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Kuo YT, Chang TS, Tsai CC, Chang HC, Chia YY. Optimizing nonintubated laryngeal microsurgery: The effectiveness and safety of superior laryngeal nerve block with high-flow nasal oxygen-A prospective cohort study. J Chin Med Assoc 2024; 87:334-339. [PMID: 38305707 DOI: 10.1097/jcma.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Laryngeal microsurgery (LMS) typically requires intubated general anesthesia (ITGA). Although nonintubated general anesthesia (NIGA) with high-flow nasal oxygen (HFNO) can be applied with LMS, a muscle relaxant is required, which can cause apnea and hypercapnia. This study evaluated the effectiveness of a superior laryngeal nerve block (SLNB) in improving safety during LMS. METHODS This prospective cohort study enrolled a cumulative total of 61 adult patients received LMS under intravenous general anesthesia and allocated to three groups: ITGA group (n = 18), which patients performed intubation; neuromuscular blocking (NMB) group (n = 21), which patients administrated muscle relaxant without intubation and superior laryngeal nerve block (NB) group (n = 22), which patients performed SLNB without intubation or muscle relaxant. RESULTS The average (SD) values of PaCO 2 after surgery in ITGA, NMB, and NB group were 50.8 (7.5), 97.5 (24.9), and 54.8 (8.8) mmHg, respectively. The mean postoperative pH values were 7.33 (0.04), 7.14 (0.07), and 7.33 (0.04), respectively. The results were all p < 0.001, and the average pH value of the NMB group was lower than that of the ITGA and NB groups. During the LMS, the mean heart rate (HR) (93.9 [18.1] bpm) and noninvasive blood pressure systolic (NBPs) (143.5 [28.2] mmHg) in the NMB group were higher than those in the ITGA group (HR = 77.4 [13.5] bpm and NBPs = 132.7 [20.8] mmHg) and NB group (HR = 82.3 [17.4] bpm and NBPs = 120.9 [25.0] mmHg). The results of p value by HR and NBPs are p < 0.001. The PaCO 2 and pH values are similar between ITGA group and NB group. CONCLUSION Our approach of using HFNO with SLNB was successful for performing nonintubated LMS, enabling the patients to maintain spontaneous breathing and effectively eliminate CO 2 . This approach reduces the risks of hypercapnia and acidosis even when the duration of LMS exceeds 30 minutes.
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Affiliation(s)
- Yu-Ting Kuo
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Ting-Shou Chang
- Department of Otolaryngology-Head & Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- School of Medicine, National Defense Medicine Center, Taipei, Taiwan, ROC
| | - Chih-Chi Tsai
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Hsin-Chih Chang
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yuan-Yi Chia
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Defense Medicine Center, Taipei, Taiwan, ROC
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Lin YH, Yang YF, Liao JB, Chang TS, Janesha UGS, Shiue YL. Analysis of Aldehyde Dehydrogenase 2 as a Prognostic Marker Associated with Immune Cell infiltration and Chemotherapy Efficacy in Head and Neck Squamous Cell Carcinoma. J Cancer 2023; 14:1689-1706. [PMID: 37476181 PMCID: PMC10355205 DOI: 10.7150/jca.85098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/03/2023] [Indexed: 07/22/2023] Open
Abstract
Background: Previous investigations have demonstrated the role of Aldehyde Dehydrogenase 2 (ALDH2) levels in the cancer initiation and progression, prognosis, and treatment response in kinds of malignancies. However, its significance in the head and neck squamous cell carcinoma (HNSC) by different human papillomavirus (HPV) statuses remains unclear. Methods: We conducted an in-depth analysis of ALDH2 in HNSC using various bioinformatics tools, investigating its expression, alteration, differential levels, prognostic significance, molecular interactions, immune characteristics, and conducting experimental validation through immunohistochemistry (IHC) arrays and Western blot to compare expression levels between tumor and normal tissues, analyze the associations with clinicopathological features, and investigate its responses to chemotherapies. Results: ALDH2 levels are downregulated in HNSC tissues and associated with higher American Joint Committee on Cancer (AJCC) T classification and worse overall survival in HPV-unrelated HNSC, yet not in HPV-related HNSC. ALDH2 is positively regulated by copy-number variation and negatively regulated by DNA methylation. The association of ALDH2 with prognosis may be due to its interaction with ALDH6A1, and its co-expressed genes are predictive biomarkers of HNSC. We also found high ALDH2 levels in bulk tumors are associated with increased immune surveillance cells, such as naïve B cells and M1 macrophages in HPV-unrelated HNSC. IHC and western blot showed that ALDH2 is downregulated in the oral cavity, hypopharyngeal cancers, and well-differentiated carcinoma. In vitro, low ALDH2 levels showed reduced response to 5-fluorouracil in HNSC-derived cell lines. Conclusion: Our analyses revealed the genetic and cellular targets and drug response of ALDH2 in HNSC. We also found ALDH2 is involved in regulating the immune response of the tumor microenvironment, and high levels of ALDH2 in bulk HNSC may enhance antitumor immunity, which could improve prognosis. These findings suggest that ALDH2 could be a potential biomarker in improving risk stratification and tailoring treatment strategies in HNSC patients, especially in the HPV-unrelated subgroup.
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Affiliation(s)
- Yu-Hsuan Lin
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Yi-Fang Yang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Jia-Bin Liao
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | | | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan, Kaohsiung 804, Taiwan
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Chang TS, Lin JJ, Cheng KC, Su JH, She YY, Wu YJ. 11- epi-Sinulariolide Acetate-induced Apoptosis in Oral Cancer Cells Is Regulated by FOXO Through Inhibition of PI3K/AKT Pathway. Anticancer Res 2023; 43:2625-2634. [PMID: 37247910 DOI: 10.21873/anticanres.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIM Oral cancer is a general term for carcinomas that occur around the oral tissues, and most are squamous cell carcinoma. Oral cancer is a common disease among Taiwanese males and poses a great threat to national health owing to its high mortality rate. In this study, we used the CAL-27 oral cancer cell lines as in vitro models to investigate the pathways involved in 11-epi-sinulariolide acetate (11-epi-SA)-induced apoptosis. MATERIALS AND METHODS There have been no previous studies of the anticancer activity of 11-epi-SA isolated from Sinularia flexibilis against oral cancer. We used MTT assay, cell morphologic analysis, DNA fragmentation, TUNEL/DAPI assay, and JC-1 fluorescence staining to analyze the inhibitory effect of 11-epi-SA against the CAL-27 oral cancer cell line and assessed the potential molecular mechanism of apoptosis using western blot. RESULTS Our results showed that 11-epi-SA inhibited CAL-27 cell proliferation, and its effect on cell growth was mediated through an apoptotic pathway mechanism. 11-epi-SA inhibited the PI3K/AKT pathway, allowing downstream FOXO to separate from 14-3-3 and return to the nucleus. We also observed that 11-epi-SA disrupted mitochondrial Bcl family protein homeostasis and activated caspase-3 and caspase-9, which led to apoptosis. CONCLUSION A low concentration of 11-epi-SA can effectively induce apoptosis in oral cancer cells through the PI3K/AKT/FOXO pathway. 11-epi-SA has great potential as a new drug for the treatment of oral cancer.
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Affiliation(s)
- Ting-Shou Chang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Jen-Jie Lin
- Yu Jun Biotechnology Co., Ltd., Kaohsiung, Taiwan, R.O.C
| | - Kai-Chun Cheng
- Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan, R.O.C
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C
- Department of Ophthalmology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Jui-Hsin Su
- National Museum of Marine Biology and Aquarium, Pingtung, Taiwan, R.O.C
| | - Yun-Ying She
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C
| | - Yu-Jen Wu
- Yu Jun Biotechnology Co., Ltd., Kaohsiung, Taiwan, R.O.C.;
- Department of Food and Nutrition, Meiho University, Pingtung, Taiwan, R.O.C
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Shiue Y, Chang TS. Diffuse Idiopathic Skeletal Hyperostosis Presenting With Hoarseness-A Case Report. Ear Nose Throat J 2023:1455613231158796. [PMID: 37024447 DOI: 10.1177/01455613231158796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Unilateral vocal cord paralysis-related voice change is a common presentation in the otorhinolaryngology clinic. The well-known etiology was recurrent laryngeal nerve injury due to surgery, traumatic event, or tumor compression, but there are still other etiologies that could interfere with the route of the recurrence laryngeal nerve and lead to unilateral paralysis of the vocal cord. In this report, we presented a rare case of unilateral vocal cord paralysis resulting in diffuse idiopathic skeletal hyperostosis.
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Affiliation(s)
- Yih Shiue
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Shou Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Huang CY, Chang TS, Alice Hwang L, Lin YS. Novel airway-cartilage combined model for medialization laryngoplasty and laryngotracheal reconstruction surgery planning. J Chin Med Assoc 2022; 85:1076-1082. [PMID: 35947024 DOI: 10.1097/jcma.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The clinical outcomes of surgical treatments for vocal cord paralysis and tracheal stenosis, such as medialization laryngoplasty and laryngotracheal reconstruction, vary owing to the complex anatomy and physiology of the human upper airway. However, advances in three-dimensional (3D) simulation and printing ushered its use on an office-based workstation to aid in several surgical areas. METHODS The preoperation neck computed tomography image was loaded into the InVesalius 3.0 software for manual segmentation of airway and nearby important anatomic landmarks including hyoid bone, thyroid cartilage, and cricoid cartilage. The 3D model of the desired anatomy structure was manufactured and used for presurgical planning and rehearsal of the surgery. RESULTS We review cases of four patients: two cases of unilateral vocal palsy undergoing medialization laryngoplasty and two cases of tracheal stenosis patients who used the air-cartilage combined model. CONCLUSION Preoperation planning of the medialization thyroplasty could be more precise by prevision of the paralyzed vocal cord plane. Tracheal surgery could benefit from a preoperative design of segmented length. The novel airway-cartilage combined model offers new insight into vocal cord and trachea surgery.
