1
|
Lin WC, Tai WC, Chang CH, Tu CH, Feng IC, Shieh MJ, Chung CS, Yen HH, Chou JW, Wong JM, Liu YH, Huang TY, Chuang CH, Tsai TJ, Chiang FF, Lu CY, Hsu WH, Yu FJ, Chao TH, Wu DC, Ho AS, Lin HH, Feng CL, Wu KL, Wong MW, Tung CC, Lin CC, Chen CC, Hu HM, Lu LS, Wang HS, Wu IC, Kuo HY, Wu JF, Yao Shih H, Ni YH, Tang SL, Chen PH, Wei SC. Real-World Evidence of Effectiveness and Safety of Vedolizumab for Inflammatory Bowel Disease in Taiwan: A Prospective Nationwide Registry (VIOLET) Study. Inflamm Bowel Dis 2023; 29:1730-1740. [PMID: 36626567 PMCID: PMC10918762 DOI: 10.1093/ibd/izac269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND This nationwide prospective registry study investigated the real-world effectiveness, safety, and persistence of vedolizumab (VDZ) in inflammatory bowel disease (IBD) patients in Taiwan. Disease relapse rates after VDZ discontinuation due to reimbursement restriction were assessed. METHODS Data were collected prospectively (January 2018 to May 2020) from the Taiwan Society of IBD registry. RESULTS Overall, 274 patients (147 ulcerative colitis [UC] patients, 127 Crohn's disease [CD] patients) were included. Among them, 70.7% with UC and 50.4% with CD were biologic-naïve. At 1 year, 76.0%, 58.0%, 35.0%, and 62.2% of UC patients and 57.1%, 71.4%, 33.3%, and 30.0% of CD patients achieved clinical response, clinical remission, steroid-free remission, and mucosal healing, respectively. All patients underwent hepatitis B and tuberculosis screening before initiating biologics, and prophylaxis was recommended when necessary. One hepatitis B carrier, without antiviral prophylaxis due to economic barriers, had hepatitis B reactivation during steroid tapering and increasing azathioprine dosage, which was controlled with an antiviral agent. No tuberculosis reactivation was noted. At 12 months, non-reimbursement-related treatment persistence rates were 94.0% and 82.5% in UC and CD patients, respectively. Moreover, 75.3% of IBD patients discontinued VDZ due to mandatory drug holiday. Relapse rates after VDZ discontinuation at 6 and 12 months were 36.7% and 64.3% in CD patients and 42.9% and 52.4% in UC patients, respectively. CONCLUSIONS The findings demonstrated VDZ effectiveness in IBD patients in Taiwan, with high treatment persistence rates and favorable safety profiles. A substantial IBD relapse rate was observed in patients who had mandatory drug holiday.
Collapse
Affiliation(s)
- Wei-Chen Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Hung Tu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Che Feng
- Division of Gastroenterology and Hepatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Jium Shieh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Shuan Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsu-Heng Yen
- Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Jen-Wei Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jau-Min Wong
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Hwa Liu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chiao-Hsiung Chuang
- Department of Internal Medicine, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tzung-Jiun Tsai
- Division of Gastroenterology and Hepatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Feng-Fan Chiang
- Division of Colon and Rectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Yu Lu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Hsin Chao
- Division of Colon and Rectal Surgery, Department of Surgery, Chiayi and Wangiao Branch, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ai-Sheng Ho
- Division of Gastroenterology, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Lung Feng
- Division of Gastroenterology and Hepatology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Keng-Liang Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ming-Wun Wong
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chien-Chih Tung
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Huang-Ming Hu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huann-Sheng Wang
- Division of Colorectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yu Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Feng Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiang Yao Shih
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Lun Tang
- Takeda Pharmaceuticals Taiwan, Ltd., Taipei, Taiwan
| | | | - Shu-Chen Wei
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
2
|
Wang SW, Yu FJ, Kuo FC, Wang JW, Wang YK, Chen YH, Hsu WH, Liu CJ, Wu DC, Kuo CH. Rescue therapy for refractory Helicobacter pylori infection: current status and future concepts. Therap Adv Gastroenterol 2023; 16:17562848231170941. [PMID: 37168402 PMCID: PMC10164852 DOI: 10.1177/17562848231170941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/04/2023] [Indexed: 05/13/2023] Open
Abstract
Helicobacter pylori infection is an important issue worldwide, and several guidelines have been published for clinicians to achieve successful eradication. However, there are still some patients who remain infected with H. pylori after treatment. Clinicians should identify the reasons that caused treatment failure and find strategies to manage them. We have searched and organized the literature and developed methods to overcome factors that contribute to prior treatment failure, such as poor compliance, inadequate intragastric acid suppression, and antibiotic resistance. To improve compliance, telemedicine or smartphone applications might play a role in the modern world by increasing doctor-patient relationships, while concomitant probiotics could be administered to reduce adverse effects and enhance adherence. For better acid suppression, high-potency and high-dose proton-pump inhibitors or potassium-competitive acid blockers have preferable efficacy. To overcome antibiotic resistance, susceptibility tests either by culture or by genotyping are the most commonly used methods and have been suggested for antibiotic selection before rescue therapy, but empirical therapy according to detailed medical history could be an alternative. Eradication with a longer treatment period (14 days) has a better outcome than shorter period (7 or 10 days). Ultimately, clinicians should select antibiotics based on the patient's history of drug allergy, previous antibiotic exposure, local antibiotic resistance, available medications, and cost. In addition, identifying patients with a high risk of cancer and shared decision-making are also essential for those who have experienced eradication failure.
Collapse
Affiliation(s)
- Song-Wei Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Fu-Chen Kuo
- School of Medicine, College of Medicine, E-Da Hospital, I-Shou University, Kaohsiung
| | - Jiunn-Wei Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yao-Kuang Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yi-Hsun Chen
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
| | - Chung-Jung Liu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Regenerative Medicine and Cell therapy Research Center, Kaohsiung Medical University, Kaohsiung
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Kaohsiung 80756
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
- Regenerative Medicine and Cell therapy Research Center, Kaohsiung Medical University, Kaohsiung
| |
Collapse
|
3
|
Hsu WH, Shih HY, Shen CS, Yu FJ, Wang HC, Chan LP, Kuo CH, Hsieh HM, Wu IC. Prevention and management of esophageal stricture after esophageal ESD: 10 years of experience in a single medical center. J Formos Med Assoc 2022; 122:486-492. [DOI: 10.1016/j.jfma.2022.12.006] [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] [Received: 05/27/2022] [Revised: 09/12/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022] Open
|
4
|
Hsieh YH, Yu FJ, Nassef Y, Liu CJ, Chen YS, Lin CY, Feng JL, Wu MH. Targeting of Mcl-1 Expression by MiRNA-3614-5p Promotes Cell Apoptosis of Human Prostate Cancer Cells. Int J Mol Sci 2022; 23:ijms23084194. [PMID: 35457012 PMCID: PMC9029607 DOI: 10.3390/ijms23084194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023] Open
Abstract
MicroRNA (miRNA) acts as a critical regulator of growth in various human malignancies. However, the role of miRNA-3614 in the progression of human prostate cancer remains unknown. In this study, our results demonstrated that miRNA-3614-5p exerts a significant inhibitory effect on cell viability and colony formation and induces sub-G1 cell cycle arrest and apoptosis in human prostate cancer cells. Myeloid cell leukemia-1 (Mcl-1) acts as a master regulator of cell survival. Using the miRNA databases, miRNA-3614-5p was found to regulate Mcl-1 expression by targeting positions of the Mcl-1-3′ UTR. The reduction of Mcl-1 expression by miRNA-3614-5p was further confirmed using an immunoblotting assay. Pro-apoptotic caspase-3 and poly (ADP-ribose) polymerase (PARP) were significantly activated by miRNA-3614-5p to generate cleaved caspase-3 (active caspase-3) and cleaved PARP (active PARP), accompanied by the inhibited Mcl-1 expression. These findings were the first to demonstrate the anti-growth effects of miRNA-3614-5p through downregulating Mcl-1 expression in human prostate cancer cells.
Collapse
Affiliation(s)
- Yi-Hsien Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (Y.N.); (Y.-S.C.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (F.-J.Y.); (C.-J.L.)
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yasser Nassef
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (Y.N.); (Y.-S.C.)
| | - Chung-Jung Liu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (F.-J.Y.); (C.-J.L.)
- Regenetative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yong-Syuan Chen
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (Y.N.); (Y.-S.C.)
| | - Ching-Yi Lin
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Jia-Liang Feng
- Laboratory Department, Chung-Kang Branch, Cheng-Ching General Hospital, Taichung 40764, Taiwan
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Chunghua 515006, Taiwan
- Correspondence: (J.-L.F.); (M.-H.W.)
| | - Min-Hua Wu
- Laboratory Department, Chung-Kang Branch, Cheng-Ching General Hospital, Taichung 40764, Taiwan
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Chunghua 515006, Taiwan
- Correspondence: (J.-L.F.); (M.-H.W.)
| |
Collapse
|
5
|
Su WL, Yu FJ, Huang JW, Shih MC, Hsu WH, Shih HY, Huang YL, Chen LA, Wu PH, Wu CJ, Chen CY, Kuo KK, Lee KT, Chang WT. The experience of use of percutaneous transhepatic biliary drainages for early biliary complications after liver transplantation. Kaohsiung J Med Sci 2022; 38:486-493. [PMID: 35199937 DOI: 10.1002/kjm2.12519] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/06/2022] [Accepted: 01/24/2022] [Indexed: 12/19/2022] Open
Abstract
This study aimed to describe our experience and discuss the results, controversies, and the use of percutaneous transhepatic biliary drainage (PTBD) in patients with biliary complications after liver transplantation (LT). Between November 2009 and August 2020, 76 consecutive patients who underwent 77 LTs (44 deceased donor LTs and 33 living donor LTs [LDLT]) were enrolled retrospectively. Endoscopic therapy as initial approach and PTBD as rescue therapy were used for patients with biliary complications. There were 31 patients (31/76, 40.8%) with biliary complications, and two of them died (2/31, 6.5%). Clinical success rate of endoscopic therapy alone was 71.0% (22/31). The remaining nine patients received salvage PTBD and their clinical results were observed according to whether their intrahepatic bile ducts (IHBDs) was dilated (group A, n = 5) or not (group B, n = 4). In group A, the technical and long-term clinical success rates of PTBD were 100% and 20%, respectively. These five patients received PTBD ranging from 75 to 732 days after their LTs, and no procedure-related complications were encountered. In group B, the technical and long-term clinical success rates of PTBD were 50% and 25%, respectively. Three group B patients (75%) underwent PTBD within 30 days after LDLT and had lethal complications. One patient had graft laceration and survived after receiving timely re-transplantation. The other two patients died of sepsis due to PTBD-related bilioportal fistula or multiple liver abscesses. Our experience showed salvage PTBD played a limited role in biliary complications without dilated IHBDs within 1 month after LT.
