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Lin PC, Chen PY, Wei KC, Lin JH, Lin MR, Wang HC, Chiu HY. Sleep disturbance in adults with untreated primary brain tumors: prevalence and impact on quality of life. Sleep Biol Rhythms 2023; 21:201-209. [PMID: 38469283 PMCID: PMC10900047 DOI: 10.1007/s41105-022-00436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
Purpose To investigate the frequency of sleep disturbance and its effects on quality of life in adults with untreated primary brain tumors. Methods This cross-sectional study recruited 68 and 35 patients with newly diagnosed benign and malignant brain tumors, respectively. All participants completed the Chinese versions of the Athens Insomnia Scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, and EORTC-QLQ-BN20 for quality-of-life assessment. An actigraph was used to measure sleep parameters [e.g., dichotomy index (I < O)], for at least 3 consecutive days in untreated status. Results The majority of the patients with benign and malignant tumors had meningioma (57.4%) and glioblastoma (40%), respectively. The prevalence of insomnia, poor sleep quality, and excessive daytime sleepiness was 59.2%, 77.7%, and 4.9%, respectively. The prevalence rates of sleep disturbances were not affected by tumor locations (suprasellar vs. non-suprasellar tumors) and tumor types (benign vs. malignant tumors). Only 36 participants completed actigraphy assessments (I < O = 95.4) due to having a tight schedule, actigraph malfunction, or not having the habit of wearing a wristwatch; 61% of them experienced circadian rhythm disruption (I < O ≤ 97.5). Insomnia was the only sleep parameter that significantly affected quality of life after controlling for potential confounders (B = 0.54, p = 0.03, adjusted R2 = 0.60). Conclusion More than 60% of the patients with primary malignant and benign brain tumors experienced insomnia, poor sleep quality, and circadian rhythm disruption. Insomnia was independently correlated with quality of life in untreated status. Health-care providers can apply these findings to design effective interventions targeting sleep disturbance to improve quality of life in this population. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-022-00436-y.
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Affiliation(s)
- Pei-Ching Lin
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110 Taiwan
- Department of Neurosurgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei, Taiwan
| | - Jian-her Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Mei-Ru Lin
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110 Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Huan-Chih Wang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110 Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry and Sleep Center, Taipei Medical University Hospital, Taipei, Taiwan
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Wang YC, Huang HH, Lin PC, Wang MJ, Huang CH. Hypothermia is an independent risk factor for prolonged ICU stay in coronary artery bypass surgery: an observational study. Sci Rep 2023; 13:4626. [PMID: 36944855 PMCID: PMC10030842 DOI: 10.1038/s41598-023-31889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/20/2023] [Indexed: 03/23/2023] Open
Abstract
Maintenance of normothermia is a critical perioperative issue. The warming process after hypothermia tends to increase oxygen demand, which may lead to myocardial ischemia. This study explored whether hypothermia was an independent risk factor for increased morbidity and mortality in patients receiving CABG. We conducted a retrospective observational study of CABG surgeries performed from January 2018 to June 2019. The outcomes of interest were mortality, surgical site infection rate, ventilator dependent time, intensive care unit (ICU) stay, and hospitalization duration. Data from 206 patients were analysed. Hypothermic patients were taller (p = 0.012), had lower left ventricular ejection fraction (p = 0.016), and had off-pump CABG more frequently (p = 0.04). Our analysis noted no incidence of mortality within 30 days. Hypothermia was not associated with higher surgical site infection rate or longer intubation time. After adjusting for sex, age, cardiopulmonary bypass duration, left ventricular ejection fraction, and EuroSCORE II, higher EuroSCORE II (p < 0.001; odds ratio 1.2) and hypothermia upon ICU admission (p = 0.04; odds ratio 3.8) were independent risk factors for prolonged ICU stay. In addition to EuroSCORE II, hypothermia upon ICU admission was an independent risk factor for prolonged ICU stay in patients receiving elective CABG.
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Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Hsing-Hao Huang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Pei-Ching Lin
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Ming-Jiuh Wang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
- National Taiwan University Cancer Center, No. 57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002.
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Lin MR, Chen PY, Wang HC, Lin PC, Lee HC, Chiu HY. Prevalence of sleep disturbances and their effects on quality of life in adults with untreated pituitary tumor and meningioma. J Neurooncol 2021; 154:179-186. [PMID: 34304334 DOI: 10.1007/s11060-021-03811-w] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore the prevalence of sleep disturbances and their effects on quality of life in adults with pituitary tumor or meningioma. METHODS This prospective study included 33 and 44 patients with pituitary tumor and meningioma, respectively. All participants completed a series of valid questionnaires for assessing sleep and quality of life; all participants wore 3-day actigraph prior to related treatment. The actigraph-derived sleep parameters included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and dichotomy index (I < O) value. RESULTS The prevalence of insomnia, excessive daytime sleepiness, and poor sleep quality was 46.8%, 6.5%, and 81.8%, respectively. The differences in these sleep parameters between patients with pituitary tumor and those with meningioma were nonsignificant. Only 27 participants completed the actigraphic assessments. The mean I < O value was 95.99%, and nearly 60% participants exhibited circadian rhythm disruption. Sleep quality was the only sleep variable independently correlated with preoperative quality of life, even after adjustments for confounders (B = 0.80, p = 0.02). CONCLUSIONS Insomnia, poor sleep quality, and disrupted circadian rhythm are highly prevalent in adults with untreated pituitary tumor or meningioma. Sleep quality independently correlated with quality of life. We indirectly confirmed that tumor location may not be a possible cause of sleep changes.
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Affiliation(s)
- Mei-Ru Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery and Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung branch, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Chih Wang
- Division of Neurosurgery, Department of Surgery Organization, National Taiwan University Hospital, Taipei, Taiwan
- Division of Neurosurgery, Department of Surgery Organization, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Pei-Ching Lin
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan.
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Lan YT, Chang SC, Lin PC, Lin CH, Liang WY, Chen WS, Jiang JK, Yang SH, Lin JK. High concordance of mutation patterns in 10 common mutated genes between tumor tissue and cell-free DNA in metastatic colorectal cancer. Am J Cancer Res 2021; 11:2228-2237. [PMID: 34094680 PMCID: PMC8167700] [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: 11/08/2020] [Accepted: 03/07/2021] [Indexed: 06/12/2023] Open
Abstract
The concordance of mutation patterns between cell-free DNA (cfDNA) and tumor DNA varies in colorectal cancers (CRCs). Next-generation sequencing (NGS) by targeted sequencing can detect novel genes. We aimed to use NGS to test the concordance between cfDNA and tumor DNA in metastatic CRCs. A total of 95 paired tumor and peripheral blood samples from metastatic CRC patients were included. The tumor DNA and cfDNA were analyzed with a 10-gene NGS panel (Illumina HiSeq2500 system). The median number of mutations in tumor samples was 3 (range 0-7). The most commonly mutated gene was TP53 (63.2%), followed by APC (49.5%), KRAS (35.8%) and FAT4 (15.8%). The concordance of mutation patterns in these 10 genes was as high as 91% between cfDNA and tumor samples in these metastatic CRC patients. A sensitivity of 88.2% and specificity of 100% was found when using KRAS mutation status of cfDNA to predict KRAS mutation in tumor tissue. For tumor DNA with TP53, KRAS, or APC mutations, right-sided CRCs were more likely to develop peritoneal metastases, while for tumor DNA with TP53 mutations, left-sided tumors were more likely to have lung metastases. For cfDNA with TP53 or KRAS mutations, right-sided CRCs were more likely to have peritoneal metastases. Due to the high concordance of mutation patterns between cfDNA and tumor samples, monitoring the mutation pattern of cfDNA may be applicable in the treatment of metastatic CRC.
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Affiliation(s)
- Yuan-Tzu Lan
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City HospitalTaipei, Taiwan
- Department of Health and Welfare, University of TaipeiTaiwan
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research InstitutesZhunan, Taiwan
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General HospitalTaipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
- Department of Surgery, National Yang Ming Chiao Tung University HospitalYilan, Taiwan
| | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
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Lin PC, Zeng JH, Su SS, Zhou Y, Chen JJ, Chen CS, Li YP. [The diagnostic performance of galactomannan detection in invasive pulmonary aspergillosis with severe and critically ill influenza]. Zhonghua Yi Xue Za Zhi 2021; 101:1050-1056. [PMID: 33878831 DOI: 10.3760/cma.j.cn112137-20200811-02337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the diagnostic performance of serum and bronchoalveolar lavage fluid (BALF) galactomannan (GM) test in invasive pulmonary aspergillosis(IPA) with severe and critically ill influenza. Methods: A retrospective study was performed for 157 patients with severe and critically ill influenza admitted to the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from December 2017 to April 2019.Clinical characteristics and serum and BALF GM values were collected. The patients were divided into an IPA group (n=18) and a non-IPA group (n=139). The definition of IPA modified from AspICU algorithm taken as the gold standard (The corresponding clinical manifestations, imaging manifestations and microbiological diagnostic criteria should be met simultaneously), the performance of serum and BALF GM test and their combination to IPA with influenza were analyzed respectively and receiver operating characteristic curve (ROC) was drawn. Results: A total of 157 cases were enrolled, 95 were critically ill, and the mortality of IPA with influenza was 55.6%(10/18). The APACHE Ⅱ score, PSI score, urea nitrogen, influenza severity (Percentage of critically ill influenza) and invasive ventilator in IPA group were (16±6), (110±31), 10.7 (8.4, 17.8) mmol/L, 88.9% and 66.7%, respectively, which were significantly higher than those in non-IPA group [(10±5), (83±30), 5.2 (3.6, 7.6) mmol/L, 56.8% and 24.5%, P<0.05]. All patients received serum GM test and 32 patients performed BALF GM test at the same time. When the cut-off valve of serum GM test was 0.5 μg/L, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 66.7% (12/18), 95.0% (132/139), 63.2% (12/19) and 95.7% (132/138) respectively. When the cut-off value of BALF GM test was 1.0 μg/L, the sensitivity, specificity, PPV and NPV were 80%(8/10),86.4%(19/22),72.7%(8/11)and 90.5%(19/21)respectively. The BALF GM cut-off value of 0.88 μg/L showed the highest diagnostic efficacy for IPA, for which the sensitivity and specificity were 90%(9/10) and 86.4%(19/22). The areas under the ROC curve of serum GM, BALF GM, and the combination of them were 0.81, 0.85, and 0.94 respectively. The difference was statistically significant (P<0.05) and the combined diagnosis efficiency was higher. Conclusions: Critically ill influenza patients should be alert for IPA. The sensitivity of serum GM test in the diagnosis of IPA with influenza was low, while the NPV was high. The optimum BALF GM cut-off value was 0.88 μg/L. The combination with BALF and serum GM test can improve the diagnostic performance.
