1
|
Chang WK, Peng CL, Chen YW, Sun CK, Chen CC, Liu TC, Chu YY, Tsai IF, Chung CS, Lin HF, Hsu FY, Tai WC, Lee HC, Yen HH, Wang EM, Chen SH, Chu CH, Chen MJ, Lu CL, Chiu CT. Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan. J Microbiol Immunol Infect 2024; 57:211-224. [PMID: 38135645 DOI: 10.1016/j.jmii.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Reprocessing of gastrointestinal (GI) endoscopes and accessories is an essential part of patient safety and quality control in GI endoscopy centers. However, current endoscopic reprocessing guidelines or procedures are not adequate to ensure patient-safe endoscopy. Approximately 5.4 % of the clinically used duodenoscopes remain contaminated with high-concern microorganisms. Thus, the Digestive Endoscopy Society of Taiwan (DEST) sets standards for the reprocessing of GI endoscopes and accessories in endoscopy centers. DEST organized a task force working group using the guideline-revision process. These guidelines contain principles and instructions of step-by-step for endoscope reprocessing. The updated guidelines were established after a thorough review of the existing global and local guidelines, systematic reviews, and health technology assessments of clinical effectiveness. This guideline aims to provide detailed recommendations for endoscope reprocessing to ensure adequate quality control in endoscopy centers.
Collapse
Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Chen-Ling Peng
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Yen-Wei Chen
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taiwan
| | - Cheuk-Kay Sun
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Yin-Yi Chu
- Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, Chang Gung University, Taoyuan, Taiwan
| | - I-Fang Tsai
- Ultrasonography and Endoscopy Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Shuan Chung
- Ultrasonography and Endoscopy Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiao-Fen Lin
- Division of Gastroenterology and Hepatology, Renai Branch, Taipei City Hospital, Taiwan
| | - Fang-Yu Hsu
- Therapeutic Endoscopic Center, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsi-Chang Lee
- Division of Gastroenterology and Hepatology, Renai Branch, Taipei City Hospital, Taiwan
| | - Hsu-Heng Yen
- Division of Gastroenterology, Changhua Christian Hospital, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - E-Ming Wang
- Department of Internal Medicine Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Taiwan
| | - Shu-Hui Chen
- Division of Gastroenterology, Changhua Christian Hospital, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - Cheng-Hsin Chu
- Division of Gastroenterology, Internal Medicine, MacKay Memorial Hospital, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Internal Medicine, MacKay Memorial Hospital, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taiwan
| | - Cheng-Tang Chiu
- Department of Gastroenterology & Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taiwan.
| |
Collapse
|
2
|
Cheng YL, Chang WK, Yen H, Peng YJ, Chang WC, Chang PY. Osimertinib-related liver injury with successful osimertinib rechallenge: A case report. Thorac Cancer 2022; 13:2271-2274. [PMID: 35793806 PMCID: PMC9346189 DOI: 10.1111/1759-7714.14556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/25/2022] Open
Abstract
Osimertinib is approved as the first‐line treatment for advanced non‐small cell lung cancer patients with epidermal growth factor (EGFR) mutation and for patients who develop EGFR T790M mutation during EGFR tyrosine kinase inhibitor (TKI) treatment and disease progression. Asymptomatic elevation of aminotransferase levels is commonly observed during TKI treatment; however, significant hepatotoxicity is infrequent. Here, we report a patient with osimertinib‐related drug‐induced liver injury who was successfully managed with osimertinib rechallenge.
Collapse
Affiliation(s)
- Yuan-Ling Cheng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hao Yen
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ping-Ying Chang
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| |
Collapse
|
3
|
Yang CW, Chu YH, Chen HC, Huang WC, Chen PJ, Chang WK. Gastrointestinal Endoscopy Performed by Gastroenterologists: Opportunistic Screening Strategy for Newly Diagnosed Head and Neck Cancers. Front Oncol 2022; 12:793318. [PMID: 35692778 PMCID: PMC9185840 DOI: 10.3389/fonc.2022.793318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Approximately 66% of head and neck cancers are diagnosed at an advanced stage. This prospective study aimed to detect newly diagnosed head and neck cancers using regular upper gastrointestinal (UGI) endoscopy with oral-pharynx-larynx examination. Methods A total of 2,849 patients underwent UGI endoscopy with an additional oral-pharynx-larynx examination. Patients aged < 20 years, those who were pregnant, had a history of head and neck cancers, were undergoing emergency endoscopy, and had a poor laryngopharyngeal view were excluded. The symptoms, incidence, location, pathology, and stage of malignant neoplasms were investigated. Results A total of 2,720 patients were enrolled. Endoscopically observable 23 abnormal findings (0.85%) included 18 (0.66%) benign lesions and 5 (0.18%) newly diagnosed malignant neoplasms. Notably, 4 (80%) of 5 patients with malignant neoplasms were diagnosed at an early stage (Stage 0, I, and II). Conclusions UGI endoscopy with oral-pharynx-larynx examination can achieve opportunistic head neck cancer screening and is recommended for every patient in endoscopy units.
Collapse
Affiliation(s)
- Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yueng-Hsiang Chu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Chen Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
4
|
Lin TH, Yang CW, Chang WK. Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia. Front Immunol 2022; 12:800029. [PMID: 35185865 PMCID: PMC8847226 DOI: 10.3389/fimmu.2021.800029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are widely used techniques to feed older patients with oropharyngeal dysphagia. Aspiration pneumonia is the most common cause of death in these patients. This study aimed to evaluate the role of oropharyngeal dysphagia in older patients on long-term enteral feeding for risk stratification of pneumonia requiring hospitalization. Methods We performed modified flexible endoscopic evaluation of swallowing to evaluate oropharyngeal dysphagia in older patients and conducted prospective follow-up for pneumonia requiring hospitalization. A total of 664 oral-feeding patients and 155 tube-feeding patients were enrolled. Multivariate Cox analysis was performed to identify risk factors of pneumonia requiring hospitalization. Results Multivariate analyses showed that the risk of pneumonia requiring hospitalization significantly increased in older patients and in patients with neurological disorders, tube feeding, and oropharyngeal dysphagia. Subgroup analysis revealed that the risk of pneumonia requiring hospitalization was significantly lower in patients with PEG than in those with NGT among the patients with oropharyngeal dysphagia (adjusted hazard ratio 0.26, 95% confidence interval: 0.11–0.63, P = 0.003). Conclusions For older patients with oropharyngeal dysphagia requiring long-term enteral tube feeding, PEG is a better choice than NGT. Further research is needed to elucidate the role of oropharyngeal dysphagia in enteral feeding in older patients.
Collapse
Affiliation(s)
- Tai-Han Lin
- Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
5
|
Huang TY, Yang SS, Liao CL, Lin MH, Lin HH, Lin JC, Chen PJ, Shih YL, Chang WK, Hsieh TY. SPAK Deficiency Attenuates Chemotherapy-Induced Intestinal Mucositis. Front Oncol 2021; 11:733555. [PMID: 34888232 PMCID: PMC8649624 DOI: 10.3389/fonc.2021.733555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Ste20-related protein proline/alanine-rich kinase (SPAK) affects cell proliferation, differentiation, and transformation, and sodium and chloride transport in the gut. However, its role in gut injury pathogenesis is unclear. Objective We determined the role of SPAK in chemotherapy-induced intestinal mucositis using in vivo and in vitro models. Methods Using SPAK-knockout (KO) mice, we evaluated the severity of intestinal mucositis induced by 5-fluorouracil (5-FU) by assessing body weight loss, histological changes in the intestinal mucosa, length of villi in the small intestine, pro-inflammatory cytokine levels, proliferative indices, and apoptotic indices. We also evaluated changes in gut permeability and tight junction-associated protein expression. Changes in cell permeability, proliferation, and apoptosis were assessed in SPAK siRNA-transfected 5FU-treated IEC-6 cells. Results 5-FU-treated SPAK-KO mice exhibited milder intestinal mucositis, reduced pro-inflammatory cytokine expression, increased villus length, good maintenance of proliferative indices of villus cells, decreased apoptotic index of enterocytes, reduced gut permeability, and restoration of tight junction protein expression (vs. 5-FU-treated wild-type mice). Under in vitro conditions, siRNA-mediated SPAK-knockdown in IEC-6 cells decreased cell permeability and maintained homeostasis following 5-FU treatment. Conclusion SPAK deficiency attenuated chemotherapy-induced intestinal mucositis by modulating gut permeability and tight junction-associated protein expression and maintaining gut homeostasis in murine small intestinal tissues following gut injury. The expression of SPAK may influence the pathogenesis of chemotherapy-induced intestinal mucositis.
Collapse
Affiliation(s)
- Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan
| | - Sung-Sen Yang
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Institute of BioMedical Science, Academia Sinica, Taipei, Taiwan
| | - Ching-Len Liao
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Hong Lin
- Department of Microbiology and Immunology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chun Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
6
|
Peng CL, Liu TC, Wang HP, Chang WK. Two novel protocols for cleaning residual simethicone and fluid in patient-ready duodenoscopes. J Gastroenterol Hepatol 2021; 36:1843-1850. [PMID: 33274470 DOI: 10.1111/jgh.15365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Approximately 42-95% of working channels have been reported to show the presence of residual fluid despite endoscope reprocessing. The aim of this study was to design two novel protocols for cleaning residual simethicone and demonstrate its efficiency by evaluating the residual fluid and cleanliness in the working channels of patient-ready duodenoscopes. METHODS The designed protocol for cleaning residual simethicone was implemented in manual cleaning and/or high-level disinfection (HLD). The residual fluid inside the working channels was estimated by visual inspection. Adenosine triphosphate (ATP) values were evaluated to determine cleanliness after manual cleaning. RESULTS Manual cleaning with novel simethicone cleaning protocol demonstrated a significant decrease in fluid droplets (14.6 ± 29.9 vs 0 ± 0, P < 0.001) and ATP values (157 ± 196 relative light units [RLUs] vs 52 ± 41 RLUs, P = 0.031). HLD with simethicone cleaning protocol, using either enzymatic detergent with effective for cleaning simethicone or cleaning time set in the automatic endoscope reprocessor program for 8 min, demonstrated significant decrease in the number of fluid droplets. Follow-up after the implementation of the simethicone cleaning protocol showed a significant decrease in fluid droplets (37.4 ± 41.0 vs 2.1 ± 5.5, P = 0.003) and ATP values (271 ± 268 RLUs vs 82 ± 136 RLUs, P = 0.021). CONCLUSIONS Simethicone cleaning protocol is advantageous for significantly decreasing fluid droplets and ATP values within endoscope working channels. After manual cleaning with the simethicone cleaning protocol, in particular, no retained fluid droplet was observed in patient-ready duodenoscopes.