Collapse
Affiliation(s)
- Wen-Lung Su
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jian-Wei Huang
- Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Ming-Chen Shih
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Ling Huang
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ling-An Chen
- Department of Surgery, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
| | - Po-Hsuan Wu
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Jen Wu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chiao-Yun Chen
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kung-Kai Kuo
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - King-Teh Lee
- Department of Surgery, Park One International Hospital, Kaohsiung, Taiwan
| | - Wen-Tsan Chang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
6
|
Hsieh MS, Kuo FC, Wu MC, Wang JW, Liu CJ, Chu NS, Tsai PY, Hsu PI, Wu IC, Wu JY, Wu DC, Yu FJ, Kuo CH. Tailored susceptibility-guided therapy via gastric juice PCR for the first-line H. pylori eradication, a randomized controlled trial. J Formos Med Assoc 2021; 121:1450-1457. [PMID: 34836662 DOI: 10.1016/j.jfma.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/22/2021] [Accepted: 10/18/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/PURPOSE Clarithromycin-based standard triple therapy is still commonly adopted by 81.4% of physicians in real-world practice but yields low eradication rates. Therefore, we conducted this study to compare the efficacy of gastric juice-guided therapy for first-line eradication with the standard triple therapy, in order to provide an alternative to real-world practice. METHODS A total of 182 treatment-naïve Hp-infected patients were included and randomly allocated to either susceptibility-guided therapy (SGT) with gastric juice PCR or Clarithromycin-based standard triple therapy (STT) for 7 days. RESULTS The intention-to-treat eradication rates were 89% (81/91) in SGT and 75.8% in STT (p < 0.031). The per-protocol eradication rates were 91.0% (81/89) in SGT and 79.3% (69/87) in STT (p < 0.034). Among the subgroups of different antibiotic resistance, patients with SGT demonstrated superior eradication rates (91.7% vs 45.5%, p < 0.027) in the subgroup of both clarithromycin resistance and levofloxacin resistance. CONCLUSION This prospective randomized controlled trial demonstrated the reliable efficacy of susceptibility-guided therapy via gastric juice PCR for the first-line Hp eradication. In Asia-Pacific area, where standard triple therapy is still adopted by the majority of the physicians, it is a recommended alternative to overcome the increasing antibiotic resistance.
Collapse
Affiliation(s)
- Meng-Shu Hsieh
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Fu-Chen Kuo
- School of Medicine, College of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Meng-Chieh Wu
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Jiunn-Wei Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Jung Liu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Neng-Sheng Chu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Pei-Yun Tsai
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Ping-I Hsu
- Department of Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jeng-Yih Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
7
|
Chen JL, Lai CY, Ying TH, Lin CW, Wang PH, Yu FJ, Liu CJ, Hsieh YH. Modulating the ERK1/2-MMP1 Axis through Corosolic Acid Inhibits Metastasis of Human Oral Squamous Cell Carcinoma Cells. Int J Mol Sci 2021; 22:ijms22168641. [PMID: 34445346 PMCID: PMC8395509 DOI: 10.3390/ijms22168641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 12/16/2022] Open
Abstract
Corosolic acid (CA; 2α-hydroxyursolic acid) is a natural pentacyclic triterpenoid with antioxidant, antitumour and antimetastatic activities against various tumour cells during tumourigenesis. However, CA’s antitumour effect and functional roles on human oral squamous cell carcinoma (OSCC) cells are utterly unknown. In this study, our results demonstrated that CA significantly exerted an inhibitory effect on matrix metalloproteinase (MMP)1 expression, cell migration and invasion without influencing cell growth or the cell cycle of human OSCC cells. The critical role of MMP1 was confirmed using the GEPIA database and showed that patients have a high expression of MMP1 and have a shorter overall survival rate, confirmed on the Kaplan–Meier curve assay. In the synergistic inhibitory analysis, CA and siMMP1 co-treatment showed a synergically inhibitory influence on MMP1 expression and invasion of human OSCC cells. The ERK1/2 pathway plays an essential role in mediating tumour progression. We found that CA significantly inhibits the phosphorylation of ERK1/2 dose-dependently. The ERK1/2 pathway played an essential role in the CA-mediated downregulation of MMP1 expression and in invasive motility in human OSCC cells. These findings first demonstrated the inhibitory effects of CA on OSCC cells’ progression through inhibition of the ERK1/2–MMP1 axis. Therefore, CA might represent a novel strategy for treating OSCC.
Collapse
Affiliation(s)
- Jen-Liang Chen
- Department of Hematology & Oncology, Chung-Kang Branch, Cheng Ching Hospital, Taichung 40764, Taiwan;
| | - Chung-Yu Lai
- Director of Surgery Department, Chung-Kang Branch, Cheng Ching General Hospital, Taichung 40764, Taiwan;
| | - Tsung-Ho Ying
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chiao-Wen Lin
- Institute of Oral Sciences, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Pei-Han Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chung-Jung Liu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (C.-J.L.); (Y.-H.H.)
| | - Yi-Hsien Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: (C.-J.L.); (Y.-H.H.)
| |
Collapse
|
8
|
Meng XZ, Jiang WW, Guo HW, Li M, Zhao MM, Yu FJ, Gu ZT. lncRNA NEAT1 regulates cerebral ischemia/reperfusion injury through miR-1306-5p. J BIOL REG HOMEOS AG 2021; 35:239-244. [PMID: 33508927 DOI: 10.23812/20-618-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- X Z Meng
- Department of Neurology, Weihai Haida Hospital, Weihai, China
| | - W W Jiang
- Spinal Surgery, Weihaiwei People's Hospital, Weihai, China
| | - H W Guo
- Weihai Haida Hospital, Weihai, China
| | - M Li
- Weihai Haida Hospital, Weihai, China
| | - M M Zhao
- Weihai Haida Hospital, Weihai, China
| | - F J Yu
- Department of Neurology, Weihai Municipal Third Hospital, Weihai, China
| | - Z T Gu
- Department of Neurology, Weihai Haida Hospital, Weihai, China
| |
Collapse
|
9
|
Hsu WH, Wu TS, Hsieh MS, Kung YM, Wang YK, Wu JY, Yu FJ, Kuo CH, Su YC, Wang JY, Wu DC, Hu HM. Comparison of Endoscopic Submucosal Dissection Application on Mucosal Tumor and Subepithelial Tumor in stomach. J Cancer 2021; 12:765-770. [PMID: 33403034 PMCID: PMC7778549 DOI: 10.7150/jca.47653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Endoscopic submucosal dissection is minimal invasive endoscopic procedure to deal with gastric tumor. Initially, it was developed to resect mucosal neoplasm since 2000 and extended its application to submucosal tumor in the following years. Although the basic ESD skills are similar in gastric mucosal tumor and subepithelial tumor, the success rate, complication may be different between the two types of gastric tumor resection. This retrospective study is conducted to analyze the ESD procedure in gastric mucosal tumor and subepithelial tumor. Methods: From 2007 to 2016, we reviewed all patients who underwent endoscopic submucosal dissection for gastric mucosal tumor and subepithelial tumor in Kaohsiung Medical University Hospital. Results: Totally, 35 patients with gastric subepithelial tumor and 41 patients with gastric mucosal tumor received endoscopic submucosal dissection are enrolled. Among 35 patients with subepithelial tumor, 32 (91.4%) patients achieved curative treatment. 1 patient received emergent operation and 2 patients received salvage operation to complete tumor resection. 8 patients (22.9%) occurred perforation and no delay bleeding was found. Among 41 patients with mucosal neoplasm, 30 (71.4%) patients achieved curative treatment. 2 patients received emergent operation and 9 patients received salvage operation to complete tumor resection. 9 patients (21.9%) occurred complication, 6 patients occurred delay bleeding and 3 patients had perforation. Conclusions: Comparing ESD between gastric mucosal tumor and subepithelial tumor, ESD had similar efficiency in curative treatment. However, ESD in subepethelial tumor encountered higher perforation and lesser delay bleeding.
Collapse
Affiliation(s)
- Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzung-Shiun Wu
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Meng-Shu Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Min Kung
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Yao-Kuang Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jeng-Yih Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Yu-Chung Su
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Ming Hu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| |
Collapse
|
10
|
Huang CW, Ma CJ, Su WC, Chen YT, Tsai HL, Yeh YS, Chang TK, Hsu WH, Yu FJ, Wang JY. Prognostic Value of EGFR Expression for Patients With Stage III Colorectal Cancer Receiving Fluoropyrimidine Metronomic Maintenance Therapy After Radical Resection and Adjuvant Oxaliplatin-Based Chemotherapy. Oncol Res 2020; 28:701-714. [PMID: 32859280 PMCID: PMC8420899 DOI: 10.3727/096504020x15986099915822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study evaluated the survival effects of metronomic maintenance therapy with oral fluoropyrimidine in patients with stage III colorectal cancer (CRC) according to epidermal growth factor receptor (EGFR) expression. We enrolled 197 patients with stage III CRC who had undergone radical resection and FOLFOX regimen adjuvant chemotherapy. The clinicopathological features and effects of metronomic maintenance therapy with oral capecitabine (daily dose of 850 mg/m2, twice daily, on days 1–14 every 3 weeks for 6 months) on survival according to treatment group and EGFR expression were analyzed. By conducting an in vitro cell line study and in vivo study through knockout of the EGFR gene, we analyzed the capacities of cell proliferation and migration. Relapse and survival were significantly more common in the FOLFOX group. Metronomic maintenance therapy was a significantly independent associated factor of relapse and survival as well as a prognostic factor of disease-free survival and overall survival. Significant intergroup differences in survival were only observed in patients with positive EGFR expression. Thus, our findings suggest EGFR expression is a prognostic factor in patients with stage III CRC receiving metronomic maintenance therapy. Analysis of EGFR expression in these patients helps identify potential candidates who may receive the optimal survival benefit from metronomic maintenance therapy.
Collapse
Affiliation(s)
- Ching-Wen Huang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Cheng-Jen Ma
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Yi-Ting Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Yung-Sung Yeh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| |
Collapse
|
11
|
Tsai HJ, Tai JJ, Chen LT, Wu MS, Yeh KH, Lin CW, Wang TE, Wang HP, Yu FJ, Liou JM, Hsiao CF, Cheng TY, Yeh HJ, Ko CW, Chen MJ, Lo GH, Hsu PI, Chang CS, Hwang WS, Chuang SS, Lee HW, Shun CT, Chiu CF, Wang WM, Hsieh CY, Liu TW, Lin JT, Kuo SH, Cheng AL. A multicenter prospective study of first-line antibiotic therapy for early-stage gastric mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma with histological evidence of mucosa-associated lymphoid tissue. Haematologica 2019; 105:e349-e354. [PMID: 31727764 DOI: 10.3324/haematol.2019.228775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hui-Jen Tsai
- National Institute of Cancer Research, National Health Research Institutes, Tainan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan
| | - John Jen Tai
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
| | - Chung-Wu Lin
- Department of Pathology, National Taiwan University Hospital, Taipei
| | - Tsang-En Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Fang-Jung Yu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Jyh-Ming Liou
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Chin-Fu Hsiao
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Tsu-Yao Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Hong-Jen Yeh
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Chung-Wang Ko
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Gin-Ho Lo
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Ping-I Hsu
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Cheng-Shyong Chang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua City
| | | | - Shih-Sung Chuang
- Department of Pathology, National Taiwan University Hospital, Taipei.,Department of Pathology, Chi-Mei Medical Center, Tainan.,Department of Pathology, School of Medicine, Taipei Medical University, Taipei
| | - Hsiao-Wei Lee
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, Taipei
| | - Chang-Fang Chiu
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, China Medical University, Taichung
| | - Wen-Ming Wang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Ching-Yun Hsieh
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, China Medical University, Taichung
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Jaw-Town Lin
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
| | - Ann-Lii Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
| | | |
Collapse
|
12
|
Wang KY, Chen YW, Wang TN, Hsu WH, Wu IC, Yu FJ, Hu HM, Wu JY, Kuo CH, Lu CY, Wu DC, Su YC. Predictor of slower gastric emptying in gastroesophageal reflux disease: Survey of an Asian-Pacific cohort. J Gastroenterol Hepatol 2019; 34:837-842. [PMID: 30550642 DOI: 10.1111/jgh.14572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/19/2018] [Accepted: 12/09/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Asian populations have relatively lower prevalence of gastroesophageal reflux disease and tend to exhibit symptoms of prolonged gastric retention. However, it remains unknown if slower gastric emptying influences its features in Asian countries. We prospectively assessed the potential implications of slower gastric emptying in an Asian-Pacific cohort of gastroesophageal reflux disease by a hospital-based survey. METHODS One hundred fifty-two patients of gastroesophageal reflux disease complete the scintigraphic measurement of solid phase of gastric emptying. Clinical symptoms and psychological stress are recorded by self-report questionnaire. The status of Helicobacter pylori infection, blood level of pepsinogen I, and I/II ratio are assessed. RESULTS Forty-seven percent and 28% of the patients have slower gastric emptying rate, depending on the incremental defined cut-off values of slower gastric emptying, respectively. Multiple logistic regression analysis indicates that older age and depression score are independently related to slower gastric emptying. Subgroup analysis discloses that patients with slower gastric emptying and higher depression score tend to present with non-erosive esophagitis whereas higher body mass index level and male gender in patients with normal gastric emptying predict the presence of erosive reflux disease. CONCLUSIONS Our study cohort of Asian patients indicates distinctive clinical implications of slower gastric emptying in patients with gastroesophageal reflux disease.
