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Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: Real-world perspective

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World Journal of Gastroenterology 2017年第22期23卷 4054-4063页

作者： James Weiquan Li Boon-Bee George Goh pik-eu chang Chee-Kiat Tan Department of Gastroenterology and Hepatology Duke-NUS Medical School

To compare the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) classification systems when applied to HCC patients from the largest tertiary-level centre in *** thousand two hundred and seventy hepatocellular carcinoma (HCC) patients prospectively enrolled in a tertiary-level centre registry in Singapore since 1988 were studied. Patients were grouped into their respective BCLC and HKLC stages. Data such as demography, aetiology of HCC and type of treatment were collected. Survival data was based on census with the National Registry of Births and Deaths on 31st October 2015. Statistical analyses were done using SPSS version 21 (Chicago, IL, United States). Survival analyses were done by the Kaplan-Meier method. Differences in survival rates were compared using the log-rank *** median age at presentation was 63 years (range 13-94); male 82.4%; Chinese 89.4%, Malay 7.1%, Indian, 2.8%. Hepatitis B was the predominant aetiology (75.0%; Hepatitis C 7.2%, Hepatitis B and C co-infection 3.8%, non-viral 14.0%). Both BCLC and HKLC staging systems showed good separation with overall log rank test confirming significant survival differences between stages in our cohort (P < 0.001). 206 out of the 240 patients (85.8%) assigned for curative treatment by the BCLC treatment algorithm received curative therapy for HCC [Stage 0 93.2% (68/73); Stage A 82.6% (138/167)]. In contrast, only 341/558 (61.1%) patients received curative treatment despite being assigned for curative treatment by the HKLC treatment algorithm [Stage I 72.7% (264/363); Stage II 40.2% (66/164); Stage Va 35.5% (11/31)]. Patients who were assigned to curative treatment by HKLC but did not receive curative treatment had significantly poorer ECOG (P < 0.001), higher Child-Pugh status (P < 0.001) and were older (median age 66 vs 61, P < 0.001) than those who received curative therapy. Median overall survival in patients assigned to curative treatment groups

关键词： Hepatocellular carcinoma Barcelona Clinic Liver Cancer Hong Kong Liver Cancer Staging systems Prognosis Survival

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Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis

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World Journal of Hepatology 2017年第22期9卷 959-966页

作者： pik-eu chang Boon-Bee George Goh Victoria Ekstrom Ming-Liang Ong Chee-Kiat Tan Department of Gastro enterology and Hepatology Singapore General Hospital Duke-NUS Medical School

To evaluate the incidence, etiology, and predictors of mortality of severe hypoxic hepatitis. METHODSWe used computerized patient records to identify consecutive cases of severe hypoxic hepatitis admitted to a tertiary hospital in Singapore over a one-year period. We defined severe hypoxic hepatitis as elevation of serum transaminases more than 100 times upper limit of normal in the clinical setting of cardiac, circulatory or respiratory failure after exclusion of other causes of hepatitis. We used multivariable regression analysis to determine predictors for mortality. RESULTSWe identified 75 cases of severe hypoxic hepatitis out of 71380 hospital admissions over one year, providing an incidence of 1.05 cases per 1000 admissions. Median age was 65 years (range 19-88); 57.3% males. The most common etiologies of severe hypoxic hepatitis were acute myocardial infarction and sepsis. Fifty-three patients (71%) died during the hospitalization. The sole independent predictive factor for mortality was serum albumin measured at the onset of severe hypoxic hepatitis. Patients with low serum albumin of less than 28 g/L have more than five-fold increase risk of death (OR = 5.39, 95%CI: 1.85-15.71). CONCLUSIONSevere hypoxic hepatitis is uncommon but has a high mortality rate. Patients with low serum albumin are at highest risk of death.

关键词： Severe Mortality Albumin Incidence Hypoxic hepatitis Predictors Etiology Prognosis

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Clinical applications, limitations and future role of transient elastography in the management of liver disease

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第1期7卷 91-106页

作者： pik eu chang George Boon-Bee Goh Jing Hieng Ngu Hiang Keat Tan Chee Kiat Tan Department of Gastroen- terology and Hepatology Singapore General Hospital George Boon-Bee Goh Duke- NUS Graduate Medical School

Transient elastography(TE) is a reliable tool for the non-invasive assessment of liver fibrosis in routine clinical practice. TE is currently approved for use in europe, Asia and the United States. The widespread adoption of this technology is certain to increase the use of TE worldwide. Although TE has been well validated in chronic viral hepatitis, its clinical role in other liver diseases remains less clear. The advent of new treatment for chronic hepatitis C and emerging prevalence of non-alcoholic steatohepatitis raises new questions on the role of TE in current clinical practice. This review aims to examine the clinical applications, limitations and future role of TE in current clinical practice in light of the changing epidemiology of liver diseases and new clinical management paradigms. In current clinical practice, TE is the most accurate noninvasive method for diagnosis of liver cirrhosis. TE is useful to rule out fibrosis and cirrhosis but does not have sufficient accuracy to discern between various stages of fibrosis. The clinical role of TE has evolved from cross-sectional point-in-time assessment of fibrosis and cirrhosis to the more relevant role of prediction of vital clinical end-points. This provides clinicians with the ability to modify treatment strategies based on the information provided by TE. TE has evolved over the past decade to become an essential tool to assist the clinician in the management of chronic liver disease.