Collapse
Affiliation(s)
- Chen-Ling Peng
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
7
|
Wang CY, Chang WC, Huang HH, Chang WK, Shih YL, Hsieh TY, Lin HH. Safety Issues in Magnetic Resonance Imaging Scan with Retention of Olympus Long Clips in the Gastrointestinal Tract. Curr Med Imaging 2021; 17:1243-1247. [PMID: 34170809 DOI: 10.2174/1573405617666210624125335] [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: 10/19/2020] [Revised: 12/29/2020] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Not all endoscopic clips are compatible with magnetic resonance imaging (MRI). The aim of this study is to investigate the safety of MRI-incompatible endoscopic clips in patients undergoing MRI scans. METHODS We retrospectively reviewed the medical records of patients who had received endoscopic clip placement of Olympus Long Clip MRI-incompatible clips and then had undergone MRI scans within two weeks in our hospital between 2014 and 2019. RESULTS A total of 44,292 patients had undergone an MRI examination at our hospital. Only 15 patients had MRI scans within two weeks after the endoscopic clip placement. Their median age was 65.5 years, and 12 of the 15 patients were men. At the time of the clip placement and MRI scan, four patients were taking anti-coagulation or anti-platelet agents. The indication for endoscopic clip placement of the 15 patients was mucosal/submucosal defect or hemorrhage and colonic perforation. Endoscopic clips were placed in the colon of 14 patients and in the stomach of only one patient for gastric hemorrhage. One patient experienced clip migration and three displayed artifacts in abdominal images. No patient complications of mortality, hemorrhage, or organ perforation occurred. CONCLUSION No serious adverse event occurred during MRI scans of patients with MRI-incompatible clips in this study, suggesting that MRI-incompatible clips may be safe to use in MRI scans. However, this does not guarantee the safety of the Long Clip for MRI scans, as further tests are needed to verify that this clip is safe for use during MRI.
Collapse
Affiliation(s)
- Cheng-Yi Wang
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
8
|
Shiu TY, Lin HH, Shih YL, Feng AC, Huang HH, Huang TY, Hsieh CB, Chang WK, Hsieh TY. CRNDE-h transcript/miR-136-5p axis regulates interleukin enhancer binding factor 2 expression to promote hepatocellular carcinoma cell proliferation. Life Sci 2021; 284:119708. [PMID: 34153299 DOI: 10.1016/j.lfs.2021.119708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022]
Abstract
AIMS Hepatocellular carcinoma (HCC) is a primary malignancy of the hepatocyte. Interleukin enhancer binding factor 2 (ILF2) plays a role in the development of HCC. However, the regulatory mechanisms of ILF2 expression in HCC remain unclear. In this study, we aimed to identify ILF2-targeting microRNAs (miRNAs) and to explore how they affect ILF2 expression in HCC. MAIN METHODS The tissue specimens were collected from 25 HCC patients. The underlying regulatory mechanism of ILF2 expression in HCC progression was determined using luciferase reporter assay, quantitative real-time PCR, Western blotting, and BrdU incorporation assay. KEY FINDINGS Of predicted miRNA candidates (miR-122-5p, miR-425-5p, miR-136-5p, miR-7-5p, miR-421 and miR-543), a statistically significant inverse correlation by linear correlation analysis was observed between miR-136-5p and ILF2 mRNA expressions in patients with HCC (r = -0.627, P < 0.001). Further analysis demonstrated that ILF2 was directly regulated by miR-136-5p. In addition, we showed that long noncoding RNA colorectal neoplasia differentially expressed-h (lncRNA CRNDE-h) transcript expression was significantly up-regulated in HCC, and a miR-136-5p binding site was newly found in the lncRNA CRNDE-h transcript sequence using IntaRNA tool. In terms of mechanism, highly-expressed lncRNA CRNDE-h transcript can sponge miR-136-5p, thereby preventing it from interacting with target ILF2 mRNA while promoting the proliferation of HCC cells. SIGNIFICANCE The lncRNA CRNDE-h/miR-136-5p/ILF2 axis plays a significant regulatory role in HCC progression, which may partly explain the pathogenic mechanisms of HCC and may provide promising potential targets for the diagnosis, treatment, and prognosis of HCC.
Collapse
Affiliation(s)
- Tzu-Yue Shiu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - An-Chieh Feng
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chung-Bao Hsieh
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
| |
Collapse
|
9
|
Wu CC, Huang HH, Lin HH, Chang WK. Oropharyngeal dysphagia increased the risk of pneumonia in patients undergoing nasogastric tube feeding. Asia Pac J Clin Nutr 2021; 29:266-273. [PMID: 32674234 DOI: 10.6133/apjcn.202007_29(2).0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Aspiration pneumonia is a major cause of death in patients on nasogastric tube (NGT) feeding. This study aimed to evaluate the oropharyngeal dysphagia and stratify risk of pneumonia in patients undergoing NGT feeding. METHODS AND STUDY DESIGN The study included patients on NGT feeding who underwent UGI endoscopy at Tri-Service General Hospital, Taiwan. Endoscopy was performed to examine the pharyngolaryngeal region. The severity of oropharyngeal dysphagia was evaluated according to the visualized amount and location of pooling of secretions in the pharyngolaryngeal region; 60 patients showed absent or minimal amount of secretions (control group), 14 patients showed moderate-to-large amounts of secretions filling the pyriform sinus (pharyngeal group), and 27 patients showed secretions entering the laryngeal vestibule (laryngeal group). Demographic data and occurrence of pneumonia were analyzed. RESULTS The incidence of pneumonia was highest in the pharyngeal group (4.2±3.6 episodes/person-years), followed by the laryngeal (2.6±2.2 episodes/ person-years) and control groups (1.7±3.8 episodes/person-years) (p=0.042). Multivariable regression showed significantly higher risk of pneumonia in the pharyngeal (adjusted odds ratio=2.7, 95% CI, 2.4-2.8, p<0.001) and laryngeal (adjusted odds ratio=2.0, 95% CI, 1.7-2.4, p<0.001) groups. The cumulative incidence rate of pneumonia was significantly higher in the laryngeal and pharyngeal groups than in the control group (log rank test, p<0.001). CONCLUSIONS Endoscopic pharyngolaryngeal observation can evaluate the oropharyngeal dysphagia. Visual evidence of oropharyngeal dysphagia increase the risk of pneumonia in patients on NGT feeding.
Collapse
Affiliation(s)
- Chih-Chung Wu
- Department of Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
10
|
Hsieh MS, Hsu WH, Wang JW, Wang YK, Hu HM, Chang WK, Chen CY, Wu DC, Kuo FC, Su WW. Nutritional and dietary strategy in the clinical care of inflammatory bowel disease. J Formos Med Assoc 2020; 119:1742-1749. [DOI: 10.1016/j.jfma.2019.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/30/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023] Open
|
11
|
Chang CF, Huang TY, Huang HH, Shih YL, Chang WK, Hsieh TY, Wu LS, Chen KW, Lin HH. Impact of endoscopic sedation on gastric polyp detection: A one-center retrospective observational study. Medicine (Baltimore) 2020; 99:e22556. [PMID: 33031301 PMCID: PMC10545299 DOI: 10.1097/md.0000000000022556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 05/03/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022] Open
Abstract
Sedation esophagogastroduodenoscopy (EGD) has become more prevalent in many countries. However, owing to the limitation of health insurance payment for sedation EGD in Taiwan, non-sedation EGD still accounts for the majority of cases. This study was aimed to explore the differences between the sedation and non-sedation groups in terms of endoscopic findings, such as detection rate of gastric polyp of any size, number of detected gastric polyps, and location of the gastric polyps detected.We enrolled 10,940 patients who underwent EGD between January 1, 2016 and December 31, 2016 at the Tri-Service General Hospital; among the patients, 1900 received intravenous sedation (IVS) and 9040 did not. The data reviewed included demographics, parameters of the polyp (number, size, and location), and pathology.Compared with the non-sedation group, the sedation group had a higher overall polyp detection rate (P < .001); a greater number of detected polyps (Odds ratio 1.50, P = .007); and a higher detection rate of smaller polyps, such as fundic gland polyp, and hyperplastic polyp (P < .001). Among the pathological findings, gastric neuroendocrine tumor (NET) was detected using EGD in 2 cases and manifested as small polyps (<0.05 cm), and it showed significantly better detection rates in the sedation EGD group than in the non-sedation EGD group (P = .002).Sedation EGD could enhance a patients willingness and cooperation during EGD. Furthermore, sedation EGD increased the detection rates of small gastric polyps and was more likely to enable identification of unusual findings, such as gastric NET.
Collapse
Affiliation(s)
- Chao-Feng Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Lian-Shan Wu
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien County, Taiwan
| | - Kai-Wen Chen
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien County, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei
| |
Collapse
|
12
|
Lo YH, Shen CM, Chang WK. Intractable Abdominal Pain With Purple Colored Urine. Am J Med Sci 2020; 360:e5-e6. [PMID: 32536418 DOI: 10.1016/j.amjms.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/21/2020] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Yuan-Hung Lo
- Division of Gastroenterology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Mao Shen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
13
|
Liao WC, Tu TC, Lee KC, Tseng JH, Chen MJ, Sun CK, Wang SY, Chang WK, Chang PY, Wu MS, Lin TJ, Lee HL, Chen JH, Yuan KC, Liu NJ, Wu HC, Liang PC, Wang HP, Hwang TL, Lee CL. Taiwanese consensus recommendations for acute pancreatitis. J Formos Med Assoc 2020; 119:1343-1352. [PMID: 31395463 DOI: 10.1016/j.jfma.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/11/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
The incidence of acute pancreatitis and related health care utilization are increasing. Acute pancreatitis may result in organ failure and various local complications with risks of morbidity and even mortality. Recent advances in research have provided novel insights into the assessment and management for acute pancreatitis. This consensus is developed by Taiwan Pancreas Society to provide an updated, evidence-based framework for managing acute pancreatitis.
