, Mathaveechotikul P, Chin Yee KL, Kim JW, Ushijima K. Asian Young Doctors Session at the 64th Annual Meeting of the Japanese Society for Gynecologic Oncology (JSGO): Educational Initiatives in the Next Generation for a New Era after the COVID-19 Pandemic. J Gynecol Oncol 2022; 34:e22. [PMID: 36509465 PMCID: PMC9807363 DOI: 10.3802/jgo.2023.34.e22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University Hospital, Tottori, Japan
| | - Masanori Isobe
- Department of Obstetrics and Gynecology, Niigata University Hospital, Niigata, Japan
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeslyn JL Wong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Shuk Tak Kwok
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong
| | - Jie Yang
- Gynecologic Oncology Division, Gynecology and Obstetrics Department, Peking Union Medical College Hospital, Beijing, China
| | - Panida Mathaveechotikul
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Salaya, Thailand
| | - Kanddy Loo Chin Yee
- Gynaeoncology Unit, Department of Obstetrics and Gynecology, Sarawak General Hospital, Kuching, Malaysia
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan.
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Fadadu PP, Cope A, Weng CS, Mara K, Khan Z, VanBuren W, Burnett T. Gastrointestinal symptoms as a predictor of deep endometriosis of the pelvic posterior compartment on magnetic resonance imaging. Journal of Endometriosis and Pelvic Pain Disorders 2022. [DOI: 10.1177/22840265221093262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine if gastrointestinal (GI) symptoms can predict deep endometriosis (DE) of the posterior pelvic compartment on magnetic resonance imaging (MRI). Methods: Patients with suspected endometriosis undergoing endometriosis protocol MRI at an academic center between 9/1/2015 and 7/31/2018 were identified. Presenting GI symptoms were collected via a standardized survey instrument prospectively at initial presentation. MRI and interdisciplinary conference notes were reviewed to identify posterior compartment DE (rectosigmoid, uterosacral ligaments, posterior cul de sac, and pelvic side walls). Associations between symptoms and DE were evaluated. Results: A total of 104 patients met inclusion criteria, and 89 (85.6%) presented with at least one GI symptom. Posterior compartment DE was identified on MRI in 47 patients (45.2%). The GI symptom that most strongly predicted DE was a bowel movement resulting in pain relief (OR 3.36, 95% CI 1.31–8.61, p = 0.012), with sensitivity, specificity, positive and negative predictive values 0.42, 0.82, 0.67, and 0.63, respectively. Other GI symptoms such as nausea, vomiting, rectal bleeding, change in frequency of bowel movements, and pain exacerbation by bowel movements did not significantly correlate to having DE. Of the 15 patients with no GI symptoms, 5 were found to have posterior compartment DE. Conclusion: In patients with suspected endometriosis, those who noted that bowel movements relieved their pain had more than three times the odds of having DE of the posterior compartment on MRI. Preoperative evaluation with MRI may be of value in these patients; however, lack of gastrointestinal symptoms does not exclude the possibility of posterior compartment DE.
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Affiliation(s)
| | - Adela Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Chia-Sui Weng
- Department of Obstetrics and Gyencology, Mackay Memorial Hospital, Taipei
| | - Kristin Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Zaraq Khan
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Tatnai Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Abstract
In late December 2019, several cases of pneumonia with unknown cause were reported in Wuhan, China, and this new type of pneumonia spread rapidly to across provinces during the subsequent weeks. The pathogen was identified quickly and was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infectious disease caused by this virus is referred to as coronavirus disease 2019 (COVID-19). Within months, it has caused a global pandemic and posed a major threat to public health worldwide. As of May 23, 2020, 5 252 452 patients have been confirmed to have the disease, and 339 026 deaths have been reported. Multiple therapeutic trials are ongoing, and some promising results have been released. A vaccine would provide the most effective approach to fight the virus by preventing infection, but none are currently available. To control the COVID-19 outbreak, large-scale measures have been applied to reduce human-to-human transmission of SARS-CoV-2. Susceptible populations, including older adults, children, and healthcare providers, warrant particular attention to avoid transmission and infection. This review introduces current understanding of SARS-CoV-2 infection and treatment strategies, emphasizing the relevant challenges associated with prevention, diagnosis, and management.