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Affiliation(s)
- P C Lin
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - J H Zeng
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - S S Su
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - Y Zhou
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - J J Chen
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - C S Chen
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - Y P Li
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
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Lan YT, Chang SC, Lin PC, Lin CC, Lin HH, Huang SC, Lin CH, Liang WY, Chen WS, Jiang JK, Yang SH, Lin JK. Clinicopathological and molecular features between synchronous and metachronous metastases in colorectal cancer. Am J Cancer Res 2021; 11:1646-1658. [PMID: 33948379 PMCID: PMC8085873] [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: 10/19/2020] [Accepted: 02/13/2021] [Indexed: 06/12/2023] Open
Abstract
The molecular difference between synchronous and metachronous metastases in colorectal cancer (CRC) remains unclear. Between 2000 and 2010, a total of 492 CRC patients were enrolled, including 280 with synchronous metastasis and 212 with metachronous metastasis. Clinicopathological and molecular features were compared between the two groups. Patients with synchronous metastasis were more likely to have right-sided CRC, poorly differentiated tumors, lymphovascular invasion, advanced pathological tumor (T) and node (N) categories, and liver metastases than those with metachronous metastasis. For right-sided CRC, patients with synchronous metastasis had more lymphovascular invasion and liver metastases than those with metachronous metastasis. For left-sided CRC, patients with synchronous metastasis were more likely to have poorly differentiated tumors, lymphovascular invasion, advanced pathological T and N categories, and liver metastases than those with metachronous metastasis. Regarding the genetic mutations, patients with metachronous metastasis had more mutations in TP53, NRAS, and HRAS and fewer mutations in APC than those with synchronous metastasis; for right-sided CRC, synchronous metastasis was associated with more APC mutations than metachronous metastasis, while for left-sided CRC, metachronous metastasis was associated with more TP53 and NRAS mutations than synchronous metastasis. The 5-year overall survival (OS) rates were significantly higher in metachronous metastasis patients than in synchronous metastasis patients, especially those with left-sided CRC. Multivariate analysis showed that age, sex, lymphovascular invasion, pathological N category, metachronous metastasis, and BRAF and NRAS mutations were independent prognostic factors affecting OS. CRC patients with synchronous metastasis had a worse OS than those with metachronous metastasis and exhibited distinct genetic mutations.
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Affiliation(s)
- Yuan-Tzu Lan
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City HospitalTaipei, Taiwan
- Department of Health and Welfare, University of TaipeiTaipei Taiwan
| | - Chun-Chi Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Shen-Chieh Huang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research InstitutesZhunan, Taiwan
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General HospitalTaipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
- Department of Surgery, National Yang Ming Chiao Tung University HospitalYilan, Taiwan
| | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei, Taiwan
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Lan YT, Chang SC, Lin PC, Lin CC, Lin HH, Huang SC, Lin CH, Liang WY, Chen WS, Jiang JK, Lin JK, Yang SH. Clinicopathological and Molecular Features of Colorectal Cancer Patients With Mucinous and Non-Mucinous Adenocarcinoma. Front Oncol 2021; 11:620146. [PMID: 33738258 PMCID: PMC7962409 DOI: 10.3389/fonc.2021.620146] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/18/2021] [Indexed: 01/10/2023] Open
Abstract
Background The prognosis of mucinous adenocarcinoma (MAC) and non-mucinous adenocarcinoma (NMAC) in colorectal cancer (CRC) is controversial, and the molecular differences between them are unclear. Methods Between 2000 and 2010, a total of 1,483 CRC patients were included. Among them, 73 patients (4.9%) were diagnosed with MAC. The clinicopathological features and genetic alterations were compared between MAC and NMAC. Results After propensity score matching to balance age and sex between MAC and NMAC patients, 292 CRC patients (73 MAC and 219 NMAC) were enrolled in the analysis at a 1:3 ratio. In right-sided colon cancer, patients with MAC were more likely to have Borrmann types 3 and 4 tumors, poor differentiation, and advanced T category and tumor, node, metastasis (TNM) stage, chemotherapy, and a similar 5-year overall survival (OS) rate compared with patients with NMAC. In left-sided colon cancer and rectal cancer, patients with MAC were more likely to have Borrmann types 3 and 4 tumors, poor differentiation, lymphovascular invasion, advanced T and N categories and TNM stages, chemotherapy, and a worse 5-year OS rate than patients with NMAC. Regarding genetic alterations, for NMAC, right-sided colon cancer had more BRAF mutations than left-sided colon cancer and rectal cancer. For MAC, right-sided colon cancer was associated with more microsatellite instability-high tumors and more AKT1 mutations than left-sided colon cancer and rectal cancer. Conclusion The genetic alterations are distinct between MAC and NMAC in CRC. Tumor location may have an impact on genetic alterations and patient prognosis in MAC and NMAC.
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Affiliation(s)
- Yuan-Tzu Lan
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ching Chang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Ching Lin
- Department of Clinical Pathology, Taipei City Hospital, Taipei, Taiwan.,Department of Health and Welfare, University of Taipei, Taipei, Taiwan
| | - Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shen-Chieh Huang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Kou Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Surgery, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
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8
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Chang SC, Li AFY, Lin PC, Lin CC, Lin HH, Huang SC, Lin CH, Liang WY, Chen WS, Jiang JK, Lin JK, Yang SH, Lan YT. Clinicopathological and Molecular Profiles of Sporadic Microsatellite Unstable Colorectal Cancer with or without the CpG Island Methylator Phenotype (CIMP). Cancers (Basel) 2020; 12:cancers12113487. [PMID: 33238621 PMCID: PMC7700556 DOI: 10.3390/cancers12113487] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The 5'-C-phosphate-G-3' island methylator phenotype (CIMP) is a specific phenotype of colorectal cancer (CRC) associated with microsatellite instability-high (MSI-high) tumors. METHODS In this study, we determined the CIMP status using eight methylation markers in 92 MSI-high CRC patients after excluding five germline mismatch repair (MMR) gene mutations analyzed by next-generation sequencing (NGS) and confirmed by Sanger sequencing. The mutation spectra of 22 common CRC-associated genes were analyzed by NGS. RESULTS Of the 92 sporadic MSI-high tumors, 23 (25%) were considered CIMP-high (expressed more than 5 of 8 markers). CIMP-high tumors showed proximal colon preponderance and female predominance. The mutation profiles of CIMP-high tumors were significantly different from those of CIMP-low or CIMP-0 tumors (i.e., higher frequencies of BRAF, POLD1, MSH3, and SMAD4 mutations but lower frequencies of APC, TP53, and KRAS mutations). Multivariate analysis demonstrated that tumor, node, metastasis (TNM) stage was the independent prognostic factor affecting overall survival (OS). Among the MSI-high cases, the CIMP status did not impact the outcome of patients with MSI-high tumors. CONCLUSIONS Only TNM stage was a statistically significant predictor of outcomes independent of CIMP profiles in MSI-high CRC patients. Sporadic MSI-high CRCs with different mechanisms of carcinogenesis have specific mutation profiles and clinicopathological features.
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Affiliation(s)
- Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
| | - Anna Fen-Yau Li
- Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (A.F.-Y.L.); (W.-Y.L.)
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei 11146, Taiwan;
- Department of Health and Welfare, University of Taipei, Taipei 11153, Taiwan
| | - Chun-Chi Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
| | - Hung-Hsin Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
| | - Shen-Chieh Huang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research Institutes, Zhunan 35053, Taiwan;
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (A.F.-Y.L.); (W.-Y.L.)
| | - Wei-Shone Chen
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
| | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
| | - Shung-Haur Yang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
| | - Yuan-Tzu Lan
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-C.C.); (C.-C.L.); (H.-H.L.); (S.-C.H.); (W.-S.C.); (J.-K.J.); (J.-K.L.); (S.-H.Y.)
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11121, Taiwan
- Correspondence: ; Tel.: +886-2-28757544-110
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Chen PY, Chiu HY, Lin PC. QOLP-28. PREOPERATIVE SLEEP DISTURBANCE AND ITS ASSOCIATION WITH QUALITY OF LIFE IN ADULT BRAIN TUMOR PATIENTS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Sleep disturbances are common complaints in adult brain tumor patients and impact their quality of life profoundly. The prevalence and pattern of preoperative sleep disturbances are still unknown.
MATERIAL AND METHOD
There were 36 adult patients with primary brain tumors who were recruited before craniotomy. All participants completed a battery of questionnaires, including the Athens Insomnia Scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Brief Fatigue Inventory, Hospital Anxiety, and Depression Scale, Morningness-Eveningness Questionnaire, and EORTC-QLQ-BN20. Actigraphy was put on a non-dominant wrist for obtaining objective sleep parameters, such as the dichotomy index.
RESULT
The prevalence of preoperative insomnia, poor sleep quality, excessive daytimes sleepiness, and circadian disruption were all high but similar between benign and malignant brain tumor groups. Patients with glioma had poorer quality of life. Insomnia was the only sleep disturbance that significantly associated with quality of life in a multivariate linear regression modal.
CONCLUSION
Sleep disturbances are common in adult brain tumor patients. Insomnia worse the quality of life of these patients. A further longitudinal investigation of sleep disturbances and quality of life in brain tumor patients is worthful.
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Affiliation(s)
- Pin-Yuan Chen
- Chang Gung Memorial Hospital, Keelung, Taiwan (Republic of China)
| | - Hsiao-Yean Chiu
- Taipei Medical University, Taipei, Taiwan (Republic of China)
| | - Pei-Ching Lin
- Taipei City Hospital, Zhong-Xiao Branch, Taipei, Taiwan (Republic of China)
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10
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Chang SC, Lan YT, Lin PC, Yang SH, Lin CH, Liang WY, Chen WS, Jiang JK, Lin JK. Patterns of germline and somatic mutations in 16 genes associated with mismatch repair function or containing tandem repeat sequences. Cancer Med 2019; 9:476-486. [PMID: 31769227 PMCID: PMC6970039 DOI: 10.1002/cam4.2702] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/19/2019] [Accepted: 10/28/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We assumed that targeted next-generation sequencing (NGS) of mismatch repair-associated genes could improve the detection of driving mutations in colorectal cancers (CRC) with microsatellite instability (MSI) and microsatellite alterations at selected tetranucleotide repeats (EMAST) and clarify the somatic mutation patterns of CRC subtypes. MATERIAL AND METHODS DNAs from tumors and white blood cells were obtained from 81 patients with EMAST(+)/MSI-high (MSI-H), 78 patients with EMAST(+)/microsatellite stable (MSS), and 72 patients with EMAST(-)/MSI-H. The germline and somatic mutations were analyzed with a 16-genes NGS panel. RESULTS In total, 284 germline mutations were identified in 161 patients. The most common mutations were in EPCAM (24.8%), MSH6 (24.2%), MLH1 (21.7%), and AXIN2 (21.7%). Germline mutations of AXIN2, POLE, POLD1, and TGFBR2 also resulted in EMAST and MSI. EMAST(+)/MSI-H tumors had a significant higher mutation number (205.9 ± 95.2 mut/MB) than tumors that were only EMAST(+) or MSI-H (118.6 ± 64.2 and 106.2 ± 54.5 mut/MB, respectively; both P < .001). In patients with AXIN2 germline mutations, the number of pathological somatic mutations in the tumors was significantly higher than those without AXIN2 germline mutations (176.7 ± 94.2 mut/MB vs 139.6 ± 85.0 mut/MB, P = .002). CONCLUSION Next-generation sequencing could enhance the detection of familial CRC. The somatic mutation burden might result from not only the affected genes in germline mutations but also through the dysfunction of downstream effectors. The AXIN2 gene might associate with hypermutation in tumors. Further in vitro experiments to confirm the causal relationship is deserved.
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Affiliation(s)
- Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Tzu Lan
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan.,Department of Health and Welfare, University of Taipei, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University Hospital, Yilan, Taiwan
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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11
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Huang SS, Zhang SN, Ye JR, Su SS, Lin PC, Li YP, Xie YP. [Diagnostic performance of pathology, culture and ROSE of lung biopsy for suspected pulmonary infectious diseases]. Zhonghua Yi Xue Za Zhi 2019; 99:3340-3344. [PMID: 31715672 DOI: 10.3760/cma.j.issn.0376-2491.2019.42.013] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the diagnostic performance of CT guided percutaneous lung biopsy (PTLB) with pathology, culture and rapid on-site evaluation (ROSE) in patients with pulmonary infectious diseases. Methods: From January 2016 to June 2018, a retrospective study was implemented in the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University. Patients who received PTLB, suspected with lung infection were included. The basic information, clinical symptoms, imaging findings, diagnostic methods, complications, and changes in treatment of cases were collected. The diagnostic sensitivity of histopathology, microbial culture, and ROSE were evaluated at the same time. Results: A total of 529 cases were enrolled, including 354 males and 175 females, (59±14) years old in average. Tuberculosis was identified in 197 cases, non-tuberculosis mycobacteria (NTM) pulmonary disease in 8, cryptococcosis in 95, pulmonary aspergillosis in 27, filamentous fungal pneumonia in 3, talaromyces marneffei pulmonary infection in 3 and pulmonary candidiasis in 1, bacterial pneumonia in 39, and pathogen were unknown in 156 cases. A total of 417 cases were submitted for histopathology and microbial culture at the same time, the diagnostic value of pathology and microbial culture were 35.0% (146/417) and 45.6% (190/417), respectively. Combined pathology with microbial culture, the diagnostic value increased to 62.8% (262/417). The diagnostic accuracy of ROSE was 51.8% (71/137). The most common complication of PTLB was pneumothorax 26.1% (138/529). 56.1% (297/529) of the patients received targeted treatment after the diagnosis was confirmed, and 43.9% (232/529) maintained the original treatment. Conclusion: The pathology, microbial culture, and ROSE of PTLB have relative high diagnostic value for pulmonary infectious diseases.