Collapse
Affiliation(s)
- Wei-Chih Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tien-Chien Tu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Kuei-Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jseng-Hwei Tseng
- Department of Imaging & Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheuk-Kay Sun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shang-Yu Wang
- Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, Taiwan
| | - Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taiwan
| | - Ming-Shun Wu
- Division of Gastroenterology, Department of Internal Medicine, Wan Fang Hospital, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Jung Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - Hsiang-Lin Lee
- Department of Surgery, Chung Shan Medical University Hospital, Institute of Medicine4, Chung Shan Medical University, Taichung, Taiwan
| | - Jiann-Hwa Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Taipei, Taiwan
| | - Kuo-Ching Yuan
- Division of Acute Care Surgery and Trauma, Department of Surgery, Taipei Medical University Hospital, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsing-Chien Wu
- Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsann-Long Hwang
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Lin-Kou, Taiwan
| | - Chia-Long Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan.
| |
Collapse
|
14
|
Liu TC, Peng CL, Wang HP, Huang HH, Chang WK. SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance. World J Gastroenterol 2020; 26:3767-3779. [PMID: 32774056 PMCID: PMC7383844 DOI: 10.3748/wjg.v26.i26.3767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%; however, it has been reported that 5.4% of clinically used duodenoscopes remain contaminated with viable high-concern organisms despite following the manufacturer’s instructions. Visual inspection of working channels has been proposed as a quality control measure for endoscope reprocessing. There are few studies related to this issue.
AIM To investigate the types, severity rate, and locations of abnormal visual inspection findings inside patient-ready duodenoscopes and their microbiological significance.
METHODS Visual inspections of channels were performed in 19 patient-ready duodenoscopes using the SpyGlass visualization system in two endoscopy units of tertiary care teaching hospitals (Tri-Service General Hospital and National Taiwan University Hospital) in Taiwan. Inspections were recorded and reviewed to evaluate the presence of channel scratches, buckling, stains, debris, and fluids. These findings were used to analyze the relevance of microbiological surveillance.
RESULTS Seventy-two abnormal visual inspection findings in the 19 duodenoscopes were found, including scratches (n = 10, 52.6%), buckling (n = 15, 78.9%), stains (n = 14, 73.7%), debris (n = 14, 73.7%), and fluids (n = 6, 31.6%). Duodenoscopes > 12 mo old had a significantly higher number of abnormal visual inspection findings than those ≤ 12 mo old (46 findings vs 26 findings, P < 0.001). Multivariable regression analyses demonstrated that the bending section had a significantly higher risk of being scratched, buckled, and stained, and accumulating debris than the insertion tube. Debris and fluids showed a significant positive correlation with microbiological contamination (P < 0.05). There was no significant positive Spearman’s correlation coefficient between negative bacterial cultures and debris, between that and fluids, and the concomitance of debris and fluids. This result demonstrated that the presence of fluid and debris was associated with positive cultures, but not negative cultures. Further multivariate analysis demonstrated that fluids, but not debris, is an independent factor for bacterial culture positivity.
CONCLUSION In patient-ready duodenoscopes, scratches, buckling, stains, debris, and fluids inside the working channel are common, which increase the microbiological contamination susceptibility. The SpyGlass visualization system may be recommended to identify suboptimal reprocessing.
Collapse
Affiliation(s)
- Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chen-Ling Peng
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 114, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Cheng Hsin General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| |
Collapse
|
15
|
Lin KT, Lee SY, Liu SC, Tsao CC, Hsu SD, Chien WC, Chung CH, Chang WK, Chen YW, Lin CS. Risk of ocular complications following radiation therapy in patients with nasopharyngeal carcinoma. Laryngoscope 2019; 130:1270-1277. [PMID: 31441954 DOI: 10.1002/lary.28254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/14/2019] [Accepted: 08/07/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the risk of ocular complications following radiotherapy in patients with nasopharyngeal carcinoma (NPC). METHODS We adopted 1:1 propensity score matching and identified an NPC cohort (n = 736) and a comparison cohort (n = 736) that comprised non-NPC head and neck cancer patients who received radiotherapy in the National Health Insurance Research Database from 1997 to 2010. The follow-up period was terminated upon developing ocular complications (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]360-379) or on December 31, 2010. RESULTS After adjusting for the confounding factors of the study, the NPC cohort had a higher adjusted hazard ratio (HR) for developing ocular complications than the comparison cohort (adjusted HR = 2.786, 95% confidence interval [CI] = 1.805-4.112, P < 0.001). The NPC cohort was associated with a significantly higher risk of developing ocular complications compared with the comparison cohort within 12 and after 24 months of follow-up (P < 0.05). The most common associated ocular complications were optic nerve disorder and retinopathy. CONCLUSIONS Patients with NPC might be at higher risk of developing ocular complications after radiotherapy than non-NPC head and neck cancer patients in Taiwan. Either further investigation or routine assessments by ophthalmological physician is recommended. LEVEL OF EVIDENCE NA Laryngoscope, 130:1270-1277, 2020.
Collapse
Affiliation(s)
- Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Shih-Yu Lee
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shao-Cheng Liu
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Cheng Tsao
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Sheng-Der Hsu
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Yuan-Wu Chen
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan.,School of Dentistry, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
| |
Collapse
|
16
|
Hsu SD, Chen CJ, Wang ID, Lin KT, Wang CC, Chien WC, Chung CH, Chang WK. The Risk of Erectile Dysfunction Following Pelvic Angiographic Embolization in Pelvic Fracture Patients: A Nationwide Population-Based Cohort Study in Taiwan. World J Surg 2019; 43:476-485. [PMID: 30242456 DOI: 10.1007/s00268-018-4803-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pelvic fracture with hypovolemic shock is a known crucial injury in trauma patients. Pelvic fracture with vessel injury often leads to hemodynamic complications; in a trauma scenario, evidence of other systems being affected is often absent. Bleeding cessation and resuscitation are important for these types of trauma patients. For this purpose, pelvic angiographic embolization is frequently used. Multiple studies have reported that angiographic embolization may cause erectile dysfunction (ED) in hemodynamically stable patients with pelvic fracture. However, no study has evaluated a large patient cohort with a long-term follow-up. We hypothesized that angiographic embolization to control bleeding may compromise blood supply to the genitourinary organs or cause secondary neurogenic injury that increases the risk of ED. Our goal was to evaluate the risk of ED following pelvic fractures in male patients treated with pelvic angiographic embolization. METHODS We used data from the National Health Insurance Research Database (NHIRD) from 1997 to 2010 provided by the Bureau of National Health Insurance of the Department of Health in Taiwan. We collected disease histories from inpatient files. The disease diagnoses were based on the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification. These data were all deidentified, and we did not contact the patients. As such, informed consent was not needed. RESULTS Eighty-five and 82,802 patients were included in the case and control cohorts, respectively. All patients were aged 15-45, and the proportion of pelvic fracture locations was equal between the groups. After investigating the causes of ED among male patients aged 15-45 with pelvic fractures using logistic regression analysis in a generalized estimating equations model and after adjusting for the influence of confounders, we found that these patients had high risks (odds ratio (OR): 32.637; 95% confidence interval: 14.137-75.346; P < 0.001) of developing ED post-angiographic embolization. CONCLUSIONS Male patients in Taiwan with pelvic fractures who undergo angiographic embolization to control bleeding have a higher risk of ED than those who do not undergo the procedure. Physicians should practice caution and inform patients of this connection before the procedure.
Collapse
Affiliation(s)
- Sheng-Der Hsu
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Jueng Chen
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - I-Duo Wang
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Chi Wang
- Department of Family Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Chengong Rd, Sec. 2, Neihu, Taipei, 114, Taiwan.
| |
Collapse
|
17
|
Lin HH, Peng YJ, Tsai MJ, Wu YY, Tsai TN, Huang HH, Shih YL, Chang WK, Hsieh TY. Upregulation of amphiregulin by retinoic acid and Wnt signalling promotes liver cancer cell proliferation. J Cell Physiol 2019; 235:1689-1699. [PMID: 31298420 DOI: 10.1002/jcp.29088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022]
Abstract
Activated hepatic stellate cells promote hepatocellular carcinoma (HCC) progression. Hepatic stellate cells play a key role in retinoid metabolism, and activation of stellate cells increases retinoic acid (RA) in the liver. However, the role of RA in HCC proliferation remains unclear. We aimed to analyse the mechanism of RA in HCC proliferation. Thirty-eight patients who had undergone hepatic resection for HCCs were recruited. Paired non-tumour tissues, adjacent and distal to HCCs, were collected, and the RA levels in the tissues were analysed. The mechanisms of RA and HCC proliferation were assessed in liver cancer cell lines by protein and gene expression analyses. Early recurrence of HCC was significantly higher in patients with a higher RA concentration than in those with a lower RA concentration in tissues adjacent to HCCs (61.1% vs. 20%, p = .010). RA promoted HCC cell proliferation and activated the expression of Amphiregulin, a growth factor in hepatocarcinogenesis. The promoter of Amphiregulin contained the binding sites of the RA receptor, RXRα. Wnt signalling also activated the expression of Amphiregulin, and the RA and Wnt pathways acted synergistically to increase the expression of Amphiregulin. Furthermore, RXRα interacted with β-catenin and then translocated to the nucleus to activate Amphiregulin. An increased RA concentration in the tissues adjacent to the tumour was associated with an early recurrence of HCC. RA activated the expression of Amphiregulin, and then promoted HCC proliferation, which might partly contribute to early recurrence of HCC after hepatic resection.
