Publications by authors named "Yu-Feng Su"

49 Publications

Minimally Invasive Transforaminal Lumbar Interbody Fusion for 2-Level Degenerative Lumbar Disease in Patients With Osteoporosis: Long-Term Clinical and Radiographic Outcomes.

Oper Neurosurg (Hagerstown) 2021 May;20(6):535-540

School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Background: Spine fusion surgery in osteoporosis remains controversial because it is related to a high incidence of osteoporosis-related complications, such as cage nonfusion, pedicle screw loosening, and new vertebral compression fractures (VCFs).

Objective: To treat 2-level degenerative lumbar disease in osteoporosis patients as an effective and safe surgical treatment for long-term results using minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Methods: We retrospectively assessed 12 patients with osteoporosis who underwent MIS-TLIF on L4 and L5 between 2011 and 2012 to assess the clinical and radiographic results for 2-level lumbar degenerative spine disease. All patients were followed-up for at least 2 yr after surgery and assessed by using X-ray. Basic patient data and clinical and radiological outcomes were collected and analyzed.

Results: Of all 12 patients, 11/12 (91.6%) and 1/12 (8.3%) demonstrated cage fusion and cage subsidence, respectively. Pedicle screw loosening was found in 1/12 (8.3%) patients. The P-values calculated using the F-test for changes in the vertebral body height pre- and postoperation in L3, L4, and L5 were .69, .87, and .39, respectively. The data revealed no significant variants of new VCFs.

Conclusion: MIS-TLIF provided a high cage fusion rate and low pedicle screw loosening rate in patients with osteoporosis with 2-level degenerative spine disease. Furthermore, no new VCFs were found in long-term follow-up. The clinical outcomes also demonstrated no significant difference compared with traditional open spine fusion surgery. Therefore, MIS-TLIF could be considered an effective and safe surgical treatment modality for 2-level degenerative spine disease in osteoporosis.
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http://dx.doi.org/10.1093/ons/opab009DOI Listing
May 2021

MiR-1271 regulates glioblastoma cell proliferation and invasion by directly targeting the CAMKK2 gene.

Neurosci Lett 2020 10 11;737:135289. Epub 2020 Aug 11.

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan. Electronic address:

This study explored the regulatory role of microRNA-1271 (miR-1271) in glioblastoma multiforme (GBM) proliferation and invasion via calcium/calmodulin-dependent protein kinase 2 (CaMKK2). MiR-1271 and CaMKK2 expression were quantified in normal human astrocyte cells, GBM cell lines, and low- and high-grade glioma tissues. MKI67 expression in GBM cells was measured using quantitative real-time polymerase chain reaction. The target relationship between miR-1271 and the CAMKK2 gene was confirmed using the luciferase reporter assay. MTT and Transwell assays were used to analyze the role of miR-1271 and CAMKK2 in cell proliferation and invasion. Finally, CaMKK2 expression and AKT phosphorylation were detected by western blotting. MiR-1271 was significantly downregulated in high-grade glioma tissues and GBM cell lines. Conversely, CAMKK2 mRNA expression was upregulated in high-grade glioma tissues and GBM cell lines. We observed that miR-1271 directly targeted the 3'-untranslated region of CAMKK2, indicating an inverse relationship with miR-1271. Overexpressing miR-1271 inhibited GBM cell proliferation and invasion, whereas inhibiting miR-1271 increased cell proliferation and invasion. Silencing CAMKK2 expression also inhibited GBM cell proliferation and invasion. Furthermore, overexpressing miR-1271 inhibited AKT phosphorylation and MKI67 mRNA expression by targeting CAMKK2. These results indicate that miR-1271 regulates GBM cell proliferation and invasion, and that these effects involve directly targeting the CAMKK2 gene. Therefore, miR-1271 may serve as a new therapeutic target for developing GBM treatments.
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http://dx.doi.org/10.1016/j.neulet.2020.135289DOI Listing
October 2020

Surgical treatment of intraspinal tumors in Southern Taiwan: The 30-year experience of a single institution.

J Clin Neurosci 2020 May 30;75:52-54. Epub 2020 Mar 30.

Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Taiwan; Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City 801, Taiwan. Electronic address:

Our institute presented two reports of intraspinal tumors, one in 1997 and the other in 2007, which assessed 120 and 117 cases of diagnosed and surgically treated intraspinal tumors at Kaohsiung Medical University Hospital, Southern Taiwan during 1988-1995 and 1999-2004, respectively. Here, we analyze data from 247 patients with medical records indicating surgery for and pathological reports of intraspinal tumors at the same institute during 2004-2014. Correlational findings from this study were compared with those from the previous two reports. There were 123 male and 124 female patients aged 7-93 (mean age: 55.4) years. The most common pathologic findings were metastasis (50.6%, 125/247), followed by nerve sheath tumors (30.8%, 76/247), meningiomas (6.0%, 15/247), and neuroepithelial tumors (5.2%, 13/247). A slight male predominance in metastasis and a slight female predominate in meningiomas were noted. The peak ages at diagnosis were 51-60 years. Motor weakness was the most common clinical presentation (46.1%). The thoracic spine segment was the most common location (51.4%, 127/247), followed by the lumbosacral (25.5%, 63/247) and cervical (23.1%, 57/247) spine segments. Among the metastatic tumors, the lung was the most common primary site of origin, followed by the liver (hepatocellular carcinoma), lymphoma, prostate, GI (gastrointestinal) tract, breast, and nasopharynx (nasopharyngeal cancer).
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http://dx.doi.org/10.1016/j.jocn.2020.03.035DOI Listing
May 2020

Higher risk of herpes zoster in stroke patients.

