Publications by authors named "Chien Chen"

136 Publications

Smoking and nasopharyngeal cancer: individual data meta-analysis of six prospective studies on 334 935 men.

Int J Epidemiol 2021 Mar 31. Epub 2021 Mar 31.

School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.

Background: The role of smoking in nasopharyngeal carcinoma (NPC) remains uncertain, especially in endemic regions. We conducted an individual participant data (IPD) meta-analysis of prospective cohort studies to investigate the associations between smoking exposure and risk of NPC.

Methods: We obtained individual participant data of 334 935 male participants from six eligible population-based cohorts in NPC-endemic regions, including two each in Guangzhou and Taiwan, and one each in Hong Kong and Singapore. We used one- and two-stage approaches IPD meta-analysis and Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of NPC for smoking exposure adjusting for age and drinking status.

Results: During 2 961 315 person-years of follow-up, 399 NPC evens were ascertained. Risks of NPC were higher in ever versus never smokers (HRone-stage = 1.32, 95% CI = 1.07-1.63, P = 0.0088; HRtwo-stage = 1.27, 1.01-1.60, 0.04). These positive associations appeared to be stronger in ever smokers who consumed 16+ cigarettes/day (HRone-stage = 1.67, 95% CI = 1.29-2.16, P = 0.0001), and in those who started smoking at age younger than 16 (2.16, 1.33-3.50, 0.0103), with dose-response relationships (P-values for trend = 0.0028 and 0.0103, respectively). Quitting (versus daily smoking) showed a small reduced risk (stopped for 5+ years: HRone-stage = 0.91, 95% CI = 0.60-1.39, P = 0.66; for former smokers: HRtwo-stage = 0.84, 0.61-1.14, 0.26).

Conclusions: This first IPD meta-analysis from six prospective cohorts in endemic regions has provided robust observational evidence that smoking increased NPC risk in men. NPC should be added to the 12-16 cancer sites known to be tobacco-related cancers. Strong tobacco control policies, preventing young individuals from smoking, would reduce NPC risk in endemic regions.
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http://dx.doi.org/10.1093/ije/dyab060DOI Listing
March 2021

Acute withdrawal of new-generation antiepileptic drugs in epilepsy monitoring units: Safety and efficacy.

Epilepsy Behav 2021 Apr 21;117:107846. Epub 2021 Feb 21.

Department of Neurology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.

Introduction: Acute withdrawal of antiepileptic drugs (AEDs) is a safe and effective approach to provoking seizures in order to complete video-electroencephalogram (V-EEG) studies in a timely manner. Previous studies have focused only on withdrawal from conventional AEDs, and the effects of withdrawal from new-generation AEDs have not been extensively studied.

Materials And Methods: This study examined adult patients with drug-resistant epilepsy admitted to an epilepsy monitoring unit between 2015 and 2018. Patients were classified according to whether they received conventional AEDs (Con; n = 13) or new-generation AEDs (N-Gen; n = 26). We then compared the effects of withdrawing these two types of AEDs over a period of one week in terms of efficacy (time to complete V-EEG monitoring) and safety, including the incidence of cluster seizures (CS), focal to bilateral tonic-clonic seizures (FBTCS) and status epilepticus (SE).

Results: In both groups, approximately one week was required to complete V-EEG analysis: N-Gen group (5.6 days) and Con group (6.3 days). No differences were observed between the two groups in terms of the median number of seizures, the onset of the 1st seizure, the distribution of CS, FBTCS, or SE. Following acute withdrawal of medication, a high percentage of patients with a history of CS or FBTCS, respectively, presented CS or FBTCS.

Conclusions: We did not observe significant differences between patients taking new-generation AEDs and those taking conventional AEDs following withdrawal during V-EEG recording. In the current study, we employed a standard protocol for the rapid withdrawal of AEDs (daily dose reduction of 50%), which was sufficient for 80% of patients to complete V-EEG monitoring within one week.
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http://dx.doi.org/10.1016/j.yebeh.2021.107846DOI Listing
April 2021

Outcomes of hippocampus-sparing lesionectomy for temporal lobe epilepsy and the significance of intraoperative hippocampography.

Clin Neurophysiol 2021 Mar 31;132(3):746-755. Epub 2020 Dec 31.

Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan.

Objectives: We investigated hippocampal-sparing lesionectomy (HSL) outcomes in temporal lobe epilepsy (TLE) and the significance of high-frequency oscillations (HFOs) detected by hippocampography in HSL.

Methods: We retrospectively reviewed data from patients who underwent HSL for lesional TLE. Patients were included when MRI confirmed (i) a lesion limited to the temporal lobe with normal hippocampi preoperatively and (ii) hippocampal integrity postoperatively. Factors possibly related to outcomes were collected. Intraoperative hippocampography was reviewed, and spikes, ripples, and fast ripples were marked. Seizure outcomes were tracked ≥ 2 years. Postoperative neuropsychological tests were performed and analyzed.

Results: We included 67 patients (35 males/32 females, median age at surgery 28 years, 57 seizure-free). Complete resection was significantly associated with being seizure-free without aura, an outcome achieved by 32 (69.6%) patients with complete resection vs 1 (12.5%) with incomplete resection (p = 0.004). Spikes/ripples/fast ripples appeared frequently in the hippocampus, occurring in 86.4%/82.4%/75.0% of cases before resection and 76.7%/78.1%/63.0% after resection. The presence and rate were unconnected to seizure outcome. Postoperative neuropsychological outcomes in intelligence and visual memory improved overall.

Conclusions: HSL in lesional TLE can produce satisfactory seizure and cognitive outcomes. Intraoperative hippocampography-guided resection of apparently normal hippocampi should be performed cautiously and might not be necessary.

Significance: This study provided evidence in decision making for patients with lesional TLE with a radiologically normal hippocampus.
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http://dx.doi.org/10.1016/j.clinph.2020.12.008DOI Listing
March 2021

Rapid On-Site Cytologic Evaluation: A Feasibility Study Using Ancillary Interventional Pulmonary Personnel.

Respiration 2021 Feb 4:1-6. Epub 2021 Feb 4.

Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Background: Ancillary health professionals helping in a procedural service is a common practice everywhere.

Objectives: This was a proof-of-concept study to assess feasibility of using ancillary personnel for rapid on-site cytologic evaluation (ROSE) at interventional pulmonary procedures.