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Affiliation(s)
- Yung-Hung Luo
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming Medical University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hwa-Yen Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming Medical University, Taipei, Taiwan, ROC
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming Medical University, Taipei, Taiwan, ROC
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Weng CS, Wu CC, Chen TC, Chen JR, Huang CY, Chang CL. Retrospective Analysis Of Comparative Outcomes In Recurrent Platinum-Sensitive Ovarian Cancer Treated With Pegylated Liposomal Doxorubicin (Lipo-Dox) And Carboplatin Versus Paclitaxel And Carboplatin. Cancer Manag Res 2019; 11:9899-9905. [PMID: 31819627 PMCID: PMC6877447 DOI: 10.2147/cmar.s217329] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/15/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose The aim of this study is to analyze the outcomes of platinum-sensitive (PS) recurrent ovarian cancer treated with pegylated liposomal doxorubicin and carboplatin (CD) versus paclitaxel and carboplatin (CP). Clinical features were examined to characterize the patient population that would benefit from CD. Materials and methods This is a retrospective review of 122 cases at a tertiary hospital. Patients with PS recurrent ovarian cancer who received CD or CP were included. Progression-free survival (PFS) and overall survival (OS) were evaluated through the Kaplan–Meier method and log-rank test. Cox proportional hazards regression was used to examine PFS predictors. Results In total, 122 patients (75% with first recurrence and 25% with second recurrence) were included. The majority of the patients were diagnosed at an advanced stage and with the histology of serous carcinoma. Median PFS and OS were 14.8 and 55.5 months in the CD group and 13.5 and 56.8 months in the CP group. Subgroup analysis of patients revealed that the CD group had longer median PFS than the CP group among patients with PFI>12 months. Additionally, during the second recurrence, longer PFS was observed in the CD group than in the CP group (medians 22.3 and 13.5 months, respectively, p = 0.019). Conclusion Comparable outcomes in recurrent platinum-sensitive ovarian cancer treated with CD versus CP were presented in this study. Longer PFS in CD group was observed among patients with PFI for more than 12 months or in second recurrence.
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Affiliation(s)
- Chia-Sui Weng
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chao-Chih Wu
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Tze-Chien Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jen-Ruei Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chueh-Yi Huang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Fadadu PP, Weng CS, Mara KC, Cope AG, Khan Z, VanBuren W, Burnett TL. Gastrointestinal Symptoms as a Predictor of Deep Infiltrating Endometriosis of the Posterior Compartment of the Pelvis on MRI Imaging. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.725] [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: 11/28/2022]
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Wu CC, Weng CS, Hsu YT, Chang CL. Antitumor effects of BMS-777607 on ovarian cancer cells with constitutively activated c-MET. Taiwan J Obstet Gynecol 2019; 58:145-152. [PMID: 30638469 DOI: 10.1016/j.tjog.2018.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Tyrosine-protein kinase MET (c-MET) has been reported to be a prognostic marker and suitable therapeutic target for ovarian cancer. BMS-777607, a small molecule, can inhibit MET and other protein kinase activities. The present study was conducted to investigate the mechanism of action and antitumor effect of BMS-777607 on ovarian cancer cells with constitutively activated c-MET. MATERIALS AND METHODS Ovarian cancer cells with constitutively activated c-MET were first identified through Western blot analysis. Bio-behaviors, including signal transduction, proliferation, apoptosis, and migration, of the cells with constitutively activated c-MET were evaluated after BMS-777607 treatment. Liu's stain and immunological staining of α-tubuline were performed to evaluate the ploidy of the cells. A xenograft mouse model was also used to evaluate the antitumor effects of BMS-777607 on ovarian cancer cells with constitutively activated c-MET. RESULTS BMS-777607 could induce the highest inhibition of cell growth in ovarian cancer cells constitutively expressing c-MET. Treating SKOV3 cells with BMS-777607 could reduce c-MET activation and inhibit downstream cell signaling, thus causing cell apoptosis and polyploidy as well as cell cycle and cell migration inhibition. This molecule also inhibited tumor growth in a mouse xenograft model of SKOV3 ovarian cancer cells in vivo. CONCLUSION BMS-777607 exhibits antitumor effects on ovarian cancer cells that constitutively express c-MET through c-MET signaling blockade and the inhibition of Aurora B activity. Combination treatments to enhance the effects of BMS-777607 warrant investigation in the future.
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Affiliation(s)
- Chao-Chih Wu
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yun-Ting Hsu
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Long Chang
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan; Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Sanchi, New Taipei City, Taiwan.