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Affiliation(s)
- Chien-Yu Huang
- Department of Otolaryngology, Head and Neck Surgery, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- College of Artificial Intelligence, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Lisa Alice Hwang
- Department of Oral and Maxillofacial Surgery, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
- Department of Stomatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, ROC
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She YY, Lin JJ, Su JH, Chang TS, Wu YJ. 4-Carbomethoxyl-10-Epigyrosanoldie E Extracted from Cultured Soft Coral Sinularia sandensis Induced Apoptosis and Autophagy via ROS and Mitochondrial Dysfunction and ER Stress in Oral Cancer Cells. Oxid Med Cell Longev 2022; 2022:3017807. [PMID: 36275891 PMCID: PMC9584738 DOI: 10.1155/2022/3017807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/03/2022] [Indexed: 02/01/2023]
Abstract
Oral cancer is a malignant neoplasia that is more common in Asian than other regions, and men are at higher risk than women. Currently, clinical treatment for oral cancer consists of radiation therapy combined with chemotherapy. Therefore, it is important to find a drug that can inhibit the growth of cancer cells more effectively and safely. In this study, we examined the cytotoxicity of 4-carbomethoxyl-10-epigyrosanoldie E extracted from cultured soft coral Sinularia sandensis towards oral cancer cells. MTT cell proliferation and colony formation assays were used to evaluate cell survival, and immunofluorescence staining and Western blotting were employed to analyze the effects of 4-carbomethoxyl-10-epigyrosanoldie E on apoptosis and autophagy. 4-Carbomethoxyl-10-epigyrosanoldie E treatment also induced the formation of reactive oxygen species (ROS), which are associated with 4-carbomethoxyl-10-epigyrosanoldie E-induced cell death. In addition, the 4-carbomethoxyl-10-epigyrosanoldie E-induced antiproliferation effects on Ca9-22 and Cal-27 cells were associated with the release of cytochrome c from mitochondria, activation of proapoptotic proteins (such as caspase-3/-9, Bax, and Bad), and inhibition of antiapoptotic proteins (Bcl-2, Bcl-xl, and Mcl-1). 4-Carbomethoxyl-10-epigyrosanoldie E treatment also triggered endoplasmic reticulum (ER) stress, leading to activation of the PERK/elF2α/ATF4/CHOP apoptotic pathway. Moreover, increased expressions of Beclin-1, Atg3, Atg5, Atg7, Atg12, Atg 16, LC3-I, and LC3-II proteins indicated that 4-carbomethoxyl-10-epigyrosanoldie E triggered autophagy in oral cancer cells. In conclusion, our findings demonstrated that 4-carbomethoxyl-10-epigyrosanoldie E suppressed human oral cancer cell proliferation and should be further investigated with regard to its potential use as a chemotherapy drug for the treatment of human oral cancer.
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Affiliation(s)
- Yun-Ying She
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Taiwan
| | - Jen-Jie Lin
- Yu Jun Biotechnology Co., Ltd., Kaohsiung, Taiwan
- Department of Food and Nutrition, Meiho University, Pingtung 91202, Taiwan
| | - Jui-Hsin Su
- National Museum of Marine Biology and Aquarium, Pingtung 94450, Taiwan
| | - Ting-Shou Chang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Taiwan
| | - Yu-Jen Wu
- Yu Jun Biotechnology Co., Ltd., Kaohsiung, Taiwan
- Department of Food and Nutrition, Meiho University, Pingtung 91202, Taiwan
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Lin YP, Chang TS, Wu FZ. Small cell lung cancer presenting with hoarseness. Postgrad Med J 2019; 95:218. [PMID: 30612097 DOI: 10.1136/postgradmedj-2018-136217] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Yun-Pei Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan .,Faculty of Medicine, School of Medicine, National Yang Ming University, Department of Radiology, Taipei, Taiwan.,Institute of Clinical Medicine, Department of Radiology, National Yang Ming University, Taipei, Taiwan
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Huang CY, Lin YS, Kang BH, Chang KP, Chi CC, Lin MY, Su HH, Chang TS, Lee HP, Lee CC. Log margin-to-thickness ratio improves disease-specific survival prediction in oral cancer: A single cancer centre database. Clin Otolaryngol 2018; 44:63-69. [DOI: 10.1111/coa.13237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/15/2018] [Accepted: 10/02/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Chien-Yu Huang
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Defense Medical Center; Taipei Taiwan
- Department of Otolaryngology, Head and Neck Surgery; Tri-Service General Hospital; Taipei Taiwan
| | - Bor-Hwang Kang
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Defense Medical Center; Taipei Taiwan
- Department of Otolaryngology, Head and Neck Surgery; Tri-Service General Hospital; Taipei Taiwan
| | - Kuo-Ping Chang
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Defense Medical Center; Taipei Taiwan
- Department of Otolaryngology, Head and Neck Surgery; Tri-Service General Hospital; Taipei Taiwan
| | - Chao-Chuan Chi
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Ming-Yee Lin
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Hsing-Hao Su
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Defense Medical Center; Taipei Taiwan
- Department of Otolaryngology, Head and Neck Surgery; Tri-Service General Hospital; Taipei Taiwan
| | - Huai-Pao Lee
- Department of Pathology and Laboratory Medicine; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
- School of Medicine; National Defense Medical Center; Taipei Taiwan
- Department of Otolaryngology, Head and Neck Surgery; Tri-Service General Hospital; Taipei Taiwan
- Institute of Hospital and Health Care Administration; National Yang-Ming University; Taipei Taiwan
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Lin SC, Chang TS, Yang KC, Lin YS, Lin YH. Factors contributing to surgical site infection in patients with oral cancer undergoing microvascular free flap reconstruction. Eur Arch Otorhinolaryngol 2018; 275:2101-2108. [DOI: 10.1007/s00405-018-5035-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/06/2018] [Indexed: 01/22/2023]
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Lee CC, Huang CY, Lin YS, Chang KP, Chi CC, Lin MY, Su HH, Chang TS, Chen HC, Yang CC. Prognostic Performance of a New Staging Category to Improve Discrimination of Disease-Specific Survival in Nonmetastatic Oral Cancer. JAMA Otolaryngol Head Neck Surg 2017; 143:395-402. [PMID: 28125757 DOI: 10.1001/jamaoto.2016.3802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Inflammatory status is associated with outcome in oral squamous cell carcinoma (OSCC). Combining the preoperative neutrophil to lymphocyte ratio (NLR) and histopathologic features may provide clinicians with more exact information regarding the prognosis of OSCC. Objective To compare the prognostic performance of the routinely used pathologic TNM staging with a new staging category that incorporates the NLR and histopathologic features. Design, Setting, and Participants This retrospective cohort study included 396 patients with newly diagnosed OSCC who underwent major surgery at a medical center from January 1, 2006, through December 31, 2013. Follow-up was completed on October 31, 2015, and data analysis was performed from January 1, 2016, through April 30, 2016. Main Outcomes and Measures The multivariate Cox proportional hazards regression model was used to determine the clinical or pathologic factors associated with 5-year disease-specific survival (DSS), and these factors were assigned integer points to create a new staging category. The monotonicity and discriminatory ability of the pathologic TNM staging and new staging category were evaluated with the linear trend χ2 test, Akaike information criterion, and Harrell C statistic. Results In total, 396 patients who underwent major surgery with curative intent for OSCC with or without adjuvant therapy were included in this study (mean [SD] age, 53 [11] years; 367 men [92.7%] and 29 women [7.3%]). Perineural invasion (adjusted hazard ratio [aHR], 1.74; 95% CI, 1.23-2.46), high NLR (aHR, 1.60; 95% CI, 1.11-2.30), advanced pT (T3 + T4) classification (aHR, 1.59; 95% CI, 1.13-2.25), and advanced pN (N2) classification (aHR, 3.96; 95% CI, 2.78-5.63) were independent prognostic survival factors. The β coefficients from the Cox proportional hazards regression model were used to develop an integer-based weighted point system (perineural invasion, score of 1; NLR, score of 1; advanced pT, score of 1; and advanced pN, score of 3). The summations of these risk scores were stratified for the new staging category as follows: new stage I, score of 0; new stage II, score of 1; new stage III, score of 2 or 3; and new stage IV, score of 4 to 6. Compared with the American Joint Committee on Cancer staging category, this new staging category provided better monotonicity with a higher linear trend χ2 value (106 vs 49), better discriminatory ability with smaller Akaike information criterion (1497 vs 1533), and greater Harrell C statistic (0.73 vs 0.69) for 5-year DSS. The results remained robust after adjusting other risk factors. Conclusions and Relevance In this study, new staging category had better DSS discriminatory ability and could help to identify high-risk patients for intense adjuvant therapy.