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Affiliation(s)
- S S Huang
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China (Huang Shuangshuang is working in the Division of Pulmonary Medicine, the People's Hospital of Cangnan, Wenzhou 325800, China)
| | - S N Zhang
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - J R Ye
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - S S Su
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - P C Lin
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - Y P Li
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - Y P Xie
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
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12
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Chen MH, Chang SC, Lin PC, Yang SH, Lin CC, Lan YT, Lin HH, Lin CH, Lai JI, Liang WY, Lu ML, Yang MH, Chao Y. Combined Microsatellite Instability and Elevated Microsatellite Alterations at Selected Tetranucleotide Repeats (EMAST) Might Be a More Promising Immune Biomarker in Colorectal Cancer. Oncologist 2019; 24:1534-1542. [PMID: 31292272 DOI: 10.1634/theoncologist.2019-0171] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/01/2019] [Accepted: 06/06/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The form of microsatellite instability (MSI) affecting tetranucleotide repeats known as elevated microsatellite alterations at selected tetranucleotide repeats (EMAST) has emerged as a new potential biomarker in multiple cancers. In colorectal cancer (CRC), the correlation between EMAST and MSI mutations remain inconclusive. MATERIALS AND METHODS We evaluated 1,505 patients with CRC using five EMAST markers (D20S82, D20S85, D8S321, D9S242, and MYCL1) and the Bethesda panel of MSI markers. Most commonly, mutations involved in CRCs were identified by MassArray Assay, and DNA repair genes were analyzed by next-generation sequencing. Clinical characteristics and prognostic relevance were correlated with EMAST and MSI. RESULTS Tumors that were EMAST positive and MSI high (MSI-H) were detected in 159 (10.6%) and 154 (10.2%) of 1,505 patients with CRC. Patients were divided into four groups according to EMAST and MSI status (EMAST-positive and MSI-H, EMAST-positive and microsatellite-stable [MSS], EMAST-negative and MSI-H, and EMAST-negative and MSS). The EMAST-positive and MSI-H group was associated with female predominance, higher prevalence of proximal colon tumors, early stage tumors, poorly differentiated tumors, mucinous histology, and higher incidence of mutations in PI3KCA, BRAF, TGFBR, PTEN, and AKT1 compared with other groups. Furthermore, compared with only EMAST-positive tumors or only MSI-H tumors, tumors that were both EMAST-positive and MSI-H had a higher frequency of MLH1, MSH3, MSH6, PMS2, and EXO1 gene mutations. Finally, the presence of EMAST-positive and MSI-H tumors was a good prognostic indicator in CRC. CONCLUSION High mutations in several DNA repair genes in EMAST-positive and MSI-H tumors suggest that this subtype of CRC might be more suitable for treatment with immune therapy. IMPLICATIONS FOR PRACTICE Elevated microsatellite alterations at selected tetranucleotide repeats (EMAST) is a unique molecular subtype of colorectal cancer (CRC). The current study demonstrated that the EMAST-positive and MSI-high (MSI-H) group was associated with female predominance, higher prevalence of proximal colon tumors, early stage tumors, poorly differentiated tumors, mucinous histology, and higher incidence of mutations in PI3KCA, BRAF, TGFBR, PTEN, and AKT1 compared with other groups. Most importantly, high mutations in DNA repair genes and MSI-related genes in EMAST-positive and MSI-H tumors suggest that this subtype of CRC might be more suitable for treatment with immune therapy compared with MSI-H tumors alone.
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Affiliation(s)
- Ming-Huang Chen
- Division of Medical Oncology, Center for Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ching Chang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan
- Department of Health and Welfare, University of Taipei, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Tzu Lan
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Jiun-I Lai
- Division of Medical Oncology, Center for Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Meng-Lun Lu
- Division of Medical Oncology, Center for Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology, Center for Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yee Chao
- Division of Medical Oncology, Center for Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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13
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Hsu YL, Lin CC, Jiang JK, Lin HH, Lan YT, Wang HS, Yang SH, Chen WS, Lin TC, Lin JK, Lin PC, Chang SC. Clinicopathological and molecular differences in colorectal cancer according to location. Int J Biol Markers 2019; 34:47-53. [PMID: 30854932 DOI: 10.1177/1724600818807164] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The incidence, pathogenesis, molecular pathways, and outcomes of colorectal cancer vary depending on the location of the tumor. This study aimed to compare the difference in tumor characteristics and the outcome between right-sided colon cancer and left-sided colorectal cancer (LCRC). MATERIALS AND METHODS A total of 1503 patients with colorectal cancer who underwent surgery at the Taipei Veterans General Hospital between 2000 and 2010 were enrolled in this study. Right-sided colon cancer was defined as cancers in the cecum, ascending colon, and transverse colon, while LCRC was defined as cancers in the splenic flexure colon, descending colon, sigmoid colon, and rectum. The endpoint was overall survival. The mutations were detected via polymerase chain reaction and MASS array. The prognostic value was determined using the log-rank test and the Cox regression analysis. RESULTS A total of 407 and 1096 cases were classified as right-sided colon cancer and LCRC, respectively. Compared to patients with LCRC, those with right-sided colon cancer had more mucinous type cancer (7.4% vs. 3.5%), poorly differentiated tumor (11.5% vs. 3.6%), and advanced tumor-node-metastasis stage. The risk for peritoneal tumor seeding was higher in the right-sided colon cancer group (12.8% vs. 5.7%). Overall survival was better in LCRC than in right-sided colon cancer ( P=0.036). CONCLUSIONS In our study, right-sided colon cancer had a more advanced tumor stage, a higher risk of peritoneal metastasis, and a poorer outcome than LCRC. Moreover, right-sided colon cancer had more gene mutations in BRAF, KRAS, SMAD4, TGF-β, PIK3CA, PTEN, AKT1, and high microsatellite instability.
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Affiliation(s)
- Yu-Lun Hsu
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Chun-Chi Lin
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Jeng-Kai Jiang
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Hung-Hsin Lin
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Yuan-Tzu Lan
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Huann-Sheng Wang
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Shung-Haur Yang
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Wei-Shone Chen
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Tzu-Chen Lin
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Jen-Kou Lin
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Pei-Ching Lin
- 3 Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taiwan.,4 Department of Health and Welfare, University of Taipei, Taiwan
| | - Shih-Ching Chang
- 1 Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,2 National Yang-Ming University, School of Medicine, Taipei, Taiwan
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14
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Kuan TC, Lin PC, Yang SH, Lin CC, Lan YT, Lin HH, Liang WY, Chen WS, Lin JK, Jiang JK, Chang SC. Impact of LINE-1 hypomethylation on the clinicopathological and molecular features of colorectal cancer patients. PLoS One 2018; 13:e0197681. [PMID: 29795620 PMCID: PMC5993106 DOI: 10.1371/journal.pone.0197681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022] Open
Abstract
Recent studies suggest that aberrant DNA methylation might occur early and commonly in colorectal tumorigenesis. In 111 normal subjects, the mean LINE-1 methylation level of peripheral blood was 81.0 ± 5.7%. Of 143 colorectal cancer (CRC) patients, the mean level of LINE-1 methylation was 60.5 ± 12.5%. We defined below 60% as cut-off value of LINE-1 hypomethylation, and 93 cases (65.0%) had LINE-1 hypomethylation in the tumor tissue. LINE-1 hypomethylation was not associated with any other clinical features. There was a trend that LINE-1 hypomethylation tumors were associated with advanced disease, but it did not reach statistical significance. There was no significant association between mutations of 12 genes, MSI-high, EMAST, and LINE-1 hypomethylation level. The median follow-up was 61.2 months. Five-year disease-free survival (DFS) and overall survival curves of patients with LINE-1 hypomethylation tumors were significantly lower than those of patients with normal LINE-1 methylation tumors (p = 0.032 and 0.001, respectively). Multivariate analysis showed that only TNM staging was an independent prognostic factor for CRC patients including DFS and overall survival (OS). LINE-1 did not impact patients' outcomes in multivariate analysis including DFS and OS. In conclusion, LINE-1 hypomethylation is marginally related to advanced stage CRC and impacts patients' outcomes in univariate analysis.
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Affiliation(s)
- Tai-Chuan Kuan
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan
- Department of Health and Welfare, University of Taipei, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
| | - Chun-Chi Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
| | - Yuan-Tzu Lan
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
| | - Hung-Hsin Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
| | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
- * E-mail: (SCC); (JKJ)
| | - Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University,Taipei, Taiwan
- * E-mail: (SCC); (JKJ)
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Lan YT, Chen MH, Fang WL, Hsieh CC, Lin CH, Jhang FY, Yang SH, Lin JK, Chen WS, Jiang JK, Lin PC, Chang SC. Clinical relevance of cell-free DNA in gastrointestinal tract malignancy. Oncotarget 2018; 8:3009-3017. [PMID: 27936467 PMCID: PMC5356859 DOI: 10.18632/oncotarget.13821] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/30/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cell-free DNA (cfDNA) extracted from blood has become a clinically feasible biomarker in various types of cancer. However, the clinical significance of cfDNA in gastrointestinal (GI) tract cancer among Asian populations requires further investigation. RESULTS The median cfDNA copy number was highest in esophageal cancer, followed by colorectal cancer and gastric cancer, which were all significantly higher than those of healthy individuals. The cfDNA levels were higher in GI tract cancer, followed by those in carcinoma in situ and then healthy individuals (P = 0.019). During the postoperative surveillance, the cfDNA level tended to be more sensitive than the carcinoembryonic antigen level in predicting recurrence. For recurrent gastric cancer, a persistently high cfDNA level and an increasing trend was observed after surgery. For stage IV colorectal cancer, dynamic changes in the cfDNA level were correlated with the responses to chemotherapy and surgery. MATERIALS AND METHODS Blood samples were collected from 95 healthy individuals and from 855 patients diagnosed with GI tract malignancy, including 98 with esophageal cancer, 428 with stomach cancer, 329 with colorectal cancer and 30 with carcinoma in situ. The copy numbers of extracted cfDNA were analyzed and compared among the different types of GI cancers. CONCLUSIONS The cfDNA level can serve as a feasible biomarker for detecting tumors in GI tract cancer. The cfDNA level may play a role in predicting tumor responses to chemotherapy and surgery in colorectal cancer; tumor recurrence should be considered in gastric cancer with a persistently high cfDNA level after surgery.