Methods: After a training interval, a respiratory therapist (RT) performed ROSE on consecutive interventional pulmonary specimens. Sample sites included lymph nodes, lung, liver, and the left adrenal gland. RT findings were subsequently correlated with blinded cytopathology-performed ROSE and with final histopathology results, with primary foci of adequacy and the presence or absence of malignancy.

Results: Seventy consecutive cases involved 163 separate sites for ROSE analysis. Adequacy: There was a high level of concordance between RT-performed ROSE (RT-ROSE) and cytopathology ROSE (CYTO-ROSE). They agreed upon the adequacy of 159 specimens. The Cohen's κ coefficient ± asymptotic standard error (ASE) was 0.74 ± 0.175, with p < 0.0001. Malignancy: RT-ROSE concurred highly with CYTO-ROSE, with agreement on 150 (92%) of the 163 specimens. Cohen's κ coefficient ± ASE was 0.83 ± 0.045, with p < 0.0001. When the comparison was for malignancy by case rather than individual site, Cohen's κ coefficient ± ASE was 0.68 ± 0.08, with p < 0.0001.

Conclusion: This study demonstrates that ancillary personnel supporting an interventional pulmonary service can be trained to perform initial ROSE. Cytopathology can be called after sampling and staining have produced adequate samples. This setup streamlines ROSE evaluation with regard to time and cost.
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http://dx.doi.org/10.1159/000513432DOI Listing
February 2021

An Examination of Serum Acylcarnitine and Amino Acid Profiles at Different Time Point of Ketogenic Diet Therapy and Their Association of Ketogenic Diet Effectiveness.

Nutrients 2020 Dec 23;13(1). Epub 2020 Dec 23.

Department of Pediatrics, Division of Pediatric Critical Care, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.

Background: This study aimed to identify metabolic parameters at different time points of ketogenic diet therapy (KDT) and investigate their association with response to KDT in pediatric drug-resistant epilepsy (DRE).

Methods: Prospectively, twenty-nine patients (0.67~20 years old) with DRE received classic ketogenic diet with non-fasting, gradual KD initiation protocol (GRAD-KD) for 1 year were enrolled. A total of 22 patients remaining in study received blood examinations at baseline, 3rd, 6th, 9th, and 12th months of KDT. β-hydroxybutyrate, free carnitine, acylcarnitines, and amino acids were compared between responders (seizure reduction rate ≥ 50%) and non-responders (seizure reduction rate < 50%) to identify the effectiveness of KDT.

Results: The 12-month retention rate was 76%. The responders after 12 months of KDT were 59% (13/22). The free carnitine level decreased significantly at 9th months ( < 0.001) but increased toward baseline without symptoms. Propionyl carnitine (C3), Isovaleryl carnitine (C5), 3-Hydroxyisovalerylcarnitine (C5:OH) and methylmalonyl carnitine (C4-DC) decreased but 3-hydroxybutyrylcarnitine (C4:OH) increased significantly at 12th months of KDT. The glycine level was persistently higher than baseline after KDT. KDT responders had lower baseline C3 and long-chain acylcarnitines, C14 and C18, as well as lower C5, C18, and leucine/isoleucine.

Conclusions: KDT should be avoided in patients with non-ketotic hyperglycemia. Routine carnitine supplementation is not recommended because hypocarnitinemia was transient and asymptomatic during KDT. Better mitochondrial βoxidation function associates with greater KDT response.
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http://dx.doi.org/10.3390/nu13010021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822492PMC
December 2020

Outpatient Percutaneous Endovascular Abdominal Aortic Aneurysm Repair: A Single-Center Experience.

J Vasc Interv Radiol 2021 03 14;32(3):466-471. Epub 2020 Dec 14.

Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address:

Purpose: To evaluate the safety of outpatient percutaneous endovascular abdominal aortic repair (PEVAR) versus inpatient PEVAR without or with adjunct procedures.

Materials And Methods: Between January 2012 and June 2019, a cohort of 359 patients comprising 168 (46.8%) outpatients and 191 (53.2%) inpatients who had undergone PEVAR were enrolled. All the patients were asymptomatic but had indications for endovascular aortic repair, ie, fit for intravenous anesthesia and anatomically feasible with standard devices. Patient sex, age, comorbidities, smoking status, type of anesthesia, adjunct procedures, type of graft device, operative times, mortality, complications, and readmissions were analyzed.

Results: Median follow-up period was 16.5 months (interquartile range, 9-31 months). Except for a higher percentage of tobacco use (42.6% vs 28.8%; P = .04), dyslipidemia (39.7% vs 19.2%; P < .01), and use of local anesthesia (99.4% vs 82.2%; P < .01) in the outpatients, there was no significant difference in the type of graft and adjunct procedures used. No outpatient mortality occurred. There was no difference in the number, severity, and onset of complications (all P > .05). Outpatient unexpected same-day admission, 30-day readmission, and emergency department visit rates were 4.8%, 2.4% (P = .13), and 10% (P < .01), respectively. Operative times for outpatient PEVAR without adjunct procedures were shorter (P < .01).

Conclusions: Outpatient PEVAR can be performed with a safety profile similar to that of inpatient PEVAR. The unexpected same-day admission, 30-day readmission, and emergency department visit rates were low. The outpatient PEVARs without adjunct procedures took less time.
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http://dx.doi.org/10.1016/j.jvir.2020.11.012DOI Listing
March 2021

FDG-PET/CT and Pathology in Newly Diagnosed Head and Neck Cancer: ACRIN 6685 Trial, FDG-PET/CT cN0.

Otolaryngol Head Neck Surg 2020 Nov 24:194599820969104. Epub 2020 Nov 24.

Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.

Objective: FDG-PET/CT (fluorodeoxyglucose-positron emission tomography/computed tomography) is effective to assess for occult neck nodal disease. We report risks and patterns of nodal disease based on primary site and nodal level from data on the dissected cN0 per the results from ACRIN 6685.

Study Design: Prospective nonrandomized enrollment included participants with first-time head and neck squamous cell carcinoma and at least 1 cN0 neck side to be dissected.

Setting: Twenty-four ACRIN-certified centers internationally (American College of Radiology Imaging Network).

Methods: A total of 287 participants were enrolled. Preoperative FDG-PET/CT findings were centrally reviewed and compared with pathology. Incidence, relative risk, pattern of lymph node involvement, and impact upon neck dissection were reported.