PLoS One 2020 4;15(2):e0228409. Epub 2020 Feb 4.

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Background: Stroke is a leading cause of death, morbidity and disability worldwide. Infection is a common complication in the acute phase after stroke. Herpes zoster is a common viral disease, in which the most debilitating complication is post-herpetic neuralgia, which can have a very large negative impact on quality of life. The aim of this study was to investigate whether stroke increases the risk of herpes zoster.

Methods: This cohort study compared patients who had herpes zoster with and without a first incident of stroke. The Taiwan National Health Insurance Research Database was utilized to identify 20,551 stroke patients and 20,551 controls matched for age, gender, age categories and Charlson Comorbidity Index (CCI) score categories at a one-to-one ratio. Cox proportional-hazards regression models were employed to estimate herpes zoster risk in the stroke group relative to general population.

Results: Compared to the control group, the stroke group had a greater risk for herpes zoster, especially within 1 year after stroke (adjust HR = 25.27). Both hemorrhagic stroke and ischemic stroke were significantly associated with herpes zoster (hemorrhagic type (IRR = 2.31, 95% CI, 1.67-3.20); ischemic type (IRR = 2.51, 95% CI 2.09-3.02)). However, the hemorrhagic stroke patients had a higher risk of herpes zoster ophthalmicus (IRR = 12.46, 95% CI 4.00-38.76) whereas the ischemic stroke patients had a higher risk of post-herpetic neuralgia (IRR = 2.24, 95% CI 1.56-3.20).

Conclusion: Physicians should know about that adults with stroke have a higher than normal risk of herpes zoster. Thus, physicians must be acquainted with proper antiviral therapy and pain control to bring down the morbidity that ensues from herpes zoster. Use of herpes zoster vaccine may be considered in stroke patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228409PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999860PMC
April 2020

Meningeal Melanocytoma Associated with Nevus of Ota: Analysis of Twelve Reported Cases.

World Neurosurg 2019 Jul 21;127:e311-e320. Epub 2019 Mar 21.

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Division of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. Electronic address:

Background: Primary melanocytic neoplasms (PMNs) are rare neoplasms, especially within the central nervous system. Meningeal melanocytomas, a subtype of PMN, are even rarer. Nevus of Ota results from the incomplete migration of melanocytes from the neural crest. Synchronous nevus of Ota and meningeal melanocytoma are infrequently encountered in clinical practice.

Objective: To evaluate and elucidate 12 cases of synchronous meningeal melanocytoma and nevus of Ota, thereby improving the understanding of the relationship between these 2 diseases.

Methods: We reviewed cases and searched the English-language literature from the PubMed database and collected clinical parameters of 12 cases of synchronously occurring nevus of Ota and meningeal melanocytoma.

Results: Among the 12 cases, 90.90% and 91.66% of the lesions were located ipsilaterally and supratentorially, respectively.

Conclusions: Our findings indicated a trend for both types of lesion to be located ipsilaterally and supratentorially. When a patient with nevus of Ota is found to harbor an intracranial neoplasm, the most likely diagnosis is PMN.
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http://dx.doi.org/10.1016/j.wneu.2019.03.113DOI Listing
July 2019

Delayed diagnosis of hereditary hemorrhagic telangiectasia type 1 in a 10-year-old boy with presentation of failure to thrive and cerebral abscess.

Kaohsiung J Med Sci 2019 Aug 19;35(8):519-520. Epub 2019 Mar 19.

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

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http://dx.doi.org/10.1002/kjm2.12054DOI Listing
August 2019

A 37-Year-Old Woman with Progressive Right Side Ptosis for One Month.

Brain Pathol 2018 05;28(3):441-442

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

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http://dx.doi.org/10.1111/bpa.12612DOI Listing
May 2018

Atypical teratoid/rhabdoid tumor of lumbar spine in a toddler child.

Spinal Cord Ser Cases 2017 4;3:16026. Epub 2017 May 4.

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

Background: Atypical teratoid/rhabdoid tumor (AT/RT) is a rare pediatric central nervous system malignancy with poor outcome. AT/RT is infrequently located in the spinal cord.

Clinical Presentation: A 16-month-old boy presented with progressive urinary retention and weakness of the lower extremities. Magnetic resonance imaging of the spine revealed an intradural extramedullary mass occupying the spinal canal at the level of T10-L3. The tumor was successfully resected by using neuroendoscopy. Histopathology demonstrated rhabdoid cells with eccentric nuclei and eosinophilic cytoplasmic hyaline inclusions. Immunohistologically, the tumor cells showed positive for epithelial membrane antigen, vimentin and neuron-specific enolase, and negative for integrase interactor 1. After surgery, the patient showed significant improvement in sitting and other neurological signs but presenting with flaccid neurogenic bladder. Intrathecal chemotherapy under European Rhabdoid Registry (EU-RHAB) protocol with Doxorubicin, Carboplatin, Etoposide, Ifosfamide, Vincristine, Cyclophosphamide and Actinomycin-D was given. However, recurrent intradural extramedullary tumor at the level of T11-L2 developed in 3 months.

Conclusion: We report a young Asian case of AT/RT in thoracolumbar spine with recurrent tumor shortly after complete surgical resection of the tumor.
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http://dx.doi.org/10.1038/scsandc.2016.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415882PMC
May 2017

A Case of Leptomeningeal Dissemination of Pilocytic Astrocytoma in a Child.

Can J Neurol Sci 2017 Sep 27;44(5):607-610. Epub 2017 Apr 27.

1Division of Neurosurgery,Department of Surgery,Kaohsiung Medical University Hospital,Kaohsiung,Taiwan.