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Lai JCY, Weng CS, Huang SM, Huang N, Chou YJ, Wang CC, Wang KL. Incidence and lifetime risk of uterine corpus cancer in Taiwanese women from 1991 to 2010. Taiwan J Obstet Gynecol 2017; 56:68-72. [PMID: 28254229 DOI: 10.1016/j.tjog.2015.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2015] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Although uterine corpus cancer has been the most common malignancy of the female genital tract in many countries, the lifetime risk of this cancer has not yet been determined among Taiwanese women. The purpose of the study was to describe the change in incidence and the lifetime risk of uterine corpus cancer over a 20-year period from 1991 to 2010 in Taiwan. MATERIALS AND METHODS We conducted a population-based registry study using the released database (available online) from the Taiwan Cancer Registry. RESULTS A total of 15,542 women newly diagnosed with uterine corpus cancer were included in this study. The total number of this cancer increased by 5.7-fold from 1991 to 2010. The annual age-specific rate nearly doubled during the past decade (2001-2010) when compared with the previous decade (1991-2000). Incidence rates were highest in women aged 50-59 years, and increasing incidence rates were observed in each age strata starting from 40 years to 85 years and more, after the year 2000. The lifetime risk of being diagnosed with uterine corpus cancer was 0.39% in 1991-1995, 0.54% in 1996-2000, 0.73% in 2001-2005, and 1.12% in 2006-2010 among Taiwanese women. CONCLUSION According to the observed changes in incidence rate, the burden of uterine corpus cancer in the general female population is expected to increase in the near future. From a public-health perspective, care providers should develop strategies for the prevention, early detection, and intervention to reduce the rapidly increasing incidence of uterine corpus cancer in Taiwan.
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Affiliation(s)
- Jerry Cheng-Yen Lai
- Institute of Public Health & Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Sheng-Miauh Huang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health & Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Chen Wang
- Department of Medicine, Medical University of Lublin, Lublin, Poland
| | - Kung-Liahng Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Obstetrics and Gynecology, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan.
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Huang CY, Yang YC, Wang KL, Chen TC, Chen JR, Weng CS, Chien HJ, Chang CL. Possible surrogate marker for an effective dose-dense chemotherapy in treating ovarian cancer. Taiwan J Obstet Gynecol 2016; 55:405-9. [DOI: 10.1016/j.tjog.2016.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 10/21/2022] Open
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Chen CA, Lin H, Weng CS, Wen KC, Lu CH, Chou HH, Huang YF, Kang CY, Ho CM, Yu MH, Chou CY. Outcome of 3-day bleomycin, etoposide and cisplatin chemotherapeutic regimen for patients with malignant ovarian germ cell tumours: a Taiwanese Gynecologic Oncology Group study. Eur J Cancer 2015; 50:3161-7. [PMID: 25459394 DOI: 10.1016/j.ejca.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/03/2014] [Accepted: 10/05/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The combination of bleomycin, etoposide and cisplatin (BEP) is currently the most widely used treatment for malignant ovarian germ cell tumours (MOGCTs). The aim of this study was to evaluate the efficacy and adverse effects of the 3-day BEP regimen in Taiwan. The prognostic factors of the MOGCT patients were also analysed. PATIENTS AND METHODS Two hundred and thirty-nine cases of MOGCTs were identified from the Taiwanese Gynecologic Oncology Group database, and 204 of those who received postoperative BEP chemotherapy were then analysed. RESULTS The estimated rate of no evidence of disease was 94.0% for 204 patients with adjuvant BEP regimen. Seven grade 3/4 haematological adverse effects including four subjects with neutropenia, one with pancytopenia and two with neutropenic fever were recorded in the 853 total courses of chemotherapeutic cycles. The rates of haematological and non-haematological adverse effects were 0.82% and 2.3%, respectively. No treatment-related mortality was noted. In the analysis of prognostic factors, only tumour stage had a significant impact on disease recurrence (95% confidence interval (CI), 4.2–94.4, p < 0.001) and disease-related mortality (95% CI, 2.2–163.9, p = 0.007). CONCLUSIONS The current 3-day adjuvant BEP regimen was effective and safe for patients with MOGCTs.