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Affiliation(s)
- Yuan-Tzu Lan
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Huang Chen
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Liang Fang
- Department of Surgery, National Yang-Ming University, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Cheng Hsieh
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Hsing Lin
- Genome Research Center, National Yang-Ming University, Taipei City, Taiwan
| | - Fang-Yu Jhang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Kou Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ching Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan
| | - Shih-Ching Chang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
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16
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Lin PC, Lai QQ, Zhou Y, Ye JR, Wu Q, Chen CS, Li YP. [The diagnostic performance of galactomannan detection for invasive pulmonary aspergillosis in non-neutropenic hosts]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 39:929-933. [PMID: 27938542 DOI: 10.3760/cma.j.issn.1001-0939.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the diagnostic performance of galactomannan(GM)detection in serum and BALF for invasive pulmonary aspergillosis (IPA) in non-neutropenic hosts. Methods: A pospective study was performed for 1 356 non-neutropenic hosts admitted to the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from September 2014 to October 2015. Serum GM test was performed for all, and BALF GM test for a proportion of the patients. The patients were divided into an IPA group and a non-IPA group. SPSS 20.0 was adopted for statistical analysis. Results: A total of 1 361 cases were enrolled, aging 18-96 years, with an average age of (64±15) years. There were 879 male and 477 female patients. Thirty-nine cases were diagnosed as IPA, accounting for 2.9%. For serum GM test, the sensitivity, specificity, PPV and NPV were 43.6%(17/39), 94.1%(1 239/1 317), 17.9%(17/95)and 98.3%(1 239/1 261)respectively. Ninety-six cases received serum and BALF GM tests at the same time. If the cut-off value of BALF GM test was 0.8, the sensitivity, specificity, PPV and NPV were 86.7%(13/15), 60.5%(49/81), 28.9%(13/45), 96.1%(49/51)respectively, but if the value was 1.0, the sensitivity, specificity, PPV and NPV were 86.7%(13/15), 74.1%(60/81), 38.2%(13/34), 96.8%(60/62)respectively. The ROC curve area of BALF GM, serum GM and the combined serum and BALF GM was 0.87, 0.75 and 0.90, respectively. Conclusions: The sensitivity of serum GM test in non-neutropenic hosts was low, but it had a high negative predictive value.The best BALF GM cut-off value was 1.0. The combined serum and BALF GM tests improved the diagnostic performance.
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Affiliation(s)
- P C Lin
- *Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
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17
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Chang CC, Lin PC, Lin CC, Lan YT, Lin HH, Lin CH, Yang SH, Liang WY, Chen WS, Jiang JK, Lin JK, Chang SC. Molecular and Clinicopathological Differences by Age at the Diagnosis of Colorectal Cancer. Int J Mol Sci 2017; 18:ijms18071441. [PMID: 28678173 PMCID: PMC5535932 DOI: 10.3390/ijms18071441] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 12/26/2022] Open
Abstract
We compared the clinicopathological and molecular profiles between different age groups of sporadic colorectal cancer (CRC) patients (age <50, 56-60, 60-70, 70-80, and >80); 1475 CRC patients were enrolled after excluding 30 individuals with Lynch syndrome. The mutation spectra for APC, TP53, KRAS, PIK3CA, FBXW7, BRAF, NRAS, HRAS, TGFbR, Akt1, and PTEN were analyzed using polymerase chain reaction (PCR), followed by MassArray and microsatellite (MSI-high) analysis by performing genotyping. Male patients (74.1%) were significantly predominant to females (25.9%) in the older age group (70-80, >80). There was an insignificantly linear trend between TNM staging and age-onset of CRC diagnosis. Patients aged < 50 had 58.7% diseases in the advanced stages (Stage III: 36.5% and IV: 22.2% respectively), while this decreased to 40.2% (Stage III: 26.2% and IV; 14.0% respectively) in patients >80. The distributions of mutation frequency were similar in majority of the genes studied among different age groups. Additionally, patients aged <50 had significantly higher frequency of MSI-high, PTEN, and HRAS mutations than those of other groups. Age-onset at diagnosis significantly affected overall survival (HR = 1.46; 95% CI: 1.35-1.58), but not cancer-specific survival (HR = 1.08; 95% CI: 0.99-1.18) in multivariate analysis. In conclusion, molecular and clinicopathological differences were not as significant among different age groups of CRC patients as previously suspected.
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Affiliation(s)
- Chu-Cheng Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei 11146, Taiwan.
| | - Chun-Chi Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Yuan-Tzu Lan
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Hung-Hsin Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research Institutes, Zhunan 350, Taiwan.
| | - Shung-Haur Yang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Wei-Shone Chen
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Jeng-Kai Jiang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei 112, Taiwan.
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18
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Wang JY, Hsieh MH, Lin PC, Liu CS, Chen JD. Parallel contagion phenomenon of concordant mental disorders among married couples: a nationwide cohort study. J Epidemiol Community Health 2017; 71:640-647. [PMID: 28219896 PMCID: PMC5485751 DOI: 10.1136/jech-2016-208283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/12/2016] [Accepted: 02/05/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aggregation of mental disorders in couples, as reported by prior research, indicates the effect of familial environments and warrants attention. However, the concordant categories of mental disorders in couples remain unclear. This study investigated spousal concordance for the category of mental disorders among couples throughout Taiwan by using factors associated with such disorders. METHODS 5643 couples in the 2002-2013 Taiwan National Health Insurance Research Database were analysed and compared with propensity-matched 5643 non-couples. Twelve independent variables, including spouse and shared characteristics, and the category of mental disorders were analysed, mainly by using multinomial logistic regression. RESULTS The determined prevalence rates for concordant categories of mental disorder were 0.19% for affective disorders, 6.96% for anxiety disorders, and 3.15% of other mental disorders. Multinomial logistic regression results revealed that two spouses were significantly more likely to be diagnosed with the same category of the aforementioned mental disorders (ORs=2.914, 1.776 and 1.727, respectively). Other associated factors included gender, age, occupation, comorbidity and region. The odds of concordances were significantly higher in couples than in non-couples. CONCLUSIONS A category of mental disorder in one spouse is a determinant of that in the other spouse. This study extended the emotional contagion theory to the phenomenon of parallel contagion to reflect the three concordances, suggesting a direction of family-based mental health intervention, particularly prevention for the same category of mental disorders in couples. Policymakers should strengthen the coping strategies of the caring spouse and external support system to psychiatrically vulnerable families.
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Affiliation(s)
- Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ming-Hong Hsieh
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Pei-Ching Lin
- Tele-Healthcare Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-De Chen
- Department of Sports, National Changhua University of Education, Changhua, Taiwan
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19
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Hsiao CC, Chiou SS, Hsu HT, Lin PC, Liao YM, Wu LM. Adverse health outcomes and health concerns among survivors of various childhood cancers: Perspectives from mothers. Eur J Cancer Care (Engl) 2017; 27:e12661. [PMID: 28169481 DOI: 10.1111/ecc.12661] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 01/08/2023]
Abstract
Advanced therapies have improved outcomes and also resulted in a growing risk of long-term adverse health events. This study intends to estimate incidences of adverse health events and examine differences in adverse health events among childhood cancer survivors, and to understand the concerns of mothers after their child has completed cancer treatment. An explanatory sequential mixed-method was used. A total of 201 paediatric cancer survivors' mothers with mean age 43.6 years were recruited. Of the survivors, 12.4% experienced five or more adverse health events. The incidence of adverse health events of altered body image, fatigue and neurocognitive problems were 31.54%, 14.77% and 12.53% respectively. Among survivors, significant differences in adverse health events of pain, endocrine problems and altered body image issues were identified. Survivors receiving radiotherapy, bone marrow transplants or completing treatment after 6-10 years experienced significantly more adverse health events. Maintaining health was the greatest concern for mothers, and the qualitative reports of their concerns could be categorised: living in uncertainty, and keeping forward-looking. Childhood brain tumour survivors were identified as experiencing more adverse health events than other survivors. The need for healthcare teams to consider mothers' health concerns was highlighted.
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Affiliation(s)
- C C Hsiao
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - S S Chiou
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H-T Hsu
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - P C Lin
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Y M Liao
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - L-M Wu
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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Chang SC, Lin PC, Lin JK, Lin CH, Yang SH, Liang WY, Chen WS, Jiang JK. Mutation Spectra of Common Cancer-Associated Genes in Different Phenotypes of Colorectal Carcinoma Without Distant Metastasis. Ann Surg Oncol 2015; 23:849-55. [PMID: 26471487 DOI: 10.1245/s10434-015-4899-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is a heterogeneous disease caused by genetic and epigenetic alterations. This study aimed to describe the mutation frequency of 12 genes in different CRC phenotypes. METHODS Patients who underwent surgery at the Taipei Veterans General Hospital during 2000-2010 for CRC (n = 1249) were enrolled. The endpoint was overall survival. The prognostic value was determined with the log-rank test and Cox regression analysis. RESULTS We found 1836 mutations of 12 genes in 997 (79.8%) tumors. Mutations were most frequently in KRAS (485, 38.8%), TP53 (373, 29.9%), APC (363, 29.0%), and PIK3CA (179, 14.3%); 137 (11.0%) cancers had high microsatellite instability (MSI). Women had significantly higher high MSI (14.3%) and BRAF mutation (6.3%) frequencies. The abnormal MSI (21.7%) and KRAS (44.6%), BRAF (8.6%), PIK3CA (19.4%), AKT1 (2.2%), and TGF - βR (9.6%) mutation frequencies were significantly higher in proximal colon cancer. The high MSI (35.6%) and BRAF (20.3%), TGF - βR (18.6%), PTEN (5.1%), and AKT1 (3.4%) mutation frequencies were significantly higher in 59 (4.7%) poorly differentiated tumors. The high MSI (21.3%) and KRAS (51.9%), BRAF (8.3%), PIK3CA (25.0%), AKT1 (4.6%), and SMAD4 (8.3%) mutation frequencies were significantly higher in 108 mucinous tumors. TNM stage, lymphovascular invasion, and mucinous histology were significantly associated with patient outcomes in univariate and multivariate analyses. Only NRAS mutation (hazard ratio 1.59, 95% confidence interval 1.06-2.38) affected patient survival. CONCLUSIONS Mutational spectra differ significantly between CRC subtypes, implying diverse carcinogenetic pathways. The NRAS mutation is important, despite its low frequency.
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Affiliation(s)
- Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Campus, Taipei City Hospital, Taipei, Taiwan
| | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Shung-Haur Yang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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21
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Lin PC, Lin JK, Lin HH, Lan YT, Lin CC, Yang SH, Chen WS, Liang WY, Jiang JK, Chang SC. A comprehensive analysis of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) loss in colorectal cancer. World J Surg Oncol 2015; 13:186. [PMID: 25986931 PMCID: PMC4489205 DOI: 10.1186/s12957-015-0601-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/29/2015] [Indexed: 01/24/2023] Open
Abstract
Background Alterations of PTEN, regulator of the PTEN/PI3K-AKT pathway, are common in several types of cancer. This study aimed to do comprehensive analysis of PTEN in colorectal cancer patients. Methods Totally, 198 colorectal cancer patients who received surgery at Taipei Veterans General Hospital from 2006 to 2008 were enrolled. Mutations, loss of protein expression, promoter hypermethylation, and DNA copy number of PTEN were analyzed by sequencing, immunohistochemistry, methylation-specific polymerase chain reaction PCR, and quantitative (QPCR), respectively, and correlated with clinicopathological features and patients’ outcome. Results Genomic mutations, loss of protein expression, promoter hypermethylation, and decreased DNA copy number of PTEN were found in 4 (2.02 %), 68 (34.3 %), 54 (27.3 %), and 36 (18.2 %) tumors, respectively. Of these 68 tumors with loss expression of PTEN, 34 (50 %) tumors had promoter methylation and 18 (26.5 %) had decreased DNA copy number. All four tumors with PTEN mutations demonstrated loss of PTEN expression. In the stage I disease, frequency of loss of PTEN expression was 20 % and significantly increased to 56.9 % in stage IV disease. Either loss expression of PTEN, PTEN hypermethylation or decreased PTEN copy number was not associated with colorectal cancer (CRC) patients’ outcome. Conclusions PTEN alterations were found in up to one-third of colorectal cancers but did not impact CRC patients’ prognosis. Electronic supplementary material The online version of this article (doi:10.1186/s12957-015-0601-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan.