We present the case of a 2-year-old boy with progressive left-sided weakness and a cranial magnetic resonance imaging (MRI) scan showing a lesion with a cystic component in the right thalamus and basal ganglia. The lesion was subtotally resected and diagnosed as a pilocytic astrocytoma by histopathology. Tumor seeding along the surgical tract was seen on MRI 16 days and 10 weeks after surgery. The patient received vincristine and carboplatin, and MRI performed 4 months after chemotherapy revealed no additional or residual lesions. This case illustrated that a World Health Organization grade I astrocytoma could disseminate along the surgical tract.
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http://dx.doi.org/10.1017/cjn.2017.22DOI Listing
September 2017

Osteoporosis in adult patients with atopic dermatitis: A nationwide population-based study.

PLoS One 2017 16;12(2):e0171667. Epub 2017 Feb 16.

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

The aim of this study was to investigate osteoporosis risk in atopic dermatitis (AD) patients. This study included patients in the Taiwan National Health Insurance Research dataset. The population-based study included all patients aged 20-49 years who had been diagnosed with AD during 1996-2010. In total, 35,229 age and gender-matched patients without AD in a 1:1 ratio were randomly selected as the non-AD group. Cox proportional-hazards regression and Kaplan-Meier analyses were used to measure the hazard ratios and the cumulative incidences of osteoporosis, respectively. During the follow-up period, 360(1.02%) AD patients and 127(0.36%) non-AD patients developed osteoporosis. The overall incidence of osteoporosis was4.72-fold greater in the AD patients compared to the non-AD patients (1.82 vs. 0.24 per 1,000 person-years, respectively) after adjusting for potential confounding factors. Osteoporosis risk factors included female gender, age, advanced Charlson Comorbidity Index, depression and use of corticosteroids. The dataset analysis showed that AD was significantly associated with subsequent risk of osteoporosis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0171667PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313211PMC
August 2017

Pedicle screw placement accuracy of bone-mounted miniature robot system.

Medicine (Baltimore) 2017 Jan;96(3):e5835

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Department of Neurosurgery, Kaohsiung Medical University Hospital Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

This article describes factors affecting the accuracy of transpedicle screw placements performed with the Renaissance robot-guided system and reviews the relevant literature. Between January 2013 and January 2015, Renaissance robot-guided spinal surgery was performed in 125 patients at Kaohsiung Medical University Hospital in Kaohsiung, Taiwan. The surgeries included 662 transpedicle screw implants and 49 Kirschner wire (K-wire) reimplants performed by intraoperative repositioning. The lead author evaluated the accuracy of all K-wire insertions and classified their accuracy into 3 categories relative to the preoperative plan for transpedicle screw placement. For cases in which screws required repositioning after the registration step, factors affecting pedicle screw placement were determined according to the consensus of 3 experienced spinal surgeons. According to the scheme developed by Kuo et al (PLoS One 2016;11:e0153235), the K-wire placement accuracies before and after repositioning were respectively classified as follows: 76.1% and 77.6% in type I; 12.2% and 17.7% in type IIa; 4.3% and 4.5% in type IIb; 6.4% and 0% in type IIIa; and 1% and 1% in type IIIb. The percentage of screws requiring repositioning due to drilling error was 85.7% (42/49). Comparisons of preoperative and postoperative function showed significantly improved accuracy. This study showed that inaccurate pedicle screw placement mainly results from errors in preoperative planning, mounting, registration, drilling, and robot assembly. Pedicle screw placement using a bone-mounted miniature robot system requires meticulous preoperative planning to minimize these errors.
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http://dx.doi.org/10.1097/MD.0000000000005835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5279084PMC
January 2017

Intramedullary spinal cord metastasis from colon cancer: analysis of 19 reported cases.

Spinal Cord Ser Cases 2016 7;2:15026. Epub 2016 Jan 7.

Department of Neurosurgery, Kaohsiung MedicalUniversity Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

We report and analyze a rare entity of intramedullary spinal cord tumor, which is metastatic from colon cancer with a very poor prognosis. The reported 19 cases including our case in the literature are analyzed. Comparison of outcomes between surgery, radiotherapy and non-treatment groups are evaluated. Life distribution is profiled. Median overall survival is 75 days. The 90 days and 150 days survival rate are 42.9% and 21.4%, respectively. There were no differences between conservative treatment (non-treatment or radiotherapy) and aggressive intervention (surgery or surgery plus radiotherapy) in mortality and the trend of survival probability. The prognosis of metastatic intramedullary spinal cord tumor is poor. Surgery may only be considered in selected patients with good control of primary cancer and without evidence of lung metastases and leptomeningeal carcinomatosis.
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http://dx.doi.org/10.1038/scsandc.2015.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125065PMC
January 2016

Traumatic Brain Injury and Substance Related Disorder: A 10-Year Nationwide Cohort Study in Taiwan.

Neural Plast 2016 27;2016:8030676. Epub 2016 Sep 27.

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; Department of Neurosurgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.