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Affiliation(s)
- Ching-Chih Lee
- Department of Otolaryngology, Head, and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan2School of Medicine, National Defense Medical Center, Taipei, Taiwan3Department of Otolaryngology, Head, and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Chien-Yu Huang
- Department of Otolaryngology, Head, and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yaoh-Shinag Lin
- Department of Otolaryngology, Head, and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan2School of Medicine, National Defense Medical Center, Taipei, Taiwan3Department of Otolaryngology, Head, and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Kuo-Ping Chang
- Department of Otolaryngology, Head, and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan2School of Medicine, National Defense Medical Center, Taipei, Taiwan3Department of Otolaryngology, Head, and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Chao-Chuan Chi
- Department of Otolaryngology, Head, and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Yee Lin
- Department of Otolaryngology, Head, and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsing-Hao Su
- Department of Otolaryngology, Head, and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Shou Chang
- Department of Otolaryngology, Head, and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan2School of Medicine, National Defense Medical Center, Taipei, Taiwan3Department of Otolaryngology, Head, and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Hung-Chih Chen
- Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan6Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan7Department of Biotechnology, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
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Lin YH, Chang KP, Lin YS, Chang TS. Pretreatment combination of platelet counts and neutrophil-lymphocyte ratio predicts survival of nasopharyngeal cancer patients receiving intensity-modulated radiotherapy. Onco Targets Ther 2017; 10:2751-2760. [PMID: 28603425 PMCID: PMC5457124 DOI: 10.2147/ott.s137000] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Increased cancer-related inflammation has been associated with unfavorable clinical outcomes. The combination of platelet count and neutrophil–lymphocyte ratio (COP-NLR) has related outcomes in several cancers, except for nasopharyngeal carcinoma (NPC). This study evaluated the prognostic value of COP-NLR in predicting outcome in NPC patients treated with intensity-modulated radiotherapy (IMRT). Materials and methods We analyzed the data collected from 232 NPC patients. Pretreatment total platelet counts, neutrophil–lymphocyte ratio (NLR), and COP-NLR score were evaluated as potential predictors. Optimal cutoff values for NLR and platelets were determined using receiver operating curve. Patients with both elevated NLR (>3) and platelet counts (>300×109/L) were assigned a COP-NLR score of 2; those with one elevated or no elevated value were assigned a COP-NLR a score of 1 or 0. Cox proportional hazards model was used to test the association of these factors and relevant 3-year survivals. Results Patients (COP-NLR scores 1 and 2=85; score 0=147) were followed up for 55.19 months. Univariate analysis showed no association between pretreatment NLR >2.23 and platelet counts >290.5×109/L and worse outcomes. Multivariate analysis revealed that those with COP-NLR scores of 0 had better 3-year disease-specific survival (P=0.02), overall survival (P=0.024), locoregional relapse-free survival (P=0.004), and distant metastasis-free survival (P=0.046). Further subgrouping by tumor stage also revealed COP-NLR to be an unfavorable prognostic indicator of 3-year failure-free survival (P=0.001) for locally advanced NPC. Conclusion COP-NLR score, but not NLR alone or total platelet count alone, predicted survival in NPC patients treated with IMRT-based therapy, especially those with stage III/IVA, B malignancies.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Otolaryngology, Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Kuo-Ping Chang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung.,Department of Otolaryngology, Head and Neck Surgery, National Defense Medical Center, Taipei
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung.,Department of Otolaryngology, Head and Neck Surgery, National Defense Medical Center, Taipei.,Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
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12
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Affiliation(s)
- Sheng-Chiao Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
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13
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Affiliation(s)
- Pei-Hsun Liao
- Resident, Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Hsuan Lin
- Chief Resident, Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Shou Chang
- Attending Physician, Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Samuelson ST, Burnett G, Sim AJ, Hofer I, Weinberg AD, Goldberg A, Chang TS, DeMaria S. Simulation as a set-up for technical proficiency: can a virtual warm-up improve live fibre-optic intubation? Br J Anaesth 2016; 116:398-404. [PMID: 26821699 DOI: 10.1093/bja/aev436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fibre-optic intubation (FOI) is an advanced technical skill, which anaesthesia residents must frequently perform under pressure. In surgical subspecialties, a virtual 'warm-up' has been used to prime a practitioner's skill set immediately before performance of challenging procedures. This study examined whether a virtual warm-up improved the performance of elective live patient FOI by anaesthesia residents. METHODS Clinical anaesthesia yr 1 and 2 (CA1 and CA2) residents were recruited to perform elective asleep oral FOI. Residents either underwent a 5 min, guided warm-up (using a bronchoscopy simulator) immediately before live FOI on patients with predicted normal airways or performed live FOI on similar patients without the warm-up. Subjects were timed performing FOI (from scope passing teeth to viewing the carina) and were graded on a 45-point skill scale by attending anaesthetists. After a washout period, all subjects were resampled as members of the opposite cohort. Multivariate analysis was performed to control for variations in previous FOI experience of the residents. RESULTS Thirty-three anaesthesia residents were recruited, of whom 22 were CA1 and 11 were CA2. Virtual warm-up conferred a 37% reduction in time for CA1s (mean 35.8 (SD 3.2) s vs. 57 (SD 3.2) s, P<0.0002) and a 26% decrease for CA2s (mean 23 (SD 1.7) s vs. 31 (SD 1.7) s, P=0.0118). Global skill score increased with warm-up by 4.8 points for CA1s (mean 32.8 (SD 1.2) vs. 37.6 (SD 1.2), P=0.0079) and 5.1 points for CA2s (37.7 (SD 1.1) vs. 42.8 (SD 1.1), P=0.0125). Crossover period and sequence did not show a statistically significant association with performance. CONCLUSIONS Virtual warm-up significantly improved performance by residents of FOI in live patients with normal airway anatomy, as measured both by speed and by a scaled evaluation of skills.
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Affiliation(s)
| | | | - A J Sim
- Department of Anesthesiology
| | - I Hofer
- Department of Anesthesiology, UCLA David Geffen School of Medicine, 757 Westwood Plaza #3325, Los Angeles, CA 90024, USA
| | - A D Weinberg
- Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA, and
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15
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Lin YH, Chang TS, Yao YC, Li YC. Increased Risk of Chronic Sinusitis in Adults With Gastroesophgeal Reflux Disease: A Nationwide Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1642. [PMID: 26426655 PMCID: PMC4616846 DOI: 10.1097/md.0000000000001642] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 12/13/2022] Open
Abstract
Although gastroesophageal reflux disease (GERD) has been reported to coexist with chronic rhinosinusitis (CRS), it remains controversial whether it increases risk of CRS in adults. This study accesses risk of CRS in adults with newly diagnosed GERD. We identified 15,807 adult patients with newly diagnosed GERD from Taiwan's National Health Insurance Research Database for January 1, 2006 to December 31, 2009. We also randomly selected 47,421 subjects without this disease and matched them with patients by age, sex, index year, and comorbidity to create a control cohort. A Cox proportional hazards model was conducted to estimate the development of CRS, including CRS without nasal polyps and CRS with nasal polyps. Subjects were followed for a median of 2.12 years. In total, CRS developed in 964 (1.52%) of the subjects: 406 patients with GERD (2.57%) and 558 without it (1.18%). After adjustment, those with GERD were found to have a 2.36 times greater risk of CRS (95% confidence interval = 2.08-2.68; P < .001). Risk of this CRS without nasal polyps was higher than the disease with polyps (adjusted hazard ratio: 2.48 vs 1.85). The individuals with GERD in this study were at significantly greater risk of CRS, most often without nasal polyps.
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Affiliation(s)
- Yu-Hsuan Lin
- From the Department of Otolaryngology, Head and Neck surgery, Kaohsiung Veterans General Hospital, Kaohsiung (Y-HL, T-SC); Department of Otolaryngology, Head and Neck surgery, National Defense Medical Center, Taipei (Y-HL, T-SC); Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (T-SC); and Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung (Y-CY, Y-CL)
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Lin JC, Liao JB, Fu HT, Chang TS, Wang JS. Salivary Gland Hyalinizing Clear Cell Carcinoma. J Pathol Transl Med 2015; 49:351-3. [PMID: 26076720 PMCID: PMC4508576 DOI: 10.4132/jptm.2015.05.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/20/2015] [Accepted: 05/06/2015] [Indexed: 02/03/2023] Open
Affiliation(s)
- Jung-Chia Lin
- Department of Pathology and Lab Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jia-Bin Liao
- Department of Pathology and Lab Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ; National Defense Medical Center, Taipei, Taiwan
| | - Hsiao-Ting Fu
- Department of Pathology and Lab Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Shou Chang
- National Defense Medical Center, Taipei, Taiwan ; Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jyh-Seng Wang
- Department of Pathology and Lab Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ; National Defense Medical Center, Taipei, Taiwan ; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Lin YH, Chang KP, Lin YS, Chang TS. Evaluation of effect of body mass index and weight loss on survival of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Radiat Oncol 2015; 10:136. [PMID: 26122711 PMCID: PMC4486696 DOI: 10.1186/s13014-015-0443-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/22/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous studies report body-mass index (BMI) and percent weight loss (WL) to have prognostic significance when treating patients with nasopharyngeal carcinoma (NPC). However, most of these investigations studied patients treated using different radiotherapeutic techniques. We evaluated the predictive effect of these two nutrition-related measurements on therapeutic outcome in NPC patients who only received intensity-modulated radiation therapy (IMRT) as part of their total treatment program. METHODS We retrospectively studied NPC patients treated with IMRT from January 2006 to February 2012. Cox proportional hazards was used to test the association of pretreatment BMI (<23 kg/m(2) vs. ≥23 kg/m(2)) and percent weight loss (≥5 % vs. <5 %) during therapy and related survival rates while controlling for various potential confounders. RESULTS Eighty-one (34 %) of the 238 patients had BMIs ≥23 kg/m(2) at pretreatment and 150 (63 %) had significant (≥5 %) weight loss. Median follow-up time was 41.71 months; median radiotherapy was 7.46 ± 0.77 weeks. Those with BMIs ≥23 kg/m(2) did not have a better 3-year overall survival (p = 0.672), 3-year disease specific survival (p = 0.341), 3-year locoregional free survival (p = 0.281), or 3-year distant metastatic free survival (p = 0.134). Those with significant WL (≥5 %) did not have worse 3-year clinical endpoints, even after stratifying magnitude of weight loss by BMI category. In sensitivity test, the adjusted hazard ratio remained statistically insignificant using different cutoffs for BMIs and percent weight loss. CONCLUSIONS This study found no significant relationship between BMI and percent weight loss on survival of NPC patients receiving IMRT based therapy. Further studies might want to consider other nutrition related factors as prognostic indicators when studying the correlate between malnutrition and survival in this population.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Otolaryngology, Head and Neck surgery, Kaohsiung Veterans General Hospital, No.386, Ta-Chung 1st Rd., Kaohsiung, 813, Taiwan.,Department of Otolaryngology, Head and Neck surgery, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Ping Chang
- Department of Otolaryngology, Head and Neck surgery, Kaohsiung Veterans General Hospital, No.386, Ta-Chung 1st Rd., Kaohsiung, 813, Taiwan
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Head and Neck surgery, Kaohsiung Veterans General Hospital, No.386, Ta-Chung 1st Rd., Kaohsiung, 813, Taiwan.,Department of Otolaryngology, Head and Neck surgery, National Defense Medical Center, Taipei, Taiwan
| | - Ting-Shou Chang
- Department of Otolaryngology, Head and Neck surgery, Kaohsiung Veterans General Hospital, No.386, Ta-Chung 1st Rd., Kaohsiung, 813, Taiwan. .,Department of Otolaryngology, Head and Neck surgery, National Defense Medical Center, Taipei, Taiwan. .,Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Lee CC, Chang TS, Wu CJ, Yang CC, Chen PC. Determinants of End-of-Life Expenditures in Patients with Oral Cancer in Taiwan: A Population-Based Study. PLoS One 2015; 10:e0126482. [PMID: 25946011 PMCID: PMC4422718 DOI: 10.1371/journal.pone.0126482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 01/23/2015] [Accepted: 04/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To investigate the association of basic demographic data, socioeconomic status, medical services, and hospital characteristics with end-of-life expenditure in patients with oral cancer in Taiwan who died between 2009 to 2011. METHODS This nationwide population-based, retrospective cohort study identified 5,386 patients who died from oral cancer. We evaluated medical cost in the last month of life by universal health insurance. The impact of each variable on the end-of-life expenditure was examined by hierarchical generalized linear model (HGLM) using a hospital-level random-intercept model. RESULTS The mean medical cost in the last six months of life was $2,611±3,329 (U.S. dollars). In HGLM using a random-intercept model, we found that patients younger than 65 years had an additional cost of $819 over those aged ≥65 years. Patients who had a high Charlson Comorbidity Index Score (CCIS) had an additional $616 cost over those with a low CCIS. Those who survived post-diagnosis less than 6 months had an additional $659 in expenses over those who survived more than 24 months. Medical cost was $249 more for patients who had medium to high individual SES, and $319 more for those who were treated by non-oncologists. CONCLUSION This study provides useful information for decision makers in understanding end-of-life expenditure in oral cancer. We found significantly increased end-of-life expenditure in patients if they were younger than 65 years or treated by non-oncologists, or had high CCIS, medium to high individual SES, and survival of less than 6 months after diagnosis.