| | - Jen-Kou Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No.201, 2nd section, ShiPai Road, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No.201, 2nd section, ShiPai Road, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yuan-Tzu Lan
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No.201, 2nd section, ShiPai Road, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chun-Chi Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No.201, 2nd section, ShiPai Road, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No.201, 2nd section, ShiPai Road, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Wei-Shone Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No.201, 2nd section, ShiPai Road, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Yi Liang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jeng-Kai Jiang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No.201, 2nd section, ShiPai Road, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Shih-Ching Chang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No.201, 2nd section, ShiPai Road, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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22
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Lin PC, Lin JK, Lin CH, Lin HH, Yang SH, Jiang JK, Chen WS, Chou CC, Tsai SF, Chang SC. Clinical Relevance of Plasma DNA Methylation in Colorectal Cancer Patients Identified by Using a Genome-Wide High-Resolution Array. Ann Surg Oncol 2014; 22 Suppl 3:S1419-27. [PMID: 25472652 DOI: 10.1245/s10434-014-4277-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND DNA methylation is a potential tumor marker for several cancers, including colorectal cancer (CRC), because of its heritable and stable characteristics. METHODS Using a high-resolution, genome-wide approach, we epigenotyped >450,000 CpG sites in tumor and adjacent non-tumor tissues from 23 microsatellite instability (MSI)/microsatellite stability (MSS) CRC cases. Using matrix-assisted laser desorption ionization-time of flight mass spectrometry, the methylation status of five frequently hypermethylated genes were confirmed in 75 independent CRC series and 353 CRC patients with available plasma. RESULTS Compared with non-tumor tissues, 13 MSI tumors had 34,836 (7 %) aberrant methylation sites, 87 % of which were hypermethylated. In contrast, only 9,806 (2 %) differentially methylated sites were identified in ten MSS cases (62 % hypermethylated). In both MSI and MSS, 228 promoter-associated CpG islands were hypermethylated, with AGBL4, ZNF625, MDFI, TWIST1, and FLI1 being most frequently hypermethylated. In an independent set of 35 MSI and 40 MSS cases, the methylation status of these five genes significantly differed between tumor and adjacent non-tumor tissues. Of 353 CRC patients, 230 (65.2 %), 232 (65.7 %), and 247 (70.0 %) had AGBL4, FLI1, and TWIST1 promoter hypermethylation in circulating cell-free DNA, respectively. In patients without metastasis, the sensitivity of any two or three hypermethylation markers was 52.8-57.8 and 27.9-38.9 %, respectively. The sensitivity of any two or three markers was significantly high in patients with stage IV disease (73.0 and 55.6 %, respectively). The prognostic value of these epimarkers was inconclusive. CONCLUSION DNA methylation patterns differed in CRC subtypes. The identified hypermethylation markers in CRC patients may have good sensitivity in different CRC stages.
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Affiliation(s)
- Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan
| | - Jen-Kou Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Hsing Lin
- Division of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Hung-Hsin Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shung-Haur Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jeng-Kai Jiang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Shone Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Chi Chou
- Department of Life Sciences and Genome Research Center and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Feng Tsai
- Division of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Taiwan. .,Department of Life Sciences and Genome Research Center and Institute of Genome Sciences, National Yang-Ming University, Taipei, Taiwan.
| | - Shih-Ching Chang
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Lin JK, Lin PC, Lin CH, Jiang JK, Yang SH, Liang WY, Chen WS, Chang SC. Clinical relevance of alterations in quantity and quality of plasma DNA in colorectal cancer patients: based on the mutation spectra detected in primary tumors. Ann Surg Oncol 2014; 21 Suppl 4:S680-6. [PMID: 24841357 DOI: 10.1245/s10434-014-3804-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND While circulating plasma DNA (cpDNA) likely originates in tumors, its utility is limited without knowledge of tumor mutations. This study assessed mutational spectra in primary tumors and clarified the utility of quantitative and qualitative cpDNA alterations in colorectal cancer (CRC) patients. MATERIALS AND METHODS Between 2005 and 2006, 191 surgical colorectal cancer patients at Taipei Veterans General Hospital were enrolled in a study of mutational spectra of 155 mutations in 74 genes. Concentrations of cpDNA in 133 patients were measured by Taqman qPCR. The measured endpoint was overall survival (OS) after surgery. The prognostic value was determined using the log-rank test and Cox regression analysis. RESULTS Of 191 tumors, 208 mutations in 17 genes were found in 137 tumors (71.7 %). Mutation frequencies were 38.7 % in KRAS, followed by APC (23.0 %), TP53 (19.9 %), PIK3CA (7.3 %), and BRAF (4.2 %). The median cpDNA in stage I, II, and III patients was 4,300, 4,800, and 5,600 copies/mL, respectively, increasing to 13,000 copies/mL in stage IV disease (p = .003). From 90 primary tumors with mutations, the sensitivity of cpDNA mutations were 24.0, 45.0, and 27.3 % in the stage I, II, and III disease, respectively, increasing to 87.5 % in stage IV. The 5-year OS of CRC patients with low cpDNA was significantly better than that of patients with high cpDNA (p = .001). Stepwise elimination showed cpDNA to be a strong prognostic factor for OS. CONCLUSIONS Plasma DNA alteration is a useful tool for clinical surveillance of colorectal cancer patients and might be an independent prognosticator.
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Affiliation(s)
- Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Lu YJ, Lin PC, Lin CC, Wang HS, Yang SH, Jiang JK, Lan YT, Lin TC, Liang WY, Chen WS, Lin JK, Chang SC. The impact of the lymph node ratio is greater than traditional lymph node status in stage III colorectal cancer patients. World J Surg 2014. [PMID: 23609344 DOI: 10.1007/s00268-0132051-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prognostic value of nodal status in colorectal cancer (CRC) patients may be influenced by the total number of lymph nodes (LNs) harvested. This study evaluates the impact of LN ratio (LNR) on CRC patients' outcome. METHODS A total of 612 stage III CRC patients who underwent curative-intent surgery between 2004 and 2008 were enrolled. The measured end point was postoperative disease-free survival (DFS) and overall survival (OS). RESULTS The metastatic LN numbers were significantly higher in patients with more than 12 LN harvested (4.6 ± 5.81 vs. 2.7 ± 1.97, P < 0.001). The mean LNR was 22.9 ± 20 % (range = 2-100 %, median = 16.7 %). As the cutoff value of LNR was set above 17 %, the impact of the LNR on 5-year DFS became statistically significant. In univariate analysis, the 5-year DFS and OS for patients with high-LNR tumors was 54.4 and 57.3 %, respectively, significantly lower than those for patients with low-LNR tumors (72.8 and 76.4 %; P < 0.001). In multivariate analysis, the independent factors affecting the 5-year DFS and OS were tumor depth, carcinoembryonic antigen level, and LNR. CONCLUSION The LNR, set at the median value or 17 %, could be an independent prognostic factor for stage III CRC patients.
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Affiliation(s)
- Yen-Jung Lu
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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Lu YJ, Lin PC, Lin CC, Wang HS, Yang SH, Jiang JK, Lan YT, Lin TC, Liang WY, Chen WS, Lin JK, Chang SC. The impact of the lymph node ratio is greater than traditional lymph node status in stage III colorectal cancer patients. World J Surg 2014; 37:1927-33. [PMID: 23609344 DOI: 10.1007/s00268-013-2051-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prognostic value of nodal status in colorectal cancer (CRC) patients may be influenced by the total number of lymph nodes (LNs) harvested. This study evaluates the impact of LN ratio (LNR) on CRC patients' outcome. METHODS A total of 612 stage III CRC patients who underwent curative-intent surgery between 2004 and 2008 were enrolled. The measured end point was postoperative disease-free survival (DFS) and overall survival (OS). RESULTS The metastatic LN numbers were significantly higher in patients with more than 12 LN harvested (4.6 ± 5.81 vs. 2.7 ± 1.97, P < 0.001). The mean LNR was 22.9 ± 20 % (range = 2-100 %, median = 16.7 %). As the cutoff value of LNR was set above 17 %, the impact of the LNR on 5-year DFS became statistically significant. In univariate analysis, the 5-year DFS and OS for patients with high-LNR tumors was 54.4 and 57.3 %, respectively, significantly lower than those for patients with low-LNR tumors (72.8 and 76.4 %; P < 0.001). In multivariate analysis, the independent factors affecting the 5-year DFS and OS were tumor depth, carcinoembryonic antigen level, and LNR. CONCLUSION The LNR, set at the median value or 17 %, could be an independent prognostic factor for stage III CRC patients.
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Affiliation(s)
- Yen-Jung Lu
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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Lin YS, Lin IF, Yen YF, Lin PC, Shiu YC, Hu HY, Yang YP. Impact of an antimicrobial stewardship program with multidisciplinary cooperation in a community public teaching hospital in Taiwan. Am J Infect Control 2013; 41:1069-72. [PMID: 23870295 DOI: 10.1016/j.ajic.2013.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 01/02/2013] [Revised: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reports of antimicrobial stewardship programs (ASPs) in community hospitals are limited, with the major focus on specific agents, small settings, or short time periods. Here we present the outcomes of cost control, consumption restraint, and quality of care after a 3-year multidisciplinary ASP in a 415-bed community public teaching hospital. METHODS Three strategies for improving antimicrobial stewardship were implemented: education, clinical pharmacists-based intervention, and regular outcome announcement. The steering panel of the program was a committee composed of infection specialists, attending physicians, clinical pharmacists, nurses, and medical laboratorists. RESULTS Semiannual data from July 2009 to June 2012 was analyzed. Antibiotic costs declined from $21,464 to $12,146 per 1,000 patient-days (-43.4%). Approximately $2.5 million was saved in 3 years, and estimated labor cost was $3,935 per month. Defined daily dose per 1,000 patient-days were diminished from 906.7 to 717.5 (-20.9%). Significant reductions were found in the consumption of aminoglycosides, first-generation cephalosporins, and aminopenicillins. However, through comprehensive auditing, increasing consumption of fourth-generation cephalosporins and fluoroquinolones was noticed. No significant difference in the quality of care (ie, length of stay, incidence of health care associated infections, and mortality) was observed. CONCLUSIONS The multidisciplinary ASP was beneficial to reduce antibiotic cost and consumption. The strategies were practical and worthy to be recommended to community health care settings.
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Affiliation(s)
- Yu-Shiuan Lin
- Department of Pharmacy, Taipei City Hospital Yang-Ming Branch, Taipei City Government, Taipei, Taiwan
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Huang YC, Tzeng WS, Wang CC, Cheng BC, Chang YK, Chen HH, Lin PC, Huang TY, Chuang TJ, Lin JW, Chang CP. Neuroprotective effect of agmatine in rats with transient cerebral ischemia using MR imaging and histopathologic evaluation. Magn Reson Imaging 2013; 31:1174-81. [PMID: 23642800 DOI: 10.1016/j.mri.2013.03.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to further investigate the effects of agmatine on brain edema in the rats with middle cerebral artery occlusion (MCAO) injury using magnetic resonance imaging (MRI) monitoring and biochemical and histopathologic evaluation. MATERIALS AND METHODS Following surgical induction of MCAO for 90min, agmatine was injected 5min after beginning of reperfusion and again once daily for the next 3 post-operative days. The events during ischemia and reperfusion were investigated by T2-weighted images (T2WI), serial diffusion-weighted images (DWI), calculated apparent diffusion coefficient (ADC) maps and contrast-enhanced T1-weighted images (CE-T1WI) during 3h-72h in a 1.5T Siemens MAGNETON Avanto Scanner. Lesion volumes were analyzed in a blinded and randomized manner. Triphenyltetrazolium chloride (TTC), Nissl, and Evans Blue stainings were performed at the corresponding sections. RESULTS Increased lesion volumes derived from T2WI, DWI, ADC, CE-T1WI, and TTC all were noted at 3h and peaked at 24h-48h after MCAO injury. TTC-derived infarct volumes were not significantly different from the T2WI, DWI-, and CE-T1WI-derived lesion volumes at the last imaging time (72h) point except for significantly smaller ADC lesions in the MCAO model (P<0.05). Volumetric calculation based on TTC-derived infarct also correlated significantly stronger to volumetric calculation based on last imaging time point derived on T2WI, DWI or CE-T1WI than ADC (P<0.05). At the last imaging time point, a significant increase in Evans Blue extravasation and a significant decrease in Nissl-positive cells numbers were noted in the vehicle-treated MCAO injured animals. The lesion volumes derived from T2WI, DWI, CE-T1WI, and Evans blue extravasation as well as the reduced numbers of Nissl-positive cells were all significantly attenuated in the agmatine-treated rats compared with the control ischemia rats (P<0.05). CONCLUSION Our results suggest that agmatine has neuroprotective effects against brain edema on a reperfusion model after transient cerebral ischemia.