Collapse
Affiliation(s)
- Kuan-Yuan Wang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung, Taiwan
| | - Yu-Wen Chen
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Chen Wu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Huang-Ming Hu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Jeng-Yih Wu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Chien-Yu Lu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Chung Su
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
13
|
Hsieh MS, Liu CJ, Hsu WH, Li CJ, Tsai PY, Hu HM, Shih HY, Lu CY, Yu FJ, Kuo FC, Wu DC, Kuo CH. Gastric juice-based PCR assay: An alternative testing method to aid in the management of previously treated Helicobacter pylori infection. Helicobacter 2019; 24:e12568. [PMID: 30821043 DOI: 10.1111/hel.12568] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/01/2019] [Accepted: 01/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Culture of Helicobacter pylori with previous eradication failure has been emphasized in clinical guidelines. The current unmet need to manage previously treated H pylori is one tool with diagnostic accuracy and ability for antibiotics susceptibility. Gastric juice PCR can provide diagnosis and antibiotics susceptibility; however, whether treatment failure affects its accuracy remains uninvestigated. Our study aimed to investigate diagnostic accuracy and antibiotics susceptibility of juice PCR in previously treated H pylori and to compare with the current standard of culture. METHODS We categorized all 547 patients into treatment-naïve, post-1st treatment, post-2nd treatment, and post-3rd treatment. Helicobacter pylori infection was confirmed using gold standards. Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic (ROC) curve and area under ROC curve (AUC) of juice PCR and culture were calculated. Intra-gastric H pylori density was evaluated. Lastly, the antibiotics susceptibility results of gastric juice and culture were compared. RESULTS Our findings demonstrated AUC was higher in juice PCR than culture in all patients (96.7% vs 91.3%, P < 0.0001). The superiority of juice PCR was statistically significant in previously treated patients (P < 0.0001) but not in treatment-naïve patients (P = 0.13). Antral H pylori density was less marked in previously treated patients (P = 0.014). The comparisons of PCR-RFLP and E-test for Clarithromycin resistance showed reliable AUC = 89.8%. CONCLUSION Compared with the current standard of culture, the gastric juice PCR contains the strengths of performing the antibiotics susceptibility and overcomes the shortcomings of low accuracy. Consequently, gastric juice PCR suits the unmet need to manage previously treated H pylori.
Collapse
Affiliation(s)
- Meng-Shu Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Ping-Tung, Taiwan
| | - Chung-Jung Liu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Jung Li
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Yun Tsai
- Department of Nursing, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Huang-Ming Hu
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Yu Lu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fu-Chen Kuo
- School of Medicine, College of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| |
Collapse
|
14
|
Liu CJ, Wang YK, Kuo FC, Hsu WH, Yu FJ, Hsieh S, Tai MH, Wu DC, Kuo CH. Helicobacter pylori Infection-Induced Hepatoma-Derived Growth Factor Regulates the Differentiation of Human Mesenchymal Stem Cells to Myofibroblast-Like Cells. Cancers (Basel) 2018; 10:cancers10120479. [PMID: 30513684 PMCID: PMC6316704 DOI: 10.3390/cancers10120479] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/24/2018] [Accepted: 11/29/2018] [Indexed: 01/05/2023] Open
Abstract
Hepatoma-derived growth factor (HDGF) plays a critical role in tumor cell proliferation, anti-apoptosis, VEGF expression, lymph node metastasis and poor prognosis in human gastric cancer. Gastric cancer, as one of the most prevalent cancers worldwide, is the second leading cause of cancer-related mortality in the world for the prognosis of gastric cancer is generally poor, especially in patients with advanced stage. Helicobacter pylori (H. pylori) infection causes the chronic inflammation of stomach as well as the development of gastric cancer, with a three to six-fold increased risk of gastric cancer. Carcinoma-associated fibroblasts (CAFs) are myofibroblasts in tumor microenvironment, which possess various abilities to promote the progression of cancer by stimulating neoangiogenesis, proliferation, migration, invasion and therapy resistance of tumor cell. Mesenchymal stem cells (MSCs) are reported to promote tumor malignance through differentiation of MSCs toward CAFs. In the present study, we demonstrated that H. pylori infection promotes HDGF expression in human gastric cancer cells. HBMMSCs treated with HDGF assume properties of CAF-like myofibroblastic phenotypes, including expression of myofibroblast markers (α-smooth muscle actin (α-SMA), procollagen α1, tropomyoson I, desmin, fibroblast activation protein (FAP)), and fibroblast markers (prolyl-4-hydroxylase A1 (PHA1) and fibroblast specific protein-1 (FSP-1)/S100A4). HDGF recruits HBMMSCs, and then HBMMSCs further contributes to cell survival and invasive motility in human gastric cancer cells. Treatment of HDGF neutralizing antibody (HDGF-NAb) and serum significantly inhibit HDGF-regulated differentiation and recruitment of HBMMSCs. These findings suggest that HDGF might play a critical role in gastric cancer progress through stimulation of HBMMSCs differentiation to myofibroblast-like cells.
Collapse
Affiliation(s)
- Chung-Jung Liu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tz-You 1st road, Kaohsiung 807, Taiwan.
- Center for Stem Cell Research, Kaohsiung Medical University, 100 Shih-Chuan 1st road, Kaohsiung 807, Taiwan.
| | - Yao-Kuang Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tz-You 1st road, Kaohsiung 807, Taiwan.
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, 482 Shanming road, Kaohsiung 812, Taiwan.
| | - Fu-Chen Kuo
- School of Medicine, College of Medicine, E-Da Hospital, I-Shou University, 1 Yida Road, Yanchao District, Kaohsiung City 824, Taiwan.
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tz-You 1st road, Kaohsiung 807, Taiwan.
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st road, Kaohsiung 807, Taiwan.
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tz-You 1st road, Kaohsiung 807, Taiwan.
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st road, Kaohsiung 807, Taiwan.
| | - Shuchen Hsieh
- Center for Stem Cell Research, Kaohsiung Medical University, 100 Shih-Chuan 1st road, Kaohsiung 807, Taiwan.
- Department of Chemistry, National Sun Yat-sen University, 70 Lienhai Rd., Kaohsiung 804, Taiwan.
| | - Ming-Hong Tai
- Center for Stem Cell Research, Kaohsiung Medical University, 100 Shih-Chuan 1st road, Kaohsiung 807, Taiwan.
- Institute of Biomedical Science, National Sun Yat-sen University, 70 Lienhai Rd., Kaohsiung 804, Taiwan.
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tz-You 1st road, Kaohsiung 807, Taiwan.
- Center for Stem Cell Research, Kaohsiung Medical University, 100 Shih-Chuan 1st road, Kaohsiung 807, Taiwan.
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st road, Kaohsiung 807, Taiwan.
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tz-You 1st road, Kaohsiung 807, Taiwan.
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, 482 Shanming road, Kaohsiung 812, Taiwan.
- Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st road, Kaohsiung 807, Taiwan.
| |
Collapse
|
15
|
Chen WJ, Wu IC, Wu CC, Yu FJ. Peritoneal epithelioid angiosarcoma: A case report. Medicine (Baltimore) 2018; 97:e12054. [PMID: 30235660 PMCID: PMC6160257 DOI: 10.1097/md.0000000000012054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Peritoneal angiosarcoma is an extremely rare sarcoma (0.01287% incidence per 100,000) with an aggressive course and a poor prognosis. In this case, the manifestation of peritoneal angiosarcoma was ascites, which caused difficulty in early diagnosis and the diagnosis of peritoneal angiosarcoma, was made only after the surgery. PATIENT CONCERNS A 61-year-old man working in Mainland China presented with a 1-month history of abdominal distension. A contrast-enhanced abdominal computed tomography (CT) scan revealed peritoneal carcinomatosis with massive ascites. However, his tuberculosis (TB) polymerase chain reaction was negative. The ascites cell block and cytology also revealed negative for malignant cells. The patient underwent intra-abdominal tumor excision. After the operation, the patient's blood pressure (BP) dropped. Due to the state of shock, he was transferred to an intensive care unit (ICU). DIAGNOSES According to the pathology report, the neoplastic cells were positive for cytokeratin, cluster of differentiation 31 (CD31), cluster of differentiation 34 (CD34), and negative for cytokeratin 7 (CK7), cytokeratin 7 (CK20). Therefore, the diagnosis of epithelioid angiosarcoma was made. INTERVENTIONS The patient took 400 mg of Pazopanib once a day. OUTCOMES Even though vasopresser was used, the patient's BP was still low. Finally, he expired. LESSONS Initialy, the patient presented with abdominal distension and large amount of ascites in the beginning. TB peritonitis was highly suspected after the abdominal CT scan. Therefore, surgical procedures would be essential in the identification of proper diagnosis. In the future, the diagnosis of peritoneal epithelioid angiosarcoma should also be taken into consideration for patients with abnormal ascites besides the common diagnoses of TB, liver cirrhosis, and infection.
Collapse
Affiliation(s)
- Wei-Jyh Chen
- Department of Internal Medicine, Division of Gastroenterology, Kaohsiung Medical University Hospital
| | - I-Chen Wu
- Department of Internal Medicine, Division of Gastroenterology, Kaohsiung Medical University Hospital
- Faculty of Medicine, Department of Medicine, College of Medicine
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Department of Internal Medicine, Division of Gastroenterology, Kaohsiung Medical University Hospital
- Faculty of Medicine, Department of Medicine, College of Medicine
| |
Collapse
|
16
|
Yu FJ, Shih HY, Wu CY, Chuang YS, Lee JY, Li HP, Fang PT, Tsai DL, Chou SH, Wu IC. Enteral nutrition and quality of life in patients undergoing chemoradiotherapy for esophageal carcinoma: a comparison of nasogastric tube, esophageal stent, and ostomy tube feeding. Gastrointest Endosc 2018; 88:21-31.e4. [PMID: 29225081 DOI: 10.1016/j.gie.2017.11.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 06/27/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS This study prospectively recruited esophageal squamous cell carcinoma patients who received esophageal stent, nasogastric tube (NGT), or jejunostomy/gastrostomy feeding to compare the changes in nutritional status and quality of life during chemoradiation therapy (CRT). METHODS In total, 81 patients were analyzed (stent, 7; surgical ostomy, 26; NGT, 19; oral intake, 29). An NGT was inserted when, despite medication, dysphagia or pain worsened with oral feeding during CRT. Serial body weight and daily narcotic demand were recorded. Changes in serum albumin level and quality of life were also assessed. In subgroup analysis comparing NGT and prophylactic surgical ostomy feeding, 5 patients with total occlusion in the ostomy group were excluded. RESULTS Patients in all groups had similar decreases in mean body weight with an overall change of -6.41% ± 5.21% at the end of CRT. The stent group had significantly worse pain, decreased albumin (-1.03 ± .9 mg/dL), and decreased quality of life across CRT compared with the other groups. In subgroup analysis the stent group had significantly higher weight loss, whereas the NGT group had higher narcotic demand and slightly worse quality of life. Two patients (7.7%) had ileus days after jejunostomy creation. Five patients (23.8%) among those received prophylactic ostomy creation and scarcely used it. CONCLUSIONS These preliminary results raise concerns that use of esophageal stents may be less suitable in patients undergoing CRT. Tube feeding by means of transnasal or percutaneous routes appear to be comparably effective during CRT, but both have advantages and disadvantages. We suggest a careful endoscopic evaluation to select the population more appropriate for NGT feeding on an as-needed basis during CRT.