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Affiliation(s)
- Ching-Chih Lee
- Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Ting-Shou Chang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Shung Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Po-Chun Chen
- Department of Radiation Oncology, Pingtung Christian Hospital, Pingtung, Taiwan
- * E-mail:
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Abstract
Few studies have addressed the association between oral cancer and end-of-life (EOL) aggressive care using population data. We investigated the relationship between patient demographics, primary physician's specialty, and hospital characteristics of patients who died from oral cancer in Taiwan from 2009 to 2011 and the aggressiveness of their EOL care. This nationwide population-based, retrospective cohort study identified 5386 patients who died from oral cancer identified from Taiwan's National Register of Deaths Database and collected their claims data from Taiwan's National Health Insurance Research Database. Accepted indicators of aggressiveness of EOL care were examined using a composite measure adapted from Earle et al. Scores ranged from 0 to 6; the higher the score, the more aggressive the EOL care. The impact of each variable on the aggressiveness of EOL care was examined by multivariate analysis using a random-intercept model. The mean composite score for aggressiveness of EOL care was 2.68 ± 1.37. Oral cancer patients who were younger, had a higher level of comorbidity or metastasis, belonged to a lower-level individual socioeconomic status, were cared for by nononcologists, had longer postdiagnosis survival times, or resided in urban areas were more likely to receive aggressive care at EOL. Compared with previous studies, oral cancer patients near death in this nationwide study had a far higher utilization rate (>50%) of chemotherapy, emergency room services, and intensive care unit services. Our findings indicate that oral cancer patients receive extensive aggressive medical care at EOL. Future research may be needed to examine the effect of the means (indicators) of aggressive treatment on survival, quality of life, and medical costs, especially since current research suggests such care may adversely affect quality of life and important preparation of death in these patients.
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Affiliation(s)
- Ting-Shou Chang
- From the Department of Otolaryngology (T-SC), Kaohsiung Veterans General Hospital, Kaohsiung; Institute of Public Health (T-SC), College of Medicine, National Cheng Kung University, Tainan; National Defense Medical Center (T-SC), Taipei; Department of Otolaryngology (C-CL); Department of Internal Medicine (Y-CS); Cancer Center (C-CL), Buddhist Dalin Tzu Chi General Hospital, Chiayi; and School of Medicine (Y-CS, C-CL), Tzu Chi University, Hualian, Taiwan
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Chang TS, Huang KY, Chang CM, Lin CH, Su YC, Lee CC. The association of hospital spending intensity and cancer outcomes: a population-based study in an Asian country. Oncologist 2014; 19:990-8. [PMID: 25117067 DOI: 10.1634/theoncologist.2014-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Different results are reported for the relationship between regional variation in medical spending and disease prognosis for acute illness and for cancer. Our objective was to investigate the association between hospital medical care spending intensity and mortality rates in cancer patients. METHODS A total of 80,597 patients with incident cancer diagnosed in 2002 were identified from the National Health Insurance Research Database of Taiwan, Republic of China. The Cox proportional hazards model was used to compare the 5-year survival rates of patients treated at hospitals with different spending intensities after adjusting for possible confounding and risk factors. RESULTS After adjustment for patient characteristics, treatment modality, and hospital volume, an association was found between lower hospital spending intensity and poorer survival rates. The 5-year survival rate expressed by hazard ratios was 1.36 (95% confidence interval [CI]: 1.30-1.43, p < .001) for colorectal cancer, 1.18 (95% CI: 1.08-1.29, p < .001) for lung cancer, 1.13 (95% CI: 1.05-1.22, p = .002) for hepatoma, 1.16 (95% CI: 1.07-1.26, p < .001) for breast cancer, and 1.23 (95% CI: 1.10-1.39, p = .001) for prostate cancer. CONCLUSION Our preliminary findings indicate that higher hospital spending intensity was associated with lower mortality rates in patients being treated for lung cancer, breast cancer, colorectal cancer, prostate cancer, hepatoma, or head and neck cancer. The cancer stages were unavailable in this series, and more research linked with the primary data may be necessary to clearly address this issue.
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Affiliation(s)
- Ting-Shou Chang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China
| | - Kuang-Yung Huang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China
| | - Chun-Ming Chang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China
| | - Chun-Hsuan Lin
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China
| | - Yu-Chieh Su
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China
| | - Ching-Chih Lee
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China
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Chang TS, Chang CM, Hsu TW, Lin YS, Lai NS, Su YC, Huang KY, Lin HL, Lee CC. The combined effect of individual and neighborhood socioeconomic status on nasopharyngeal cancer survival. PLoS One 2013; 8:e73889. [PMID: 24069242 PMCID: PMC3771923 DOI: 10.1371/journal.pone.0073889] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/23/2013] [Indexed: 11/26/2022] Open
Abstract
Background The relationship between individual and neighborhood socioeconomic status (SES) and mortality rates in patients with nasopharyngeal carcinoma (NPC) is unknown. This population-based study aimed to examine the association between SES and survival of patients with NPC in Taiwan. Materials and Methods A population-based follow-up study was conducted of 4691 patients diagnosed with NPC between 2002 and 2006. Each patient was traced to death or for 5 years. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income dichotomized into advantaged and disadvantaged areas. Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding factors and risk factors. Results In NPC patients below the age of 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score), NPC patients with low individual SES residing in disadvantaged neighborhoods were found to have a 2-fold higher risk of mortality than patients with high individual SES residing in advantaged neighborhoods. We found no significant difference in mortality rates between different SES groups in NPC patients aged 65 and above. Conclusions Our findings indicate that NPC patients with low individual SES who live in disadvantaged neighborhoods have the higher risk of mortality than their more privileged counterparts. Public health strategies and welfare policies would be well advised to try to offset the inequalities in health care and pay more attention to addressing the needs of this vulnerable group.
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Affiliation(s)
- Ting-Shou Chang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Ming Chang
- Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Ta-Wen Hsu
- Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Yaoh-Shiang Lin
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ning-Sheng Lai
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Yu-Chieh Su
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Cancer Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Kuang-Yung Huang
- Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Division of Rheumatology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Hung-Lung Lin
- Department of Research, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Center for Clinical Epidemiology and Biostatistics, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
- Community Medicine Research Center and the Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Education, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- * E-mail:
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Chang TS, Hou SJ, Su YC, Chen LF, Ho HC, Lee MS, Lin CH, Chou P, Lee CC. Disparities in oral cancer survival among mentally ill patients. PLoS One 2013; 8:e70883. [PMID: 23951029 PMCID: PMC3737269 DOI: 10.1371/journal.pone.0070883] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 01/31/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022] Open
Abstract
Background Many studies have reported excess cancer mortality in patients with mental illness. However, scant studies evaluated the differences in cancer treatment and its impact on survival rates among mentally ill patients. Oral cancer is one of the ten most common cancers in the world. We investigated differences in treatment type and survival rates between oral cancer patients with mental illness and without mental illness. Methods Using the National Health Insurance (NHI) database, we compared the type of treatment and survival rates in 16687 oral cancer patients from 2002 to 2006. The utilization rate of surgery for oral cancer was compared between patients with mental illness and without mental illness using logistic regression. The Cox proportional hazards model was used for survival analysis. Results Oral cancer patients with mental disorder conferred a grave prognosis, compared with patients without mental illness (hazard ratios [HR] = 1.58; 95% confidence interval [CI] = 1.30–1.93; P<0.001). After adjusting for patients’ characteristics and hospital characteristics, patients with mental illness were less likely to receive surgery with or without adjuvant therapy (odds ratio [OR] = 0.47; 95% CI = 0.34–0.65; P<0.001). In multivariate analysis, oral cancer patients with mental illness carried a 1.58-times risk of death (95% CI = 1.30–1.93; P<0.001). Conclusions Oral cancer patients with mental illness were less likely to undergo surgery with or without adjuvant therapy than those without mental illness. Patients with mental illness have a poor prognosis compared to those without mental illness. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this vulnerable group.