Results: An overall 983 nodal levels were dissected (n = 261 necks, n = 203 participants). The highest percentages of ipsilateral positive nodes by primary location and nodal level were oral cavity (level I, 17/110, 15.5%), pharynx (level II, 6/30, 20.0%), and larynx (level VI, 1/3, 33.3%).

Conclusion: Levels at greatest risk for nodal disease in cN0 in terms of ipsilateral neck dissection are level I (oral cavity), II (pharynx), and VI (larynx). These data should be considered when treating patients presenting with cN0. This is the first study to comprehensively report the incidence, location, and risk of metastases in cN0 in the FDG-PET/CT era.
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http://dx.doi.org/10.1177/0194599820969104DOI Listing
November 2020

Prospective Consensus Reporting by Gynecologic Pathology and Dermatopathology Improves Diagnosis of Vulvar Biopsies.

Arch Pathol Lab Med 2020 11;144(12)

From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock.

Context.—: Vulvar biopsy interpretation and reporting, particularly of vulvar dermatoses, can be challenging in daily practice for both surgical pathologists (SPs) and dermatopathologists (DPs).

Objective.—: To investigate whether prospective consensus reporting of vulvar biopsies by SPs and DPs would provide value and improve overall diagnostic concordance.

Design.—: Consecutive vulvar biopsies during a 6-month period were reviewed prospectively by both gynecologic SPs and DPs. Preliminary, independently generated diagnoses were recorded and then shared in consensus review (SPs+DPs). A third pathologist adjudicated cases without consensus. Multiple data elements were collected for each case: division (SP/DP), age, site, clinical history, diagnostic category, preliminary and final (consensus) diagnosis, need for adjudication, ancillary tests, and diagnostic discrepancy.

Results.—: Eighty-four biopsies (48 SP, 36 DP) from 70 patients were reviewed. Forty-two of 84 cases (50%) were neoplastic, 38 of 84 (45%) were reactive/inflammatory, with the remaining (5%) showing both or other features. Independent diagnoses were discrepant in 22 of 84 cases (26%), but consensus review resulted in an agreed-upon diagnosis in all cases, with adjudication required in 6 cases. Independent diagnostic agreement increased over time with a reduction in major and minor discrepancies between the first and second half of the study period.

Conclusions.—: Prospective review of vulvar biopsies by both SPs and DPs can improve overall reporting. Consensus review allows pathologists to gain diagnostic confidence in interpretation of inflammatory (for SPs) and neoplastic (for DPs) vulvar biopsies; therefore, intradepartmental consultation is of value, particularly in select cases.
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http://dx.doi.org/10.5858/arpa.2020-0331-OADOI Listing
November 2020

Role of External Beam Radiotherapy in Hepatocellular Carcinoma.

Authors:
Chien Peter Chen

Clin Liver Dis 2020 11 2;24(4):701-717. Epub 2020 Sep 2.

Department of Radiation Oncology, Scripps Radiation Therapy Center, 10670 John Jay Hopkins Drive, San Diego, CA 92121, USA. Electronic address:

External beam radiotherapy (EBRT) has improved efficacy and safety with advancements in technology and techniques. EBRT plays an important role in management of hepatocellular carcinoma (HCC). In resectable cases, EBRT serves as a bridge to transplantation or improves local control through adjuvant radiotherapy. In unresectable patients, EBRT offers high local control rates. In metastatic settings, EBRT provides effective palliation. This review presents an overview of radiotherapy treatment modalities used for HCC, current treatment guidelines for the role of EBRT in HCC, clinical outcomes between various EBRT approaches and other locoregional treatments for HCC, and the future role of EBRT for HCC.
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http://dx.doi.org/10.1016/j.cld.2020.07.006DOI Listing
November 2020

A novel vitamin D gene therapy for acute myeloid leukemia.

Transl Oncol 2020 Dec 18;13(12):100869. Epub 2020 Sep 18.

Department of Hematology and Oncology, Loma Linda University Cancer Center, Loma Linda, CA, USA. Electronic address:

Current treatment approaches for older adult patients with acute myeloid leukemia (AML) are often toxic and lack efficacy. Active vitamin D3 (1,25(OH)D3) has been shown to induce myeloid blast differentiation but at concentrations that have resulted in unacceptable, off-target hypercalcemia in clinical trials. In our study, we found that the combination of 1,25(OH)D3 and the hypomethylating agent (HMA) 5-Azacytidine (AZA) enhanced cytotoxicity and differentiation, and inhibited proliferation of several AML cell lines (MOLM-14, HL60) and primary AML patient samples. This observation was corroborated by our RNA sequence analysis data in which VDR, CD14, and BAX expression were increased, and FLT-3, PIM1 and Bcl-2 expression were decreased. To address the hypercalcemia issue, we genetically engineered MOLM-14 cells to constantly express CYP27B1 (the VD3 activating enzyme, 1-α-hydroxylase-25(OH)D3) through lentiviral transduction procedures. Subsequently, we used these cells as vehicles to deliver the CYP27B1 enzyme to the bone marrow of AML mice. We observed that AML mice with CYP27B1 treatment had longer overall survival compared to no treatment and displayed no significant change in calcium level.
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http://dx.doi.org/10.1016/j.tranon.2020.100869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509076PMC
December 2020

Discovery of proangiogenic CD44+mesenchymal cancer stem cells in an acute myeloid leukemia patient's bone marrow.

J Hematol Oncol 2020 06 3;13(1):63. Epub 2020 Jun 3.

Division of Hematology and Oncology, Loma Linda University Medical Center, Loma Linda, CA, USA.

Here, we report a unique acute myeloid leukemia (AML) bone marrow-derived mesenchymal stem cell (MSC) with both mesenchymal and endothelial potential, which we have named Mesenchymal Cancer Stem Cells (MCSCs). These MCSCs are CD90-CD13-CD44+ and differ from MSCs in isolation, expansion, differentiation, immunophenotype, and cytokine release profile. Furthermore, blocking CD44 inhibited the proliferation and cluster formation of early MCSCs with lower ICAM-1 protein levels. Similar CD90-CD44+ cancer stem cells have been reported in both gastric and breast cancers, which grew in floating spheres in vitro and exhibited mesenchymal features and high metastatic/tumorigenic capabilities in vivo. Our novel discovery provides the first evidence that certain AMLs may be comprised of both hematopoietic and stromal malignant cells. Targeting MCSCs and their cytokine release has potential as a novel therapeutic approach in AML.
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http://dx.doi.org/10.1186/s13045-020-00899-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268388PMC
June 2020

Intravesical prostatic protrusion does not compromise the therapeutic effects of Mirabegron in male patients with overactive bladder.