Collapse
Affiliation(s)
- Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yun-Shiuan Chuang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jui-Ying Lee
- Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsien-Pin Li
- Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pen-Tzu Fang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Dong-Lin Tsai
- Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shah-Hwa Chou
- Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Chest Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
17
|
Hsu WH, Kuo CH, Wu MC, Su YC, Chen CY, Wang JY, Shih HY, Lu CY, Wu DC, Yu FJ. Application of miniprobe sonography in the local staging of earlier stage upper gastrointestinal epithelial neoplasm: A four-year experience in a single center. Adv Dig Med 2018. [DOI: 10.1002/aid2.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Meng-Chieh Wu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Yu-Chung Su
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chiao-Yun Chen
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Jaw-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chien-Yu Lu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| |
Collapse
|
18
|
Hsu WH, Wang YK, Hsieh MS, Kuo FC, Wu MC, Shih HY, Wu IC, Yu FJ, Hu HM, Su YC, Wu DC. Insights into the management of gastric antral vascular ectasia (watermelon stomach). Therap Adv Gastroenterol 2018; 11:1756283X17747471. [PMID: 29399041 PMCID: PMC5788127 DOI: 10.1177/1756283x17747471] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/30/2017] [Indexed: 02/04/2023] Open
Abstract
Gastric antral vascular ectasia (GAVE) is an uncommon but important cause of chronic gastrointestinal bleeding. It is often associated with systemic diseases such as autoimmune diseases, liver cirrhosis, chronic renal insufficiency and cardiovascular disease. The etiology of GAVE has not been fully explored and remains controversial. Diagnosis is mainly based on endoscopic presentation with flat or raised erythematous stripes radiating from the pylorus to the antrum and resembles a watermelon. Clinical presentation may range from iron-deficiency anemia secondary to occult blood loss, melena to hematemesis. In past decades, many therapeutic modalities including medical, endoscopic and surgical intervention have been introduced for GAVE treatment with variable efficacy. Herein, we review the efficacy and safety of these treatment options for GAVE.
Collapse
Affiliation(s)
- Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Kuang Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Meng-Shu Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fu-Chen Kuo
- Shool of Medicine, College of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Meng-Chieh Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Ming Hu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chung Su
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | |
Collapse
|
19
|
Kuo SH, Yu FJ, Shih HY, Kuo HK, Wu CC, Lee PY, Wu IC. Unusual subcutaneous and choroidal metastases from esophageal squamous cell carcinoma denote a poor prognosis: A case report and literature review. Advances in Digestive Medicine 2017. [DOI: 10.1002/aid2.12144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shin-Huei Kuo
- Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Medicine, College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Hsi-Kung Kuo
- Department of Ophthalmology; Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Chun-Chieh Wu
- Department of Pathology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Po-Yen Lee
- Department of Ophthalmology; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Department of Medicine, College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| |
Collapse
|
20
|
Wu IC, Hsieh HM, Yu FJ, Wu MC, Wu TS, Wu MT. A long-term risk-benefit analysis of low-dose aspirin in primary prevention. Eur J Clin Invest 2016; 46:130-40. [PMID: 26640116 DOI: 10.1111/eci.12575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/25/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The long-term risk-benefit effect of occasional and regular use of low-dose aspirin (≤ 100 mg per day) in primary prevention of vascular diseases and cancers was calculated. METHODS One representative database of 1 000 000 participants from Taiwan's National Health Insurance scheme in 1997-2000 was used. The potential study subjects were those aged 30-95 years, were found not to have been prescribed aspirin before 1 January 2000, but to have first been prescribed low-dose aspirin (≤ 100 mg per day) after that date and were followed up to 31 December 2009. Participants prescribed low-dose aspirin < 20% during the study period were considered occasional users and those prescribed ≥ 80% regular users. After the propensity score matching, rate differences of haemorrhage, ischaemia and cancer between these users were calculated their net clinical risk. RESULTS A total of 1720 pairs were analysed. During the study period, haemorrhage and ischaemia occurred in 25 (1·45%) and 67 participants (3·90%) in occasional users and 69 (4·01%) and 100 participants (5·81%) in regular users, whereas cancer occurred in 32 participants (1·86%) in occasional users and 26 participants (1·51%) in regular users. The crude and adjusted net clinical risks of low-dose aspirin use between the two frequency of users (≥ 80% vs. < 20%) were 4·12% (95% CI = 2·19%, 6·07%; P < 0·001) and 3·93% (95% CI = 2·01%, 5·84%; P < 0·001). CONCLUSIONS A long-term regular use of low-dose aspirin might not be better than occasional use in the primary prevention against major vascular diseases and cancer.
Collapse
Affiliation(s)
- I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chieh Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tzung-Shiun Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Tsang Wu
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
21
|
Kan JY, Wu DC, Yu FJ, Wu CY, Ho YW, Chiu YJ, Jian SF, Hung JY, Wang JY, Kuo PL. Chemokine (C-C Motif) Ligand 5 is Involved in Tumor-Associated Dendritic Cell-Mediated Colon Cancer Progression Through Non-Coding RNA MALAT-1. J Cell Physiol 2015; 230:1883-94. [PMID: 25546229 DOI: 10.1002/jcp.24918] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 12/10/2014] [Accepted: 12/18/2014] [Indexed: 12/22/2022]
Abstract
Tumor micro-environment is a critical factor in the development of cancer. The aim of this study was to investigate the inflammatory cytokines secreted by tumor-associated dendritic cells (TADCs) that contribute to enhanced migration, invasion, and epithelial-to-mesenchymal transition (EMT) in colon cancer. The administration of recombinant human chemokine (C-C motif) ligand 5 (CCL5), which is largely expressed by colon cancer surrounding TADCs, mimicked the stimulation of TADC-conditioned medium on migration, invasion, and EMT in colon cancer cells. Blocking CCL5 by neutralizing antibodies or siRNA transfection diminished the promotion of cancer progression by TADCs. Tumor-infiltrating CD11c(+) DCs in human colon cancer specimens were shown to produce CCL5. The stimulation of colon cancer progression by TADC-derived CCL5 was associated with the up-regulation of non-coding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1), which subsequently increased the expression of Snail. Blocking MALAT-1 significantly decreased the TADC-conditioned medium and CCL5-mediated migration and invasion by decreasing the enhancement of Snail, suggesting that the MALAT-1/Snail pathway plays a critical role in TADC-mediated cancer progression. In conclusion, the inhibition of CCL5 or CCL5-related signaling may be an attractive therapeutic target in colon cancer patients.
Collapse
Affiliation(s)
- Jung-Yu Kan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Gastrointestinal and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Kuo CH, Lu CY, Shih HY, Liu CJ, Wu MC, Hu HM, Hsu WH, Yu FJ, Wu DC, Kuo FC. CYP2C19 polymorphism influences Helicobacter pylori eradication. World J Gastroenterol 2014; 20:16029-16036. [PMID: 25473155 PMCID: PMC4239489 DOI: 10.3748/wjg.v20.i43.16029] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/04/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
The known factors that have contributed to the decline of Helicobacter pylori (H. pylori) eradication rate include antibiotic resistance, poor compliance, high gastric acidity, high bacterial load, and cytochrome P450 2C19 (CYP2C19) polymorphism. Proton pump inhibitor (PPI) is important in the eradication regimen. The principal enzyme implicated in the metabolism of PPIs is CYP2C19. The effects of PPI depend on metabolic enzyme, cytochrome P450 enzymes, and CYP2C19 with genetic differences in the activity of this enzyme (the homozygous EM, heterozygous EM (HetEM), and poor metabolizer). The frequency of the CYP2C19 polymorphism is highly varied among different ethnic populations. The CYP2C19 genotype is a cardinal factor of H. pylori eradication in patients taking omeprazole- based or lansoprazole-based triple therapies. In contrast, the CYP2C19 polymorphism has no significant effect on the rabeprazole-based or esomeprazole-based triple therapies. The efficacy of levofloxacin-based rescue triple therapy might be also affected by the CYP2C19 polymorphism, but CYP2C19 genotypes did not show obvious impact on other levofloxacin-based rescue therapies. Choice of different PPIs and/or increasing doses of PPIs should be individualized based on the pharmacogenetics background of each patient and pharmacological profile of each drug. Other possible factors influencing gastric acid secretion (e.g., IL-1β- 511 polymorphism) would be also under consideration.
Collapse
|
23
|
Lu CY, Yeh YS, Huang CW, Ma CJ, Yu FJ, Wang JY. FOLFIRI and regorafenib combination therapy with dose escalation of irinotecan as fourth-line treatment for patients with metastatic colon cancer according to UGT1A1 genotyping. Onco Targets Ther 2014; 7:2143-6. [PMID: 25473295 PMCID: PMC4246994 DOI: 10.2147/ott.s69774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Here we report a case of metastatic colon cancer treated with 5-fluorouracil, leucovorin, and escalated doses of irinotecan (FOLFIRI) combined with regorafenib in the fourth-line setting after uridine diphosphate glucuronosyltransferase (UGT)1A1 genotyping analysis. A 66-year-old male was initially diagnosed with Union Internationale Contre le Cancer stage III descending colon cancer and underwent curative surgery. He received postoperative adjuvant chemotherapy; however, liver metastasis developed and a partial hepatectomy was performed thereafter. Unfortunately, pulmonary metastases and recurrent liver tumors were found despite a series of systemic treatments with multiple combinations of cytotoxic and biologic agents. Recently, a novel multikinase inhibitor, regorafenib, was approved for the treatment of metastatic colorectal cancer refractory to other therapeutic modalities. As further treatment, we combined regorafenib with FOLFIRI, which included dose escalations of irinotecan, after UGT1A1 genotyping analysis. The therapeutic results were promising, with the improvement in liver and pulmonary metastases being classified as stable disease and partial response, respectively. Moreover, the progression-free survival was over 6 months. FOLFIRI, with dose escalation of irinotecan according to UGT1A1 genotyping plus regorafenib appears to be a promising salvage therapy for patients with refractory metastatic colorectal cancer.