Collapse
Affiliation(s)
- Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Yi-Jen Peng
- Division of Experimental Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Ming-Jiun Tsai
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Yi-Ying Wu
- Division of Haematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Tsung-Neng Tsai
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| |
Collapse
|
18
|
Chang WK, Huang HH, Lin HH, Tsai CL. Evaluation of Oropharyngeal Dysphagia in Patients Who Underwent Percutaneous Endoscopic Gastrostomy: Stratification Risk of Pneumonia. JPEN J Parenter Enteral Nutr 2019; 44:239-245. [PMID: 30983013 DOI: 10.1002/jpen.1592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Aspiration pneumonia is the most common cause of death in patients who undergo percutaneous endoscopic gastrostomy (PEG). This study aims to evaluate the severity of oropharyngeal dysphagia and predict the risk of pneumonia in such patients, using upper gastrointestinal endoscopy. METHODS Endoscope examined the pharyngolaryngeal region in patients who underwent PEG. The severity of oropharyngeal dysphagia was evaluated according to the amount and location of pooling of secretions in the pharyngolaryngeal region. Overall, 55 patients showed absent or minimal amount of secretions (control group), 10 patients showed moderate-to-large amounts of secretions filling the pyriform sinus (pharyngeal group), and 23 patients showed secretions entering the laryngeal vestibule (laryngeal group). Demographic data, swallowing level scale, and occurrence of pneumonia were recorded. RESULTS The incidence of pneumonia was the highest in the pharyngeal group (70.0%), followed by that in the laryngeal (60.9%) and control groups (30.9%; P = 0.010). Multivariable regression showed that risk of pneumonia was significantly higher in the pharyngeal and laryngeal groups. Cumulative incidence rate of pneumonia was significantly higher in the laryngeal and pharyngeal groups than in the control group (log-rank test, P = 0.001). Mortality rate was significantly higher in patients with suboptimal protective cough reflex than in others (50.0% vs 5.9%, P = 0.034). CONCLUSION Accumulation of abnormal amounts of secretions in the pyriform sinus or in the laryngeal vestibule increased the risk of the hospital admission following pneumonia in patients who underwent PEG. The mortality rate was higher in patients with suboptimal protective cough reflex.
Collapse
Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
19
|
Tseng YC, Chen BC, Chen CT, Chou YC, Dai NT, Chen PJ, Huang TY, Shih YL, Chang WK, Hsieh TY, Lin JC. Early Initiation of Post-Pyloric Feeding in Patients with Major Burns: Experience in Taiwan Formosa Water Park Dust Explosion Disaster. TOHOKU J EXP MED 2019; 247:111-118. [PMID: 30787234 DOI: 10.1620/tjem.247.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Early initiation of enteral nutrition improves clinical outcomes in critical patients with serious burns. Post-pyloric tube feeding is a valuable therapeutic option for severely burned patients with poor gastric emptying. How early post-pyloric feeding can be initiated to provide more benefits to patients has not yet been examined. A fire erupted at a recreational water park in New Taipei City, Taiwan, on June 27, 2015. The results of early initiation versus delayed post-pyloric feeding in severely burned patients in this mass-casualty incident were compared. Door-to-post-pyloric feeding time ≤ 24 h was considered as early post-pyloric feeding (EPF) and that > 24 h was considered as delayed post-pyloric feeding (DPF). Thirteen patients with severe burn injuries (> 40% of the total body surface area) were assigned to undergo either EPF (five patients) or DPF (eight patients). This study is a "fortuitously controlled" study, and the authors were able to formulate and test whether EPF is better than DPF by comparing the two groups. In patients in the EPF, the intake of calories increased rapidly and was maintained throughout the study period. In addition, rapid restoration of plasma magnesium concentrations as well as pronounced recovery of platelet count in the EPF group was observed. In conclusion, our findings indicate that the time from injury to the onset of post-pyloric feeding is crucial, and EPF allows for the administration of calculated caloric needs. Therefore, EPF can be successfully initiated with beneficial outcomes of nutritional reconstruction in severely burned patients.
Collapse
Affiliation(s)
- Yu-Chen Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Bao-Chung Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Chun-Ting Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center
| | - Niann-Tzyy Dai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Peng-Jen Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Tien-Yu Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Yu-Lueng Shih
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Wei-Kuo Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - Jung-Chun Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| |
Collapse
|
20
|
Chen PT, Ting CK, Lee MY, Cheng HW, Chan KH, Chang WK. A randomised trial comparing real-time double-lumen endobronchial tube placement with the Disposcope ® with conventional blind placement. Anaesthesia 2019; 72:1097-1106. [PMID: 28804889 DOI: 10.1111/anae.13984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/27/2022]
Abstract
Double-lumen endobronchial tube placement is challenging. This study compared double-lumen tube placement with the Disposcope® , a wireless videostylet allowing real-time visualisation, with conventional blind placement. Patients undergoing elective thoracic surgery with normal airways requiring one-lung ventilation were randomly allocated into two groups (27 patients in each group). The Disposcope was used to assist left-sided double-lumen tube placement in one group, and conventional blind placement was performed in the control group. Placement in both groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4 (2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0) s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs. 154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the double-lumen tube was inserted in the correct side in all patients (100.0%), whereas in the conventional group, the double-lumen tube was placed in the correct side in 25 (92.6%) patients and in the wrong side in 2 (7.4%) patients; the difference was not significant (p = 0.150). In the Disposcope-assisted group, the double-lumen tube was inserted to the optimal depth in 24 (88.9%) patients, whereas in the conventional group it was inserted to the optimal depth in one (4.0%) patient. The Disposcope increased the success rate of double-lumen tube placement, and shortened the total operation time when compared with standard placement with confirmation using fibreoptic bronchoscopy, and may replace the conventional method.
Collapse
Affiliation(s)
- P T Chen
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,School of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - C K Ting
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - M Y Lee
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - H W Cheng
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - K H Chan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - W K Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, Republic of China
| |
Collapse
|
21
|
Yang CW, Chen HW, Chen BC, Chen PJ, Shih YL, Chang WK, Hsieh TY, Huang TY. Is a bleeding scan prior to single-balloon enteroscopy necessary in patients with obscure gastrointestinal bleeding? J Formos Med Assoc 2018; 118:1031-1037. [PMID: 30473414 DOI: 10.1016/j.jfma.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/20/2018] [Accepted: 11/07/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/PURPOSE To evaluate the efficacy and accuracy of bleeder localization in a pre-enteroscopic bleeding scan in patients with obscure gastrointestinal bleeding (OGIB). METHODS From January 2009 to December 2014, 98 patients with OGIB undergoing single-balloon enteroscopy (SBE) were enrolled. These patients were classified based on their history of a previous bleeding scan; 56 patients had undergone a previous bleeding scan, whereas 42 had not. The clinical characteristics, endoscopic findings, and rebleeding rate were compared between these two groups. The ability of the bleeding scan to localize the bleeding site was analyzed. RESULTS The mean age of patients was 56 ± 22 years; final diagnostic yield, 65.3%; and the most common etiology of OGIB, angiodysplasia (29.6%). There was no significant difference in demographic characteristics, OGIB etiologies, and final diagnostic yields (67.9% vs. 61.2%, bleeding scan vs. control group) between groups. In the bleeding scan group, the rate of positive detection was approximately 80.4%. However, only 26.7% patients with a positive bleeding scan showed correct localization of bleeding. Moreover, the bleeding scan delayed SBE (8.9 days vs. 3.0 days, p < 0.001). During the 24 months of follow-up, 15 patients (15.3%) exhibited rebleeding and needed to be hospitalized, but there was no significant difference between the groups. CONCLUSION In our study, bleeding scans in patients with OGIB revealed poor localization of the bleeder and delay in performing SBE. Thus, a bleeding scan prior to SBE showed a limited role for patients with OGIB.
Collapse
Affiliation(s)
- Chih-Wei Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Hsuan-Wei Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Bao-Chung Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan.
| |
Collapse
|
22
|
Lin JC, Chiang AL, Chang WK. Cervical esophageal perforation during endoscopic ultrasonography. Adv Dig Med 2018. [DOI: 10.1002/aid2.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jung-Chun Lin
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Austin L Chiang
- Division of Gastroenterology and Hepatology; Thomas Jefferson University Hospital; Philadelphia Pennsylvania, PA USA
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| |
Collapse
|
23
|
Tsao CC, Lee SY, Chang WK, Lin KT, Hsu SD, Tsai CL, Lin CS. Risk of gastric cancer following percutaneous endoscopic gastrostomy: A nationwide population-based cohort study. Med Hypotheses 2018; 118:93-97. [PMID: 30037624 DOI: 10.1016/j.mehy.2018.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/19/2018] [Accepted: 06/27/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is associated with increased risk of gastric cancer. METHODS We conducted a nationwide population-based retrospective study in Taiwan. Inpatient data from 1997 to 2010 were collected from Taiwan National Health Insurance Research Database. Patients with age less than 20 years; those with histories of PEG before 2000; those with histories of cancers; and those diagnosed with gastric cancer before or within 6 months of the first PEG procedure were excluded. Finally, 3505 patients who underwent PEG were included (PEG cohort), along with 7010 randomly-selected individuals, matched by age, sex, and year of index date, as the control cohort. RESULTS After adjusting for age, sex, peptic ulcer, gastritis, hypertension, diabetes and coronary artery disease, risk of gastric cancer was significantly higher in the PEG cohort (adjusted hazard ratio, 5.31; 95% confidence interval, 4.12-6.00; p = 0.011). Patients with 2 or more PEG procedures were significantly associated with increasingly developing gastric cancer risk (adjusted hazard ratio, 2.73; 95% confidence interval, 1.91-3.85; p < 0.001). The possible hypothesis may be due to chronic inflammation caused by chemical and physical conditions of the tube. CONCLUSIONS Patients with PEG might be associated with a greater risk of subsequent gastric cancer in Taiwan. Physicians should be aware of the link when assessing patients with PEG.
Collapse
Affiliation(s)
- Chih-Cheng Tsao
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Yu Lee
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan.