Int J Clin Pract 2020 Sep 4;74(9):e13537. Epub 2020 Jun 4.

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Aims: Intravesical prostatic protrusion (IPP) is associated with the degree of benign prostatic obstruction. We evaluated the effects of Mirabegron, a selective β3 adrenoceptor agonist, on overactive bladder (OAB) in male patients with different degrees of IPP.

Methods: About 185 male patients ≥40 years with lower urinary tract symptoms were recruited from a tertiary referral center. OAB was defined by the overactive bladder symptom score (OABSS) urgency score of ≥2 and sum score of ≥3. IPP was measured in the midsagittal section using transrectal ultrasound and patients were divided into IPP ≤5 mm and IPP >5 mm groups. Outcomes were assessed at the baseline, 4, and 12 weeks.

Results: About 104 patients (56.2%) were diagnosed with OAB and received Mirabegron (50 mg) daily use. Both IPP groups (≤5 and >5 mm) had similar baseline OABSS and International Prostate Symptom Scores (IPSS). Four-week Mirabegron usage was associated with significant decreases in both symptom score measurements, OABSS: IPP ≤5 mm -27.4% and IPP >5 mm -19.7% (P = .419) and IPSS: -32% and -22.5% (P = .202), respectively. Urgency, urge incontinence, and nocturia sub-scores were decreased in both groups, -26.3% and -27.4% (P = .690), 53.3% and 46.2% (P = .916), and 20.8% and 15.4% (P = .958). Effects were maintained at 12 weeks. We found no significant improvement in the frequency sub-score in either group. One patient stopped medication because of intolerable hypertension. Most frequent adverse event was increased residual urine (≥50 mL higher than baseline), IPP ≤5 mm 9.2% and IPP >5 mm 5.1% (P = .707), but no case had acute urinary retention.

Conclusions: Mirabegron is an effective drug to treat male OAB regardless of IPP grade.
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http://dx.doi.org/10.1111/ijcp.13537DOI Listing
September 2020

Comparative study of polycyclic aromatic hydrocarbons (PAHs) and heavy metals (HMs) in corals, sediments and seawater from coral reefs of Hainan, China.

Environ Pollut 2020 Sep 8;264:114719. Epub 2020 May 8.

Department of Environmental Resources and Management, Chia Nan University of Pharmacy and Science, Taiwan, China.

This work investigated levels of PAHs and HMs in fourteen species from seven genera of scleractinian corals, adjacent sediments, and surface seawater in Hainan, China. The sources of contaminations were analyzed as well. The results showed that scleractinian corals had a relatively higher bioaccumulation capacity for PAHs from sediments than for HMs. There were inter-species differences for these contaminants enriched in corals. Pavona varians and Porites lutea could accumulate PAHs more readily. While higher concentrations of Cr, Mn and Pb occurred in Favites flexuosa, other metal levels, such as for Ni, Cu, Zn and As, were found to be elevated in Pocillopora damicornis, as well as for Cd in Acropora echinata. It was found that PAHs originated from petrogenic and pyrolytic sources, and were mainly linked to onshore and on-sea activities, such as motorboats. Mn, Ni, As and Cd were from crustal materials or natural weathering, while Cr, Cu, Zn and Pb were non-crustal origin connecting with the use of anti-fouling boat paint and agricultural and/or aquacultural chemicals. This study suggested that corals could serve as good bioindicators for two types of chemical pollution in the reef system, especially for the two species P. varians and P. lutea for PAHs contaminants.
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http://dx.doi.org/10.1016/j.envpol.2020.114719DOI Listing
September 2020

Cingulate gyrus epilepsy: semiology, invasive EEG, and surgical approaches.

Neurosurg Focus 2020 04;48(4):E8

1School of Medicine and.

Objective: The semiology of cingulate gyrus epilepsy is varied and may involve the paracentral area, the adjacent limbic system, and/or the orbitofrontal gyrus. Invasive electroencephalography (iEEG) recording is usually required for patients with deeply located epileptogenic foci. This paper reports on the authors' experiences in the diagnosis and surgical treatment of patients with focal epilepsy originating in the cingulate gyrus.

Methods: Eighteen patients (median age 24 years, range 5-53 years) with a mean seizure history of 23 years (range 2-32 years) were analyzed retrospectively. The results of presurgical evaluation, surgical strategy, and postoperative pathology are reported, as well as follow-up concerning functional morbidity and seizures (median follow-up 7 years, range 2-12 years).

Results: Patients with cingulate gyrus epilepsy presented with a variety of semiologies and scalp EEG patterns. Prior to ictal onset, 11 (61%) of the patients presented with aura. Initial ictal symptoms included limb posturing in 12 (67%), vocalization in 5, and hypermotor movement in 4. In most patients (n = 16, 89%), ictal EEG presented as widespread patterns with bilateral hemispheric origin, as well as muscle artifacts obscuring the onset of EEG during the ictal period in 11 patients. Among the 18 patients who underwent resection, the pathology revealed mild malformation of cortical development in 2, focal cortical dysplasia (FCD) Ib in 4, FCD IIa in 4, FCD IIb in 4, astrocytoma in 1, ganglioglioma in 1, and gliosis in 2. The seizure outcome after surgery was satisfactory: Engel class IA in 12 patients, IIB in 3, IIIA in 1, IIIB in 1, and IVB in 1 at the 2-year follow-up.

Conclusions: In this study, the authors exploited the improved access to the cingulate epileptogenic network made possible by the use of 3D electrodes implanted using stereoelectroencephalography methodology. Under iEEG recording and intraoperative neuromonitoring, epilepsy surgery on lesions in the cingulate gyrus can result in good outcomes in terms of seizure recurrence and the incidence of postoperative permanent deficits.
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http://dx.doi.org/10.3171/2020.1.FOCUS19914DOI Listing
April 2020

Relationship between left ventricular ejection fraction and cardiovascular outcomes following hospitalization for heart failure: insights from the RELAX-AHF-2 trial.

Eur J Heart Fail 2020 04 5;22(4):726-738. Epub 2020 Mar 5.

Division of Cardiology, University of California, San Diego, CA, USA.

Aims: Although left ventricular ejection fraction (LVEF) is routinely used to categorize patients with heart failure (HF), whether it predicts outcomes after hospitalization for acute heart failure (AHF) is uncertain. Consequently, we assessed the relationship between LVEF and cardiovascular (CV) outcomes in a large, well characterized cohort of patients hospitalized for AHF.