Collapse
Affiliation(s)
- Chien-Yu Lu
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung, Taiwan ; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Yung-Sung Yeh
- Department of Emergency Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan ; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cheng-Jen Ma
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung, Taiwan ; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Department of Genomic Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
24
|
Lu CY, Huang CW, Hu HM, Tsai HL, Huang CM, Yu FJ, Huang MY, Chang SF, Huang ML, Wang JY. Prognostic advantage of irinotecan dose escalation according to uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) genotyping in patients with metastatic colorectal cancer treated with bevacizumab combined with 5-fluorouracil/leucovorin with irinotecan in a first-line setting. Transl Res 2014; 164:169-76. [PMID: 24462762 DOI: 10.1016/j.trsl.2013.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 10/05/2013] [Revised: 12/22/2013] [Accepted: 12/27/2013] [Indexed: 02/08/2023]
Abstract
This study compared the clinical responses of patients with metastatic colorectal cancer (mCRC) with 5-fluorouracil/leucovorin with irinotecan (FOLFIRI) plus bevacizumab therapy either with or without uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) genotyping and irinotecan dose escalation. Of 107 total patients with mCRC, 79 were classified as the study group and 28 as the control group. The study group received irinotecan dose escalation based on UGT1A1 genotyping whereas the control group did not. Clinicopathologic features, response rates, and survival were compared for the 2 groups. The clinical response rate of patients with mCRC treated with FOLFIRI plus bevacizumab under UGT1A1 genotyping and irinotecan dose escalation was significantly better than that of those without these prospective tests and dose escalation (P = 0.028). Both progression-free survival (PFS) and overall survival were significantly greater in clinical responders than nonresponders (both, P < 0.001), and PFS was significantly greater among the study group patients than among the control group patients, with a median PFS of 12.2 months vs 9.4 months (P = 0.025). Grade 3/4 adverse events were not significantly different between the 2 groups (P = 0.189). Patients with mCRC undergoing UGT1A1 genotyping may receive escalated doses of irinotecan to obtain a better clinical response/outcome with comparable toxicities.
Collapse
Affiliation(s)
- Chien-Yu Lu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Wen Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Gastrointestinal and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Ming Hu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of General Surgery Medicine, Department of Surgery, Kaohsiung Medical, University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ming Huang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Radiation Oncology, Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Radiation Oncology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Se-Fen Chang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Lin Huang
- Division of Colorectal Surgery, Department of Surgery, ZuoYing Armed Forces General Hospital, Kaohsiung, Taiwan; Department of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Jaw-Yuan Wang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Gastrointestinal and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Genomic Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
25
|
Wu IC, Lin MY, Yu FJ, Hsieh HM, Chiu KF, Wu MT. A short-term effect of low-dose aspirin on major hemorrhagic risks in primary prevention: a case-crossover design. PLoS One 2014; 9:e98326. [PMID: 24879431 PMCID: PMC4039487 DOI: 10.1371/journal.pone.0098326] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/01/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Very few studies have examined the risk of short-term adverse hemorrhage of low-dose aspirin use in primary prevention. This case-crossover study examined the transient effect of low-dose aspirin use on major hemorrhagic risks. METHODS A representative database of 1,000,000 patients randomly sampled from the Taiwan's National Health Insurance Research Database in 2000 was analyzed. The study cohort consisted of a total of 501,946 individuals, aged 30-95 years old, at risk of a major bleeding event in 2000. A case-crossover study was used to retrieve data on 10,905 incident patients with major hemorrhagic complications (3,781 cerebral and 7,124 gastrointestinal) and prescribed low-dose aspirin (≤300 mg/day) from 2000-2008. A 56-day time window (∼2 months) was used as the case period for which the odds ratio (OR) was estimated using the ratio of patients exposed during the 56-day case period only (1-56 days before the index date) compared to its corresponding 56-day control period only (57-112 days before the index date). RESULTS Four hundred eighty-nine (4.5%) of the 10,905 hemorrhagic patients had used low-dose aspirin during the 56-day case only period; 294 (2.7%) of the same patients had used low-dose aspirin during control only period. Low-dose aspirin use increase the risk of developing a major hemorrhage 1.33-fold (95% CI = 1.13-1.55, P<0.0001). Significance was found prominent in 4,453 non-hypertensive and non-diabetic subjects (Adjusted odds ratio = 1.88, 95% CI = 1.21-2.91). CONCLUSION Transient low-dose aspirin use increases risk for major hemorrhagic events in Han Chinese.
Collapse
Affiliation(s)
- I-Chen Wu
- Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Fang-Jung Yu
- Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Kuei-Fen Chiu
- Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ming-Tsang Wu
- Kaohsiung Medical University, Kaohsiung, Taiwan
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
- * E-mail:
| |
Collapse
|
26
|
Li RN, Yu FJ, Wu CC, Chen YK, Yu CC, Chou SH, Lee JY, Cheng YJ, Wu MT, Wu IC. Methylation status of retinoic acid receptor beta2 promoter and global DNA in esophageal squamous cell carcinoma. J Surg Oncol 2014; 109:623-7. [PMID: 24510455 DOI: 10.1002/jso.23522] [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: 11/05/2013] [Accepted: 11/12/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Focal hypermethylation in promoter regions of tumor suppressor genes against the background of global hypomethylation is a landmark of carcinogenesis. This study aimed to investigate the methylation status of retinoic acid receptor beta2 (RARβ2) and long interspersed nuclear elements (LINE-1) in different stages of esophageal squamous cell carcinoma (ESCC). METHOD The tumor and adjacent normal esophageal tissues from 125 male ESCC patients who underwent primary surgery were analyzed for the methylation status of RARβ2 promoter and LINE-1 through methylation-specific polymerase chain reaction and pyrosequencing. RESULTS RARβ2 hypermethylation was detected in 20% of the tumor samples, but not in the normal counterparts. The methylation frequency of LINE-1 was significantly lower in the tumor than in the normal parts (median: 67.7% vs. 80%, P < 0.0005). Ninety-eight patients (78.4%) had both RARβ2 hypermethylation and LINE-1 hypomethylation or either one. There was a trend toward higher risk of advanced T stage (P for trend = 0.05) or lymph node metastasis (P for trend = 0.02) when more adverse gene methylation profiles were present. CONCLUSION Methylation status of RARβ2 and LINE-1 was related to the development and possibly the severity of ESCC.
Collapse
Affiliation(s)
- Ruei-Nian Li
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Ou CH, Kuo FC, Hsu WH, Lu CY, Yu FJ, Kuo CH, Wang JY, Wu MT, Shiea J, Wu DC, Hu HM. Comparison of the performance of guaiac-based and two immunochemical fecal occult blood tests for identifying advanced colorectal neoplasia in Taiwan. J Dig Dis 2013; 14:474-83. [PMID: 23701988 DOI: 10.1111/1751-2980.12077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We aimed to evaluate the performance of fecal occult blood tests (FOBT) for the screening of colorectal cancer (CRC). METHODS We selected participants from a medical center in Taiwan, China from November 2009 to June 2011. All participants underwent screening colonoscopy and were asked to provide their stool samples for qualitative immunochemical FOBT (qlFIT), quantitative immunochemical FOBT (qnFIT) and the guaiac-based FOBT(GT). The receiver operating characteristic curve was utilized to determine the optimal cut-off value of qnFIT. We measured the detection ability of the FOBT for colonic polypoid lesions. RESULTS In all, 699 participants were enrolled in this study. For qnFIT, we found increased levels of fecal hemoglobin in participants with polyps ≥10 mm (251.0 ng/mL), villous-containing adenomas (98.7 ng/mL) and advanced adenomas (187.9 ng/mL). The optimal cut-off value for qnFIT was 25 ng/mL for detecting advanced colorectal neoplasms (ACRN). All three FOBT had a similar but low estimate in detecting small and tubular adenomatous polyps. The qnFIT had a better detection ability for large adenomas (positive likelihood ratio [PLR], 5.6 vs 3.1 vs 0.3) and adenomas with villous-components (PLR 3.7 vs 3.3 vs 0.3) than qlFIT and GT. For the ACRN group, qnFIT also showed the best screening ability with a sensitivity of 56.8%, accuracy of 86.7% and PLR 5.0. CONCLUSIONS Both qnFIT and qlFIT perform better than GT in detecting advanced adenomas and CRC in the Taiwanese population.
Collapse
Affiliation(s)
- Chi-Hsing Ou
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Ho BL, Yu FJ, Lai CL, Lin HH. Avellis syndrome as presenting manifestation of ulcerative colitis. J Neurol Sci 2013; 325:160-1. [DOI: 10.1016/j.jns.2012.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 11/12/2012] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
|
29
|
Liu MK, Wu IC, Lu CY, Kuo CH, Yu FJ, Liu CJ, Hsu PI, Hsu WH, Su YC, Chen A, Wu DC, Kuo FC, Chen JJ. Randomized trial comparing rabeprazole- versus lansoprazole-based Helicobacter pylori eradication regimens. Kaohsiung J Med Sci 2013; 29:379-84. [PMID: 23768702 DOI: 10.1016/j.kjms.2012.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 04/11/2012] [Indexed: 12/12/2022] Open
Abstract
Different types of proton pump inhibitor (PPI)-based triple therapies could result in different Helicobacter pylori eradication rates. This study aimed to compare the efficacy and safety of rabeprazole- and lansoprazole-based triple therapies in primary treatment of H. pylori infection. From September 2005 to July 2008, 426 H. pylori-infected patients were randomly assigned to receive a 7-day eradication therapy with either rabeprazole 20mgbid (RAC group, n=222) or lansoprazole 30mgbid (LAC group, n=228) in combination with amoxicillin 1gbid and clarithromycin 500mgbid. The patients received follow-up esophagogastroduodenoscopy (EGD) and/or (13)C-urea breath test 12-16 weeks later to define H. pylori status. Their personal and medical history, compliance and side effects were obtained by using a standardized questionnaire. Intention-to-treat analysis revealed that the eradication rate was 87.84% in the RAC group and 85.96% in the LAC group (p=0.56). All patients returned for assessment of compliance (100% in the LAC group vs. 99.50% in the RAC group; p=0.32) and adverse events (7.20% in the RAC group vs. 5.70% in the LAC group, p=0.51). Univariate analysis suggested that patients with nonsteroid anti-inflammatory agent (NSAID) use had lower eradication rates than those without (76.71% vs. 88.74%; p=0.006). Our results showed that efficacy and safety were similar in rabeprazole- and lansoprazole-based primary therapies. The influence of NSAID usage on H. pylori eradication needs to be further investigated.
Collapse
Affiliation(s)
- Meng-Kwan Liu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Huang JC, Chen SC, Yang TK, Yu FJ, Ou-Yang F, Chang JM. Peritoneal adhesion: it can be life-threatening, and life-saving. BMC Nephrol 2012; 13:113. [PMID: 22992203 PMCID: PMC3506508 DOI: 10.1186/1471-2369-13-113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 09/17/2012] [Indexed: 11/16/2022] Open
Abstract
Background The inevitable post-inflammatory fibrosis and adhesion often compromises future treatment in peritoneal dialysis patients. Here, we describe a patient who experienced an unusual form of peritoneal adhesion that made her give up peritoneal dialysis. However, its unique pattern also saved her from infection caused by bowel perforation. Case presentation The female patient discontinued peritoneal dialysis due to gradual dialysis inadequacy. Two months after shifting to hemodialysis with generally improved sense of well-being and no sign of abdominal illness, she was admitted to remove the Tenckhoff catheter. The procedure was smooth, but fever and abdominal pain not at the site of operation developed the next day. Abdominal ultrasound showed the presence of ascites and aspiration revealed slimy, green-yellowish pus that gave a negative result on bacterial culture. Abdominal computed tomography (CT) with oral contrast medium was performed, but failed to demonstrate the suspected bowel perforation. The examination, however, did show accumulation of pus inside the abdomen but outside the peritoneal cavity. We drained the pus with two 14-F Pig-tail catheters and the total amount of drainage approached 4000 ml. The second CT was performed with double dose of the contrast medium and found a leak of the contrast from the jejunum. She then received laparotomy and had the perforation site closed. Conclusions In summary, this uremic patient suffered from pus accumulation inside her abdomen without obvious systemic toxic effect. The bowel perforation and pus formation might be caused by repeated peritonitis, but the peritoneal adhesion itself might also isolate her peritoneal cavity from the anticipated toxic injuries of bowel perforation.