关键词： Liver stiffness Transient elastography Non-invasive Fibrosis Chronic

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Prevalence and medical management of erectile ：lysfunction in Asia

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Asian Journal of Andrology 2011年第4期13卷 543-549页

作者： Kwangsung Park eu chang Hwang Sun-Ouck Kim Department of Urology Chonnam National University Medical School Sexual Medicine Research Center Chonnam National University Gwangju 501-757 Korea

Erectile dysfunction （ED） is an important worldwide health issue that has a significant negative impact on the quality of life and life satisfaction of both the affected individual and his partner. Here we review the prevalence of ED in Asia, associated factors that may influence sexual attitudes and sexual behaviours, and randomized clinical trials （RCTs） of phosphodiesterase-5 （PDE-5） inhibitors to evaluate the clinical efficacy and safety of PDE-5 inhibitors in Asian men. We searched for English-language articles in MEDLINE and PubMed from January 2000 to September 2010. Our results showed that the overall reported prevalence rate of ED in Asia ranged widely, from 2% to 88%. This finding indicates that ED is a common and major health problem in this region. However, sociocultural and economic factors in Asia prevent people from seeking and obtaining appropriate medical care. We found reports on five kinds of PDE-5 inhibitors for the management of ED.＇ sildenafil, vardenafil, tadalafil, udenafil and mirodenafih The results of RCTs showed that these five PDE-5 inhibitors are more effective than placebo in improving erectile function in Asian men with ED and that these drugs have similar efficacy and safety profiles.

关键词： Asia erectile dysfunction phosphodiesterase inhibitors prevalence

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Bursting in Neuronal Networks with and without Glia

Bursting in Neuronal Networks with and without Glia

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第七届全国液体和软物质物理学术会议

作者： Cin-He chang pik-Yin Lai Institute of Physics Academia SinicaNanKangTaipeiTaiwan Department of Physics Institute of Biophysics and Center for Complex SystemsNational Central University

The phenomenon of spontaneous firings induced by low Mg condition in primary cortical neuronal cultures with different amounts of glia are used to study the effects of glia on the dynamics of the *** cell patch-clamp measurements have shown that the forms of firing during spontaneous firings are different for networks with and without *** general,

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Association of accelerometer-measured sleep duration and different intensities of physical activity with incident type 2 diabetes in a population-based cohort study

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Journal of Sport and Health Science 2024年第2期13卷 222-232页

作者： Xinyi Jin Yilin Chen Hongliang Feng Mingqing Zhou Joey W.Y.chang Yaping Liu Alice pik Shan Kong Xiao Tan Yun-Kwok Wing Yannis Yan Liang Jihui Zhang Guangdong Cardiovascular Institute Guangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention Guangdong Cardiovascular InstituteGuangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhou 510080China School of Medicine South China University of TechnologyGuangzhou 510641China Center for Sleep and Circadian Medicine The Affiliated Brain Hospital of Guangzhou Medical UniversityGuangzhou 510180China The Second School of Clinical Medicine Southern Medical UniversityGuangzhou 510282China Guangdong Mental Health Center Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhou 510120China Li Chiu Kong Family Sleep Assessment Unit Department of PsychiatryFaculty of MedicineThe Chinese University of Hong KongHong Kong 999077China Department of Psychiatry Faculty of MedicineThe Chinese University of Hong KongHong Kong 999077China Department of Medicine and Therapeutics Faculty of MedicineThe Chinese University of Hong KongHong Kong 999077China Department of Medical Sciences Uppsala UniversityUppsala 75185Sweden Department of Big Data in Health Science Zhejiang University School of Public HealthHangzhou 310058China Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China Guangzhou 510260China

Purpose:The aim of the current study was to investigate the association of accelerometer-measured sleep duration and different intensities of physical activity(PA)with the risk of incident type 2 diabetes in a population-based prospective cohort ***:Altogether,88,000 participants(mean age=62.2±7.9 years,mean±SD)were included from the UK *** duration(short:8 h/day)and PA of different intensities were measured using a wrist-won accelerometer over a 7-day period between 2013 and *** was classified according to the median or World Health Organization-recommendation:total volume of PA(high,low),moderate-to-vigorous PA(MVPA)(recommended,not recommended),and light-intensity PA(high,low).Incidence of type 2diabetes was ascertained using hospital records or death ***:During a median follow-up of 7.0 years,1615 incident type 2 diabetes cases were *** with normal sleep duration,short(hazard ratio(HR)=1.21,95%confidence interval(95%CI):1.03-1.41)but not long sleep duration(HR=1.01,95%CI:0.89-1.15)was associated with excessive type 2 diabetes *** increased risk among short sleepers seems to be protected against by *** with normal sleepers with high or recommended PA,short sleepers with low volume of PA(HR=1.81,95%CI:1.46-2.25),not recommended(below the World Health Organization-recommended level of)MVPA(HR=1.92,95%CI:1.55-2.36),or low light-intensity PA(HR=1.49,95%CI:1.13-1.90)had a higher risk of type 2 diabetes,while short sleepers with a high volume of PA(HR=1.14,95%CI:0.88-1.49),recommended MVPA(HR=1.02,95%CI:0.71-1.48),or high light-intensity PA(HR=1.14,95%CI:0.92-1.41)did ***:Accelerometer-measured short but not long sleep duration was associated with a higher risk of incident type 2 diabetes.A higher level of PA,regardless of intensity,potentially ameliorates this excessive risk.