Methods And Results: The 6128 patients from the RELAX-AHF-2 trial who had LVEF measured during AHF hospitalization were separated into LVEF quartiles and the relationship between LVEF and a composite of CV mortality and rehospitalization for HF or renal failure through 180 days was assessed. We found progressively lower risk for this composite outcome as LVEF increased (hazard ratio 0.95, 95% confidence interval 0.93-0.98 per 5% LVEF increase, P < 0.001) that was driven predominantly by decreased risk for rehospitalization. The smoothed spline curve depicting risk remained stable as LVEF decreased until reaching approximately 40%, at which point risk increased progressively with further reductions in LVEF. Significant differences between LVEF quartiles for post-discharge CV risk were seen in patients with an ischaemic aetiology or with a history of HF preceding index hospitalization, but were less robust in patients with non-ischaemic aetiology and absent in those with de novo HF.

Conclusion: In patients hospitalized with AHF, CV events over 180 days were more frequent in patients with lower LVEF. This was due predominantly to a significant increase in risk for HF/renal failure rehospitalization but not in either CV or all-cause mortality. LVEF had greater prognostic value in patients with ischaemic aetiology or pre-existing HF.
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http://dx.doi.org/10.1002/ejhf.1772DOI Listing
April 2020

Primary Breast Carcinoma of the Vulva Metastatic to Lymph Nodes and Bones: A Case Report and Literature Review.

Perm J 2020 14;24. Epub 2020 Feb 14.

Department of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock.

Introduction: Primary breast carcinoma can occur at ectopic sites. The axilla is the most common site of ectopic primary breast cancer, but presentation in the vulva is rare. We discuss a rare presentation of primary breast carcinoma of the vulva with distant lymph node and bone metastases in a premenopausal woman.

Case Presentation: A vulvar malignancy consistent with adenocarcinoma of the mammary gland type was diagnosed in a 47-year-old premenopausal woman. The patient underwent radical vulvectomy with bilateral superficial and deep inguinal lymphadenectomy. The tumor was positive for estrogen receptor and negative for progesterone receptor and human epidermal growth factor receptor 2/neu on immunohistochemical findings. A positron emission tomography-computed tomography scan demonstrated lymph node and bone metastases. Her disease was treated as stage IV breast cancer with metastases to the bone. Palliative treatment with ovarian suppression, aromatase inhibitor, and cyclin-dependent kinase 4/6 inhibitor was recommended.

Discussion: For a diagnosis of primary breast cancer of the vulva, a thorough metastatic workup should be performed, with attention directed toward detecting a breast primary disease by results of the history, physical examination, and radiologic examination of the breasts mainly to help confirm that the vulvar lesion is the primary site as opposed to metastasis from a breast primary cancer and also for staging. Management of this rare entity is challenging because of a lack of specific guidelines, and treatment, therefore, is similar to that of breast cancer.Treatment should consist of an individualized combination of surgery, radiotherapy, chemotherapy, and antiestrogen hormonal therapy.
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http://dx.doi.org/10.7812/TPP/19.084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039421PMC
February 2020

Analysis of spectrometry and thermodynamics of the metallothionein in freshwater crab Sinopotamon henanense for its binding ability with different metals.

Chemosphere 2020 May 20;246:125670. Epub 2019 Dec 20.

School of Life Science, Shanxi University, Taiyuan, Shanxi Province, 030006, China. Electronic address:

The metal binding nature of heterologously expressed metallothionein of Sinopotamon henanense (ShMT) had been demonstrated previously. In this study, we analysed the stoichiometry of ShMT yielded in vivo and exchange reactions of the Zn-ShMT with Cd, Pb and Cuin vitro via electrospray ionization time-of-flight mass spectrometry (ESI-TOF-MS), circular dichroism (CD) spectroscopy, inductively coupled plasma mass spectrometry (ICP-MS), and isothermal titration calorimetry (ITC). The results of ESI-TOF-MS analyses showed that metal-ShMT synthesized in vivo had three major forms, namely Zn-, Cd-, and Pb-ShMT. The ITC analyses of exchange reactions demonstrated that Zn-ShMT exhibited up to 6, 6, and 7 binding sites for Cd, Pb and Cu. By the analyses of the UV and CD spectra in the substitution experiments showed that the geometric structural stability of metal-ShMT could be influenced when excess of over 6, 6, or 7 equivalents of Cd, Pb, or Cu were added into Zn-ShMT. Although both the reconstructed apo-ShMT and substituted Zn-ShMT with three metal ions fitted the same MⅡ- and MⅠ-ShMT binding models for divalent and monovalent metals, the differences in their thermodynamic data suggested that discrepancies exit in their physiological functions. These results suggested that ShMT yielded in vivo had a higher storage capability for Zn and a uptake ability for Cd, and Zn-ShMT was more easy to release Zn as well as to uptake Cd, Cu, or Pb. The results presented in this work will be very valuable to understand the function(s) of ShMT not only in a normal physiological condition but also in the presence of non-essential metals in crabs.
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http://dx.doi.org/10.1016/j.chemosphere.2019.125670DOI Listing
May 2020

Synthesis and Properties of Quinoxaline-Containing Benzoxazines and Polybenzoxazines.

ACS Omega 2019 May 23;4(5):9092-9101. Epub 2019 May 23.

Advanced Research Center for Green Materials Science and Technology, National Taiwan University, Taipei 10617, Taiwan.

The object of this work is to prepare quinoxaline-based benzoxazines and evaluate thermal properties of their thermosets. For this object, 4,4'-(quinoxaline-2,3-diyl)diphenol (QDP)/furfurylamine-based benzoxazine (QDP-fu) and 4,4',4″,4‴-([6,6'-biquinoxaline]-2,2',3,3'-tetrayl)tetraphenol (BQTP)/furfurylamine-based benzoxazine (BQTP-fu) were prepared. The structures of QDP-fu and BQTP-fu were successfully confirmed by FTIR and H and C NMR spectra. We studied the curing behavior of QDP-fu and BQTP-fu and thermal properties of their thermosets. According to DSC thermograms, QDP-fu and BQTP-fu have the attractive onset exothermic temperatures of 181 and 186 °C, respectively. The onset temperature is approximately 45 °C lower than that of a bisphenol A/furfurylamine-based benzoxazines. According to DMA TMA and TGA thermograms, the thermoset of BQTP-fu shows impressive thermal properties, with a value of 418 °C, a coefficient of thermal expansion of 39 ppm/°C, a 5% decomposition temperature of 430 °C, and a char yield of 72%.
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http://dx.doi.org/10.1021/acsomega.9b01042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6648507PMC
May 2019

Modest dose anti-thymocyte globulin administered intraoperatively is safe and effective in kidney transplantations: a retrospective study.