Whether traumatic brain injury (TBI) is causally related to substance related disorder (SRD) is still debatable, especially in persons with no history of mental disorders at the time of injury. This study analyzed data in the Taiwan National Health Insurance Research Database for 19,109 patients aged ≥18 years who had been diagnosed with TBI during 2000-2010. An additional 19,109 randomly selected age and gender matched patients without TBI (1 : 1 ratio) were enrolled in the control group. The relationship between TBI and SRD was estimated with Cox proportional hazard regression models. During the follow-up period, SRD developed in 340 patients in the TBI group and in 118 patients in the control group. After controlling for covariates, the overall incidence of SRD was 3.62-fold higher in the TBI group compared to the control group. Additionally, patients in the severe TBI subgroup were 9.01 times more likely to have SRD compared to controls. Notably, patients in the TBI group were prone to alcohol related disorders. The data in this study indicate that TBI is significantly associated with the subsequent risk of SRD. Physicians treating patients with TBI should be alert to this association to prevent the occurrence of adverse events.
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http://dx.doi.org/10.1155/2016/8030676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059606PMC
September 2017

A retrospective study to validate an intraoperative robotic classification system for assessing the accuracy of kirschner wire (K-wire) placements with postoperative computed tomography classification system for assessing the accuracy of pedicle screw placements.

Medicine (Baltimore) 2016 Sep;95(38):e4834

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Department of Neurosurgery, Kaohsiung Medical University Hospital Department of Neurosurgery, Kaohsiung Municipal Hsiao-Kang Hospital Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

This purpose of this retrospective study is validation of an intraoperative robotic grading classification system for assessing the accuracy of Kirschner-wire (K-wire) placements with the postoperative computed tomography (CT)-base classification system for assessing the accuracy of pedicle screw placements.We conducted a retrospective review of prospectively collected data from 35 consecutive patients who underwent 176 robotic assisted pedicle screws instrumentation at Kaohsiung Medical University Hospital from September 2014 to November 2015. During the operation, we used a robotic grading classification system for verifying the intraoperative accuracy of K-wire placements. Three months after surgery, we used the common CT-base classification system to assess the postoperative accuracy of pedicle screw placements. The distributions of accuracy between the intraoperative robot-assisted and various postoperative CT-based classification systems were compared using kappa statistics of agreement.The intraoperative accuracies of K-wire placements before and after repositioning were classified as excellent (131/176, 74.4% and 133/176, 75.6%, respectively), satisfactory (36/176, 20.5% and 41/176, 23.3%, respectively), and malpositioned (9/176, 5.1% and 2/176, 1.1%, respectively)In postoperative CT-base classification systems were evaluated. No screw placements were evaluated as unacceptable under any of these systems. Kappa statistics revealed no significant differences between the proposed system and the aforementioned classification systems (P <0.001).Our results revealed no significant differences between the intraoperative robotic grading system and various postoperative CT-based grading systems. The robotic grading classification system is a feasible method for evaluating the accuracy of K-wire placements. Using the intraoperative robot grading system to classify the accuracy of K-wire placements enables predicting the postoperative accuracy of pedicle screw placements.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044894PMC
http://dx.doi.org/10.1097/MD.0000000000004834DOI Listing
September 2016

Increased risk of osteoporosis in patients with erectile dysfunction: A nationwide population-based cohort study.

Medicine (Baltimore) 2016 Jun;95(26):e4024

aGraduate Institute of Medicine, College of Medicine bDepartment of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University cDepartment of Dermatology, Kaohsiung Veterans General Hospital dCosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care & Management eGraduate Institute of Medicine, College of Medicine fDepartment of Pathology, Kaohsiung Medical University Hospital gGraduate Institute of Medicine hDepartment of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University iInstitute of Biomedical Sciences, National Sun Yat-Sen University jDepartment of Neurosurgery, Kaohsiung Medical University Hospital kGraduate Institute of Medicine lDepartment of Neurosurgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

In this study, we aimed to investigate the risk of osteoporosis in patients with erectile dysfunction (ED) by analyzing data from the Taiwan National Health Insurance Research Database (NHIRD). From the Taiwan NHIRD, we analyzed data on 4460 patients aged ≥40 years diagnosed with ED between 1996 and 2010. In total, 17,480 age-matched patients without ED in a 1:4 ratio were randomly selected as the non-ED group. The relationship between ED and the risk of osteoporosis was estimated using Cox proportional hazard regression models. During the follow-up period, 264 patients with ED (5.92%) and 651 patients without ED (3.65%) developed osteoporosis. The overall incidence of osteoporosis was 3.04-fold higher in the ED group than in the non-ED group (9.74 vs 2.47 per 1000 person-years) after controlling for covariates. Compared with patients without ED, patients with psychogenic and organic ED were 3.19- and 3.03-fold more likely to develop osteoporosis. Our results indicate that patients with a history of ED, particularly younger men, had a high risk of osteoporosis. Patients with ED should be examined for bone mineral density, and men with osteoporosis should be evaluated for ED.
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http://dx.doi.org/10.1097/MD.0000000000004024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937938PMC
June 2016

Herpes zoster as a risk factor for osteoporosis: A 15-year nationwide population-based study.

Medicine (Baltimore) 2016 Jun;95(25):e3943

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Institute of Biomedical Sciences, National Sun Yat-Sen University Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University Department of Dermatology, Kaohsiung Veterans General Hospital Cosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care and Management Department of Neurosurgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