Collapse
Affiliation(s)
- Jiun-Chi Huang
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, 482 San-Ming Rd, Hsiao-Kang District, Kaohsiung, 812, Taiwan
| | | | | | | | | | | |
Collapse
|
31
|
Yang PF, Chen CY, Yu FJ, Yang SF, Chen YT, Kao LC, Wang JY. A rare complication of Meckel's diverticulum: a fistula between Meckel's diverticulum and the appendix. Asian J Surg 2012; 35:163-5. [PMID: 23063090 DOI: 10.1016/j.asjsur.2012.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 04/12/2011] [Revised: 08/03/2011] [Accepted: 01/19/2012] [Indexed: 11/16/2022] Open
Abstract
Meckel diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2%-4% of the population. Meckel diverticulum results from incomplete closure of the omphalomesenteric duct. The presentation of symptomatic Meckel diverticulum includes gastrointestinal hemorrhage, intestinal obstruction, volvulus, intussusception, diverticulitis, and neoplasms. The development of fistula is an extremely rare complication. Previous literature has even shown an enterocolonic fistula, a vesicodiverticular fistula, ileorectal fistula, and fistula-in-ano. To the best of our knowledge, we present the first case of the fistula complicated between Meckel diverticulum and the appendix in a review of the English literature.
Collapse
Affiliation(s)
- Ping-Fu Yang
- Division of Gastroenterology and General Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | |
Collapse
|
32
|
Shih HY, Wu DC, Huang WT, Chang YY, Yu FJ. Glutaraldehyde-induced colitis: case reports and literature review. Kaohsiung J Med Sci 2011; 27:577-80. [PMID: 22208542 DOI: 10.1016/j.kjms.2011.06.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 01/03/2011] [Indexed: 10/14/2022] Open
Abstract
Glutaraldehyde-induced colitis is an uncommon colitis in clinical practice. Because the involvement of colonic segment is determined by the endoscopic part where glutaraldehyde remains, a recent history of endoscopy and a demarcated involvement of colonic segment are the most characteristic signs of glutaraldehyde-induced colitis. The typical clinical scenario is acute onset of lower abdominal pain, fever, and bloody stool. Laboratory data usually show leukocytosis and elevated C-reactive protein. The endoscopic pictures of involved segments are compatible with acute colitis, including hyperemic, edematous, with or without multiple erosions. Acute ischemic colitis and infectious colitis should be differentiated at the outset of the disease. Stool pathogen tests are usually negative. Parenteral empiric antibiotic may be considered if severe transmural edema of the involved segment is observed in computed tomography. Conservative treatment, including bowel rest and parenteral hydration, is able to stabilize the condition in a week. Herein, we present two cases of acute proctocolitis caused by glutaraldehyde after uneventful colonoscopy.
Collapse
Affiliation(s)
- Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | |
Collapse
|
33
|
Hwang CC, Chai HT, Chen HW, Tsai HL, Lu CY, Yu FJ, Huang MY, Wang JY. S100B protein expressions as an independent predictor of early relapse in UICC stages II and III colon cancer patients after curative resection. Ann Surg Oncol 2010; 18:139-45. [PMID: 20628824 DOI: 10.1245/s10434-010-1209-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND S100 calcium-binding proteins such as S100B are elevated in primary malignant melanoma and are used as tumor markers for malignant melanoma and numerous other cancers. The purpose of this study was to identify the novel predictors of early relapse in UICC stages II and III colon cancer patients and thus to identify a subgroup of patients who are at high risk for postoperative early relapse. METHODS Clinicopathological factors and S100B expression by immunohistochemical staining were retrospectively analyzed in 357 postoperative UICC stages II and III colon cancer patients to determine the predictors of early relapse. RESULTS Of 357 patients, 114 patients developed postoperative relapse during the follow-up period. Among 114 relapsed colon cancer patients, postoperative early relapse and non-early relapse were found in 56 patients (49.1%) and 58 patients (50.9%), respectively. Multivariate Cox proportional hazards analysis revealed that the presence of vascular invasion (P = .025; hazard ratio [HR], 5.532; 95% confidence interval [95% CI], 1.985-14.729), high postoperative CEA levels (P = .019; HR, 6.845; 95% CI, 2.393-15.256), and S100B overexpression (P < .001; HR, 26.250; 95% CI, 7.463-96.804) were demonstrated to be independent predictors of postoperative early relapse. Furthermore, postoperative relapsed colon cancer patients with S100B overexpression were demonstrated to have significantly lower overall survival rates than those without S100B overexpression (P < .001). CONCLUSIONS This study suggests that S100B protein expression is a crucial predictor of early relapse in UICC stages II and III postoperative colon cancer patients and thus could help to define patients with this tumor entity who would benefit from enhanced follow-up and therapeutic program(s).
Collapse
Affiliation(s)
- Chi-Ching Hwang
- Department of Biochemistry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Lu CY, Chuang HY, Yu FJ, Sun LC, Shih YL, Chen FM, Hsieh JS, Wang JY. Hypocaloric peripheral parenteral nutrition with lipid emulsion in postoperative gastrointestinal cancer patients. World J Gastrointest Oncol 2010; 2:51-5. [PMID: 21160817 PMCID: PMC2999150 DOI: 10.4251/wjgo.v2.i1.51] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 07/12/2009] [Accepted: 07/19/2009] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the use of lipid emulsion substituting for glucose in postoperative hypocaloric peripheral parenteral nutrition (HPPN).
METHODS: This prospective, randomized study was conducted on 20 postoperative gastrointestinal cancer patients. They were randomized and equally divided into interventional group and control group, and both were administered isocaloric and isonitrogenous diets with for lipid emulsion substituting for partial glucose loads in the interventional group.
RESULTS: Nutritional parameters and biochemical data were compared between the two groups before and after 6-d of HPPN. Most investigated variables showed no significant changes after administration of HPPN with lipid emulsion. However, the postoperative triglyceride level was significantly lower in the interventional group than in the control group (P < 0.05). In comparison with lipid emulsion, glucose administration resulted in less decrease in postoperative prealbumin level (P < 0.05).
CONCLUSION: In addition to supplementing with essential fatty acid, it seems that HPPN with lipid emulsion is well-tolerated and beneficial to postoperative gastrointestinal cancer patients.
Collapse
Affiliation(s)
- Chien-Yu Lu
- Chien-Yu Lu, Li-Chu Sun, Ying-Ling Shih, Fang-Ming Chen, Jan-Sing Hsieh, Jaw-Yuan Wang, Nutrition Support Team, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, China
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Wu IC, Wu DC, Yu FJ, Wang JY, Kuo CH, Yang SF, Wang CL, Wu MT. Association between Helicobacter pylori seropositivity and digestive tract cancers. World J Gastroenterol 2009; 15:5465-71. [PMID: 19916178 PMCID: PMC2778104 DOI: 10.3748/wjg.15.5465] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the role of Helicobacter pylori (H pylori) infection on the risk of digestive tract cancers.
METHODS: In total, 199 oral squamous-cell carcinoma (SCC), 317 esophageal SCC, 196 gastric cardia and non-cardia adenocarcinoma and 240 colon adenocarcinoma patients were recruited for serum tests of H pylori infection. Two hospital- and one community-based control groups were used for the comparisons. H pylori seropositivity was determined by an enzyme linked immunosorbent assay method against H pylori IgG.
RESULTS: Presence of H pylori infection was significantly inversely associated with esophageal SCC [adjusted odds ratio (AOR): 0.315-0.472, all P-value < 0.05] but positively associated with gastric adenocarcinoma (both cardia and non-cardia) (AOR: 1.636-3.060, all P-value < 0.05) in comparison to the three control groups. Similar results were not found in cancers of the oral cavity and colon.
CONCLUSION: Our findings support the finding that H pylori seropositivity is inversely associated with esophageal SCC risk, but increases the risk of gastric cardia adenocarcinoma.
Collapse
|
36
|
Wang JY, Cheng KI, Yu FJ, Tsai HL, Huang TJ, Hsieh JS. Analysis of the Correlation of Plasma NO and ET-1 Levels in Rats With Acute Mesenteric Ischemia. J INVEST SURG 2009; 19:155-61. [PMID: 16809225 DOI: 10.1080/08941930600674652] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mesenteric ischemia is a devastating disease process that frequently challenges clinicians. To enhance the early diagnosis of gut ischemia and judgment of its severity, it may be helpful to detect the unusual existence or increase in biomarkers in the body fluid. The aim of the present study was to evaluate the correlation of plasma nitric oxide (NO) and endothelin-1 (ET-1) levels to mesenteric ischemia using an animal model. Acute mesenteric ischemia (AMI) was produced experimentally by occlusion of the mesenteric vessels in the terminal ileum by the tenting of a thread. The determination of plasma NO and ET-1 levels were obtained before operation (T0, baseline value), and at 10 (T10), 20 (T20), 30 (T30), and 60 (T60) min after the creation of AMI. Sham-operated rats served as controls. After 30 min of experiments, the plasma NO and ET-1 levels were significantly higher in the AMI group than in the control group (both p < .01). Both the plasma NO and ET-1 levels in AMI group increased significantly after 30 min of ischemia (both p < .001 vs. respective baseline value), and they were 60% and 84% above the baseline value, respectively. In addition, ischemic intestinal injury was confirmed by the significantly elevated histological scores in the AMI group after 60 min of ischemia (p < .001). Our preliminary results suggest the possibility of important insights regarding NO and ET-1 changes into the mechanism of pathogenesis in AMI in rats. The increases in plasma NO and ET-1 levels may potentially be noninvasive biomarkers for the early detection of this disease.
Collapse
Affiliation(s)
- Jaw-Yuan Wang
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University and Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | |
Collapse
|
37
|
Hsu WH, Yu FJ, Chuang CH, Chen CF, Lee CT, Lu CY. Occult colon cancer in a patient with diabetes and recurrent Klebsiella pneumoniae liver abscess. Kaohsiung J Med Sci 2009; 25:98-103. [PMID: 19321414 DOI: 10.1016/s1607-551x(09)70048-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Klebsiella pneumoniae (Kp) is a well-known leading cause of liver abscess in patients with diabetes, but recurrent Kp liver abscess in such patients within a period of time is seldom seen. Here, we report a patient with diabetes who experienced three episodes of Kp liver abscess within 1 year. The patient was subsequently diagnosed to have an occult sigmoid cancer. The liver abscess did not recur after resection of the colonic tumor. Occult sigmoid colonic cancer may have played an important role in the recurrent Kp liver abscess in our case. Therefore, further investigation of gastrointestinal malignancies, particularly of the colonic tract, is necessary in patients with diabetes and Kp liver abscess.