PeerJ 2019 16;7:e7274. Epub 2019 Aug 16.

Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Background: Anti-thymocyte globulin (ATG) as induction therapy in renal transplantation is facing the dilemma of reducing the incidence of acute rejection (AR) and delayed graft function (DGF) or increasing risks of infection and malignancy. The purpose of this study was to delineate the safety and efficiency of the optimal ATG dosage.

Methods: We retrospectively evaluated 91 deceased donor kidney transplant recipients (KTRs) in our institution between March 2011 and January 2019. The patients were classified into three groups based on induction therapy: (1) Group 1: modest-dose ATG (three mg/kg) intraoperatively ( = 21); (2) Group 2: low-dose ATG (1-1.5 mg/kg) intraoperatively ( = 23); (3) Group 3: basiliximab 20 mg both on day 0 and 4 ( = 47). In Groups 1 and 2, all patients received a daily low-dose program (1-1.5 mg/kg each day) with target dosage of six mg/kg. Induction therapy was combined with standard immunosuppressive regimen consisting of calcineurin inhibitors, mycophenolate/the mammalian target of rapamycin inhibitors and corticosteroids.

Results: There was no significant difference in patient characteristics among groups. The outcomes of infection rate, biopsy-proven acute rejection, post-transplant diabetes mellitus, graft survival, and patient survival were similar among groups. Compared to the daily low-dose ATG regimen, the intraoperative modest-dose regimen did not cause more dose interruption and hence was more likely to reach the target ATG dosage. The intraoperative modest-dose regimen also seemed to reduce the rate of DGF.

Discussion: In recent years, a trend of using a "lower" dose of ATG has seemed to emerge. Our results suggest intraoperative modest-dose ATG followed by daily low-dose ATG regimen was safe and effective in cadaveric renal transplantations for preventing DGF, AR, and graft loss.
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http://dx.doi.org/10.7717/peerj.7274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699478PMC
August 2019

Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma.

Authors:
Chien Pong Chen

J Clin Transl Hepatol 2019 Jun 27;7(2):183-190. Epub 2019 May 27.

Department of Radiation Oncology, Scripps MD Anderson Cancer Center, San Diego, CA, USA.

The role of radiotherapy in the treatment of hepatocellular carcinoma (HCC) has evolved over the past few decades with the advancement of technology and improved imaging. Radiotherapy can offer high local control rates in unresectable HCC, including cases with major vascular involvement, and can provide a modality to help bridge patients to potentially curative resection or transplantation. In metastatic cases, radiotherapy can provide good palliation. This review focuses on the common radiotherapy treatment modalities used for HCC, provides outcome comparisons of these radiotherapy techniques to outcomes with other treatment modalities for HCC, and highlights the discrepancy of the role of radiotherapy in HCC amongst the current available treatment guidelines.
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http://dx.doi.org/10.14218/JCTH.2018.00060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609847PMC
June 2019

Early recovery of interhemispheric functional connectivity after corpus callosotomy.

Epilepsia 2019 06 14;60(6):1126-1136. Epub 2019 May 14.

Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

Objective: To investigate whether interhemispheric functional connectivity (FC) recovers in the first year after total callosotomy.

Methods: Eight epilepsy patients undergoing total callosotomy were recruited. Resting-state functional magnetic resonance imaging was acquired before and after surgery. The precallosotomy and postcallosotomy interhemispheric and intrahemispheric FC was analyzed by using graph theory and voxel-mirrored homotopic connectivity (VMHC). The seizure outcome was scored using the Engel surgical outcome scale.

Results: After callosotomy (mean postoperative interval = 4 months), the network density, average node degree, characteristic path length, and global efficiency of the whole interhemispheric networks were significantly decreased, compared to those in the precallosotomy networks. However, postcallosotomy interhemispheric FC and homotopic VMHC were not significantly reduced in bilateral frontal and temporal lobes. The network density and average node degree of the intrahemispheric networks were significantly increased. The characteristic path length and global efficiency of intrahemispheric networks were unchanged.

Significance: The interhemispheric FC may be preserved or recover early within the first postoperative year after total callosotomy, particularly in the frontal and anterior temporal lobes.
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http://dx.doi.org/10.1111/epi.14933DOI Listing
June 2019

Prevalence of Persistent Tinnitus and Dizziness in an Elderly Population in Southern Taiwan.

J Int Adv Otol 2019 Apr;15(1):99-105

Department of Otorhinolaryngology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Objectives: Tinnitus and dizziness are common among the elderly. The conditions may increase depression, and patients may become susceptible to falls, thereby affecting the quality of life of the geriatric population. Investigating the prevalence of persistent tinnitus and chronic/recurrent dizziness in an elderly population and analyzing the association of certain comorbidities with tinnitus and dizziness in southern Taiwan were the main purposes of this study.

Materials And Methods: This was a cross-sectional study performed in a metropolitan hospital. Hearing tests were conducted in a total of 597 volunteers aged ≥65 years involving 322 (53.9%) men and 275 (46.1%) women recruited in the study. The pure tone average (PTA) and hearing handicap (HH) score were calculated. Patients completed questionnaires regarding the history of hypertension and diabetes and symptoms of tinnitus and dizziness. The association of gender, age, PTA/HH, body mass index (BMI), hypertension, diabetes, and metabolic syndrome (MetS) with tinnitus and dizziness were analyzed.

Results: The prevalence of persistent tinnitus and chronic/recurrent dizziness was 32.0% and 24.1%, respectively. Tinnitus or dizziness were not associated with age, BMI, hypertension, diabetes, and MetS but was associated with hearing impairment. Women and those with fasting glucose levels <100 mg/dL were more likely to experience dizziness.

Conclusion: Persistent tinnitus and dizziness were common in an elderly population in southern Taiwan. These findings may help develop strategies to promote the quality of life in the elderly population.
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http://dx.doi.org/10.5152/iao.2019.6257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483451PMC
April 2019

Ictal networks of temporal lobe epilepsy: views from high-frequency oscillations in stereoelectroencephalography.