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Affiliation(s)
- Ting-Shou Chang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Szu-Jen Hou
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Yu-Chieh Su
- Cancer Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Division of Hematology-Oncology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Li-Fu Chen
- Department of Emergency, National Yang-Ming University Hospital, Taipei, Taiwan
| | - Hsu-Chieh Ho
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Cancer Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Moon-Sing Lee
- Cancer Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Chun-Hsuan Lin
- Department of Medical Research, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and the Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- Cancer Center, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualian, Taiwan
- Community Medicine Research Center and the Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Huang YS, Lee CC, Chang TS, Ho HC, Su YC, Hung SK, Lee MS, Chou P, Chang YH, Lee CC. Increased risk of stroke in young head and neck cancer patients treated with radiotherapy or chemotherapy. Oral Oncol 2011; 47:1092-7. [PMID: 21852184 DOI: 10.1016/j.oraloncology.2011.07.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/20/2011] [Accepted: 07/22/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Chemo-radiotherapy-induced carotid stenosis and cerebrovascular events in head and neck cancer patients can cause severe disability and death. We aimed to estimate the risk of stroke in such patients over a six-year follow-up period. PATIENTS AND METHODS The study cohort consisted of head and neck cancer patients (n=10,172). Cox proportional hazard model was used to compare the stroke-free survival rate between the patients treated with radiotherapy or chemotherapy, surgery alone, and surgery with adjuvant therapy after adjusting for possible confounding factors. RESULTS At the end of follow-up, 384 patients had strokes: 126 (4.3%) from the surgery alone group, 167 (3.8%) from the radiotherapy or chemotherapy group, and 91 (3.2%) from the surgery with adjuvant therapy (P=0.222). Head and neck cancer patients aged less than 55 years treated with radiotherapy or chemotherapy conferred a 1.8-fold higher risk for stroke (95% CI, 1.22-2.56; P=0.003) after adjusting for patient characteristics, co-morbidities, geographic region, urbanization level, and socio-economic status. There was no statistical difference in stroke risk between different treatment modalities in head and neck cancer patients aged 55 years and more. CONCLUSIONS Young head and neck cancer patients treated with radiotherapy or chemotherapy have higher risks for stroke. Different treatment strategies should be considered in such patients.
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Affiliation(s)
- Yung-Sung Huang
- Division of Neurology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
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Ward BH, Bohm-Velez M, Kieper D, Chang TS, Straka MR. Abstract P5-01-13: The Clinical Role and Cost Effectiveness of Breast-Specific Gamma Imaging (BSGI) in the Management of Patients with Negative or Indeterminate Mammographic and Sonographic Findings and an Unresolved Diagnostic Concern. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-01-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: BSGI is a molecular imaging technique increasingly used to aid in the management of patients with negative or indeterminate mammograms and an unresolved clinical concern such as indeterminate densities, new vague calcifications, bloody nipple discharge, focal breast pain or palpable masses; especially in those of elevated risk and patients with dense breast tissue.
Purpose: This study examines the role and cost effectiveness of BSGI in providing additional information when conventional imaging is indeterminate and greater confidence is required to improve diagnostic accuracy.
Methods: This is a retrospective analysis of patients in our practice for whom BSGI was recommended due to an unresolved clinical concern following negative (BI-RADS 1 or2), indeterminate (BI-RADS 0 or 3), or discordant findings on mammography (MMG) or ultrasound (US). For all modalities, the radiologist had the patient's history and imaging studies available to them at the time of interpretation. BSGI studies were classified as negative (BI-RADS 0-3) or positive (BI-RADS 4-5). Biopsy or follow up imaging was performed as recommended by the radiologist. Pathology or 6 month follow up imaging was used as the gold standard and were classified as negative (benign pathology or no evidence of malignancy on follow up imaging) or positive (biopsy proven cancer).
Results: There were 95 patients with 102 regions of concern, yielding 15 biopsy proven malignant lesions and 87 benign findings on pathology or follow up imaging. BSGI was positive in 12 malignant and 33 benign lesions and negative in 54 benign lesions, yielding a sensitivity of 80% and a specificity of 62%. The negative predictive value of BSGI in this population was 95%.
Conclusion: BSGI contributed significantly to patient management by detecting cancer in 12 of the 95 patients (12.6%). The Medicare reimbursement rate for BSGI in our area is $203.26. Therefore the cost per cancer diagnosis in this population was approximately $1,608.35. If these patients had been sent for breast MRI, $1,026.38 Medicare locally, the cost per diagnosis would rise to $8,129.07. BSGI is a useful, cost effective, complimentary tool in the diagnostic work up of patients when a diagnostic concern remains after negative or indeterminate conventional imaging.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-01-13.
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Affiliation(s)
- BH Ward
- Weinstein Imaging Associates, Pittsburgh, PA; Hampton University Center for Advanced Medical Instrumentation, Hampton, VA
| | - M Bohm-Velez
- Weinstein Imaging Associates, Pittsburgh, PA; Hampton University Center for Advanced Medical Instrumentation, Hampton, VA
| | - D Kieper
- Weinstein Imaging Associates, Pittsburgh, PA; Hampton University Center for Advanced Medical Instrumentation, Hampton, VA
| | - TS Chang
- Weinstein Imaging Associates, Pittsburgh, PA; Hampton University Center for Advanced Medical Instrumentation, Hampton, VA
| | - MR. Straka
- Weinstein Imaging Associates, Pittsburgh, PA; Hampton University Center for Advanced Medical Instrumentation, Hampton, VA
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Chang TS, Chu ST, Hou YY, Chang KP, Chi CC, Lee CC. Validation of bidimensional measurement in nasopharyngeal carcinoma. Radiat Oncol 2010; 5:72. [PMID: 20712871 PMCID: PMC2930639 DOI: 10.1186/1748-717x-5-72] [Citation(s) in RCA: 3] [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: 06/11/2010] [Accepted: 08/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our previous study showed a close relationship between computed tomography (CT)-derived bidimensional measurement of primary tumor and retropharyngeal nodes (BDMprn) and gross tumor volume of primary tumor and retropharyngeal nodes (GTVprn) in nasopharyngeal carcinoma (NPC) and better prognosis for NPC patients with smaller BDMprn. In this study, we report the results on of a study to validate the use of BDM in a separate cohort of NPC patients. METHODS We retrospectively reviewed 103 newly diagnosed NPC cases who were treated with radiotherapy/concurrent chemoradiotherapy (CCRT) or CCRT with adjuvant chemotherapy from 2002 to 2009. We used magnetic resonance imaging (MRI) to measure BDMprn. We calculated overall survival, recurrence-free and distant metastasis-free survival curves and set a BDMprn cut off point to categorize patients into a high- or low-risk group. We then used Cox proportional hazard model to evaluate the prognostic influence of BDMprn after correcting age, gender and chemotherapy status. RESULTS After adjusting for age, gender, and chemotherapy status, BDMprn remained an independent prognostic factor for distant metastasis [Hazard ratio (HR) = 1.046; P = 0.042] and overall survival (HR = 1.012; P = 0.012). Patients with BDMprn < 15 cm2 had a greater 3-year overall survival rate than those with BDMprn > or = 15 cm2 (92.3% vs. 73.7%; P = 0.009). They also had a greater 3-year distant metastasis-free survival (94% vs.75%; P = 0.034). CONCLUSION The predictive ability of BDMprn was validated in a separate NPC cohort. A BDMprn of 15 cm2 can be used to separate NPC patients into high- and low-risk groups and predict survival rates and metastasis potential. It can, therefore, be used as a reference to design clinical trials, predict prognosis, and make treatment decisions.
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Affiliation(s)
- Ting-Shou Chang
- Department of Otolaryngology, Buddhist Tzu Chi Dalin General Hospital, Chiayi County 622, Taiwan
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Wan HM, Chen CC, Giridhar R, Chang TS, Wu WT. Repeated-batch production of kojic acid in a cell-retention fermenter using Aspergillus oryzae M3B9. J Ind Microbiol Biotechnol 2005; 32:227-33. [PMID: 15895266 DOI: 10.1007/s10295-005-0230-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 04/13/2005] [Indexed: 10/25/2022]
Abstract
A cell-retention fermenter was used for the pilot-scale production of kojic acid using an improved strain of Aspergillus oryzae in repeated-batch fermentations. Among the various carbon and nitrogen sources used, sucrose and yeast extract promoted pellet morphology of fungi and higher kojic acid production. Repeated-batch culture using a medium replacement ratio of 75% gave a productivity of 5.3 gL(-1)day(-1) after 11.5 days of cultivation. While batch culture in shake-flasks resulted in a productivity of 5.1 gL(-1)day(-1), a productivity of 5 gL(-1)day(-1) was obtained in a pilot-scale fermenter. By converting the batch culture into repeated batches, the non-productive downtime of cleaning, filling and sterilizing the fermenter between each batch were eliminated, thereby increasing the kojic acid productivity.