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Der Hsu
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
24
|
Lin MC, Shueng PW, Chang WK, Mu-Hsin Chang P, Feng HC, Yang MH, Lou PJ. Consensus and clinical recommendations for nutritional intervention for head and neck cancer patients undergoing chemoradiotherapy in Taiwan. Oral Oncol 2018; 81:16-21. [PMID: 29884409 DOI: 10.1016/j.oraloncology.2018.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 01/10/2023]
Abstract
Because of the anatomical location, patients with head and neck cancer (HNC) frequently experience dysphagia and malnutrition at the time of diagnosis and these conditions are often exacerbated after chemoradiotherapy. There is an emerging medical need to establish a consensus on nutritional intervention for these patients. A panel of 30 senior physicians and experts from multidisciplinary teams drafted clinical recommendations to improve the management of nutritional interventions in Taiwan and to provide updated treatment strategy recommendations in hope of improving the nutritional status of patients with HNC. This clinical review describes the resulting consensus document, including the impact of malnutrition on clinical outcomes, the role of prophylactic tube feeding, the choice of tube feeding, and the benefit of oral nutritional supplements in patients with HNC undergoing chemoradiotherapy. The outcomes of this review will support clinicians in their efforts to improve the nutritional status of patients with HNC.
Collapse
Affiliation(s)
- Mei-Chun Lin
- Department of Otolaryngology, National Taiwan University Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Peter Mu-Hsin Chang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Chun Feng
- Department of Dietetics and Nutrition, National Taiwan University Hospital, Taipei, Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| |
Collapse
|
25
|
Chen KW, Meng FC, Shih YL, Su FY, Lin YP, Lin F, Lin JW, Chang WK, Lee CJ, Li YH, Hsieh CB, Lin GM. Sex-Specific Association between Metabolic Abnormalities and Elevated Alanine Aminotransferase Levels in a Military Cohort: The CHIEF Study. Int J Environ Res Public Health 2018; 15:ijerph15030545. [PMID: 29562671 PMCID: PMC5877090 DOI: 10.3390/ijerph15030545] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 12/13/2022]
Abstract
The association of metabolic syndrome (MetS) components with elevated serum alanine aminotransferase (ALT) levels, a marker of hepatic injury, may differ between men and women. However, the sex-specific association in a military young population which has a low prevalence of MetS was unclear. We conducted a cross-sectional examination in 6738 men and 766 women, aged 18-50 years, from the cardiorespiratory fitness study in armed forces (CHIEF) in eastern Taiwan. The components of MetS were defined according to the updated International Diabetes Federation (IDF) ethnic criteria for Asians. Elevated ALT levels were defined as ≥40 U/L for both sexes and ≥30 U/L for women alternatively. Multivariate logistic regression analysis was performed to determine the sex-specific association between MetS components and elevated ALT. The prevalence of MetS and elevated ALT in men were 11.9% and 12.7% respectively, and in women were 3.5%, and 3.8% respectively. In men, high-density lipoprotein < 40 mg/dL, blood pressures ≥ 130/85 mmHg, serum triglycerides ≥ 150 mg/dL, and waist size ≥ 90 cm were associated with elevated ALT (odds ratios (OR) and 95% confidence intervals: 1.59 (1.34-1.90), 1.40 (1.19-1.65), 2.00 (1.68-2.39), and 1.68 (1.38-2.04); all p < 0.001); whereas in women, only fasting plasma glucose ≥ 100 mg/dL was associated with elevated ALT ≥ 40 U/L (OR: 7.59 (2.35-24.51), p = 0.001) and ALT ≥ 30 U/L (2.67 (0.89-7.95), p = 0.08). Our findings suggest that the relationship between metabolic abnormalities and elevated ALT may differ by sex, possibly due to the MetS more prevalent in young adult men than in women.
Collapse
Affiliation(s)
- Kai-Wen Chen
- Department of Medicine, Hualien Armed Forces General Hospital, No. 100, Jin-Feng St., Hualien 970, Taiwan.
| | - Fan-Chun Meng
- Departments of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
| | - Yu-Lueng Shih
- Departments of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
| | - Fang-Ying Su
- Department of Public Health, Tzu-Chi University, Hualien 970, Taiwan.
| | - Yen-Po Lin
- Department of Critical Care Medicine, Yonghe Cardinal Tien Hospital, Fu-Jen Catholic University, New Taipei City 234, Taiwan.
| | - Felicia Lin
- Department of Medicine, Hualien Armed Forces General Hospital, No. 100, Jin-Feng St., Hualien 970, Taiwan.
| | - Jia-Wei Lin
- Department of Dentistry, National Yang-Ming University, Taipei 112, Taiwan.
| | - Wei-Kuo Chang
- Departments of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
| | - Chung-Jen Lee
- Department of Nursing, Tzu-Chi College of Technology, Hualien 970, Taiwan.
| | - Yi-Hwei Li
- Department of Public Health, Tzu-Chi University, Hualien 970, Taiwan.
| | - Chung-Bao Hsieh
- Department of Medicine, Hualien Armed Forces General Hospital, No. 100, Jin-Feng St., Hualien 970, Taiwan.
- Departments of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, No. 100, Jin-Feng St., Hualien 970, Taiwan.
- Departments of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
- College of Science and Engineering, National Dong Hwa University, Hualien 974, Taiwan.
| |
Collapse
|
26
|
Hsu SD, Lee SY, Lin KT, Lin CS, Chien WC, Chen CJ, Chung CH, Chang WK. Risk of infertility following pelvic angiographic embolization in female patients with pelvic fractures: A nationwide population-based cohort study in Taiwan. PLoS One 2017; 12:e0174733. [PMID: 29194450 PMCID: PMC5711024 DOI: 10.1371/journal.pone.0174733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/14/2017] [Indexed: 11/19/2022] Open
Abstract
Pelvic angiographic embolization is an effective procedure to provide haemostasis in patients with pelvic fractures. However, management with repeated follow-up radiographs may result in infertility. The study aimed to evaluate the risk of infertility following pelvic fracture treated with pelvic angiographic embolization in female patients. We used data from the National Health Insurance Research Database (NHIRD) provided by the Bureau of National Health Insurance of the Department of Health in Taiwan from the period of 1997–2010. A total of 36 and 18,029 patients were included in the case and control cohorts, respectively. The risk estimations for the case and control cohorts were compared using a Cox’s proportional hazards regression model. The significance level was set at <0.05. After adjusting for possible confounding factors, the incidence of infertility in the case cohort was nearly 30.7-fold higher than that in the control cohort (adjust hazard ratio [HR] = 30.7, 95% confidence interval [CI] = 10.643–70.109). Patients between 15–35 years of age had a much higher incidence of infertility in the case cohort than in the control cohort (adjusted HR = 49.9, 95% CI = 15.177–64.099). Taken together, pelvic fractures in female patients treated with arterioembolization for haemostasis might be associated with a higher risk of infertility in Taiwan. Physicians should be aware of the link and inform patients of this risk prior to arterioembolization.
Collapse
Affiliation(s)
- Sheng-Der Hsu
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Yu Lee
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kuen-Tze Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Jueng Chen
- Division of Traumatic and General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
27
|
Lin JC, Chen PJ, Shih YL, Chang YM, Chang WK, Hsieh TY. A case of a large colonic lipoma resected by endoscopic submucosal dissection: A long-term endoscopic observation. Advances in Digestive Medicine 2017. [DOI: 10.1002/aid2.12114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jung-Chun Lin
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| | - Yi-Ming Chang
- Department of Pathology; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| |
Collapse
|
28
|
Shiu TY, Huang SM, Shih YL, Chu HC, Chang WK, Hsieh TY. Correction: Hepatitis C Virus Core Protein Down-Regulates p21Waf1/Cip1 and Inhibits Curcumin-Induced Apoptosis through MicroRNA-345 Targeting in Human Hepatoma Cells. PLoS One 2017; 12:e0181299. [PMID: 28686748 PMCID: PMC5501671 DOI: 10.1371/journal.pone.0181299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
29
|
Huang MY, Chung CH, Chang WK, Lin CS, Chen KW, Hsieh TY, Chien WC, Lin HH. The role of thiazolidinediones in hepatocellular carcinoma risk reduction: a population-based cohort study in Taiwan. Am J Cancer Res 2017; 7:1606-1616. [PMID: 28744408 PMCID: PMC5523039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the effect of thiazolidinediones (TZDs) on the risk of hepatocellular carcinoma (HCC) development among diabetes mellitus (DM) patients. METHODS We conducted a population-based case-control study in Taiwan based on data from the Taiwan National Health Insurance Research Database. A total of 76,349 newly diagnosed DM patients were identified from claims between 2000 and 2010. Among diabetics, 3,026 and 12,104 patients respectively, received or did not receive TZDs. Comparison frequency was matched with age, sex, and index date, excluding those with cancer at baseline. The incidence of HCC at the end of 2010 and the risks associated with the presence of hepatitis B and C infections were analyzed. The effect of TZDs use on the reduction of HCC risk was also assessed. RESULTS The incidence of HCC was lower in the TZD cohort compared with the non-TZD cohort (418.3 vs. 484.6 per 100,000 person-years), with an adjusted hazard ratio (HR) of 0.53 (95% confidence interval = 0.38-0.77) using multivariable Cox proportional hazard regression. In the stratified analysis, HCC risk reduction was greater for diabetics without the comorbidities of cirrhosis, hepatitis B, hepatitis C, nonalcoholic fatty liver disease, end-stage renal disease, and hyperlipidemia, in the TZD cohort than in the non-TZD cohort. Male sex, cirrhosis, hepatitis B, and hepatitis C were significant independent factors predicting HCC (HRs of 1.43, 13.96, 2.31, and 2.15, respectively). CONCLUSIONS This study suggests that the use of TZDs may reduce the risk of developing HCC among DM patients. Comorbidity with cirrhosis and/or hepatitis B/C infection appears to be associated with an extremely increased risk of developing HCC in this patient subset. These high-risk patients should be closely monitored.