The objective of this study was to investigate the risk of osteoporosis in patients with herpes zoster (HZ) infection using a nationwide population-based dataset. The Taiwan National Health Insurance Research Database was used to compare data between 11,088 patients aged 20 to 49 years diagnosed with HZ during 1996 to 2010 and a control group of 11,088 patients without HZ. Both cohorts were followed up until the end of 2010 to measure the incidence of osteoporosis. Cox proportional-hazards regression and Kaplan-Meier analyses were used to calculate hazard ratio and cumulative incidences of osteoporosis, respectively. The overall risk of osteoporosis was 4.55 times greater in the HZ group than in the control group (2.48 vs. 0.30 per 1000 person-years, respectively) after adjusting for age, gender, Charlson Comorbidity Index, and related comorbidities. Compared with controls, patients with HZ and subsequent postherpetic neuralgia had a 4.76-fold higher likelihood of developing osteoporosis (95% confidence interval: 2.44-9.29), which was a statistically significant difference (P <0.001). Osteoporosis risk factors included female gender, age, advanced Charlson Comorbidity Index, depression, and postherpetic neuralgia. This study identified HZ is associated with an increased osteoporosis risk. Further evaluation of the value of bone mineral density test in detecting osteoporosis after HZ may be suggested. HZ vaccination could also be evaluated to lower the incidence of HZ and possibly subsequent osteoporosis. Physicians should be alerted to this association to improve early identification of osteoporosis in patients with HZ.
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http://dx.doi.org/10.1097/MD.0000000000003943DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998325PMC
June 2016

A 32-Year-Old Man with Intermittent Headaches for Over Two Weeks.

Brain Pathol 2016 07;26(4):561-2

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

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http://dx.doi.org/10.1111/bpa.12396DOI Listing
July 2016

Increased Risk of Osteoporosis in Patients With Peptic Ulcer Disease: A Nationwide Population-Based Study.

Medicine (Baltimore) 2016 Apr;95(16):e3309

From the Graduate Institute of Medicine (C-HW, C-YC, Y-YL, C-LL), Department of Public Health and Environmental Medicine (Y-CT), Department of Pathology (C-YC), Department of Neurosurgery, Faculty of Medicine, College of Medicine (C-LL), Department of Neurosurgery (C-HW, Y-FS, T-HT, K-LK, C-LL), Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University (C-YC), Institute of Biomedical Sciences, National Sun Yat-Sen University (C-YC), Department of Dermatology, Kaohsiung Veterans General Hospital (Y-YL), and Cosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care & Management, Kaohsiung, Taiwan (Y-YL).

To investigate osteoporosis risk in patients with peptic ulcer disease (PUD) using a nationwide population-based dataset. This Taiwan National Health Insurance Research Database (NHIRD) analysis included 27,132 patients aged 18 years and older who had been diagnosed with PUD (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 531-534) during 1996 to 2010. The control group consisted of 27,132 randomly selected (age- and gender)-matched patients without PUD. The association between PUD and the risk of developing osteoporosis was estimated using a Cox proportional hazard regression model. During the follow-up period, osteoporosis was diagnosed in 2538 (9.35 %) patients in the PUD group and in 2259 (8.33 %) participants in the non-PUD group. After adjusting for covariates, osteoporosis risk was 1.85 times greater in the PUD group compared to the non-PUD group (13.99 vs 5.80 per 1000 person-years, respectively). Osteoporosis developed 1 year after PUD diagnosis. The 1-year follow-up period exhibited the highest significance between the 2 groups (hazard ratio [HR] = 63.44, 95% confidence interval [CI] = 28.19-142.74, P < 0.001). Osteoporosis risk was significantly higher in PUD patients with proton-pump-inhibitors (PPIs) use (HR = 1.17, 95% CI = 1.03-1.34) compared to PUD patients without PPIs use. This study revealed a significant association between PUD and subsequent risk of osteoporosis. Therefore, PUD patients, especially those treated with PPIs, should be evaluated for subsequent risk of osteoporosis to minimize the occurrence of adverse events.
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http://dx.doi.org/10.1097/MD.0000000000003309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845819PMC
April 2016

Hip Fracture in People with Erectile Dysfunction: A Nationwide Population-Based Cohort Study.

PLoS One 2016 14;11(4):e0153467. Epub 2016 Apr 14.

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

The aims of this study were to investigate the risk of hip fracture and contributing factors in patients with erectile dysfunction(ED). This population-based study was performed using the Taiwan National Health Insurance Research Database. The analysis included 4636 patients aged ≥ 40 years who had been diagnosed with ED (International Classification of Diseases, Ninth Revision, Clinical Modification codes 302.72, 607.84) during 1996-2010. The control group included 18,544 randomly selected age-matched patients without ED (1:4 ratio). The association between ED and hip fracture risk was estimated using a Cox proportional hazard regression model. During the follow-up period, 59 (1.27%) patients in the ED group and 140 (0.75%) patients in the non-ED group developed hip fracture. After adjusting for covariates, the overall incidence of hip fracture was 3.74-times higher in the ED group than in the non-ED group (2.03 vs. 0.50 per 1000 person-years, respectively). The difference in the overall incidence of hip fracture was largest during the 3-year follow-up period (hazard ratio = 7.85; 95% confidence interval = 2.94-20.96; P <0.0001). To the best of our knowledge, this nationwide population-based study is the first to investigate the relationship between ED and subsequent hip fracture in an Asian population. The results showed that ED patients had a higher risk of developing hip fracture. Patients with ED, particularly those aged 40-59 years, should undergo bone mineral density examinations as early as possible and should take measures to reduce the risk of falls.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0153467PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831780PMC
August 2016

Assessing the Intraoperative Accuracy of Pedicle Screw Placement by Using a Bone-Mounted Miniature Robot System through Secondary Registration.

PLoS One 2016 7;11(4):e0153235. Epub 2016 Apr 7.

Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Introduction: Pedicle screws are commonly employed to restore spinal stability and correct deformities. The Renaissance robotic system was developed to improve the accuracy of pedicle screw placement.

Purpose: In this study, we developed an intraoperative classification system for evaluating the accuracy of pedicle screw placements through secondary registration. Furthermore, we evaluated the benefits of using the Renaissance robotic system in pedicle screw placement and postoperative evaluations. Finally, we examined the factors affecting the accuracy of pedicle screw implantation.