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Weng CS, Chen MY, Wang TY, Tsai HW, Hung YC, Yu KJ, Chiang YC, Lin H, Lu CH, Chou HH. Sertoli–Leydig cell tumors of the ovary: A Taiwanese Gynecologic Oncology Group study. Taiwan J Obstet Gynecol 2013; 52:66-70. [DOI: 10.1016/j.tjog.2012.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2012] [Indexed: 10/27/2022] Open
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Abstract
Cyanosis is a bluish skin due to deoxygenated hemoglobin or methomoglobin in the arterial blood.Central cyanosis mostly results from cardiovascular or pulmonary shunts. Tet spell is an episodic central cyanosis due to total occlusion of right ventricle outflow in a patient with a congenital heart disease, such as Tetralogy of Fallot (TOF). There are limited cases of patients who lived with untreated TOF until adulthood. Tet spell in an adult is rarely seen in an emergency department. Early recognition of this condition, along with proper disposition andmanagement, can prevent majormorbidity or mortality. We report a 29-year-old man who presented with cyanotic spell and in whom a diagnosis of TOF was later confirmed. This case reminds us of TOF as a differential diagnosis of hypercyanotic crises and its unique manifestations and management.
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Affiliation(s)
- Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Yu-Che Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chia-Sui Weng
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
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Mahmarian JJ, Moyé LA, Chinoy DA, Sequeira RF, Habib GB, Henry WJ, Jain A, Chaitman BR, Weng CS, Morales-Ballejo H, Pratt CM. Transdermal nitroglycerin patch therapy improves left ventricular function and prevents remodeling after acute myocardial infarction: results of a multicenter prospective randomized, double-blind, placebo-controlled trial. Circulation 1998; 97:2017-24. [PMID: 9610531 DOI: 10.1161/01.cir.97.20.2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [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: 02/07/2023]
Abstract
BACKGROUND Nitrates are widely used in the treatment of angina in patients with acute myocardial infarction (AMI). Short-term administration prevents left ventricular (LV) dilation and infarct expansion. However, little information is available regarding their long-term effects on LV remodeling in patients surviving Q-wave AMI. METHODS AND RESULTS This was a randomized, double-blind, placebo-controlled trial designed to investigate the long-term (6-month) efficacy of intermittent transdermal nitroglycerin (NTG) patches on LV remodeling in 291 survivors of AMI. Patients meeting entry criteria had baseline gated radionuclide angiography (RNA) followed by randomization to placebo or active NTG patches delivering 0.4-, 0.8-, or 1.6-mg/h. RNA was repeated at 6 months and 6.5 days after withdrawal of double-blind medication. The primary study end point was the change in end-systolic volume index (ESVI). Both ESVI and end-diastolic volume index (EDVI) were significantly reduced with 0.4-mg/h NTG patches (-11.4 and -11.6 mL/m2, respectively, P<.03). This beneficial effect was observed primarily in patients with a baseline LV ejection fraction < or =40% (deltaESVI, -31 mL/m2; deltaEDVI, -33 mL/m2; both P<.05) and only at the 0.4-mg/h dose. After NTG patch withdrawal, ESVI significantly increased but did not reach pretreatment values. CONCLUSIONS Transdermal NTG patches prevent LV dilation in patients surviving AMI. The beneficial effects are limited to patients with depressed LV function and only at the lowest (0.4-mg/h) dose. Continued administration is necessary to maintain efficacy. Whether these remodeling effects confer a clinical or survival advantage will need to be addressed in an adequately powered cardiac event trial.
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Lapane KL, Jakiche AF, Sugano D, Weng CS, Carey WD. Hepatitis C infection risk analysis: who should be screened? Comparison of multiple screening strategies based on the National Hepatitis Surveillance Program. Am J Gastroenterol 1998; 93:591-6. [PMID: 9576453 DOI: 10.1111/j.1572-0241.1998.170_b.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [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: 12/11/2022]
Abstract
OBJECTIVES Hepatitis C, an infection of high prevalence worldwide, is insidiously progressive in many. Reduction of person-to-person spread is possible, and treatment is possible for many, particularly if offered before cirrhosis develops. Screening for hepatitis C (HCV) would be appropriate if strategies could be developed to afford adequate sensitivity and specificity at reasonable cost. We evaluated the performance characteristics of several screening strategies to determine the best balance between cost and performance. METHODS The database of a national hepatitis screening program was used to define risk factors for HCV. Features associated with increased risk for HCV by multivariable analysis were combined in various ways to construct HCV screening models. Screening Model 1 employed a mathematical model constructed to predict the probability of hepatitis C. Using this model, testing for HCV was done if the probability of HCV was determined to be higher than 7%. Models 2 and 3 called for HCV testing if certain risk factors, stratified as socially intrusive, or nonintrusive in nature, were present. Model 4 calls for testing for HCV only when ALT values are elevated. Costs per case discovered were calculated for each model. RESULTS Nine thousand two-hundred sixty-nine individuals from a database of 13,997 has sufficient information to be included in the modeling studies. Risk factors considered socially intrusive were intravenous (i.v.) drug use and sex with an i.v. drug user. Risk factors considered not socially intrusive were: history of blood transfusion, age 30-49 yrs, and male gender. The sensitivity of Models 1-4 were 65%, 69%, 53%, and 63%, respectively. Specificities were 84%, 74%, 77%, and 92%, respectively. The cost per case detected was lowest when Models 1 or 2 were used ($357 and $439, respectively) and higher for models 3 and 4 ($487 and $1047, respectively). CONCLUSIONS The yield and cost of screening for HCV compares favorably with accepted current screening practices for other diseases. Models 1, 2, and 3 may be appropriate in certain clinical and epidemiological settings. Selective screening by a risk factor questionnaire (first three models) is more cost-effective than blood testing with ALT (Model 4).