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Affiliation(s)
- Y C Huang
- Department of Radiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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Lin PC, Lin JK, Lin CC, Wang HS, Yang SH, Jiang JK, Lan YT, Lin TC, Li AFY, Chen WS, Chang SC. Carbohydrate antigen 19-9 is a valuable prognostic factor in colorectal cancer patients with normal levels of carcinoembryonic antigen and may help predict lung metastasis. Int J Colorectal Dis 2012; 27:1333-8. [PMID: 22426691 DOI: 10.1007/s00384-012-1447-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE We retrospectively analyzed preoperative levels of carbohydrate antigen (CA) 19-9 in colorectal cancer (CRC) patients to determine the prognostic value of CA19-9 in CRC patients with normal carcinoembryonic antigen (CEA) levels. METHODS A total of 639 patients who underwent curative surgery at Taipei Veterans General Hospital between 2002 and 2006 were enrolled. We excluded 254 patients (39.7 %) with high preoperative CEA levels and analyzed 385 patients with normal CEA levels. The measured endpoint was the postoperative disease-free survival (DFS). The prognostic value of CA19-9 was determined using log-rank test and Cox regression analysis. RESULTS High CA19-9 levels were significantly associated with advanced disease and were detected in 5.8 % of patients with stage I disease, 11.7 % of those with stage II disease, and 22.5 % of those with stage III disease (P < 0.001). The 5-year DFS in patients with normal CA19-9 levels was 82.0 %, which was significantly higher than that in patients with high CA19-9 levels (68 %; P < 0.001). In a multivariate analysis, the most important independent factor affecting the 5-year DFS was tumor-node-metastasis stage (95 % CI, 1.26-2.36; HR = 1.72). After stratification by other factors, high CA19-9 level remained an independent prognostic factor for patients with normal CEA levels. Patients with high CA19-9 levels also showed a higher incidence of lung metastasis (23.1 %) than those with normal CA19-9 levels (7.2 %). CONCLUSIONS CA19-9 may be a prognostic factor for CRC patients with normal CEA levels. An aggressive follow-up protocol for lung metastasis should be used for these patients.
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Affiliation(s)
- Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Campus, Taipei City Hospital, Taipei, Taiwan
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Chang SC, Lin PC, Yang SH, Wang HS, Liang WY, Lin JK. Taiwan hospital-based detection of Lynch syndrome distinguishes 2 types of microsatellite instabilities in colorectal cancers. Surgery 2010; 147:720-8. [DOI: 10.1016/j.surg.2009.10.069] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 10/30/2009] [Indexed: 11/27/2022]
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Wang SE, Yu Y, Criswell TL, Debusk LM, Lin PC, Zent R, Johnson DH, Ren X, Arteaga CL. Oncogenic mutations regulate tumor microenvironment through induction of growth factors and angiogenic mediators. Oncogene 2010; 29:3335-48. [PMID: 20383197 PMCID: PMC2883631 DOI: 10.1038/onc.2010.112] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Activating mutations in the tyrosine kinase domain of HER2 (ErbB2) have been identified in human cancers. Compared to wild-type HER2, mutant HER2 shows constitutively activate kinase activity and increased oncogenicity. Cells transformed by mutant HER2 are resistant to EGFR tyrosine kinase inhibitors and exhibit an attenuated response to the HER2 antibody trastuzumab. We investigated herein pathways through which mutant HER2 alters the extracellular environment, potentially leading to drug resistance and the effect of simultaneously targeting HER2 and the tumor cell microenvironment with a therapeutic intent. Expression of mutant HER2 in mammary epithelial cells activated autocrine transforming growth factor (TGF) β1 signaling through a mechanism involving Rac1 and JNK-AP1-dependent transcription. Cells transformed by an activating mutant of H-Ras (G12V) also expressed higher TGF-β1 level through Rac1 activation. In addition, mutant HER2 induced the EGFR ligands TGF-α and amphiregulin at the mRNA and protein levels. Vascular endothelial growth factor (VEGF), a target of the TGF-β-Smad transcriptional regulation, was also induced as a result of expression of mutant HER2. Inhibition of TGF-β signaling with the Alk5 small molecule inhibitor LY2109761 reduced growth and invasiveness of cells expressing mutant HER2. Combined inhibition of intracellular and paracrine effects of mutant HER2 by trastuzumab and the EGFR antibody cetuximab was more efficient than single-agent therapies. These data suggest that mutations in oncogenes such as HER2 and Ras not only alter intracellular signaling and also influence on other components of the tumor microenvironment by inducing several pro-invasive growth factors. In turn, these serve as extracellular targets of novel therapeutic strategies directed at both cancer-driving oncogenes and the modified tumor microenvironment.
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Affiliation(s)
- S E Wang
- Division of Tumor Cell Biology, Beckman Research Institute of City of Hope, Duarte, CA, USA.
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Chang SC, Lin PC, Yang SH, Wang HS, Liang WY, Lin JK. Mitochondrial D-loop mutation is a common event in colorectal cancers with p53 mutations. Int J Colorectal Dis 2009; 24:623-8. [PMID: 19198855 DOI: 10.1007/s00384-009-0663-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2009] [Indexed: 02/04/2023]
Abstract
PURPOSE p53 is the most frequently mutated gene in colorectal cancer. In mitochondria, p53 protein is involved in regulation of transcription/replication and maintenance of genomic stability. Our aim was to examine the relationship between p53, D-loop mutation, and mitochondrial DNA content in colorectal cancer (CRC). METHODS A total of 194 patients with sporadic CRC without microsatellite instability who underwent surgery in Taipei Veterans General Hospital from January 1999 to December 2000 were included. The mitochondrial DNA content and D-loop mutation were quantified using real-time PCR and sequencing. RESULTS D-loop mutation occurred at significantly higher frequency in tumors with p53 mutation (34/88; 38.6%) than in tumors without p53 mutation (23/106; 21.7%). The frequency of the decreased mtDNA content was significantly associated with TNM stage (p = 0.009) and p53 mutation (p = 0.036). The 5-year DFS rate was 39% in patients exhibiting tumors with decreased mtDNA content, and was significantly poorer in these patients than in those exhibiting tumors with normal level of mtDNA content (61%, p = 0.01). The presence of D-loop mutations had no effect on 5-year DFS rate. In multivariate survival analysis, TNM stage, and p53 mutation, but not decreased mtDNA content and D-loop instability, had significant impacts on prognosis. CONCLUSION Change of mitochondrial DNA is a common event in colorectal cancer with p53 mutation, but is not associated with prognosis of CRC patients.
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Affiliation(s)
- Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan
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Chang SC, Lin PC, Yang SH, Wang HS, Li AFY, Lin JK. SDF-1α G801A Polymorphism Predicts Lymph Node Metastasis in Stage T3 Colorectal Cancer. Ann Surg Oncol 2009; 16:2323-30. [DOI: 10.1245/s10434-009-0501-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 04/13/2009] [Accepted: 04/13/2009] [Indexed: 11/18/2022]
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Wang HC, Chiang WC, Chen SY, Ke YL, Chi CL, Yang CW, Lin PC, Ko PCI, Wang YC, Tsai TC, Huang CH, Hsiung KH, Ma MHM, Chen SC, Chen WJ, Lin FY. Video-recording and time-motion analyses of manual versus mechanical cardiopulmonary resuscitation during ambulance transport. Resuscitation 2007; 74:453-60. [PMID: 17386966 DOI: 10.1016/j.resuscitation.2007.01.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 01/08/2007] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The quality of cardiopulmonary resuscitation (CPR) plays a crucial role in saving lives from out-of-hospital cardiac arrest (OHCA). Previous studies have identified sub-optimal CPR quality in the prehospital settings, but the causes leading to such deficiencies were not fully elucidated. OBJECTIVE This prospective study was conducted to identify operator- and ambulance-related factors affecting CPR quality during ambulance transport; and to assess the effectiveness of mechanical CPR device in such environment. MATERIALS AND METHODS A digital video-recording system was set up in two ambulances in Taipei City to study CPR practice for adult, non-traumatic OHCAs from January 2005 to March 2006. Enrolled patients received either manual CPR or CPR by a mechanical device (Thumper). Quality of CPR in terms of (1) adequacy of chest compressions, (2) instantaneous compression rates, and (3) unnecessary no-chest compression interval, was assessed by time-motion analysis of the videos. RESULTS A total of 20 ambulance resuscitations were included. Compared to the manual group (n=12), the Thumper group (n=8) had similar no-chest compression interval (33.40% versus 31.63%, P=0.16); significantly lower average chest compression rate (113.3+/-47.1 min(-1) versus 52.3+/-14.2 min(-1), P<0.05), average chest compression rate excluding no-chest compression interval (164.2+/-43.3 min(-1) versus 77.2+/-6.9 min(-1), P<0.05), average ventilation rate (16.1+/-4.9 min(-1) versus 11.7+/-3.5 min(-1), P<0.05); and longer no-chest compression interval before getting off the ambulance (5.7+/-9.9s versus 18.7+/-9.1s, P<0.05). The majority of the no-chest compression interval was considered operator-related; only 15.3% was caused by ambulance related factors. CONCLUSIONS Many unnecessary no-chest compression intervals were identified during ambulance CPR, and most of this was operator, rather than ambulance related. Though a mechanical device could minimise the no-chest compression intervals after activation, it took considerable time to deploy in a system with short transport time. Human factors remained the most important cause of poor CPR quality. Ways to improve the CPR quality in the ambulance warrant further study.