Results: Through use of the Renaissance robotic system, the accuracy of Kirschner-wire (K-wire) placements deviating <3 mm from the planned trajectory was determined to be 98.74%. According to our classification system, the robot-guided pedicle screw implantation attained an accuracy of 94.00% before repositioning and 98.74% after repositioning. However, the malposition rate before repositioning was 5.99%; among these placements, 4.73% were immediately repositioned using the robot system and 1.26% were manually repositioned after a failed robot repositioning attempt. Most K-wire entry points deviated caudally and laterally.

Conclusion: The Renaissance robotic system offers high accuracy in pedicle screw placement. Secondary registration improves the accuracy through increasing the precision of the positioning; moreover, intraoperative evaluation enables immediate repositioning. Furthermore, the K-wire tends to deviate caudally and laterally from the entry point because of skiving, which is characteristic of robot-assisted pedicle screw placement.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0153235PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824416PMC
September 2016

Bilaterally isolated abducens palsy after an aneursym rupture is related with intracranial hypertension.

Springerplus 2015 10;4:765. Epub 2015 Dec 10.

Department of Neurosurgery, Kaohsiung Medical University Hospital, No 100, Tz-you 1st Road, Kaohsiung, 807 Taiwan.

Background: Bilateral and isolated abducens nerve palsy is a rare initial presentation after aneurysms rupture. Several possible mechanisms including intracranial hypertension have been purposed. To date, there have been no reports with objective measurements to demonstrate the relationship between intracranial pressure and isolated abducens palsy in the setting of acute subarachnoid hemorrhage due to aneurysm rupture.

Findings: A 50 year-old female presented with severe headache and bilaterally isolated abducens nerve palsy. A series of image studies showed a ruptured aneurysm over right internal carotid artery and posterior communicating artery bifurcation with minimal subarachnoid hemorrhage. Surgery of aneurysm clipping was performed and intracranial pressure monitoring was applied. Postoperatively no new neurological deficit developed but persistent headache and increased intracranial pressure measured by a fiber-optic device had been observed. The intracranial hypertension then decreased gradually with rapid recovery from the bilateral abducens palsy 7 days after the surgery. The relationship between postoperative intracranial pressure, subarachnoid hematoma and isolated abducens palsy are illustrated.

Conclusions: The report demonstrated the clinical presentation of bilaterally isolated abducens palsy after an intracranial aneurysm rupture is related with the increased intracranial pressure level, rather than the hematoma compression to the nerve or vasospasm of pontine branches of basilar artery.
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http://dx.doi.org/10.1186/s40064-015-1560-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675756PMC
December 2015

Osteoporosis Self-Assessment Tool for Asians Can Predict Neurologic Prognosis in Patients with Isolated Moderate Traumatic Brain Injury.

PLoS One 2015 17;10(7):e0132685. Epub 2015 Jul 17.

Division of Traumatology, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Objectives: Osteoporosis Self-Assessment Tool for Asians (OSTA) has been proved to be a simple and effective tool for recognizing osteoporosis risk. Our previous study has demonstrated that the preoperative OSTA index was a good prognostic predictor for stage II and III colon cancer patients after surgery. We aim to evaluate the value of OSTA index in prognostication of isolated traumatic brain injury with moderate severity (GCS 9-13).

Methods: We retrospectively reviewed all patients visiting Kaohsiung Medical University Hospital emergency department due to isolated moderate traumatic brain injury from Jan. 2010 to Dec. 2012. Background data (including the OSTA index), clinical presentations, management and outcomes (ICU admission days, total admission days, complications, Glasgow outcome score (GOS) at discharge, mortality) of the patients were recorded for further analysis. Our major outcome was good neurologic recovery defined as GOS of 5. Pearson chi-square test and the Mann-Whitney U test were used to compare demographic features. Multiple logistic regression was used to identify independent risk factors.

Results: 107 isolated moderate TBI patients were studied. 40 patients (37.4%) showed good recovery and 10 (9.3%) died at discharge. The univariate analysis revealed that younger age, higher OSTA index, lower ISS, lower AIS-H, and avoidance to neurosurgery were associated with better neurologic outcome for all moderate TBI patients. Multivariate analysis revealed that lower ISS, higher OSTA, and the avoidance of neurosurgery were independent risk factors predicting good neurologic recovery.

Conclusion: Higher ISS, lower OSTA index and exposure to neurosurgery were the independent risk factors for poorer recovery from isolated moderate TBI. In addition to labeling the cohort harboring osteoporotic risk, OSTA index could predict neurologic prognosis in patients with isolated moderate traumatic brain injury.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132685PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4506087PMC
May 2016

Toona sinensis leaf extract has antinociceptive effect comparable with non-steroidal anti-inflammatory agents in mouse writhing test.

BMC Complement Altern Med 2015 Mar 19;15:70. Epub 2015 Mar 19.

Department of Neurosurgery, Kaohsiung Medical University Hospital, No. 100, Tz-you Road, Kaohsiung, 80708, Taiwan.

Background: The antinociceptive effect of an aqueous extract from the leaves of Toona sinensis (TS, [A. Juss., M. Roem.]) was studied using the writhing test in mice.

Methods: Different extraction fractions from TS leaf extracts (TSL1 to TSL5) were administered orally 1 h before intraperitoneal injection of acetic acid.