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Affiliation(s)
- H M Wan
- Department of Chemical Engineering, National Tsing Hua University, Taiwan, Republic of China
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Zheng B, Ganott MA, Britton CA, Hakim CM, Hardesty LA, Chang TS, Rockette HE, Gur D. Soft-copy mammographic readings with different computer-assisted detection cuing environments: preliminary findings. Radiology 2001; 221:633-40. [PMID: 11719657 DOI: 10.1148/radiol.2213010308] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the performance of radiologists in the detection of masses and microcalcification clusters on digitized mammograms by using different computer-assisted detection (CAD) cuing environments. MATERIALS AND METHODS Two hundred nine digitized mammograms depicting 57 verified masses and 38 microcalcification clusters in 85 positive and 35 negative cases were interpreted independently by seven radiologists using five display modes. Except for the first mode, for which no CAD results were provided, suspicious regions identified with a CAD scheme were cued in all the other modes by using a combination of two cuing sensitivities (90% and 50%) and two false-positive rates (0.5 and 2.0 per image). A receiver operating characteristic study was performed by using soft-copy images. RESULTS CAD cuing at 90% sensitivity and a rate of 0.5 false-positive region per image improved observer performance levels significantly (P < .01). As accuracy of CAD cuing decreased so did observer performances (P < .01). Cuing specificity affected mass detection more significantly, while cuing sensitivity affected detection of microcalcification clusters more significantly (P < .01). Reduction of cuing sensitivity and specificity significantly increased false-negative rates in noncued areas (P < .05). Trends were consistent for all observers. CONCLUSION CAD systems have the potential to significantly improve diagnostic performance in mammography. However, poorly performing schemes could adversely affect observer performance in both cued and noncued areas.
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Affiliation(s)
- B Zheng
- Division of Imaging Research, Department of Radiology, University of Pittsburgh, 300 Halket St, Suite 4200, Pittsburgh, PA 15213, USA.
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Affiliation(s)
- S G Rhee
- Laboratory of Cell Signaling, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-8015, USA.
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Chang TS, Lee KS, Lee GY, Jeon SD, So DS, Khil LY, Chung MK, Moon CK. NQ-Y15 inhibits the calcium mobilization by elevation of cyclic AMP in rat platelets. Biol Pharm Bull 2001; 24:480-3. [PMID: 11379764 DOI: 10.1248/bpb.24.480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
2-1(4-Cyanophenyl)aminol-3-chloro-1,4-naphthalenedione (NQ-Y15) is a dual action drug which acts as a thromboxane A2 (TXA2) synthase inhibitor and TXA2/PGH2 receptor antagonist. In the present study, we examined the effects of NQ-Y15 on Ca2+ mobilization, which is the common event in various types of platelet activation, in arachidonic acid (AA)-stimulated rat platelets. The elevation of cytosolic Ca2+ concentration ([Ca2+]i) induced by AA was inhibited by NQ-Y15 in a concentration-dependent manner. This inhibition-effect of NQ-Y15 was found to be based on the suppression of the rise in [Ca2+]i by the inhibition of both Ca2+ release from internal stores and Ca2+ influx from the extracellular space. Our successive trial was focused on the role of cyclic AMP (cAMP) in the action of NQ-Y15, because cAMP was reported to be increased by dual action drugs such as picotamide and to inhibit the increase in [Ca2+]i. NQ-Y15 was confirmed to increase cAMP in AA-stimulated rat platelets. These results suggested that NQ-Y15 might inhibit the rise in [Ca2+]i in AA-treated rat platelets by increasing cAMP, which is involved in the inhibition of platelet activation.
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Affiliation(s)
- T S Chang
- College of Pharmacy, Seoul National University, Korea
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Cho SG, Lee YH, Park HS, Ryoo K, Kang KW, Park J, Eom SJ, Kim MJ, Chang TS, Choi SY, Shim J, Kim Y, Dong MS, Lee MJ, Kim SG, Ichijo H, Choi EJ. Glutathione S-transferase mu modulates the stress-activated signals by suppressing apoptosis signal-regulating kinase 1. J Biol Chem 2001; 276:12749-55. [PMID: 11278289 DOI: 10.1074/jbc.m005561200] [Citation(s) in RCA: 295] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Apoptosis signal-regulating kinase 1 (ASK1) is a mitogen-activated protein kinase kinase kinase that can activate the c-Jun N-terminal kinase and the p38 signaling pathways. It plays a critical role in cytokine- and stress-induced apoptosis. To further characterize the mechanism of the regulation of the ASK1 signal, we searched for ASK1-interacting proteins employing the yeast two-hybrid method. The yeast two-hybrid assay indicated that mouse glutathione S-transferase Mu 1-1 (mGSTM1-1), an enzyme involved in the metabolism of drugs and xenobiotics, interacted with ASK1. We subsequently confirmed that mGSTM1-1 physically associated with ASK1 both in vivo and in vitro. The in vitro binding assay indicated that the C-terminal portion of mGSTM1-1 and the N-terminal region of ASK1 were crucial for binding one another. Furthermore, mGSTM1-1 suppressed stress-stimulated ASK1 activity in cultured cells. mGSTM1-1 also blocked ASK1 oligomerization. The ASK1 inhibition by mGSTM1-1 occurred independently of the glutathione-conjugating activity of mGSTM1-1. Moreover, mGSTM1-1 repressed ASK1-dependent apoptotic cell death. Taken together, our findings suggest that mGSTM1-1 functions as an endogenous inhibitor of ASK1. This highlights a novel function for mGSTM1-1 insofar as mGSTM1-1 may modulate stress-mediated signals by repressing ASK1, and this activity occurs independently of its well-known catalytic activity in intracellular glutathione metabolism.
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Affiliation(s)
- S G Cho
- National Creative Research Initiative Center for Cell Death, Graduate School of Biotechnology, Korea University, Anam-dong, Sungbuk-ku, Seoul 136-701, South Korea
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Chang YH, Hardesty LA, Hakim CM, Chang TS, Zheng B, Good WF, Gur D. Knowledge-based computer-aided detection of masses on digitized mammograms: a preliminary assessment. Med Phys 2001; 28:455-61. [PMID: 11339741 DOI: 10.1118/1.1359250] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this work was to develop and evaluate a computer-aided detection (CAD) scheme for the improvement of mass identification on digitized mammograms using a knowledge-based approach. Three hundred pathologically verified masses and 300 negative, but suspicious, regions, as initially identified by a rule-based CAD scheme, were randomly selected from a large clinical database for development purposes. In addition, 500 different positive and 500 negative regions were used to test the scheme. This suspicious region pruning scheme includes a learning process to establish a knowledge base that is then used to determine whether a previously identified suspicious region is likely to depict a true mass. This is accomplished by quantitatively characterizing the set of known masses, measuring "similarity" between a suspicious region and a "known" mass, then deriving a composite "likelihood" measure based on all "known" masses to determine the state of the suspicious region. To assess the performance of this method, receiver-operating characteristic (ROC) analyses were employed. Using a leave-one-out validation method with the development set of 600 regions, the knowledge-based CAD scheme achieved an area under the ROC curve of 0.83. Fifty-one percent of the previously identified false-positive regions were eliminated, while maintaining 90% sensitivity. During testing of the 1,000 independent regions, an area under the ROC curve as high as 0.80 was achieved. Knowledge-based approaches can yield a significant reduction in false-positive detections while maintaining reasonable sensitivity. This approach has the potential of improving the performance of other rule-based CAD schemes.
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Affiliation(s)
- Y H Chang
- Department of Radiology, University of Pittsburgh, Pennsylvania 15261-0001, USA
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Li HY, Chang TS. Vaginal fluid creatinine, human chorionic gonadotropin and alpha-fetoprotein levels for detecting premature rupture of membranes. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:686-90. [PMID: 11037644] [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: 02/18/2023]
Abstract
BACKGROUND Diagnosis of premature rupture of membranes (PROM) is difficult in equivocal cases. The concentrations of human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and creatinine are high in amniotic fluid. The purpose of this study was to determine the usefulness of vaginal fluid hCG, AFP and creatinine measurements in the detection of PROM. METHODS About 3 ml of normal saline was used to irrigate the posterior vaginal fornix and was collected for the measurement of hCG, AFP and creatinine. The control group included 10 normal pregnant women in the third trimester (> 28 weeks of gestational age). Levels of hCG, AFP and creatinine were compared with those of 10 women with confirmed PROM. RESULTS The median levels of vaginal fluid hCG of normal pregnant women and pregnant women with confirmed PROM were 35.0 mIU/ml and 478.0 mIU/ml (p = 0.0046), respectively. For AFP, the corresponding values were 0.80 ng/ml and 54.24 ng/ml (p < 0.0001), respectively, and for creatinine, the values were 0.05 mg/dl and 0.95 mg/dl (p < 0.0001), respectively. All three markers were significantly higher in the experimental group than in the control group. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for hCG were 80%, 70%, 72.7%, 77.8% and 75%, respectively. For AFP, these values were 90%, 100%, 100%, 90.9%, and 95.0%, respectively, and for creatinine, they were 90%, 100%, 100%, 90.9%, and 95%, respectively. The diagnostic value of AFP or creatinine level in vaginal washing may be better than that of hCG, though the difference was not statistically significant, probably due to the limited case number. CONCLUSIONS Creatinine in vaginal fluid washings is a useful marker for PROM. It was less expensive and easier to measure than hCG and AFP, and appears to be more accurate than hCG.
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Affiliation(s)
- H Y Li
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan, ROC
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Potter MJ, Chang TS, Lee AS, Rai S. Improvement in macular function after retinal translocation surgery in a patient with age-related macular degeneration. Am J Ophthalmol 2000; 129:547-9. [PMID: 10764875 DOI: 10.1016/s0002-9394(99)00480-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess focal electroretinographic findings before and after retinal translocation surgery in a patient with age-related macular degeneration. METHOD Case report. A 79-year-old man with a well-defined subfoveal choroidal neovascular membrane from age-related macular degeneration underwent preoperative and postoperative focal electroretinography. RESULTS After retinal translocation surgery, best-corrected Snellen visual acuity improved from 9/200 to 20/60. A significant increase in mean foveal amplitude, from 0.08 microV to 0.16 microV (P = 0.008) was recorded. CONCLUSION Age-related macular degenerative changes in visual acuity and foveal electroretinogram amplitude may be reversible after retinal translocation surgery.
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Affiliation(s)
- M J Potter
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada.