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Affiliation(s)
- Hui-Chih Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Chang SC, Lin PC, Lin JK, Yang SH, Wang HS, Li AFY. Role of MTHFR polymorphisms and folate levels in different phenotypes of sporadic colorectal cancers. Int J Colorectal Dis 2007; 22:483-9. [PMID: 16941173 DOI: 10.1007/s00384-006-0190-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS By altering both DNA methylation and nucleotide synthesis, folate metabolism is thought to contribute to colorectal carcinogenesis. We examined the role of folate metabolism in three different phenotypes of sporadic colorectal cancers (CRCs), phenotypes that were classified by the status of microsatellite instability (MSI) and chromosomal instability (CIN): MSI-H, microsatellite stability (MSS)/aneuploidy, and MSS/diploid. PATIENTS AND METHODS A total of 195 sporadic colorectal tumors and another 195 age- and gender-matched healthy volunteers in Taipei-Veteran General Hospital and Taipei City Hospital were collected. We analyzed for MTHFR (methylenetetrahydrofolate reductase) polymorphisms (C677T, A1297C), folate, and vitamin B(12) levels. We determined MSI status and DNA ploidy with fluorescent polymerase chain reaction and flow cytometry. Relations between clinicopathological variables and molecular variables were analyzed by chi (2) tests (with Yates' correction) for categorical variables and Student's t test for numerical variables. RESULTS Folate levels (5.02+/-4.43 ng/ml) were significantly lower in cancer patients than in controls (7.22+/-4.46 ng/ml). Vitamin B(12) level was similar between cancer patients and controls. The frequency of the TT genotype of MTHFR C627T (12.3%) was slightly higher than controls (8.2%), but it did not reach statistical significance (p=0.174). Within the low-folate group (<5 ng/ml), the frequency of the TT genotype in cancer patients (14.4%) was significantly higher than in controls (4.6%). Sixteen patients who had MSI-H CRC (8.2%) had a significantly higher frequency of TT MTHFR (37.5%) and lower folate levels (3.56+/-2.41 ng/ml) than patients with MSS tumors (10.1%, 5.14+/-3.72 ng/ml). Patients with MSS/aneuploid tumors had significantly lower folate levels (4.50+/-3.06 ng/ml) than those with MSS/diploid tumors (6.69+/-4.73 ng/ml). CONCLUSION Folate deficiency and the MTHFR genetic polymorphism play an important role in colorectal carcinogenesis, including MSI and CI. SYNOPSIS Folate metabolism plays an important role in colorectal carcinogenesis. We demonstrate that patients with MSI-H tumors had higher frequency of TT MTHFR C627T (37.5%), and patients with MSS/aneuploid tumor had lower folate level (4.50+/-3.06 ng/ml).
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Affiliation(s)
- Shih-Ching Chang
- Department of Surgery, Division of Colon & Rectal Surgery, Taipei Veterans General Hospital, National Yang-Ming University, No 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan.
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Abstract
Tumor growth and progression depends on tumor angiogenesis, the growth of tumor blood vessels, therefore, targeting tumor angiogenesis is a very promising approach for controlling tumor growth and/or causing regression. Tumor blood vessels have been recognized as a critical component of radiation response to the point of being independent of tumor oxygenation during radiation. An anti-angiogenic approach has been considered less likely to develop drug resistance. But recent findings suggest that anti-angiogenesis causes hypoxia that selects tumor cells (due to genetic instability) that are less dependent on blood supply and leads to drug resistance. The approach of combination of anti-angiogenesis with ionizing radiation by targeting both endothelial and tumor cells should minimize this possibility. The combination may produce a synergistic anti-tumor effect.
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Affiliation(s)
- H Kobayashi
- Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Kamiyama M, Pozzi A, Yang L, DeBusk LM, Breyer RM, Lin PC. EP2, a receptor for PGE2, regulates tumor angiogenesis through direct effects on endothelial cell motility and survival. Oncogene 2006; 25:7019-28. [PMID: 16732324 DOI: 10.1038/sj.onc.1209694] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prostaglandin E2 (PGE2), a major cyclooxygenase (COX) metabolite, plays important roles in tumor biology. We studied the role of EP2, a receptor for PGE2, in tumor angiogenesis using EP2 knockout mice. We found that deletion of the EP2 receptor impaired tumor angiogenesis and this finding was confirmed by an in vivo corneal angiogenesis model and an ex vivo aortic ring assay. To further characterize the cellular mechanisms of the EP2 receptor in angiogenesis, we isolated primary pulmonary endothelial cells (ECs) from wild-type (wt) and EP2-/- mice and observed that EP2-/- ECs exhibited defects in vascular branch formation when compared to wt ECs. In addition, EP2-/- ECs showed impaired cell motility on collagen-coated surface and they responded poorly to PGE2-induced cell migration compared to control cells. However, no difference in cell proliferation was observed between the EP2-/- and wt Ecs. In addition, EP2-/- ECs were more susceptible to apoptosis than wt cells under growth factor depletion conditions. Collectively, our data demonstrate that EP2 signaling in endothelium directly regulates tumor angiogenesis by contributing to cell survival and endothelial cell motility. Moreover, our finding suggests that EP2 is a major receptor in PGE2-mediated cell motility in ECs.
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Affiliation(s)
- M Kamiyama
- Department of Radiation Oncology, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Lin PC, Chiu NC, Li WC, Chi H, Hsu CH, Hung HY, Kao HA, Huang FY. Characteristics of nosocomial bacterial meningitis in children. J Microbiol Immunol Infect 2004; 37:35-8. [PMID: 15060685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Nosocomial meningitis is uncommon in children. We reviewed the medical records of all children who developed bacterial meningitis at least 72 hours after admission to Mackay Memorial Hospital for the period July 1992 through June 2000. Clinical manifestations, predisposing factors, pathogens, and outcomes were analyzed. Twenty-two cases of nosocomial meningitis were identified, comprising 9.2% (22/239) of all pediatric cases of bacterial meningitis during the study period. The male-to-female ratio was 14:8. All patients were younger than 6 months of age except for one, who was 7 years old. The mean duration between admission and onset of meningitis was 15.3 days (range, 3 to 58 days). Twenty-two organisms were isolated, including 13 Gram-negative bacteria (59%) and 9 Gram-positive bacteria (41%). The most common pathogen was Escherichia coli (5 cases), followed by Enterobacter cloacae (3), Staphylococcus aureus (3), and Chryseobacterium meningosepticum (3). Seventeen patients (77%) had concomitant bacteremia. Predisposing factors for acquisition of nosocomial meningitis included previous treatment with broad-spectrum antibiotics (68%), prematurity with very low birth weight (41%), and total parenteral nutrition (32%). Two patients (9%) had previous neurosurgical intervention. Four patients (18%) died, 3 of whom were low birth weight premature infants. Nine patients (41%) had sequelae, including developmental delay, hydrocephalus, hearing impairment, and epilepsy. Neurosurgery was not a significant risk factor for the development of nosocomial meningitis, while very low birth weight played an important role. Previous intraventricular hemorrhage or hydrocephalus, prematurity with very low birth weight, infection with Gram-negative bacteria, and prior broad-spectrum antibiotic administration were associated with poor outcome.
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Affiliation(s)
- Pei-Ching Lin
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC
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Abstract
The upper genital tract of women contains functional LH/human chorionic gonadotropin (hCG) receptors. Whether the cervix, an anatomical continuum of the uterus and fallopian tubes, also contains these receptors has never been investigated. Multiple receptor detection techniques revealed their presence with higher levels in endocervix than in ectocervix. The receptor positive cells include stratified squamous luminal epithelium of the ectocervix, columnar epithelium, glands, blood vessels, and smooth muscle in the endocervix. Treatment of cervical tissue minces with hCG resulted in a significant increase in cAMP levels and a decrease in cyclooxygenase-2 protein levels in endocervix, but not in ectocervix. In summary, human cervix contains functional LH/hCG receptors, which suggests that LH during the menstrual cycle and hCG during pregnancy may regulate cervical functions.
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Affiliation(s)
- P C Lin
- Division of Research, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville Health Sciences Center, Louisville, Kentucky 40292, USA
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Lee Y, Lin PC, Lai HY, Huang SJ, Lin YS, Cheng CR. Prevention of PONV with dexamethasone in female patients undergoing desflurane anesthesia for thyroidectomy. Acta Anaesthesiol Sin 2001; 39:151-6. [PMID: 11840580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Desflurane is associated with a higher incidence of 24-h postoperative nausea and vomiting (PONV) as compared with sevoflurane or isoflurane. Dexamethasone 5 mg i.v. is suggested to be the minimum effective dose for prophylaxis of PONV in women undergoing thyroidectomy with isoflurane anesthesia. The objective of this study was to investigate whether a 5 mg dose of dexamethasone could be enough for, or a larger dose at 8 mg, could be more capable of preventing PONV in women undergoing desflurane anesthesia for thyroidectomy. METHODS One hundred and thirty five patients were assigned to receive one of three treatment regimens prior to induction i.e., dexamethasone 8 mg i.v. (Group D8), dexamethesone 5 mg i.v. (Group D5) or saline (Group S). RESULTS It was demonstrated that the prophylactic administration of either dexamethasone 8 mg or 5 mg significantly reduced the overall incidence of PONV in patients undergoing thyroidectomy with desflurane anesthesia (P < 0.001, Group D8 vs. Group S; Group D5 vs. Group S). However, patients who received dexamethasone 8 mg showed a higher incidence of complete responses (no vomiting or need of rescue antiemetic medication for a 24-h postoperative period) in comparison with those receiving dexamethasone 5 mg (86% vs. 67%; P < 0.01). CONCLUSIONS The results of this study showed that in PONV prophylaxis, in female patients undergoing desflurane anesthesia for thyroidectomy, the effect of dexamethasone 8 mg was superior to that of dexamethasone 5 mg.
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Affiliation(s)
- Y Lee
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital, No 707, Section 3, Chung Yang Road, Hualien, Taiwan, R.O.C.
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Lee Y, Huang SJ, Lin PC, Lai HY, Pan MH. Low dose fentanyl and propofol improve the speed and quality of tidal-breathing induction techniques in sevoflurane anesthesia for adults. Acta Anaesthesiol Sin 2001; 39:83-8. [PMID: 11475180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND The objective of this study was to investigate whether low dose fentanyl, with or without low dose propofol, as pretreatment agent/s is capable of speeding up and improving the quality of laryngeal mask airway (LMA) insertion in tidal-breathing induction technique with high-concentration sevoflurane. METHODS One hundred and twenty patients were assigned to one of the three groups: Group S, induction with 8% sevoflurane only; Group F + S, 1.0 microgram/kg fentanyl prior to induction; and Group F + P + S, 1.0 microgram/kg fentanyl and 0.5 mg/kg propofol prior to induction. RESULTS It was demonstrated that the time from administration of drug (drugs) to loss of eyelash reflex (P < 0.05, Group F + P + S vs. F + S; P < 0.01, Group F + P + S vs. S), to jaw relaxation (P < 0.05, Group F + P + S vs. S) and time taken for LMA insertion (P < 0.01, Group F + P + S vs. S) were all shorter in Group F + P + S, with fewer complications (coughing and involuntary movement) during induction, however, the first time success rate with LMA insertion did not significantly differ among the comparing groups. According to a postoperative inquiry (by questionnaire), there were significantly more patients in the Group F + P + S (57.5%) who considered the induction as pleasant (P < 0.05), of whom 75% expressed that they would be willing to undergo an induction of the same form again in the future (P < 0.05). This more positive rating may be related to the mild sedative effects of the agents given and shorter induction time, which significantly helped reduce the rate of recall of the unpleasant gas. CONCLUSIONS The results of this study of LMA insertion, for ASA I or II adult patients undergoing the tidal-breathing technique with 8% sevoflurane, suggest that pretreatment with 1 microgram/kg fentanyl plus 0.5 mg/kg propofol is superior in comparison with either pretreatment with 1 microgram/kg fentanyl or absence of pretreatment.
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Affiliation(s)
- Y Lee
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital, No 707, Section 3, Chung Yang Rd., Hualien, Taiwan, R.O.C.
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Geng L, Donnelly E, McMahon G, Lin PC, Sierra-Rivera E, Oshinka H, Hallahan DE. Inhibition of vascular endothelial growth factor receptor signaling leads to reversal of tumor resistance to radiotherapy. Cancer Res 2001; 61:2413-9. [PMID: 11289107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Certain refractory neoplasms, such as glioblastoma multiforme (GBM) and melanoma, demonstrate a resistant tumor phenotype in vivo. We observed that these refractory tumor models (GBM and melanoma) contain blood vessels that are relatively resistant to radiotherapy. To determine whether the vascular endothelial growth factor receptor-2 (Flk-1/KDR) may be a therapeutic target to improve the effects of radiotherapy, we used the soluble extracellular component of Flk-1 (ExFlk), which blocks vascular endothelial growth factor binding to Flk-1 receptor expressed on the tumor endothelium. Both sFlk-1 and the Flk-1-specifc inhibitor SU5416 eliminated the resistance phenotype in GBM and melanoma microvasculature as determined by both the vascular window and Doppler blood flow methods. Human microendothelial cells and human umbilical vein endothelial cells showed minimal radiation-induced apoptosis. The Flk-1 antagonists sFlk-1 and SU5416 reverted these cell models to apoptosis-prone phenotype. Flk-1 antagonists also reverted GBM and melanoma tumor models to radiation-sensitive phenotype after treatment with 3 Gy. These findings demonstrate that the tumor microenvironment including the survival of tumor-associated endothelial cells contributes to tumor blood vessel resistance to therapy.