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Affiliation(s)
- K L Lapane
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, USA
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Abstract
The current applications of Schuirmann's two one-sided tests procedure for the original scale ignore the variability of the least squares mean of the reference formulation when it substitutes for the unknown reference average of pharmacokinetic responses. We propose a modified two one-sided test procedure that takes into account the variability of the least squares mean of the reference formulation. The non-parametric version of the modified procedure is also available. We conducted a simulation study to examine the true level of significance and empirical power of four current parametric and non-parametric two one-sided tests procedures under a 2 x 2 crossover design with different combinations of sample size, intrasubject variability, and correlation between the two responses from a subject. Both theoretical results and empirical evidence show that the true level of significance of the current two one-sided tests procedures converges to 0.5 when the correlation of the two responses approaches 1. However, not only is the modified two one-sided tests procedure a test of size alpha, but empirical evidence indicates it is also an unbiased test. The modified non-parametric procedure also controls the size of the tests and is competitive even under normality assumption.
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Affiliation(s)
- J P Liu
- Berlex Laboratories, Inc., Wayne, NJ 07470, USA
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Liu JP, Weng CS. Evaluation of parametric and nonparametric two one-sided tests procedures for assessing bioequivalence of average bioavailability. J Biopharm Stat 1993; 3:85-102. [PMID: 8485538 DOI: 10.1080/10543409308835050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A simulation study was conducted to compare the levels of significance and power between Schuirmann's and nonparametric two one-sided tests procedures for a 2 x 2 crossover design under different combinations of sample sizes, intrasubject variabilities, and underlying distributions. Empirical results suggest that Schuirmann's two one-sided tests procedure is robust to minor departure from the assumption of normality.
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Affiliation(s)
- J P Liu
- Berlex Laboratories, Inc., Wayne, New Jersey 07470
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Abstract
This paper considers estimation of a measure of relative bioavailability of a test formulation to a reference formulation, on the original scale, under the assumption of a log-normal distribution for the data from a 2 x 2 crossover bioavailability/bioequivalence study. We propose the minimum variance unbiased estimator which is equal to the maximum likelihood estimator adjusted for bias by a correction factor. We also derive the variance of the minimum variance unbiased estimator and its unbiased estimator. We derive the biases and mean square errors of the maximum likelihood estimator, the ratio of the least square means, and the least squares mean of individual subject ratios, with respect to this measure, and compare them in a simulation study. Both theoretical and empirical results strongly suggest that one always consider the minimum variance unbiased estimator. A numerical example illustrates the proposed estimation procedure.
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Affiliation(s)
- J P Liu
- Berlex Laboratories, Inc., Wayne, NJ 07470
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Abstract
This paper considers the problem of detecting outlying data in bioavailability/bioequivalence studies. We define outlying subjects as those whose responses in bioavailability to all formulations differ from the rest of the subjects. We also define an outlying observation as the response in bioavailability of a subject to a particular formulation which is grossly different from the average bioavailability of that formulation calculated from all subjects. We propose two test procedures. The first, based on two-sample Hotelling T2, is to detect possible outlying subjects. The second, based on residuals from formulation means, is to identify possible outlying observations within subjects. Both procedures take into account the covariance structure of the responses to formulations, dependence of test statistics, and multiplicity of test procedures. We apply the Monte Carlo or bootstrap simulation to evaluate the sampling distributions of test statistics. An example from a 3-way crossover bioequivalence study illustrates the two procedures.
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Affiliation(s)
- J P Liu
- Berlex Laboratories, Inc., Wayne, NJ 07470
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