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Hardesty LA, Sumkin JH, Nath ME, Edwards RP, Price FV, Chang TS, Johns CM, Kelley JL. Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis. Radiology 2000; 215:45-9. [PMID: 10751466 DOI: 10.1148/radiology.215.1.r00ap3945] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the cost of magnetic resonance (MR) imaging and its ability to direct the use of lymph node dissection with the cost and ability of conventional surgery for the staging of endometrial carcinoma. MATERIALS AND METHODS Preoperative MR images of 25 patients who underwent hysterectomy for endometrial carcinoma were retrospectively evaluated. MR imaging results were compared with those of intraoperative gross dissection of the uterus and final histopathologic examination. Medicare reimbursements for two scenarios were compared in each patient. In the MR imaging scenario, the necessity for lymph node dissection was based on MR imaging results and histologic findings at biopsy. In the actual scenario, lymph node dissection was performed at the surgeon's discretion on the basis of findings at gross dissection of the uterus and histologic examination at biopsy. RESULTS The cost of the MR imaging scenario, as defined by Medicare reimbursements, was 1% ($1, 265/$148,500) less than that of the actual scenario. In the MR imaging scenario, all patients who required lymph node dissection received it, and 86% of the lymph node dissections performed were necessary. In the actual scenario, one necessary lymph node dissection was not performed, and only 31% of the lymph node dissections performed were necessary. CONCLUSION Staging with MR imaging has costs and accuracy similar to those of the current method of staging with intraoperative gross dissection of the uterus. In addition, MR imaging decreases the number of unnecessary lymph node dissections.
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Affiliation(s)
- L A Hardesty
- Department of Radiology, Magee Women's Hospital, University of Pittsburgh, PA 15213, USA.
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Abstract
The effects of brazilin on glucose transport into isolated rat epididymal adipocytes were investigated. Brazilin increased [3H]2-deoxy-D-glucose uptake, which was characterized by an increase in Vmax with no effect on the Km value. Phenylarsine oxide, which inhibits the translocation of glucose transporters, decreased brazilin-stimulated glucose transport to the basal level. The inhibition of phosphatidylinositol 3-kinase (PI3-kinase) with wortmannin also blocked brazilin-stimulated glucose transport. Western blot analysis with an anti-GLUT4 antibody revealed that brazilin increased the translocation of GLUT4 from intracellular pools to the plasma membrane. Brazilin, in combination with phorbol ester, showed an additive effect on glucose transport. The stimulating effect of phorbol ester on glucose transport was inhibited by staurosporine, but the effect of brazilin remained unchanged. Protein kinase C activity was not influenced by brazilin treatment. The inhibition of protein synthesis showed no effect on brazilin-stimulated glucose transport, and GLUT4 content in the total membrane fraction was not altered as a result of treatment with brazilin for 4 hr. Metabolic labeling of GLUT4 with [35S]methionine showed that de novo synthesis of GLUT4 was not induced by brazilin. These data suggest that brazilin may increase glucose transport by recruitment of GLUT4 from intracellular pools to the plasma membrane of adipocytes via the activation of PI3-kinase. However, the effect of brazilin may not be mediated by GLUT4 synthesis and protein kinase C activation.
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Affiliation(s)
- L Y Khil
- College of Pharmacy, Seoul National University, Kwanak-Gu, Korea
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Linder M, Chang TS, Scott IU, Hay D, Chambers K, Sibley LM, Weis E. Validity of the visual function index (VF-14) in patients with retinal disease. Arch Ophthalmol 1999; 117:1611-6. [PMID: 10604665 DOI: 10.1001/archopht.117.12.1611] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To test the validity of the Visual Function Index (VF-14) in patients with retinal disease. DESIGN A self-administered questionnaire package in association with clinical examination findings. PARTICIPANTS Consecutive patients attending the Vancouver General Hospital Eye Care Centre, Vancouver, British Columbia, retina clinic between May 1 and August 15, 1998. MAIN OUTCOME MEASURES Responses to the questionnaire package as they relate to global self-assessment scales and visual acuity. In addition, correlations were calculated between the VF-14, the 36-Item Short-Form Health Survey, a Weighted Comorbidity Scale, and visual acuity scores. RESULT Five hundred forty-seven patients were given the questionnaire package to complete. The VF-14 demonstrated a moderately strong positive association with patient self-rating of amount of trouble, satisfaction, and overall quality of vision. Correlations between the 36-Item Short-Form Health Survey, visual acuity, and the global scales were mild to moderate. The VF-14 was moderately correlated with visual acuity in the better and the worse eyes. CONCLUSIONS This study provides support for the validity of the VF-14 as a measure of functional impairment in patients with retinal disease. Once responsiveness has been measured and an analysis of disease subtypes has been carried out, the VF-14 will be ready for inclusion in clinical trials to evaluate patients' functional ability. Further implementation and development of this outcome measure will better our understanding of the utility of the functional assessment format for patients with retinal disease.
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Affiliation(s)
- M Linder
- Department of Ophthalmology, University of British Columbia, Vancouver, Canada
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Chang CW, Hay D, Chang TS, Nguyen R, Lyons CJ. Retinal periphlebitis in a patient with pineal germinoma. Arch Ophthalmol 1999; 117:1434-6. [PMID: 10532463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Chang TS, McGill E, Hay DA, Ross WH, Maberley AL, Sibley LM, Ma PE, Potter MJ. Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole. Br J Ophthalmol 1999; 83:944-8. [PMID: 10413699 PMCID: PMC1723162 DOI: 10.1136/bjo.83.8.944] [Citation(s) in RCA: 20] [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] [Indexed: 02/02/2023]
Abstract
AIM To review the rate of retinal detachment after macular hole surgery in patients who received vitrectomy and scleral buckle versus those who had vitrectomy alone. METHODS All patient charts and hospital records were examined for patients who underwent vitrectomy surgery for macular hole between September 1993 and June 1997. A total of 326 patients were identified and all were followed for a minimum of 6 months. Clinical records were examined for details of the surgical procedure, visual acuity, hole closure status, adjuvant therapies used, and postoperative retinal attachment status. Relative risks (the ratio of the incidence rate in the exposed to that in the unexposed) with 95% confidence intervals and chi(2) tests were calculated to determine which variables were associated with retinal detachment. The primary outcome measure in this review was retinal attachment status. RESULTS Of 326 eyes which underwent surgery for macular hole during the study period, scleral buckles were utilised in 152 (46.6%) patients. Analysis revealed a detachment rate of 13.2% in patients who did not receive a scleral buckle compared with 5.9% detachment rate in those who did. Analysis of these results indicated a 2.42 times greater risk of developing a retinal detachment in patients without a scleral buckle. Complications related to the use of scleral buckles occurred in two of 152 cases (1.3%) CONCLUSIONS A reduction in the rate of retinal detachment was noted in patients receiving prophylactic scleral buckles. Those finding suggest a possible beneficial effect of this adjunctive procedure in preventing postoperative retinal detachments. The authors are currently preparing a multicentred, prospective, clinical trial to further study this hypothesis
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Affiliation(s)
- T S Chang
- Division of Vitreo-Retinal Surgery, Department of Ophthalmology, University of British Columbia, Vancouver, Canada
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Chang TS, Hay D, Courtright P. Age-related macular degeneration in Chinese-Canadians. Can J Ophthalmol 1999; 34:266-71. [PMID: 10486685] [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: 02/14/2023]
Abstract
BACKGROUND Ethnicity has long been suspected to play a role in the risk of macular degeneration as well as its neovascular complications. We carried out a study to determine the prevalence of retinal diseases in Chinese-Canadians presenting for fluorescein angiography compared to a matched group of Canadians of European origin. METHODS We reviewed 20,000 consecutive fluorescein angiograms obtained between December 1987 and November 1993 at a tertiary referral centre for ophthalmic care in Vancouver. All patients identified by name as being of Chinese ancestry were identified and matched to a patient of European ancestry. The two groups were compared in regard to the prevalence of specific retinal diseases, including age-related macular degeneration (AMD). RESULTS Among the first 10,000 fluorescein angiograms, 417 patients of Chinese ancestry were identified, of whom 61 (14.6%) had the primary diagnosis of AMD. The rate among the patients of European ancestry was 30.4% (127/417) (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.79 to 2.56) (p < 0.001). A total of 88 ethnic Chinese patients were identified among the subsequent 10,000 angiograms. Pigment epithelial detachments were more than twice as common in the overall group of ethnic Chinese patients as in their counterparts of European ancestry (OR 2.6, 95% CI 0.7 to 10.1). Choroidal neovascularization was 1.6 times more common in the latter group (95% CI 0.98 to 2.8). INTERPRETATION The findings support the growing clinical observations of a lower prevalence of AMD in nonwhite populations in addition to an increased prevalence of pigment epithelial detachments in ethnic Chinese patients.
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Affiliation(s)
- T S Chang
- Vitreoretinal Trials and Methodology Centre, Vancouver, BC
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Silver RI, Rodriguez R, Chang TS, Gearhart JP. In vitro fertilization is associated with an increased risk of hypospadias. J Urol 1999; 161:1954-7. [PMID: 10332480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
PURPOSE The purpose of this study was to determine if there is an increased incidence of hypospadias in male offspring conceived by in vitro fertilization (IVF). MATERIALS AND METHODS A retrospective institutional chart review from 1988 to 1992 and data from the Maryland Birth Defects Registry were statistically analyzed to assess the risk of hypospadias with IVF. RESULTS The data for the 5-year period indicated a 5-fold increased risk of hypospadias after IVF, with an incidence of approximately 1.5% in the IVF group and 0.3% in the control group. The only recognized difference between the groups was maternal progesterone administration in the IVF group but the cause of the increased risk of hypospadias was unknown. The distribution of hypospadias severity was similar in both groups. CONCLUSIONS Male newborns conceived by IVF have a 5-fold increased risk of hypospadias, which may be related to maternal progesterone administration, or other maternal or fetal endocrine abnormalities that may or may not be related to infertility. Health care providers should be aware of this risk so that they can properly counsel infertile couples seeking assisted reproduction by IVF technology.