Collapse
Affiliation(s)
- Wen-Hung Hsu
- Department of Internal Medicine, Division of Gastroenterology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | |
Collapse
|
38
|
Chen CY, Kuo YT, Lee CH, Hsieh TJ, Jan CM, Jaw TS, Huang WT, Yu FJ. Differentiation between malignant and benign gastric ulcers: CT virtual gastroscopy versus optical gastroendoscopy. Radiology 2009; 252:410-7. [PMID: 19487467 DOI: 10.1148/radiol.2522081249] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To retrospectively compare computed tomographic virtual gastroscopy (VG) and conventional optical gastroendoscopy for the differentiation of malignant and benign gastric ulcers. MATERIALS AND METHODS The institutional review board approved this study and confirmed that informed consent was not required. Gastric ulcers in 115 patients (mean age, 64.7 years; range, 31-86 years; 61 men, 54 women) were evaluated by using endoscopy and VG. Ulcer shape, base, and margin and periulcer folds were evaluated by two independent reviewers. Malignant gastric ulcers were identified by irregular, angulated, or geographic shape; uneven base; irregular or asymmetric edges; and disrupted or moth-eaten appearance of periulcer folds near the crater edge and/or clubbed or fused folds. Benign gastric ulcers were identified by smooth and regular shapes, even bases, clearly demarcated and regular edges, and folds that tapered and converged toward the ulcer. The performance of VG and endoscopy for the diagnosis of benign and malignant gastric ulcers was evaluated by using histopathologic results as the reference standard. The McNemar test was used to compare VG and endoscopic data. A P value less than .05 was considered to indicate a significant difference. RESULTS At histopathologic examination, 39 gastric ulcers were benign, while 76 were malignant. VG and endoscopy had sensitivities of 92.1% (70 of 76) and 88.2% (67 of 76), respectively, for overall diagnosis of malignant gastric ulcers, and specificities of 91.9% (34 of 37) and 89.5% (34 of 38), respectively, for overall diagnosis of malignant gastric ulcers. Endoscopy was more sensitive in depicting malignancy according to ulcer base (85.5% [65 of 76] vs 68.4% [52 of 76]) (P = .034), and VG was more specific in depicting malignancy according to ulcer margin (78.4% [29 of 37] vs 63.2% [24 of 38]) (P = .034). CONCLUSION VG and endoscopy were almost equally useful in distinguishing between malignant and benign gastric ulcers. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/2522081249/DC1.
Collapse
Affiliation(s)
- Chiao-Yun Chen
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No. 100 Tz-You First Road, Kaohsiung City, 807 Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Kuo CH, Hu HM, Kuo FC, Hsu PI, Chen A, Yu FJ, Tsai PY, Wu IC, Wang SW, Li CJ, Weng BC, Chang LL, Jan CM, Wang WM, Wu DC. Efficacy of levofloxacin-based rescue therapy for Helicobacter pylori infection after standard triple therapy: a randomized controlled trial. J Antimicrob Chemother 2009; 63:1017-24. [PMID: 19246508 DOI: 10.1093/jac/dkp034] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This prospective study was designed to determine the efficacy of a levofloxacin-based rescue therapy for Helicobacter pylori infection after failure of standard triple therapies. We also surveyed the predictors of this rescue therapy. PATIENTS AND METHODS From June 2005 to March 2007, 1036 patients infected with H. pylori received standard triple regimens (proton pump inhibitor, clarithromycin and amoxicillin). H. pylori eradication was achieved in 855 (82.5%) subjects. One hundred and sixty-six eradication-failure patients were enrolled and randomly assigned to receive a 7 day eradication therapy with esomeprazole, bismuth subcitrate, tetracycline and metronidazole (EBTM) or esomeprazole, amoxicillin and levofloxacin (EAL). Follow-up endoscopy was done 16 weeks later to assess the treatment response. Patients' response, CYP2C19 genotypes and antibiotic resistances were also examined. RESULTS Intention-to-treat analysis revealed that both groups showed similar eradication rates [EBTM 63.9%; 95% confidence interval (CI): 53.6-74.2 and EAL 69.9%; 95% CI: 60.1-79.7] (P = 0.89). Per-protocol results were EBTM = 84.1% (95% CI: 75.1-93.1) and EAL = 75.3% (95% CI: 65.8-84.8) (P = 0.82). Both regimens had similar compliance (P = 0.32), but the EBTM group had more adverse events (P = 0.27). Logistic regression analysis showed that poor compliance, CYP2C19 homozygous extensive metabolizer genotype and levofloxacin resistance were important predictors for eradication failure. CONCLUSIONS The EAL regimen can achieve an efficacy similar to that of the standard EBTM therapy. It may be very useful in countries where bismuth salts are not available. Compliance, CYP2C19 genotype and resistances to antibiotics may influence the outcome of levofloxacin-based rescue therapy. It seems advisable to reserve levofloxacin for rescue treatment to avoid an increase in the resistance phenomenon.
Collapse
|
40
|
Tsai HL, Yeh YS, Yu FJ, Lu CY, Chen CF, Chen CW, Chang YT, Wang JY. Predicting factors of postoperative relapse in T2-4N0M0 colorectal cancer patients via harvesting a minimum of 12 lymph nodes. Int J Colorectal Dis 2009; 24:177-83. [PMID: 18853168 DOI: 10.1007/s00384-008-0594-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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] [Accepted: 09/26/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM The aim of this retrospective study was to determine which clinicopathological factors influenced the incidence of postoperative relapse and overall survival rates after radical resection of T(2-4)N(0)M(0) colorectal cancer (CRC) patients via harvesting a minimum of 12 lymph nodes. MATERIALS AND METHODS Between January 2001 and June 2006, a total of 342 T(2-4)N(0)M(0) CRC patients who underwent radical resection were retrospectively analyzed in Kaohsiung Medical University Hospital. Of these 342 patients, 155 were observed by harvesting a minimum of 12 lymph nodes. These 155 patients were followed up intensively, and their outcomes were investigated retrospectively. RESULTS Of 155 patients, 83 were men (53.5%) and 72 (46.5%) were women. The mean age was 65.5 +/- 11.1 years (range, 24-89 years). The median follow-up period was 49 months (range, 19-80 months). The present data showed invasive depth (P = 0.012), vascular invasion (P < 0.001), and perineural invasion (P = 0.009) as significantly prognostic factors for postoperative 5-year relapse rate by Kaplan-Meier analysis. Likewise, invasive depth (P = 0.013), vascular invasion (P < 0.001), and perineural invasion (P = 0.008) were significant factors for postoperative 5-year survival rate. Meanwhile, using a Cox proportional hazards analysis, depth of tumor invasion (P = 0.026) and vascular invasion (P = 0.001) were the independent predictors for postoperative relapse. Furthermore, the presence of vascular invasion was considerably correlated to the higher postoperative relapse rate and the poorer overall survival rates by survival analyses (P < 0.0001). CONCLUSIONS Besides the conventional depth of tumor invasion, this study highlights the potential for using vascular invasion as a means of identifying a subgroup of T(2-4)N(0)M(0) CRC patients with adequate lymph node harvest at higher risk who would potential benefit from adjuvant therapy after surgery.
Collapse
Affiliation(s)
- Hsiang-Lin Tsai
- Department of Emergency Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, No. 482, Shan-Ming Road, Kaohsiung, 812, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Wu IC, Lee CH, Kuo CH, Kuo FC, Wu DC, Ko YC, Yu FJ. Consumption of Cigarettes but not Betel Quid or Alcohol Increases Colorectal Cancer Risk. J Formos Med Assoc 2009; 108:155-63. [DOI: 10.1016/s0929-6646(09)60046-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
42
|
Hsu PI, Wu DC, Chen A, Peng NJ, Tseng HH, Tsay FW, Lo GH, Lu CY, Yu FJ, Lai KH. Quadruple rescue therapy for Helicobacter pylori infection after two treatment failures. Eur J Clin Invest 2008; 38:404-9. [PMID: 18435764 DOI: 10.1111/j.1365-2362.2008.01951.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND A standard third-line therapy for Helicobacter pylori infection is lacking, and antimicrobial sensitivity data for patients who failed eradication therapy are often unavailable in clinical practice. We therefore designed the prospective study to assess the efficacy of levofloxacin, amoxicillin, bismuth and rabeprazole quadruple therapy as a third-line treatment for H. pylori infection. PATIENTS AND METHODS From September 2005 to August 2007, 37 consecutive H. pylori-infected patients who had failed standard first-line and second-line treatments underwent a 10-day quadruple therapy comprising rabeprazole (20 mg b.i.d.), bismuth subcitrate (300 mg q.d.s.), amoxicillin (500 mg q.d.s.) and levofloxacin (500 mg o.d.). Follow-up endoscopy with rapid urease test, histological examination and culture was performed at 6 weeks after the end of treatment to evaluate the response to therapy. RESULTS Helicobacter pylori was successfully eradicated in 31 out of 37 patients (84% by both intention-to-treat analysis and per-protocol analysis). All patients complied with the eradication therapies, and only seven patients (19%) complained of mild-to-moderate adverse events. Amoxicillin- and levofloxacin-resistant strains were observed in 17% and 22% of the patients, respectively. There were no significant differences between H. pylori eradication rates and antibiotic resistances. CONCLUSIONS The 10-day levofloxacin- and amoxicillin-based quadruple therapy is well tolerated and achieves a high eradication rate as a third-line empirical treatment for H. pylori infection.
Collapse
Affiliation(s)
- P I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Uen YH, Lu CY, Tsai HL, Yu FJ, Huang MY, Cheng TL, Lin SR, Wang JY. Persistent presence of postoperative circulating tumor cells is a poor prognostic factor for patients with stage I-III colorectal cancer after curative resection. Ann Surg Oncol 2008; 15:2120-8. [PMID: 18481151 DOI: 10.1245/s10434-008-9961-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Revised: 04/18/2008] [Accepted: 04/18/2008] [Indexed: 02/01/2023]
Abstract
AIM To detect pre- and postoperative circulating tumor cells (CTCs) in stage I-III colorectal cancer (CRC) patients undergoing curative resection and so identify a subgroup of patients who are at high risk for relapse. METHODS Four mRNA molecular markers including human telomerase reverse transcriptase, cytokeratin-19, cytokeratin-20, and carcinoembryonic antigen mRNA were used to detect CTCs in 438 CRC patients underwent curative resection. RESULTS Out of 438 patients, 80 CRC patients were classified to preoperative (-)/postoperative (-), 221 patients were preoperative (+)/postoperative (-), while 137 patients were preoperative (+)/postoperative (+). Univariately, postoperative relapse was significantly correlated with depth of invasion (P = 0.032), lymph node metastasis (P < 0.001), vascular invasion (P = 0.001), perineural invasion (P = 0.013), and persistent presence of CTCs (P < 0.001). Using a multivariate proportional hazards regression analysis, the presence of lymph node metastasis (P = 0.012; HR, 7.652; 95% CI: 4.162-14.827), vascular invasion (P = 0.033; HR, 4.360; 95% CI: 2.793-10.847), and the persistent presence of CTCs (P < 0.001; HR, 29.486; 95% CI: 10.281-87.792) were demonstrated to be independent predictors for postoperative relapse. Combination of these three independent predictors showed that patients with any one positive predictor had a hazard ratio of sevenfold to develop postoperative relapse (P < 0.001; HR, 7.064; 95% CI: 4.354-11.464). Furthermore, the persistent presence of CTCs was strongly correlated with poorer relapse-free survival rates (all P < 0.001). CONCLUSION The promising results of this study suggest that persistent presence of postoperative CTCs may be a crucial prognostic factor adjuvant to conventional tumor markers in CRC patients who have undergone curative resection. Identification of these high-risk patients of persistent CTCs positivity is important and thus could help to define patients for adjuvant therapy with this tumor entity.