Results: After treatment with TSL1, TSL2, TSL3, TSL4, and TSL5 at a dose of 1 g/kg, the respective writhing responses were 39.9% (P < 0.001), 19.9% (P < 0.05), 11.7% (P = 0.052), 8.1% (P = 0.188), and 11.4% (P = 0.057) lower than the control group. Mice treated with TSL1 at 1 g/kg (39.9%, P < 0.001), 0.3 g/kg (38.0%, P < 0.001), 0.1 g/kg (46.9%, P < 0.001), and 0.03 g/kg (31.1%, P < 0.001) had significantly lower writhing responses compared with control mice. A time-course experiment was performed, which involved oral administration of TSL1 (0.1 g/kg) at 0, 0.5, 1, 2, and 6 h before acetic acid intraperitoneal injection. The most effective dose of TSL1 was 0.1 g/kg orally, with the effect beginning 30 min before treatment and persisting until 6 h.

Conclusions: This study showed that TS has anti-visceral pain properties comparable with those of rofecoxib (a cyclooxygenase-2 inhibitor) and diclofenac, which suggests promise for the treatment of intractable visceral pain in humans.
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http://dx.doi.org/10.1186/s12906-015-0599-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378551PMC
March 2015

Progesterone attenuates experimental subarachnoid hemorrhage-induced vasospasm by upregulation of endothelial nitric oxide synthase via Akt signaling pathway.

Biomed Res Int 2014 13;2014:207616. Epub 2014 May 13.

Department of Neurosurgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 80708, Taiwan ; Faculty of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.

Cerebral vasospasm is the leading cause of mortality and morbidity in patients after aneurysmal subarachnoid hemorrhage (SAH). However, the mechanism and adequate treatment of vasospasm are still elusive. In the present study, we evaluate the effect and possible mechanism of progesterone on SAH-induced vasospasm in a two-hemorrhage rodent model of SAH. Progesterone (8 mg/kg) was subcutaneously injected in ovariectomized female Sprague-Dawley rats one hour after SAH induction. The degree of vasospasm was determined by averaging the cross-sectional areas of basilar artery 7 days after first SAH. Expressions of endothelial nitric oxide synthase (eNOS) and phosphorylated Akt (phospho-Akt) in basilar arteries were evaluated. Prior to perfusion fixation, there were no significant differences among the control and treated groups in physiological parameters recorded. Progesterone treatment significantly (P < 0.01) attenuated SAH-induced vasospasm. The SAH-induced suppression of eNOS protein and phospho-Akt were relieved by progesterone treatment. This result further confirmed that progesterone is effective in preventing SAH-induced vasospasm. The beneficial effect of progesterone might be in part related to upregulation of expression of eNOS via Akt signaling pathway after SAH. Progesterone holds therapeutic promise in the treatment of cerebral vasospasm following SAH.
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http://dx.doi.org/10.1155/2014/207616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4052693PMC
February 2015

Predictors of memory and processing speed dysfunctions after traumatic brain injury.

Biomed Res Int 2014 29;2014:129796. Epub 2014 Apr 29.

Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City 807, Taiwan.

Background: The aims of this study were to evaluate the predictive value of admission Glasgow Coma Scale (GCS) scores, duration of unconsciousness, neurosurgical intervention, and countercoup lesion on the impairment of memory and processing speed functions six months after a traumatic brain injury (TBI) based on a structural equation modeling.

Methods: Thirty TBI patients recruited from Neurosurgical Department at the Kaohsiung Medical University Hospital were administered the Wechsler Memory Scale-III (WMS-III) and the Wechsler Adult Intelligence Scale-III processing speed index to evaluate the memory and processing speed functions.

Results: The study showed that GCS scores accounted for 40% of the variance in memory/processing speed. No significant predictive effects were found for the other three variables. GCS classification at the time of TBI seems to correspond moderately to the severity of memory/processing speed dysfunctions.

Conclusions: The present study demonstrated that admission GCS score is a robust predictor of memory/processing speed dysfunctions after TBI. The results should be replicated with a large sample of patients with TBI, or be extended by examining other potential clinical predictors.
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http://dx.doi.org/10.1155/2014/129796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022287PMC
February 2015

Lack of efficacy of motor cortex stimulation for the treatment of neuropathic pain in 14 patients.

Neuromodulation 2014 Jun 28;17(4):303-10; discussion 310-1. Epub 2014 Apr 28.

Division of Neurosurgery, Department of Surgery, The Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada.

Objectives: Motor cortex stimulation has been reported as an effective treatment for medically resistant neuropathic pain. The goal of this study is to review the efficacy of this treatment in a series of 14 patients.

Materials And Methods: The records of a consecutive series of 14 patients undergoing MCS for neuropathic pain at Stanford University Hospital and Clinics between 2002 and 2010 were retrospectively analyzed. The primary outcome measure was a visual analogue scale, which patients completed prior to surgery and following each programming session. The motor cortex was localized using 1) MR image guidance, 2) intraoperative somatosensory evoked potentials and motor response to stimulation, and 3) postoperative imaging. All patients underwent extensive stimulator programming.

Results: Five patients exhibited a transient improvement of >50%. Of these, only two patients maintained >50% improvement to their last clinic visit. One of these patients died of unrelated causes, and the other complained of variable response at home. The median time from best to final VAS was 50 days. Average postoperative follow-up was 55.5 weeks. Postoperative imaging demonstrated appropriate lead placement in 12 patients. The other two patients did not undergo postoperative imaging.

Conclusions: In our cohort of 14 patients with neuropathic pain, motor cortex stimulation failed to produce acceptable long-term benefit. Possible reasons for this failure are discussed in the context of a small retrospective study.
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http://dx.doi.org/10.1111/ner.12181DOI Listing
June 2014

Intraoperative intracranial pressure and cerebral perfusion pressure for predicting surgical outcome in severe traumatic brain injury.