Collapse
Affiliation(s)
- Mao-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Taoyuan Armed Forces General HospitalTaoyuan County, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterTaipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical CenterTaipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterTaipei, Taiwan
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical CenterTaipei, Taiwan
| | - Kai-Wen Chen
- Division of Gastroenterology, Department of Internal Medicine, Hualien Armed Forces General HospitalHualien County, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterTaipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical CenterTaipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical CenterTaipei, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical CenterTaipei, Taiwan
| |
Collapse
|
30
|
Chen HC, Chung CH, Wang CH, Lin JC, Chang WK, Lin FH, Tsao CH, Wu YF, Chien WC. Increased risk of sudden sensorineural hearing loss in patients with hepatitis virus infection. PLoS One 2017; 12:e0175266. [PMID: 28384326 PMCID: PMC5383281 DOI: 10.1371/journal.pone.0175266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/23/2017] [Indexed: 12/20/2022] Open
Abstract
The etiology of sudden sensorineural hearing loss (SSNHL) remains unclear. Possible causes of SSNHL include vascular diseases, viral infection, and autoimmune disorders. Therefore, we investigated whether hepatitis virus infection is correlated with the risk of SSNHL. Using data from the Taiwan Longitudinal Health Insurance Database, we conducted a retrospective matched-cohort study to compare patients diagnosed with hepatitis B or C virus (HBV/HCV) infections from January 1, 2000, to December 31, 2010, (N = 170,942) with frequency-matched controls (N = 512,826) at a ratio of 1:3 by sex, age, and index year. We followed each patient until the end of 2010 and evaluated the incidence of SSNHL. At the end of the follow-up period, 647 (0.38%, 647/170,942) patients developed SSNHL in the HBV/HCV group compared with 978 (0.19%, 978/512,826) in the control groups, with a statistical significance of P < 0.001 (using the log-rank test). The incidence rate ratio of SSNHL was 5.743-fold higher in the HBV/HCV group than in the control group (283.17 vs. 49.31 per 100,000 person-years, P < 0.001). The risk of SSNHL increased with HBV/HCV infection, and an adjusted hazard ratio of 5.103 (95% CI, 4.585–5.678) was determined using Cox proportional hazards regression. This study contributes to the awareness of the increased risk of SSNHL in HBV/HCV-infected populations. Our findings suggest that an underlying viral infection contributes to the development of SSNHL.
Collapse
Affiliation(s)
- Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chun Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Fu Wu
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
31
|
Shiu TY, Shih YL, Feng AC, Lin HH, Huang SM, Huang TY, Hsieh CB, Chang WK, Hsieh TY. HCV core inhibits hepatocellular carcinoma cell replicative senescence through downregulating microRNA-138 expression. J Mol Med (Berl) 2017; 95:629-639. [PMID: 28258280 DOI: 10.1007/s00109-017-1518-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/23/2016] [Accepted: 02/07/2017] [Indexed: 01/06/2023]
Abstract
Hepatitis C virus (HCV) infection is a major cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). HCV core protein is considered as a positive regulator of telomerase activity. In this study, we focused on the deregulated microRNA-138 (miR-138) in HCV-associated HCC. Differential expression of miR-138 was determined by TaqMan quantitative real-time PCR. The target gene of miR-138 was verified by luciferase reporter assay, quantitative real-time PCR, and Western blotting. Moreover, three assays based on telomerase activity, cell proliferation, and senescence-associated β-galactosidase activity were performed. The correlation analysis revealed a significantly negative correlation between miR-138 and telomerase reverse transcriptase (TERT) mRNA expression in HCC. Further, we showed that mature HCV core protein of 173 amino acids, but not full-length form of 191 amino acids, suppressed miR-138 expression. TERT was verified as a direct target of miR-138 in HCC cells. Furthermore, TERT-targeting miR-138 supplementation can prevent HCV core protein from repressing HCC cell replicative senescence. Collectively, HCV core protein can enhance TERT protein expression through downregulating TERT-targeting miR-138 expression, which in turn inhibits HCC cell replicative senescence. This study may further help our understanding on the pathogenic mechanisms of HCV core protein in HCV-associated HCC development. KEY MESSAGE: miR-138 is downregulated in HCV-associated HCC. Mature HCV core protein plays a pathogenic role in suppressing miR-138 expression. Telomerase reverse transcriptase represents a direct target of miR-138 in HCC cells. miR-138 promotes HCC cell senescence, suggesting potential for HCC treatment.
Collapse
Affiliation(s)
- Tzu-Yue Shiu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - An-Chieh Feng
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ming Huang
- Department and Graduate Institute of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Bao Hsieh
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
32
|
Chen BC, Chen PJ, Shih YL, Huang HH, Lin XH, Lin JC, Tseng YC, Chen CT, Hsu CH, Chang WK, Hsieh TY, Huang TY. Single-balloon enteroscopy for managing obscure gastrointestinal bleeding: Results from a tertiary medical center in Taiwan. Advances in Digestive Medicine 2017. [DOI: 10.1002/aid2.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Bao-Chung Chen
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Xuan-Huai Lin
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Jung-Chun Lin
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Yu-Chen Tseng
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Chun-Ting Chen
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Chin-Hui Hsu
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| |
Collapse
|
33
|
Abstract
The traditional practice of gastric residual volumes (GRVs) is flawed in its design and conception, is poorly standardized in its technique, is an inaccurate measure of gastric emptying, and serves as an insensitive marker for regurgitation and aspiration. The refractive index of a solution (like an enteral formula) is a physical property of that solution, which is remarkably constant and reproducible under varying conditions of concentration, pH, and temperature. Refractometry may be performed quickly and easily at the bedside, requires only a small representative sample of aspirated solution, and provides valuable measurements that can be used to calculate both the true total volume of contents and the specific volume of formula remaining in the stomach. Refractometry complements the use of GRVs as a monitor for patients receiving enteral feeding and should improve the accuracy with which patients at risk for aspiration may be identified.
Collapse
Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Tapei, Taiwan, Republic of China
| | | | | |
Collapse
|
34
|
Abstract
Whether to provide artificial enteral nutrition therapy to a patient with evidence of gastrointestinal bleeding (GIB) creates a difficult clinical dilemma. Concern that enteral feeding may contribute to the morbidity associated with GIB leads to delays in initiating enteral therapy or to cessation of feeding in the patient in whom artificial nutrition support has already been started. Surprisingly, evidence of GIB is not an automatic contraindication to further enteral feeding. Depending on the etiology of the GIB, enteral nutrition may protect the gut mucosa and reduce further bleeding in some patients, actually increase risk for rebleeding in other patients, or serve as a moot point with no relation to further bleeding or morbidity in still other patients. In many cases, an endoscopic evaluation is needed to distinguish the differential etiology of the GIB. The nutrition support specialist needs a full understanding of the physiology behind the varying diagnoses for GIB to know whether feedings can be initiated or continued or whether enteral feedings need to be withheld for 48-72 hours until risk for rebleeding and further morbidity is minimized.
Collapse
Affiliation(s)
- Stephen A McClave
- Division of Gastroenterology/Hepatology, 550 S. Jackson St., Louisville, Kentucky 40202, USA.
| | | |
Collapse
|
35
|
Abstract
BACKGROUND Traditional use of gastric residual volumes (GRVs), obtained by aspiration from a nasogastric tube, is inaccurate and cannot differentiate components of the gastric contents (gastric secretion vs delivered formula). The use of refractometry and 3 mathematical equations has been proposed as a method to calculate the formula concentration, GRV, and formula volume. In this paper, we have validated these mathematical equations so that they can be implemented in clinical practice. METHODS Each of 16 patients receiving a nasogastric tube had 50 mL of water followed by 100 mL of dietary formula (Osmolite HN, Abbott Laboratories, Columbus, OH) infused into the stomach. After mixing, gastric content was aspirated for the first Brix value (BV) measurement by refractometry. Then, 50 mL of water was infused into the stomach and a second BV was measured. The procedure of infusion of dietary formula (100 mL) and then water (50 mL) was repeated and followed by subsequent BV measurement. The same procedure was performed in an in vitro experiment. Formula concentration, GRV, and formula volume were calculated from the derived mathematical equations. RESULTS The formula concentrations, GRVs, and formula volumes calculated by using refractometry and the mathematical equations were close to the true values obtained from both in vivo and in vitro validation experiments. CONCLUSIONS Using this method, measurement of the BV of gastric contents is simple, reproducible, and inexpensive. Refractometry and the derived mathematical equations may be used to measure formula concentration, GRV, and formula volume, and also to serve as a tool for monitoring the gastric contents of patients receiving nasogastric feeding.
Collapse
Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | | | | | | |
Collapse
|
36
|
Chang WK, Chung HP, Chou YY, Geiss R, Yang SD, Pertsch T, Chen YH. Electro-optically spectrum narrowed, multiline intracavity optical parametric oscillators. Opt Express 2016; 24:28905-28914. [PMID: 27958555 DOI: 10.1364/oe.24.028905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report on the first building of an active spectral narrowing mechanism in a pulsed, multiline optical parametric oscillator (OPO) based on a novel aperiodically poled lithium niobate (APPLN) device constructed using the aperiodic optical superlattice technique. The APPLN device functions simultaneously in the system as a multi-channel optical parametric down converter (OPDC) and an electro-optic (EO) gain spectral filter working on the corresponding (multiple) signal bands. When the APPLN OPO was installed in a diode pumped Nd:YVO4 laser system, highly narrowed dual-wavelength signal lines (at 1540 and 1550 nm) were observed at the output of the system through EO control of the APPLN. Correspondingly, an enhancement of the power spectral density of the source by a factor of ~7.8 with respect to the system operated in passive mode was found.
Collapse
|
37
|
Hsu SD, Chen CJ, Chang WK, Hu YJ. An Investigation of the Outcomes of PGY Students' Cognition of and Persistent Behavior in Learning through the Intervention of the Flipped Classroom in Taiwan. PLoS One 2016; 11:e0167598. [PMID: 27911937 PMCID: PMC5135136 DOI: 10.1371/journal.pone.0167598] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/16/2016] [Indexed: 11/23/2022] Open
Abstract
The Postgraduate Year (PGY) Program allows doctors-in-training to learn about the diagnosis, treatment and nursing of various common, general diseases. These items form the core curriculum and are mostly learned through caring for patients and clinical teaching. Doctors-in-training are evaluated for their knowledge through written tests or assignments, based on which the effectiveness of their training is also assessed; however, this generally produces a negative learning attitude among them. So we introduced the flipped classroom into PGY training program to change PGY students' learning behavior. Although the flipped classroom is highly valued and has been practiced by teachers in schools of various levels, very few attempts have been made until now to report the learning outcomes achieved through the flipped classroom by means of rigorous research methods. Therefore we tried to employed Ajzen and Fishbein's (1980) theory of reasoned action and Bandura's self-efficacy to predict and explain the participants' behavioral intention when participating in the core curriculum learning of the flipped classroom and to assess the change in students' learning behavior and learning effectiveness. From August 2013 to July 2014, 39 PGY students from the General Surgery of the Tri-Service General Hospital were selected as the participants of this study. The control group included 43 students of the previous year, that is, the year before the intervention of the flipped classroom. A comparative analysis was performed. The questionnaire's related matrices indicated highest correlation between self-efficacy and behavioral intention (r = 0.491, P < 0.01), followed by attitude (r = 0.365, P < 0.01) and subjective norms (r = 0.360, P < 0.01.) All three showed positive correlations with behavioral intention; among attitude, subjective norms, and self-efficacy, the pairwise correlations also reached significance level. The flipped classroom can indeed change PGY students' the learning behavior from "passive learning" to "active learning."