J Neurosurg 2018 Nov 1:1-9. Epub 2018 Nov 1.

4Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and.

OBJECTIVEIn this study, the authors investigated high-frequency oscillation (HFO) networks during seizures in order to determine how HFOs spread from the focal cerebral cortex and become synchronized across various areas of the brain.METHODSAll data were obtained from stereoelectroencephalography (SEEG) signals in patients with drug-resistant temporal lobe epilepsy (TLE). The authors calculated intercontact cross-coefficients between all pairs of contacts to construct HFO networks in 20 seizures that occurred in 5 patients. They then calculated HFO network topology metrics (i.e., network density and component size) after normalizing seizure duration data by dividing each seizure into 10 intervals of equal length (labeled I1-I10).RESULTSFrom the perspective of the dynamic topologies of cortical and subcortical HFO networks, the authors observed a significant increase in network density during intervals I5-I10. A significant increase was also observed in overall energy during intervals I3-I8. The results of subnetwork analysis revealed that the number of components continuously decreased following the onset of seizures, and those results were statistically significant during intervals I3-I10. Furthermore, the majority of nodes were connected to a single dominant component during the propagation of seizures, and the percentage of nodes within the largest component grew significantly until seizure termination.CONCLUSIONSThe consistent topological changes that the authors observed suggest that TLE is affected by common epileptogenic patterns. Indeed, the findings help to elucidate the epileptogenic network that characterizes TLE, which may be of interest to researchers and physicians working to improve treatment modalities for epilepsy, including resection, cortical stimulation, and neuromodulation treatments that are responsive to network topologies.
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http://dx.doi.org/10.3171/2018.6.JNS172844DOI Listing
November 2018

Comparative study of polycyclic aromatic hydrocarbons (PAHs) and heavy metals (HMs) in corals, surrounding sediments and surface water at the Dazhou Island, China.

Chemosphere 2019 Mar 16;218:157-168. Epub 2018 Nov 16.

State Key Laboratory of Marine Resource Utilization in South China Sea, Hainan University, Haikou, 570228, China; Institute of Tropical Agriculture and Forestry, Hainan University, Haikou, 570228, China. Electronic address:

This study investigated polycyclic aromatic hydrocarbons (PAHs) content in corals (Acropora sp.), surficial sediments, and surface seawater, and heavy metals (HMs) contents in corals and sediments from Dazhou Island, Hainan, China. Concentrations of PAHs in seawater and sediment seasonally ranged from 191.5 ng L to 587.7 ng L, and from 37.9 ng g to 233 ng g, while levels in corals were higher (185.2-545.0 ng g) compared to those found in sediments, demonstrating bioaccumulation of PAHs by corals. A similar seasonally variation of PAHs was observed in water/sediments and corals, and the proportions of low molecular weight PAHs (LPAHs) in seawater and corals were higher. Pyrolytic and petrogenic contaminations were identified to be the main sources of PAHs. Lower HMs concentrations were detected in corals (9.8-39.4 μg g) than in sediments (65.0-83.3 μg g), but HMs bioaccumulation still occurs in corals. Higher concentrations of HMs in sediment and corals were detected in March and December, especially Mn and Zn. Application of an enrichment factor showed that Cu in corals was delivered from non-crustal materials, and anthropogenic inputs were possibly the main sources. According to Biota Sediment Accumulation Factor, corals could strongly bioaccumulate LPAHs and Cd, and PAHs at a higher (p < 0.05) rate than HMs. There was a lack of correlation between the accumulation of PAHs and HMs in corals based on the cluster analysis. Dual hierarchical clustering analysis result revealed that feeding, instead of symbiosis, might be the main process responsible for the bioaccumulation of PAHs and HMs.
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http://dx.doi.org/10.1016/j.chemosphere.2018.11.063DOI Listing
March 2019

Sample Entropy of High Frequency Oscillations for Epileptogenic Zone Localization.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:1-4

For epileptic patients whose seizures are poorly controlled with medication, removing the brain region responsible for seizure onset is a treatment option. This requires the epileptogenic zone (EZ) to be accurately delineated. In this paper, a two-stage approach for EZ delineation is proposed. The algorithm starts by detecting events of high-frequency oscillations (HFOs) directly from the multi-channel intracranial electroencephalograms (iEEGs). The sample entropy is then computed for each of their channels that will be used for determining the channels correlated with the EZ. The performance of our proposed method is evaluated using the receiver operating characteristic curve analysis, and the results indicate that our proposed approach can provide an accurate estimation of the EZ.
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http://dx.doi.org/10.1109/EMBC.2018.8512380DOI Listing
July 2018

Identification of genes associated with cortical malformation using a transposon-mediated somatic mutagenesis screen in mice.

Nat Commun 2018 06 27;9(1):2498. Epub 2018 Jun 27.

Institute of Brain Science, National Yang-Ming University, Taipei, 112, Taiwan.

Mutations in genes involved in the production, migration, or differentiation of cortical neurons often lead to malformations of cortical development (MCDs). However, many genetic mutations involved in MCD pathogenesis remain unidentified. Here we developed a genetic screening paradigm based on transposon-mediated somatic mutagenesis by in utero electroporation and the inability of mutant neuronal precursors to migrate to the cortex and identified 33 candidate MCD genes. Consistent with the screen, several genes have already been implicated in neural development and disorders. Functional disruption of the candidate genes by RNAi or CRISPR/Cas9 causes altered neuronal distributions that resemble human cortical dysplasia. To verify potential clinical relevance of these candidate genes, we analyzed somatic mutations in brain tissue from patients with focal cortical dysplasia and found that mutations are enriched in these candidate genes. These results demonstrate that this approach is able to identify potential mouse genes involved in cortical development and MCD pathogenesis.
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http://dx.doi.org/10.1038/s41467-018-04880-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021418PMC
June 2018

Survival benefit of patients with early-stage ovarian carcinoma treated with paclitaxel chemotherapeutic regimens.

J Gynecol Oncol 2018 Jan;29(1):e16

Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.

Objective: Adjuvant chemotherapy was introduced in patients with early-stage ovarian cancer (OC). The benefit of standard chemotherapeutic regimens including taxane has not been established.

Methods: Patients with early-stage OC from the National Health Insurance Research database of Taiwan who received platinum plus cyclophosphamide (CP) or platinum plus paclitaxel (PT) for 3-6 cycles were recruited, and the disease-free survival (DFS) and overall survival (OS) were determined.