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Affiliation(s)
- R I Silver
- Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Kim IJ, Lee KW, Park BY, Lee JK, Park J, Choi IY, Eom SJ, Chang TS, Kim MJ, Yeom YI, Chang SK, Lee YD, Choi EJ, Han PL. Molecular cloning of multiple splicing variants of JIP-1 preferentially expressed in brain. J Neurochem 1999; 72:1335-43. [PMID: 10098834 DOI: 10.1046/j.1471-4159.1999.721335.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK) is activated by a variety of cellular or environmental stresses. Proper regulation of the SAPK/JNK pathway may be critical for cell survival or death under various conditions. In this study, we report the molecular cloning of novel isoforms of JIP-1, which harbor a putative phosphotyrosine interaction domain and a helix-loop-helix domain, as well as an SH3 homologous region in the C terminus. Northern analysis indicates that transcription variant jip-1 is expressed in brain and kidney and transcription variants jip-2 and jip-3 are specifically expressed in brain. In situ hybridization data showed that the hybridized jip messages were heavily concentrated in adult brain, and were particularly enriched in the cerebral cortex and hippocampus, the brain regions vulnerable to pathological states such as hypoxia-ischemia, epilepsy, and Alzheimer's disease. All the deduced protein products of the jip transcription variants appear to have a similar property in that they inhibit the SAPK/JNK stimulation when overexpressed. Inhibition of SAPK activation by overexpression of the novel isoform JIP-2a resulted in suppression of etoposide-induced cell death in a neuroglioma cell line, N18TG. These findings suggest that JIP may play an important role in regulation of the SAPK pathway that is involved in stress-induced cellular responses.
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Affiliation(s)
- I J Kim
- Laboratory for Basic Research, Hanhyo Institutes of Technology, Taejon, Korea
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Hwang GS, Kim JY, Chang TS, Jeon SD, So DS, Moon CK. Effects of Brazilin on the phospholipase A2 activity and changes of intracellular free calcium concentration in rat platelets. Arch Pharm Res 1998; 21:774-8. [PMID: 9868555 DOI: 10.1007/bf02976775] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Brazilin (7,11b-dihydrobenz[b]indeno[1,2-d]pyran-3,6a,9,10 (6 H)-tetrol) inhibited thrombin-,collagen- and ADP-induced aggregation of washed rat platelets. Thrombin- and collagen-induced ATP release were also inhibited by brazilin in a concentration-dependent manner. Brazilin inhibited the formation of platelet thromboxane A2 caused by thrombin, whereas it had no effect on the prostaglandin D2 formation. Brazilin inhibited [3H]-arachidonic acid liberation from membrane phospholipids of thrombin-stimulated platelets. Brazilin inhibited the rise of intracellular free calcium caused by thrombin. These results indicate that the inhibition of phospholipase (PLA2) activity and [Ca2+]i elevation might be at least a part of antiplatelet mechanism of brazilin.
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Affiliation(s)
- G S Hwang
- College of Oriental Medicine, Kyung Won University, Seongnam, Korea
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Chang TS, Tawansy K, Hay P, Holland S. Endophthalmitis induced by Chryseomonas indologen. Arch Ophthalmol 1998; 116:1533-4. [PMID: 9823363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Lee YH, Chang TS, Liu HJ, Chu WS. An acidic glutaryl-7-aminocephalosporanic acid acylase from Pseudomonas nitroreducens. Biotechnol Appl Biochem 1998; 28:113-8. [PMID: 9756463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A glutaryl-7-aminocephalosporanic acid (GL-7-ACA) acylase was purified 58-fold from Pseudomonas nitroreducens in a two-step procedure involving osmotic shock and carboxymethyl-Sepharose chromatography with a yield of 26%. The molecular mass of the native enzyme was 58 kDa. SDS/PAGE revealed that it consisted of two non-identical subunits with molecular masses of 35 and 21 kDa. The isoelectric point of the purified enzyme was 5.3. The enzyme had an optimal pH of 5.5 and an optimal temperature of 43 degrees C. The purified enzyme exhibited not only GL-7-ACA acylase activity but also gamma-glutamyltranspeptidase activity. The Km values of the enzyme for GL-7-ACA and L-gamma-glutamyl p-nitroanilide were 10.41 mM and 5.92 microM respectively.
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Affiliation(s)
- Y H Lee
- Food Industry Research and Development Institute, Hsinchu, Taiwan 300, Republic of China
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Abstract
OBJECTIVE To provide long-term follow-up information on a large series of patients with choroidal osteoma. METHODS Review of patients with a diagnosis of choroidal osteoma who had been examined at the Bascom Palmer Eye Institute, Miami, Fla, or known to one of us (J.D.M.G.). Information was obtained from hospital medical records or by a questionnaire sent to referring ophthalmologists. Life-table analysis was used to study the loss of vision and development of choroidal neovascularization. RESULTS We followed up 36 patients, 31 (89%) were female, mean age, 21 years (range, 5-54 years) for a mean of 10 years (range, 2-22 years). Growth was observed for 9 (41%) of 22 well-documented osteomas. The probability of loss of visual acuity to 20/200 or worse was 58% by 10 years and 62% by 20 years. The probability of developing choroidal neovascularization was 47% by 10 years and 56% by 20 years. Successful treatment of the choroidal neovascularization with laser photocoagulation was performed for 5 (25%) of 20 patients. CONCLUSIONS Most patients with choroidal osteomas maintain good vision in at least 1 eye, but they have a high risk of developing choroidal neovascularization. When this occurs, only a minority can be successfully treated with laser photocoagulation.
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Affiliation(s)
- G W Aylward
- Bascom Palmer Eye Institute, Miami, Fla, USA
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Crone JK, Burnett AL, Chamness SL, Strandberg JD, Chang TS. Neuronal nitric oxide synthase in the canine prostate: aging, sex steroid, and pathology correlations. J Androl 1998; 19:358-64. [PMID: 9639053] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nitric oxide synthase (NOS) is expressed in the prostate of various species, including humans. NOS catalyzes the production of nitric oxide (NO), which may function in prostatic smooth-muscle relaxation. To investigate further the role of NO in the prostate, we examined neuronal NOS expression in the aging canine prostate, after hormonal perturbation, and correlated these results with histopathologic findings. The study comprised the following treatment groups: intact dogs (treatment group 1, n = 6); dogs who were castrated at 7 days of age and received testosterone and estrogen replacement at 2 years of age (treatment group 2, n = 10); and dogs who were castrated at 2 years of age and received testosterone and estrogen replacement at 2 years of age (treatment group 3, n = 9). Studies were done on prostates removed from dogs after euthanasia at 6 years of age. In treatment group 1, complex benign prostatic hyperplasia (BPH) was observed in all specimens. In treatment group 2, atrophy was observed in 70%, normal prostate with small areas of hyperplasia in 20%, and BPH in 10% of specimens. In treatment group 3, atrophy was observed in 78%, normal histology with small areas of hyperplasia in 11%, and BPH in 11% of specimens. Neuronal NOS localizations were confirmed by western blot analysis and by immunohistochemistry in 0% and 17%, respectively, of specimens in treatment group 1, in 60% and 70%, respectively, of specimens in treatment group 2, and in 67% and 71%, respectively, of specimens in treatment group 3. Neuronal NOS immunoreactivity was localized in histologically normal prostates of four intact, young-adult control dogs (2 years of age). For all treatment groups, neuronal NOS immunoreactivity was confirmed by western blot in 86% of atrophic prostates but in no prostates with BPH (P < 0.001), and it was confirmed by immunohistochemistry in 75% of atrophic prostates but in only 13% of prostates with BPH (P < 0.02). These data suggest that, in the canine prostate, NO release relates to growth and pathology. Low levels of neuronal NOS expression in BPH tissue, compared with higher levels in atrophic tissue, suggest that neuronal NOS expression is down-regulated in the prostate with benign cellular proliferation whereas it is maintained or possibly up-regulated in the prostate with prostatic involution. Whether altered neuronal NOS expression contributes to the pathogeneses of BPH and prostatic involution or whether it occurs as a consequence of these processes requires further investigation.
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Affiliation(s)
- J K Crone
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Shaw CC, Wang T, King JL, Breitenstein DS, Chang TS, Harris KM, Baratz AB, Ganott MA, Reginella R, Sumkin JH, Gur D. Computed radiography versus screen-film mammography in detection of simulated microcalcifications: a receiver operating characteristic study based on phantom images. Acad Radiol 1998; 5:173-80. [PMID: 9522883 DOI: 10.1016/s1076-6332(98)80281-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES The authors compare a 43-micron computed radiographic system with a mammographic screen-film system for detection of simulated microcalcifications in an observer-performance study. MATERIALS AND METHODS The task of detecting microcalcifications was simulated by imaging aluminum wire segments (200-500 microns in length; 100, 125, or 150 microns in diameter) that overlapped with tissue background structures produced by beef brisket. A total of 288 such simulations were generated and examined with both computed radiography and conventional screen-film mammography techniques. Computed radiography was performed with high-resolution plates, a 43-micron image reader, and a 43-micron laser film printer. Computed radiographic images were printed with simple contrast enhancement and compared with screen-film images in a receiver operating characteristic study in which experienced readers detected and scored the simulated microcalcifications. Observer performance was quantitated and compared by computing the area under the receiver operating characteristic curve. RESULTS Although the resolution of the computed radiography system was better than that of commercial systems, it fell short of that of screen-film systems. For the 100-micron microcalcifications, the difference in the average area under the curve was not statistically significant, but it was significant for the larger simulated microcalcifications: the average area under the curve was 0.58 for computed radiography versus 0.76 for screen-film imaging for the 125-micron microcalcifications and 0.83 versus 1.00, respectively, for the 150-micron microcalcifications. CONCLUSION Observer performance in the detection of small simulated microcalcifications (100-150 microns in diameter) is better with screen-film images than with high-resolution computed radiographic images.
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Affiliation(s)
- C C Shaw
- Department of Radiology, University of Pittsburgh, PA 15261-0001, USA
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