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MESH Headings
- Angiogenesis Inhibitors/pharmacology
- Animals
- Cell Survival/drug effects
- Cell Survival/physiology
- Cell Survival/radiation effects
- Dose-Response Relationship, Radiation
- Endothelial Growth Factors/metabolism
- Endothelium, Vascular/cytology
- Endothelium, Vascular/radiation effects
- Enzyme Inhibitors/pharmacology
- Glioblastoma/blood supply
- Glioblastoma/radiotherapy
- Indoles/pharmacology
- Lymphokines/metabolism
- Melanoma, Experimental/blood supply
- Melanoma, Experimental/radiotherapy
- Mice
- Mice, Inbred C57BL
- Neovascularization, Pathologic/drug therapy
- Neovascularization, Pathologic/radiotherapy
- Pyrroles/pharmacology
- Radiation Tolerance/drug effects
- Radiation Tolerance/physiology
- Receptor Protein-Tyrosine Kinases/antagonists & inhibitors
- Receptor Protein-Tyrosine Kinases/metabolism
- Receptor Protein-Tyrosine Kinases/pharmacology
- Receptor Protein-Tyrosine Kinases/physiology
- Receptors, Growth Factor/antagonists & inhibitors
- Receptors, Growth Factor/metabolism
- Receptors, Growth Factor/physiology
- Receptors, Vascular Endothelial Growth Factor
- Signal Transduction/drug effects
- Signal Transduction/physiology
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
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Affiliation(s)
- L Geng
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
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Li G, Sun PC, Lin PC, Fainman Y. Interference microscopy for three-dimensional imaging with wavelength-to-depth encoding. Opt Lett 2000; 25:1505-7. [PMID: 18066260 DOI: 10.1364/ol.25.001505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A novel interference microscope for three-dimensional (3D) imaging based on a wavelength-to-depth encoding technique is presented. Wavelength-to-depth encoding is realized by use of a diffractive lens and wavelength tuning. A high depth resolution of 0.71 mum is obtained with 0.90-N.A. objective lenses. Experimental measurements of a four-level grating are presented, and the results are found to be comparable with those obtained with a Dektak profilometer and a similar interference microscope that uses mechanical depth scanning. The system is promising for fast, noncontact, high-resolution 3D imaging.
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Affiliation(s)
- G Li
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California 92093-0407, USA
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Cha S, Lin PC, Zhu L, Sun PC, Fainman Y. Nontranslational three-dimensional profilometry by chromatic confocal microscopy with dynamically configurable micromirror scanning. Appl Opt 2000; 39:2605-2613. [PMID: 18345178 DOI: 10.1364/ao.39.002605] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A confocal microscope profilometer, which incorporates chromatic depth scanning with a diffractive optical element and a digital micromirror device for configurable transverse scanning, provides three-dimensional (3D) quantitative measurements without mechanical translation of either the sample or the microscope. We used a microscope with various objective lenses (e.g., 40x, 60x, and 100x) to achieve different system characteristics. With a 100x objective, the microscope acquires stable measurements over a 320 microm x 240 microm surface area with a depth resolution of 0.39 microm at a 3-Hz scan rate. The total longitudinal field of view is 26.4 microm for a wavelength tuning range of 48.3 nm. The FWHM value of the longitudinal point-spread function is measured to be 0.99 microm. We present 3D measurements of a four-phase-level diffractive element and an integrated-circuit chip. The resolution and the accuracy are shown to be equivalent to those found with use of conventional mechanical scanning.
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Affiliation(s)
- S Cha
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, California 92093-0407, USA
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Abstract
OBJECTIVE To establish cycle fecundity with a modification of the follicle aspiration, sperm injection, and assisted rupture (FASIAR) technique. DESIGN Prospective, observational study. SETTING University and health maintenance organization-based infertility centers. PATIENT(S) Infertile couples were enrolled from our professional practices. All patients were </=41 years of age and had documentation of at least one patent tube. INTERVENTION(S) After administration of clomiphene citrate, patients were given an intramuscular injection of hCG when the lead ovarian follicle was >16-18 mm in diameter by transvaginal ultrasonography. A modified FASIAR procedure was performed 22 to 28 hours after hCG injection. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate. RESULT(S) No clinical pregnancies were observed with the modified FASIAR technique. CONCLUSION(S) The FASIAR technique is still an attractive and economical technique. Our modification of the FASIAR technique, however, resulted in a suboptimal cycle fecundity.
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Affiliation(s)
- P C Lin
- University of Louisville School of Medicine, Louisville, Kentucky, USA
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Lin PC, Lee MJ, Yang W, Hwang CC. Group A streptococcal necrotizing fasciitis after varicella: report of two cases. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1998; 39:415-8. [PMID: 9926519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The most common complication in children with varicella is cutaneous superimposed infection with pyogenic bacteria. The association between varicella and group A beta-hemolytic streptococci (GABHS) necrotizing fasciitis has been recorded for over 50 years. Two cases with the specific problems are presented here together with a review of the literature. This infection is caused by GABHS superinfection of the skin lesions due to chickenpox. It can be unrecognized or late-diagnosed, with fatal consequences. Because of prompt recognition and aggressive surgical and medical treatment, the two patients survived without loss of the affected limb.
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Affiliation(s)
- P C Lin
- Department of Pediatrics, Taipei Municipal Yang-Ming Hospital, Taiwan
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Lin PC, Sun PC, Zhu L, Fainman Y. Single-shot depth-section imaging through chromatic slit-scan confocal microscopy. Appl Opt 1998; 37:6764-6770. [PMID: 18301490 DOI: 10.1364/ao.37.006764] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A chromatic confocal microscope constructed with a white-light source in combination with a diffractive lens provides wavelength-to-depth coding for profile measurements of a three-dimensional sample. We acquired depth-section images nonmechanically and in parallel by incorporating a slit-scan confocal technique into the system. A system using a 100x objective obtained a depth resolution of 0.023 mum comparable with surface profilometers that operate using conventional confocal microscopy. Experimental measurements of a four-phase-level diffractive element and of a machined, metal bearing are presented.
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Lin BC, Lin PC, Lai YY, Huang SJ, Yeh FC. The maternal and fetal effects of the addition of sufentanil to 0.5% spinal bupivacaine for cesarean delivery. Acta Anaesthesiol Sin 1998; 36:143-8. [PMID: 9874862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Opioid added to local anesthetic for spinal anesthesia was first introduced into clinical practice in 1979 with intrathecal morphine as a forerunner. As morphine is water soluble and has prolonged action, late respiratory depression following spinal anesthesia is not infrequent and is the most serious complication that causes our concern. Sufentanil which is more hydrophobic than morphine also with shorter duration of action and quicker onset when injected into the subarchnoid space could be more effective and a safer drug as an adjuvant to local anesthetic in spinal anesthesia. METHODS Forty-one parturients who had given consent to spinal anesthesia for Cesarean delivery, were anesthetized with 12.5 mg of 0.5% bupivacaine alone or in combination with 10 micrograms sufentanil in a randomized double blind manner. They were assigned either to C group (Control group) in which nothing is added to the local anesthetic and S group (Study group) in which sufentanil was added to the local anesthetic. RESULTS Perioperatively, hypotension occurred more in S group (17 against 11) but chest discomfort was less (3 against 7). Within 3 h after anesthesia 3 out of 19 parturients in S group requested analgesics but almost all parturients in C group did so. CONCLUSIONS The addition of intrathecal sufentanil to 0.5% bupivacaine for spinal anesthesia improved perioperative discomfort and significantly reduced the demand of post-operative analgesia but on the other hands, it tended to increase perioperative hypotension and cause mild pruritus.
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Affiliation(s)
- B C Lin
- Department of Anesthesiology, Buddhist TZ'U-CHI General Hospital, Hualien, Taiwan, R.O.C
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Lin PC, Lin LC, Lin JJ. Comparing the effectiveness of different educational programs for patients with total knee arthroplasty. Orthop Nurs 1997; 16:43-9. [PMID: 9369734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To compare the effects of preadmission and postadmission educational programs for patients with total knee arthroplasty. DESIGN Quasiexperimental study. SAMPLE 60 total knee arthroplasty patients. METHODS Subjects in the experimental group received preadmission preoperative teaching with an instruction booklet during a preoperative outpatient clinic visit. Upon admission to the hospital, they were presented with an educational video tape. The control group received only postadmission preoperative teaching with the same instruction booklet and no video. PREADMISSION AND POSTADMISSION: Preoperative anxiety level, knowledge about postoperative care, exercise performance and postoperative recovery were used as outcome measures. FINDINGS The research results found: 1. there was no significant difference between the two groups in reduction of preoperative anxiety score: 2. the experimental group had a significantly higher knowledge level than the control group; 3. the experimental group performed exercise more regularly and correctly than those in the control group; 4. the experimental group had greater flexion of the operative knee joint than the control group. CONCLUSION Preadmission teaching with a videotape program and a health manual for patients with total knee arthroplasty is recommended. IMPLICATIONS FOR NURSING RESEARCH More indicators such as postoperative pain and patient satisfaction can be used to investigate the effectiveness of intervention. In addition, increasing the sample size is recommended for future studies.
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Affiliation(s)
- P C Lin
- Veterans General Hospital in Taipei, Taiwan
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Lin PC, Lin LC, Lin JJ. [Andragogy and health education among the elderly]. Hu Li Za Zhi 1997; 44:81-6. [PMID: 9355405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
OBJECTIVES To assess the accuracy of clinical examination as compared with ultrasound imaging in the diagnosis of infantile hypertrophic pyloric stenosis. Duration of hospital stay, time between admission and surgery, and financial implications were also considered. DESIGN A prospective study of patients referred to the surgical team with a possible diagnosis of pyloric stenosis from May 1993 to January 1995. SETTING Neonatal and paediatric surgical wards and imaging department of a paediatric teaching hospital. SUBJECTS 116 patients referred to the surgical team with a possible diagnosis of pyloric stenosis. RESULTS 75 patients in this study had pyloric stenosis (64.6%). Clinical examination had a sensitivity of 72%, specificity of 97%, with a positive and negative predictive value of 98% and 61% respectively. There were 16 diagnostic errors (one false positive and 15 false negative). Ultrasound imaging had a sensitivity of 97%, specificity of 100%, with a positive and negative predictive value of 100% and 98% respectively. There was one diagnostic error (one false negative). Eight patients required repeat scans for confirmation of the diagnosis. On review of the initial scans in these patients, seven were noted to have inaccurate measurements due to poor technique. The average time between repeated scans was 28.2 hours. Ultrasound imaging cost 13.90 pounds per scan and initiated a change in management only in the clinically false negative group at a cost of 52 pounds per patient. The average duration of hospital stay was 3.1 days and the mean time between admission and surgery was 19.2 hours. The total cost for treatment of a patient with pyloric stenosis was 1602 pounds. CONCLUSION Ultrasound imaging should be reserved for those cases where clinical examination is negative and should be carried out by sonographers who see enough cases to maintain their expertise.
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Affiliation(s)
- P Godbole
- Department of Paediatric Surgery, Sheffield Children's Hospital
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