Collapse
Affiliation(s)
- Yih-Huei Uen
- Department of Surgery, Division of General Surgery, Chi Mei Foundation Medical Center, Taipei Medical University, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Hsu PI, Wu DC, Chen A, Peng NJ, Tseng HH, Tsay FW, Lo GH, Lu CY, Yu FJ, Lai KH. Quadruple rescue therapy for Helicobacter pylori infection after two treatment failures. Eur J Clin Invest 2008. [PMID: 18435764 DOI: 10.1111/j.1365-2362.2008.01951] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND A standard third-line therapy for Helicobacter pylori infection is lacking, and antimicrobial sensitivity data for patients who failed eradication therapy are often unavailable in clinical practice. We therefore designed the prospective study to assess the efficacy of levofloxacin, amoxicillin, bismuth and rabeprazole quadruple therapy as a third-line treatment for H. pylori infection. PATIENTS AND METHODS From September 2005 to August 2007, 37 consecutive H. pylori-infected patients who had failed standard first-line and second-line treatments underwent a 10-day quadruple therapy comprising rabeprazole (20 mg b.i.d.), bismuth subcitrate (300 mg q.d.s.), amoxicillin (500 mg q.d.s.) and levofloxacin (500 mg o.d.). Follow-up endoscopy with rapid urease test, histological examination and culture was performed at 6 weeks after the end of treatment to evaluate the response to therapy. RESULTS Helicobacter pylori was successfully eradicated in 31 out of 37 patients (84% by both intention-to-treat analysis and per-protocol analysis). All patients complied with the eradication therapies, and only seven patients (19%) complained of mild-to-moderate adverse events. Amoxicillin- and levofloxacin-resistant strains were observed in 17% and 22% of the patients, respectively. There were no significant differences between H. pylori eradication rates and antibiotic resistances. CONCLUSIONS The 10-day levofloxacin- and amoxicillin-based quadruple therapy is well tolerated and achieves a high eradication rate as a third-line empirical treatment for H. pylori infection.
Collapse
Affiliation(s)
- P I Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Ma CJ, Lu CY, Chen CW, Chu KS, Yu FJ, Chang YT, Hsieh JS, Wang JY. Preoperative localization of colonic tumors using transabdominal illumination of the colonoscope. Int J Colorectal Dis 2008; 23:213-4. [PMID: 17657503 DOI: 10.1007/s00384-007-0363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2007] [Indexed: 02/04/2023]
|
46
|
Kuo CH, Hu HM, Tsai PY, Liu CJ, Yu FJ, Chang K, Pan YS, Chen A, Jan CM, Wang WM, Wu DC. A better method for preventing infection of percutaneous endoscopic gastrostomy. J Gastrointest Surg 2008; 12:358-63. [PMID: 18040748 DOI: 10.1007/s11605-007-0390-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 10/16/2007] [Indexed: 01/31/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) has been widely used to maintain enteral nutrition in dysphagic patients. Local and occasional life-threatening systemic infections are still the most common complications, and the major infection source may be nosocomial flora. The effect of antibiotic prophylaxis on reducing peristomal infection is popularly accepted. However, it is accompanied with a possible risk of increasing antibiotic resistance. AIM This study attempted to determine whether 14-day discharge before PEG could reduce the rate of peristomal infection. MATERIALS AND METHODS Fifty patients who had received PEG in our hospital were included in this study and followed for at least 6 months (except for those patients who died during this period). Patients were separated into two groups randomly. Twenty-five patients received PEG during in-hospitalization (group A). The other 25 patients received PEG until discharge at least for 14 days (group B). The most frequent indication for PEG insertion was the neurological condition. Risk factors for peristomal infection were analyzed statistically using logistic regression and expressed by odds ratios. Every possible factor was analyzed by chi-square test or Student's t test. RESULT Our data showed that group A had a higher peristomal infection rate than group B (32 vs 8%) (p < 0.05). Group A also showed more need of antibiotics. The risk factors related to peristomal infection were group A and lower albumin. The total rate of 30-day mortality was 4%. DISCUSSION When compared with previous data, our study showed a similar infection rate in group A, a lower infection rate in group B, and a lower 30-day mortality rate. This meant that one period of discharge could reduce the peristomal infections caused by colonized bacteria. It also decreased the need of using antibiotics and might avoid the possible adverse consequence of promoting bacterial resistance, which is an alarming and growing problem in hospital practice. CONCLUSION We suggest that a 14-day grace period after discharge, before PEG insertion, may decrease peristomal infection rate, length of hospital stay after PEG, and the need for antibiotics. This is suitable for moral and ethical considerations.
Collapse
Affiliation(s)
- Chao-Hung Kuo
- Division of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Wang JY, Hsieh JS, Lu CY, Yu FJ, Wu JY, Chen FM, Huang CJ, Lin SR. The differentially mutational spectra of the APC, K-ras, and p53 genes in sporadic colorectal cancers from Taiwanese patients. Hepatogastroenterology 2007; 54:2259-2265. [PMID: 18265644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND/AIMS Adenomatous polyposis coli (APC), K-ras and p53 gene mutations are the most common genetic alterations present in colorectal cancer (CRC). The aim of this study was to analyze tumor mutation frequencies and spectra in a large cohort of Taiwanese patients with CRC. METHODOLOGY APC, K-ras, and p53 gene mutations in primary tumor tissues and their paired normal tissues of 123 CRC patients were detected by polymerase chain reaction-single strand conformation polymorphism analysis, followed by direct sequencing. RESULTS Of these 123 CRC patients, 43.1%, 44.7%, 35% of tumor tissue specimens presented mutations in APC, K-ras, and p53 genes, respectively. Overall, gene mutations in APC, K-ras and/or p53 were present in 78% (96/123) of tumor tissues. Among 96 CRC patients harboring gene mutations, 49 (51%) contained mutations of at least two different genes and 47 (49%) contained mutations of one gene only. The most common combination of gene mutations was APC and K-ras mutations (21.9%), followed by K-ras and p53 mutations (12.5%) and then APC and p53 mutations (10.4%). In addition, there were only 6.3% (6/96) of tumor tissues from CRC patients simultaneously containing mutations of APC, K-ras and p53 genes. The most common mutation spectrum of these genes was missense mutations, at a frequency of 38.8%, 92.7% and 70.5% for APC, K-ras and p53 genes, respectively. CONCLUSIONS These data support that the frequencies and patterns of somatic mutation of the APC, Kras and p53 genes in CRCs are considerably variable and distinct among populations, for which the interaction between exogenous environmental factors and endogenous gene alterations may be important determinants.
Collapse
Affiliation(s)
- Jaw-Yuan Wang
- Department of Surgery, Kaohsiung Medical University Hospital, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Wu IC, Wu DC, Hsu PI, Lu CY, Yu FJ, Wang TE, Chang WH, Chen JJ, Kuo FC, Wu JY, Wang WM, Bair MJ. Rabeprazole- versus esomeprazole-based eradication regimens for H. pylori infection. Helicobacter 2007; 12:633-7. [PMID: 18001406 DOI: 10.1111/j.1523-5378.2007.00553.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Different kinds of proton pump inhibitor-based triple therapies could result in different Helicobacter pylori eradication rates. AIM The aims of this study were to compare the efficacy and safety of rabeprazole- and esomeprazole-based triple therapy in primary treatment of H. pylori infection in Taiwan. PATIENTS AND METHODS From June 2005 to March 2007, 420 H. pylori-infected patients were randomly assigned to receive a 7-day eradication therapy with either esomeprazole 40 mg daily (EAC group, n = 209) or rabeprazole 20 mg b.i.d. (RAC group, n = 211) in combination with amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d.. Follow-up endoscopy with biopsy was done 12-16 weeks after completion of eradication therapy. Those who refused endoscopic exams underwent (13)C-urea breath test to assess the treatment response. RESULTS Intention-to-treat analysis revealed that the eradication rate was 89.4% in the EAC group and 90.5% in RAC groups (p-value = .72). All of the subjects returned for assessment of compliance (100% in EAC group vs. 99.5% in RAC group, p-value = .32) and adverse events (3.83% in EAC group vs. 6.16% in RAC group, p-value = .27). Sixty (28.7%) and 37 (17.6%) patients in EAC and RAC group, respectively, refused endoscopy and underwent a (13)C-urea breath test to determine the treatment effect. CONCLUSION In conclusion, rabeprazole- and esomeprazole-based primary therapies for H. pylori infection are comparable in efficacy and safety.
Collapse
Affiliation(s)
- I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Wang JY, Lu CY, Chu KS, Ma CJ, Wu DC, Tsai HL, Yu FJ, Hsieh JS. Prognostic significance of pre- and postoperative serum carcinoembryonic antigen levels in patients with colorectal cancer. Eur Surg Res 2007; 39:245-50. [PMID: 17457032 DOI: 10.1159/000101952] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 02/24/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND To evaluate the prognostic significance of pre- and postoperative serum carcinoembryonic antigen(CEA) levels in colorectal cancer (CRC) patients. METHODS 425 CRC patients underwent curative resection at our institution. Their pre- and postoperative serum CEA level was classified into two groups according to concentration: normal CEA (<5.0 ng/ml) and abnormal CEA (> or =5.0 ng/ml). RESULTS Of all patients, abnormal pre- and postoperative serum CEA levels were observed in 181 (42.6%) and 48 (11.3%) patients, respectively. Abnormal preoperative serum CEA level was significantly correlated with the tumor located in the colon, the depth of tumor invasion, the status of lymph node metastasis, UICC stage, and the presence of postoperative relapse (p < 0.05). Concurrently, an abnormal postoperative serum CEA level was also prominently related to the above corresponding parameters (p < 0.05), except for the tumor location. Patients with a failed conversion of abnormal preoperative value to normal postoperative concentration were found to have the worst overall survival rate. Abnormal pre- and postoperative serum CEA levels were single independent predictors for survival and postoperative relapse, respectively. CONCLUSIONS The identification of abnormal pre- and postoperative serum CEA levels may be useful in the auxiliary cancer prognosis or postoperative surveillance of CRC patients.
Collapse
Affiliation(s)
- J Y Wang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Wang JY, Lin SR, Wu DC, Lu CY, Yu FJ, Hsieh JS, Cheng TL, Koay LB, Uen YH. Multiple molecular markers as predictors of colorectal cancer in patients with normal perioperative serum carcinoembryonic antigen levels. Clin Cancer Res 2007; 13:2406-13. [PMID: 17406027 DOI: 10.1158/1078-0432.ccr-06-2054] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE In this study, a high-sensitivity colorimetric membrane array method was used to detect circulating tumor cells (CTC) in the peripheral blood of colorectal cancer (CRC) patients with normal perioperative serum carcinoembryonic antigen (CEA) levels. This membrane array method was evaluated as a potential diagnostic and postoperative surveillance tool. STUDY DESIGN Membrane arrays consisting of a panel of mRNA markers that include human telomerase reverse transcriptase, cytokeratin-19, cytokeratin-20, and CEA mRNA were used to detect CTCs in the peripheral blood of 157 postoperative CRC patients with normal perioperative serum CEA levels and in 80 healthy individuals. Digoxigenin-labeled cDNA were amplified by reverse transcription-PCR from the peripheral blood samples, which were then hybridized to the membrane array. The sensitivity, specificity, and accuracy of membrane arrays for the detection of CTCs were then calculated. RESULTS Using the four markers in combination, expression of any three markers or all the four markers in this panel was significantly correlated with the clinicopathologic characteristics, including depth of tumor invasion, lymph node metastasis, tumor-node-metastasis stage, and postoperative relapse (all P < 0.05). The interval between the detection of all four positive molecular markers and subsequent elevated CEA ranged from 3 to 8 months (median 6 months). The expression of all four mRNA markers was an independent predictor for postoperative relapse. CRC patients with all four mRNA markers expression showed a significantly poorer survival rate than those with less than four positive markers. CONCLUSIONS The constructed membrane array method was helpful in the early prediction of postoperative relapse in CRC patients with normal perioperative serum CEA levels.
Collapse
Affiliation(s)
- Jaw-Yuan Wang
- Department of Surgery, Kaohsiung Medical University Hospital, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|