Collapse
Affiliation(s)
- Sheng-Der Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Division of Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Cheng-Jueng Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Division of Trauma Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yih-Jin Hu
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan, ROC
| |
Collapse
|
38
|
Lin MC, Chen PJ, Shih YL, Huang HH, Chang WK, Hsieh TY, Huang TY. Outcome and Safety of Anterograde and Retrograde Single-Balloon Enteroscopy: Clinical Experience at a Tertiary Medical Center in Taiwan. PLoS One 2016; 11:e0161188. [PMID: 27548619 PMCID: PMC4993377 DOI: 10.1371/journal.pone.0161188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/01/2016] [Indexed: 02/07/2023] Open
Abstract
Single-balloon enteroscopy (SBE) is designed for identifying possible small bowel lesions with balloon-assisted enteroscopy that allows deep intubation of the intestine. However, data regarding the outcome and safety of SBE remain limited. We conducted this study to evaluate the outcome and safety of anterograde and retrograde SBE approaches. This retrospective review from a tertiary medical center in Taiwan included endoscopic reports and chart data from 128 patients with 200 anterograde and retrograde procedures from September 2009 to November 2014. In this study, the most common indication for both anterograde and retrograde SBE was obscure gastrointestinal bleeding (64.4% vs. 60.6%). There were no significant differences between anterograde and retrograde approaches in terms of the diagnostic yield (69.3% vs. 52.5%) and intervention rate (23.8% vs. 17.2%). The procedure time was shorter for anterograde SBE than for retrograde SBE (68.1 ± 23.9 vs. 76.8 ± 27.7 min, P = 0.018). In addition, among the subgroup of patients with obscure gastrointestinal bleeding, the most common etiologies for those in different age-groups were angiodysplasia (≥ 65 years), non-specific ulcers (30–64 years), and Meckel’s diverticulum (< 30 years). The major complication rate during the study was 1.5%; the rate of asymptomatic hyperamylasemia was higher for patients who underwent anterograde SBE than for those who underwent retrograde SBE (13.9% vs. 2%, P = 0.005). The outcome and safety of anterograde and retrograde SBE are similar. However, anterograde SBE has a shorter procedural time and a higher rate of asymptomatic hyperamylasemia.
Collapse
Affiliation(s)
- Meng-Chiung Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Internal Medicine, Taichiung Armed Forces General Hospital, Taichiung, Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan, Taiwan
- * E-mail:
| |
Collapse
|
39
|
Chang WK, Chung HP, Lin YY, Chen YH. Electro-optic spectral tuning in a fan-out double-prism domain periodically poled lithium niobate intracavity optical parametric oscillator. Opt Lett 2016; 41:3904-3907. [PMID: 27519119 DOI: 10.1364/ol.41.003904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report on the design and experimental demonstration of an electro-optically tunable, pulsed intracavity optical parametric oscillator (IOPO) based on a unique fan-out double-prism domain periodically poled lithium niobate (DPD PPLN) in a diode-pumped Nd:YVO4 laser. The PPLN device combines the functionalities of fan-out and ramped duty-cycle domain structured nonlinear crystals, working simultaneously as a continuous grating-period quasi-phase-matched optical parametric downconverter and an electro-optic beam deflector/Q switch in the laser system. When driving the fan-out DPD PPLN with a voltage pulse train and varying the DC offset of the pulse train, a pulsed IOPO was realized with its signal and idler being electro-optically tunable over the 1880 and 2453 nm bands at spectral tuning rates of 13.5 (measured) and 25.8 (calculated) nm/(kV/mm), respectively.
Collapse
|
40
|
Abstract
Animal and human research has established the beneficial effects of enteral nutrition on the gut. Both the innate and acquired immune systems are bolstered by enteral alimentation. Emerging clinical concepts tie these beneficial effects to a significant influence on the host immune response to stressors during critical illness. In this article, we examine how enteral nutrition impacts gastrointestinal immunity and demonstrate how these changes may affect the body's systemic immune response to nongastrointestinal challenges. This modulatory effect occurs because of changes in the pattern of cytokine secretion and alterations in lymphocyte and neutrophil recruitment. Imbalances in these regulatory mechanisms may be the engine driving hyperresponsiveness to subsequent challenges in the critically ill patient.
Collapse
Affiliation(s)
- Abdul Jabbar
- Department of Medicine, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY 40202, USA
| | | | | | | |
Collapse
|
41
|
Abstract
Percutaneous endoscopic gastrostomy (PEG) is widely used in patients requiring long-term tube feeding. Traditional PEG studies usually focused on practical, technical, and ethical issues. There have been little epidemiological studies on PEG utilization and services in Asia. We evaluated the changes in PEG utilization, patient selection, patient characteristics, and medical service in Taiwan from 1997 to 2010.This retrospective study analyzed the data of patients admitted for PEG tube placement according to the International Classification of Diseases, Ninth Revision (procedure code 43.11) extracted from the National Health Insurance database between 1997 and 2010.From 1997 to 2010, the incidence of PEG increased from 0.1 to 3.8/10 population and incidence of PEG among aged patients increased from 0.9 to 19.0/10 population. Compared 1997-2004 to 2005-2010 periods, the percentage of cerebrovascular diseases decreased and esophageal cancer increased in the later period. PEG was mainly performed in male patients and at medical centers. Medical costs, Charlson Comorbidity Index (CCI) scores, and post-PEG mortality rates were higher in the 2005-2010 period than in the 1997-2004 period.PEG procedures are being increasingly performed in Taiwan, and changes in patient selection were noted. The seriousness of accompanying diseases, medical costs, and post-PEG mortality rates in patients undergoing PEG has increased. The present findings may help in the implementation of PEG, relocation of medical resources, and improvement of PEG-related care.
Collapse
Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine
| | | | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | | | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | | |
Collapse
|
42
|
Lay PL, Huang HH, Chang WK, Hsieh TY, Huang TY, Lin HH. Outcome of nonsurgical intervention in patients with perforated peptic ulcers. Am J Emerg Med 2016; 34:1556-60. [PMID: 27292601 DOI: 10.1016/j.ajem.2016.05.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although surgical intervention is the favorable treatment modality for perforated peptic ulcer, nonsurgical treatment is another option. The aim of this study is to analyze the results of conservative treatment for perforated peptic ulcer. METHODS Between 2003 and 2014, 403 patients were admitted to our hospital for perforated peptic ulcer, and 383 patients underwent surgery, whereas 20 were allocated to conservative treatment. The results of nonsurgical intervention in these patients were analyzed retrospectively. RESULTS The overall mortality rate of conservative treatment was 40%. Eleven patients remained hospitalized less than 2 weeks; among them, patients with a high (≥IV) American Society of Anesthesiologists class at admission had higher mortality than those with a low (<IV) American Society of Anesthesiologists class (83.3% vs 0%, P=.015). However, when patients remained hospitalized longer than 2 weeks, the mortality rates did not differ between patients with the low and high American Society of Anesthesiologists classes. Eight patients presented with a high American Society of Anesthesiologists class, of which 3 received early enteral feeding, and all of them survived. In contrast, the survival of patients without early enteral feeding was 0%, suggesting that early enteral feeding improved survival of patients with the high American Society of Anesthesiologists class (P=.018). CONCLUSIONS A higher American Society of Anesthesiologists class correlated with mortality in patients undergoing conservative treatment during the first 2 weeks of hospitalization. Early enteral feeding might improve the outcome of conservative treatment in patients with high American Society of Anesthesiologists class.
Collapse
Affiliation(s)
- Ping-Lien Lay
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung, Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
43
|
Huang IH, Wu YY, Huang TC, Chang WK, Chen JH. Statistics and outlook of primary hepatic angiosarcoma based on clinical stage. Oncol Lett 2016; 11:3218-3222. [PMID: 27123094 DOI: 10.3892/ol.2016.4348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/24/2016] [Indexed: 12/13/2022] Open
Abstract
Hepatic angiosarcoma is a rare condition that has been associated with exposure to colloidal solutions of thorium dioxide, vinyl chloride, arsenic and radiation. Therapeutic guidelines have not been definitively established due to the small number of cases of this disease. The present study reviewed 28 cases of hepatic angiosarcoma from studies that had been published between January 2000 and December 2012, in addition to 6 cases diagnosed at Tri-Service General Hospital (Taipei, Taiwan). Clinical staging was based on American Joint Committee on Cancer staging system for soft tissue sarcoma (2014). With a mean follow-up of 27.5 months (range, 0.27-102 months), 18% (6/34) of the patients survived. The 1-, 3- and 5-year survival rates were 68.0±9.3, 42.1±10.2 and 32.7±9.8% for patients with stage I disease (mean follow-up, 32.7 months), whilst the 1- and 3-year survival rates were 33.3±15.7 and 22.2±13.9% for patients with stage IV disease (mean follow-up, 13.0 months). Determining an appropriate therapeutic strategy for this patient group is necessary. New studies encompassing larger patient populations are required in order to analyze and define standard prognostic parameters and to standardize a treatment approach for this extremely rare neoplasm.