Kaohsiung J Med Sci 2013 Oct 28;29(10):540-6. Epub 2013 May 28.

Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address:

Intraoperative intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were evaluated for use as prognostic indicators after surgery for severe traumatic brain injury (TBI), and threshold ICP and CPP values were determined to provide guidelines for patient management. This retrospective study reviewed data for 66 patients (20 females and 46 males) aged 13-83 years (average age, 48 years) who had received decompressive craniectomy and hematoma evacuation for severe TBI. The analysis of clinical characteristics included Glascow Coma Scale score, trauma mechanism, trauma severity, cerebral hemorrhage type, hematoma thickness observed on computed tomography scan, Glasgow Outcome Scale score, and mortality. Patients whose treatment included ICP monitoring had significantly better prognosis (p < 0.001) and significantly lower mortality (p = 0.016) compared to those who did not receive ICP monitoring. At all three major steps of the procedure, i.e., creation of the burr hole, evacuation of the hematoma, and closing of the wound, intraoperative ICP and CPP values significantly differed. The ICP and CPP values were also significantly associated with surgical outcome in the severe TBI patients. Between hematoma evacuation and wound closure, ICP and CPP values differed by 6.8 ± 4.5 and 6.5 ± 4.6 mmHg, respectively (mean difference, 6 mmHg). Intraoperative thresholds were 14 mmHg for ICP and 56mmH for CPP. Monitoring ICP and CPP during surgery improves management of severe TBI patients and provides an early prognostic indicator. During surgery for severe TBI, early detection of increased ICP is also crucial for enabling sufficiently early treatment to improve surgical outcome. However, further study is needed to determine the optimal intraoperative ICP and CPP thresholds before their use as subjective guidelines for managing severe TBI patients.
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http://dx.doi.org/10.1016/j.kjms.2013.01.010DOI Listing
October 2013

17β-Estradiol attenuates secondary injury through activation of Akt signaling via estrogen receptor alpha in rat brain following subarachnoid hemorrhage.

J Surg Res 2013 Jul 8;183(1):e23-30. Epub 2013 Feb 8.

Center for General Education, Southern Taiwan University of Technology, Tainan, Taiwan.

Background: Apoptosis is implicated in vasospasm and the long-term sequelae of subarachnoid hemorrhage (SAH). This study tested the hypothesis that attenuation of SAH-induced apoptosis after 17β-estradiol (E2) treatment is associated with an increase in phosphorylation of Akt via estrogen receptor-α (ER-α) in rats.

Materials And Methods: We examined the expression of phospho-Akt, ERα and ERβ, and apoptosis in cerebral cortex, hippocampus, and dentate gyrus in a two-hemorrhage SAH model in rats. We subcutaneously implanted other rats with a silicone rubber tube containing E2; they received daily injections of nonselective estrogen receptor antagonist (ICI 182,780), selective ERα-selective antagonist (methyl-piperidino-pyrazole), or ERβ-selective antagonist (R,R-tetrahydrochrysene) after the first hemorrhage.

Results: At 7 d after the first SAH, protein levels of phospho-Akt and ERα were significantly decreased and caspase-3 was significantly increased in the dentate gyrus. The cell death assay revealed that DNA fragmentation was significantly increased in the dentate gyrus. Those actions were reversed by E2 and blocked by ICI 182,780 and methyl-piperidino-pyrazole, but not R,R-tetrahydrochrysene. However, there were no significant changes in the expression of the protein levels of phospho-Akt, ERα, ERβ, and caspase-3, and DNA fragmentation after SAH.

Conclusions: The present study shows that a beneficial effect of E2 in attenuating SAH-induced apoptosis is associated with activation of the expression of phospho-Akt and ERα, and alteration in caspase-3 protein expression via an ERα-dependent mechanism in the dentate gyrus. These data support further the investigation of E2 in the treatment of SAH in humans.
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http://dx.doi.org/10.1016/j.jss.2013.01.033DOI Listing
July 2013

Plasma levels of transforming growth factor-beta 1 before and after removal of low- and high-grade astrocytomas.

Cytokine 2013 Feb 20;61(2):413-8. Epub 2012 Dec 20.

Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Transforming growth factor-beta 1 (TGF-β1) has been reported to be a possible marker for a number of tumors, including brain tumors. The aim of this study was to measure the plasma levels of TGF-β1 in patients with low- and high-grade astrocytomas before and after surgery. This prospective study included 14 patients with low-grade astrocytomas and 25 with high-grade astrocytomas who underwent tumor removal and 13 controls (patients who underwent cranioplasty for skull bone defects). Plasma levels of TGF-β1 were measured in all subjects using enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis showed that when the level of TGF-β1 before tumor removal was ≥ 2.52 ng/ml, astrocytoma was predicted with a sensitivity of 94.9% and specificity of 100%. The mean plasma level of TGF-β1 in both the low-grade and high-grade astrocytoma groups significantly decreased after tumor removal (p<0.05); there was no significant change in TGF-β1 plasma level of the controls following surgery. Patients with high-grade astrocytomas had a significantly higher mortality rate than patients with low-grade astrocytomas (p=0.019) and significantly shorter survival (p=0.008). A positive correlation between TGF-β1 level after tumor removal and tumor volume was only found in the high-grade astrocytoma group (γ=0.597, p=0.002). The findings show that plasma TGF-β1 level was increased in patients with low-grade and high-grade astrocytoma, and that the levels significantly decreased after tumor removal in both groups. The results provide additional evidence that TGF-β1 might be useful as a tumor marker for astrocytomas.
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http://dx.doi.org/10.1016/j.cyto.2012.11.011DOI Listing
February 2013