Results: A total of 1,510 early-stage OC patients, including 841 who received CP regimen and 699 who received PT regimen, were included. The 2 groups had a similar estimated probability of 5-year DFS (PT vs. CP, 79.0% vs. 77.6%; p=0.410) and OS (84.6% vs. 84.3%; p=0.691). Patients >50 years of age who received the CP regimen had a lower 5-year DFS than the patients ≤50 years of age who received the CP (p<0.001) or PT regimens (p=0.001). Additionally, patients >50 years of age who received the CP regimen had a worse 5-year OS compared with the other 3 groups (p=0.019) (p=0.179 for patients >50 years of age in the PT group; p=0.002 for patients ≤50 years of age in the CP group; and p=0.061 for patients ≤50 years of age in the PT group). Patients with the CP or PT regimen for 3-5 cycles had a similar 5-year DFS and OS compared to 6 cycles (p>0.050).

Conclusion: Chemotherapeutic regimens with taxane could be recommended for early-stage OC patients >50 years of age.
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http://dx.doi.org/10.3802/jgo.2018.29.e16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709526PMC
January 2018

Characteristics of martensitic and strain-glass transitions of the Fe-substituted TiNi shape memory alloys probed by transport and thermal measurements.

Sci Rep 2017 11 27;7(1):16336. Epub 2017 Nov 27.

Department of Materials Science and Engineering, National Taiwan University, Taipei, 10617, Taiwan.

The electrical resistivity, Seebeck coefficient, thermal conductivity, and specific heat of TiNi Fe (x = 2.0-10.0 at.%) shape memory alloys (SMAs) were measured to investigate the influence of point defects (Fe) on the martensitic transformation characteristics. Our results show that the TiNiFe and TiNiFe SMAs have a two-step martensitic transformation (B2 → R and R → B19'), while the TiNiFe, TiNiFe, and TiNiFe SMAs display a one-step martensitic transition (B2 → R). However, the compounds TiNiFe and TiNiFe show strain glass features (frozen strain-ordered state). Importantly, the induced point defects significantly alter the martensitic transformation characteristics, namely transition temperature and width of thermal hysteresis during the transition. This can be explained by the stabilization of austenite B2 phase upon Fe substitution, which ultimately leads to the decrease in enthalpy that associated to the martensitic transition. To determine the boundary composition that separates the R-phase and strain glass systems in this series of SMAs, a Ni-rich specimen TiNiFe was fabricated. Remarkably, a slight change in Ti/Ni ratio converts TiNiFe SMA into a strain glass system. Overall, the evolution of phase transformation in the Fe-substituted TiNi SMAs is presumably caused by the changes in local lattice structure via the induced local strain fields by Fe point defects.
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http://dx.doi.org/10.1038/s41598-017-16574-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703723PMC
November 2017

Prognostic significance of postoperative spikes varied in different surgical procedures for mesial temporal sclerosis.

Seizure 2017 Nov 3;52:71-75. Epub 2017 Oct 3.

Department of Neurology, Taipei Veterans General Hospital, and National Yang-Ming University, Taiwan.

Purpose: We conducted this study to compare the occurrence and prognostic significance of early postoperative interictal epileptiform discharges (IEDs) on seizure outcomes between corticoamygdalohippocampectomy (CAH) and selective amygdalohippocampectomy (SAH).

Methods: We reviewed our database of patients who had epilepsy surgery with hippocampus atrophy or signal changes on brain MRIs and pathology of mesial temporal sclerosis. One hundred and seventy-seven CAH and 39 SAH patients were enrolled. Postoperative EEG within 30days, other preoperative variables and seizure outcome 2years after surgery were obtained for analysis. Engel's IA and IB were defined as seizure-free.

Results: There was no significant difference in the seizure-free rate between the two procedures (127 (71.8%) of CAH vs 30 (76.9%) of SAH, p=0.51). Postoperative IEDs were more frequently seen in the SAH group (64.1%) than in the CAH group (29.9%), p<0.001. The IEDs in the SAH group did not show correlation with the seizure outcome 2 years after surgery. In the CAH group, patients who had no postoperative IEDs showed a higher seizure-free rate compared to those with IEDs (78.2% vs 56.6%, p=0.003; OR 2.267, 95% CI 1.09-4.73, p=0.029 in multivariate logistic regression).

Conclusions: Early postoperative IEDs are more frequently seen in SAH than in CAH. Unlike in patients with CAH, the presence of IEDs after SAH was not a predictor of seizure recurrence. The type of surgery should be considered while utilizing postoperative IEDs for evaluating the prognosis.
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http://dx.doi.org/10.1016/j.seizure.2017.09.018DOI Listing
November 2017

Pattern of Corticospinal Projections Defined by Brain Mapping During Resective Epilepsy Surgery in a Patient with Congenital Hemiparesis and Intractable Epilepsy.

World Neurosurg 2017 Nov 24;107:1050.e9-1050.e12. Epub 2017 Aug 24.

Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Departments of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan. Electronic address:

Background: Congenital or early-onset brain structural lesions often cause contralateral hemiparesis, cognitive deficits, developmental delays, and seizures. Seizure is the most debilitating condition, as it greatly impairs quality of life in both the affected individuals and their caregivers and prevents them from active social participation.

Case Description: A 34-year-old man with hemiparesis and early-onset seizures since childhood owing to a congenital brain lesion developed intractable seizures in the last 2 years and was subsequently admitted for resective epileptic surgery. During the operation, we employed an innovative intraoperative neurophysiologic monitoring technique. In contrast to routine application for transcranial stimulation, we recorded compound muscle action potentials over the bilateral limb muscles simultaneously, instead of over the contralateral muscles only, to determine the patterns of the corticospinal projections. Transcranial stimulation over the bilateral hemispheres was applied before craniotomy, and direct cortical stimulation over the lesioned hemisphere was applied after craniotomy. By integrating both approaches, we could first identify the pattern of corticospinal projections before craniotomy and then accurately define the noneloquent area, which guided the resection to successfully accomplish the surgical goal.

Conclusions: This technique is simple because no patient participation is required. We believe that it has the potential to replace conventional preoperative functional magnetic resonance imaging and transcranial magnetic stimulation in resective epilepsy surgery, particularly for young patients. Not only can it improve the safety of surgical procedures, but also it can help predict functional outcome.
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http://dx.doi.org/10.1016/j.wneu.2017.08.071DOI Listing
November 2017