Collapse
Affiliation(s)
- I-Hsuan Huang
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C
| | - Yi-Ying Wu
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C
| | - Tzu-Chuan Huang
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C
| | - Wei-Kuo Chang
- Division of Gastroenterology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C
| | - Jia-Hong Chen
- Division of Hematology and Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan R.O.C.; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 116, Taiwan R.O.C
| |
Collapse
|
44
|
Lin KT, Lin CS, Lee SY, Huang WY, Chang WK. Risk of Esophageal Cancer Following Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients: A Nationwide Population-Based Cohort Study in Taiwan. Medicine (Baltimore) 2016; 95:e2958. [PMID: 26945412 PMCID: PMC4782896 DOI: 10.1097/md.0000000000002958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Esophageal cancers account for majority of synchronous or metachronous head and neck cancers. This study examined the risk of esophageal cancer following percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients using the Taiwan National Health Insurance Research Database. From 1997 to 2010, we identified and analyzed 1851 PEG patients and 3702 sex-, age-, and index date-matched controls. After adjusting for esophagitis, esophagus stricture, esophageal reflux, and primary sites, the PEG cohort had a higher adjusted hazard ratio (2.31, 95% confidence interval [CI] = 1.09-4.09) of developing esophageal cancer than the controls. Primary tumors in the oropharynx, hypopharynx, and larynx were associated with higher incidence of esophageal cancer. The adjusted hazard ratios were 1.49 (95% CI = 1.01-1.88), 3.99 (95% CI = 2.76-4.98), and 1.98 (95% CI = 1.11-2.76), respectively. Head and neck cancer patients treated with PEG were associated with a higher risk of developing esophageal cancer, which could be fixed by surgically placed tubes.
Collapse
Affiliation(s)
- Kuen-Tze Lin
- From the Department of Radiation Oncology (K-TL, C-SL, W-YH), Tri-Service General Hospital; Graduate Institute of Aerospace and Undersea Medicine (S-YL); and Division of Gastroenterology (W-KC), Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
45
|
Chen CT, Tseng YC, Yang CW, Lin HH, Chen PJ, Huang TY, Shih YL, Chang WK, Hsieh TY, Chu HC. Increased Risks of Spontaneous Bacterial Peritonitis and Interstitial Lung Disease in Primary Biliary Cirrhosis Patients With Concomitant Sjögren Syndrome. Medicine (Baltimore) 2016; 95:e2537. [PMID: 26765478 PMCID: PMC4718304 DOI: 10.1097/md.0000000000002537] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/25/2015] [Accepted: 12/21/2015] [Indexed: 12/11/2022] Open
Abstract
The incidence of Sjögren syndrome (SS) in primary biliary cirrhosis (PBC) patients is high. The influence of SS on the clinical outcomes of PBC patients, however, remains unclear. Our study retrospectively collected data on PBC-only patients and PBC patients with concomitant SS (PBC-SS) to compare the clinical differences of long-term outcomes between them.A total of 183 patients were diagnosed with PBC from January 1999 to December 2014 at our hospital. Of these, the authors excluded patients with diabetes, hypertension, advanced liver cirrhosis at initial diagnosis of PBC (Child-Turcotte-Pugh classification score of ≥7) and other liver diseases (ie, alcoholic liver disease, alpha-antitrypsin deficiency, viral hepatitis, and primary sclerosing cholangitis), and autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. Of the remaining 125 patients, 77 (61.6%) were PBC-only and 48 (38.4%) were PBC-SS patients.The mean follow-up duration was 8.76 years. During the observation period, the incidence of interstitial lung disease was higher in the PBC-SS group than in the PBC-only group (P = 0.005). The occurrence of spontaneous bacterial peritonitis was significantly different in PBC-SS patients than in PBC-only patients (P = 0.002). The overall survival was lower in PBC-SS patients than in PBC-only patients (P = 0.033). Although the incidence of hepatocellular carcinoma, end-stage renal disease, variceal bleeding, and hypothyroidism were all higher in the PBC-SS group than in the PBC-only group, the differences were not significant.Our study suggests that PBC-SS patients have a higher risk of developing interstitial lung disease and spontaneous bacterial peritonitis and have a poor prognosis. Aggressive surveillance of thyroid and pulmonary functions should therefore be performed in these patients.
Collapse
Affiliation(s)
- Chun-Ting Chen
- From the Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China (C-TC, Y-CT, C-WY, H-HL, P-JC, T-YH, Y-LS, W-KC, T-YH); and Division of Gastroenterology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China (H-CC)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
|
47
|
Chung HP, Huang KH, Yang SL, Chang WK, Wu CW, Setzpfandt F, Pertsch T, Neshev DN, Chen YH. Adiabatic light transfer in titanium diffused lithium niobate waveguides. Opt Express 2015; 23:30641-30650. [PMID: 26698696 DOI: 10.1364/oe.23.030641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report on the realization of adiabatic light transfer in lithium niobate (LiNbO3) waveguides. This peculiar adiabatic tunneling scheme was implemented in a three-waveguide coupling configuration with the intermediate waveguide being inclined with respect to the outer waveguides to facilitate the adiabatic passage process. We have investigated and determined the adiabatic conditions of the LiNbO3 device in terms of the structure configuration of the waveguide system and found optimal structure parameters by both simulation and experimental approaches. Broadband adiabatic couplings of bandwidth ~456 and 185 nm and peak coupling efficiencies of >0.96 have been obtained with a 2-cm long device for TE- and TM-polarized fundamental modes, respectively. Longer (5 cm) devices were also studied and found to be useful in increasing the adiabaticity of the device, especially for the TM-polarized mode.
Collapse
|
48
|
Chung HP, Chang WK, Tseng CH, Geiss R, Pertsch T, Chen YH. Electro-optically spectrum tailorable intracavity optical parametric oscillator. Opt Lett 2015; 40:5132-5135. [PMID: 26565817 DOI: 10.1364/ol.40.005132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a unique, pulsed intracavity optical parametric oscillator (IOPO) whose output spectrum is electro-optically (EO) tailorable based on an aperiodically poled lithium niobate (APPLN) working simultaneously as an optical parametric gain medium and an active gain spectrum filter in the system. We have successfully obtained from the IOPO the emission of single to multiple narrow-line signal spectral peaks in a near-infrared (1531 nm) band simply by electro-optic control. The power spectral density of the EO tailored signal can be enhanced by up to 10 times over the original (nontailored) signal.
Collapse
|
49
|
Yang CW, Lin HH, Hsieh TY, Chang WK. Palliative enteral feeding for patients with malignant esophageal obstruction: a retrospective study. BMC Palliat Care 2015; 14:58. [PMID: 26542798 PMCID: PMC4635529 DOI: 10.1186/s12904-015-0056-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 06/17/2015] [Accepted: 11/02/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Malignant esophageal obstruction leads to dysphagia, deterioration in quality of life, and malnutrition. Traditional bedside nasogastric (NG) tube placement is very difficult under these circumstances. However, endoscopically assisted NG tube placement under fluoroscopic guidance could be an alternative option for establishing palliative enteral nutrition. This study aimed to compare the clinical outcomes of enteral tube feeding and esophageal stenting for patients with malignant esophageal obstruction and a short life expectancy. METHODS Thirty-one patients were divided into 3 groups according to their treatment modality: NG tube (n = 12), esophageal stent group (n = 10), and supportive care with nil per os (NPO) (n = 9). Enteral nutrition, clinical outcomes, length of hospital stay, and median survival were evaluated. RESULTS There were no significant baseline differences among the groups, except in age. The tube and stent groups had significantly higher enteral calorie intake (p = 0.01), higher serum albumin (p < 0.01), shorter hospital stay (p = 0.01), and longer median survival (p < 0.01) than the NPO group. The incidence of dislodgement in the tube group was significantly higher than in the stent group (58% vs. 20%, respectively; p = 0.01). However, stenting costs more than NG tube placement. CONCLUSIONS Palliative enteral feeding by NG tube is safe, inexpensive, and has a low complication rate. Endoscopically assisted NG tube placement under fluoroscopic guidance could be a feasible palliative option for malignant esophageal obstruction for patients who have a short life expectancy.
Collapse
Affiliation(s)
- C W Yang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 11490, Taipei, Taiwan.
| | - H H Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 11490, Taipei, Taiwan.
| | - T Y Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 11490, Taipei, Taiwan.
| | - W K Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No 325, Section 2, Cheng-Kung Road, Neihu 11490, Taipei, Taiwan.
| |
Collapse
|
50
|
Shiu TY, Huang HH, Lin HH, Shih YL, Chu HC, Chang WK, Hsieh TY. Restriction fragment length polymorphism effectively identifies exon 1 mutation of UGT1A1 gene in patients with Gilbert's Syndrome. Liver Int 2015; 35:2050-6. [PMID: 25611851 DOI: 10.1111/liv.12785] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/14/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Gilbert's syndrome causes pharmacological variation in drug glucuronidation and unexpected toxicity from therapeutic agents. The two common genotypes of Gilbert's syndrome are a dinucleotide polymorphism (TA)7 in TATA-Box as well as the 211G>A mutation in the coding exon 1, particularly in Asians, of human UGT1A1 gene. In this study, we aimed to establish an effective method to detect the 211G>A mutation. METHODS The coding exon 1 sequence of human UGT1A1 gene was analysed by Vector NTI software. The 211G>A mutation in the coding exon 1 of UGT1A1 gene was determined by restriction fragment length polymorphism (RFLP) method. Serum total bilirubin level was measured as well. RESULTS A newly identified BsmBI site was located in the coding exon 1 of UGT1A1 gene. The 211G>A mutation in the coding exon 1 of UGT1A1 gene was determined by DNA RFLP. Furthermore, we reported our present work on genetic analysis of mutations of UGT1A1 gene, and the correlation of UGT1A1 mutations with serum total bilirubin levels in Taiwanese population. The results showed that 15 subjects carried 211G>A mutation in 23 subjects related with Gilbert's syndrome. The homozygous 211G>A mutant as well as simultaneously heterozygous mutants both in TATA-Box and 211G>A significantly increased the risk of Gilbert's syndrome similar to subjects carrying homozygous TATA-Box mutant. CONCLUSIONS BsmBI RFLP is an effective method to detect 211G>A mutation in the coding exon 1 of UGT1A1 gene. The common 211G>A mutation is one of the causes of Gilbert's syndrome in Taiwanese population.
Collapse
Affiliation(s)
- Tzu-Yue Shiu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Heng-Cheng Chu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|