关键词： Light physical activity Sleep duration Triaxial accelerometer Type 2 diabetes UK Biobank

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Effect of serum testosterone and percent tumor volume on extra-prostatic extension and biochemical recurrence after laparoscopic radical prostatectomy

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Asian Journal of Andrology 2016年第1期18卷 54-59页

作者： eu chang Hwang Seong Hyeon Yu Yang Hyun Jo Seung I1 Jung Taek Won Kang Dong Deuk Kwon Chan Choi Suk Hee Heo Jun eul Hwang Sung-Hoon Jung Tae-Young Jung Department of Urology Chonnam National University Medical School Gwangju Republic of Korea Department of Pathology Chonnam National University Medical School Gwangju Republic of Korea Department of Radiology Chonnam National University Medical School Gwangju Republic of Korea Department of Hemato-oncology Chonnam National University Medical School Gwangju Republic of Korea Department of Neurosurgery Chonnam National University Medical Schoo Gwangju Republic of Korea

Several studies have revealed that the preoperative serum testosterone and percent tumor volume （PTV） predict extra-prostatic extension （EPE） and biochemical recurrence （BCR） after radical prostatectomy. This study investigated the prognostic significance of serum testosterone and PTV in relation to EPE and BCR after laparoscopic radical prostatectomy （LRP）. We reviewed 520 patients who underwent LRP between 2004 and 2012. PTV was determined as the sum of all visually estimated tumor foci in every section. BCR was defined as two consecutive increases in the postoperative prostate-specific antigen （PSA）〉0.2 ng ml^-1. The threshold for serum total testosterone was 3.0 ng ml^-1, Multivariate logistic regression was used to define the effect of variables on the risk of EPE and BCR. A low serum testosterone （〈3.0 ng ml^-1） was associated with a high serum PSA, Gleason score, positive core percentage of the prostate biopsy, PTV, and all pathological variables. On multivariate analysis, similar to previous studies, the serum PSA, biopsy positive core percentage, Gleason score, and pathological variables predicted EPE and BCR. In addition, low serum testosterone （〈3.0 ng ml^-1, adjusted OR, 8.52; 95% CI, 5.04-14.4, P = 0.001） predicted EPE and PTV （adjusted OR, 1.02; 95% CI, 1.01-1.05, P = 0.046） predicted BCR. In addition to previous predictors of EPE and BCR, low serum testosterone and PTV are valuable predictors of EPE and BCR after LRP.

关键词： biochemical recurrence extra-prostatic extension prostate neoplasms prostatectomy testosterone tumor burden

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Optimal sequential therapy using tyrosine kinase inhibitors as the first-line treatment in patients with metastatic renal cell carcinoma: A nationwide multicenter study

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Asian Journal of Urology 2024年第3期11卷 450-459页

作者： Jung Ki Jo Seong Il Seo MinYong Kang Jinsoo Chung Cheol Kwak Sung-Hoo Hong Cheryn Song Jae Young Park chang Wook Jeong Seok Hwan Choi Sung Han Kim eu chang Hwang Chan Ho Lee Hakmin Lee Department of Urology Medical and Digital EngineeringCollege of MedicineHanyang UniversitySeoulRepublic of Korea Department of Urology Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea Department of Urology National Cancer CenterGoyangRepublic of Korea Department of Urology Seoul National University HospitalSeoulRepublic of Korea Department of Urology Kangnam St Mary’s HospitalSeoulRepublic of Korea Department of Urology Asan Medical CenterSeoulRepublic of Korea Department of Urology Korea University Ansan HospitalAnsanRepublic of Korea Department of Urology Kyungpook National University HospitalDaeguRepublic of Korea Department of Urology Chonnam National University Hwasun HospitalHwasunRepublic of Korea Department of Urology Inje University Busan Paik HospitalBusanRepublic of Korea Department of Urology Seoul National University Bundang HospitalSeongnamRepublic of Korea

Objective:The purpose of the study was to identify the best sequence of therapy beginning with a tyrosine kinase inhibitor(TKI)as the first-line therapy for patients with metastatic renal cell carcinoma(mRCC)in terms of overall survival(OS),progression-free survival(PFS),and rates of discontinuation and adverse effects during the treatment ***:This is a retrospective,nationwide multicenter study of patients with mRCC after diagnosis at 10 different tertiary medical centers in Korea from January 1992 to December *** focused on patients at either“favorable”or“intermediate”risk according to the International mRCC Database Consortium criteria,and they were followed up(median 335 days).Finally,a total of 1409 patients were selected as the study *** generated a Cox proportional hazard model adjusted for covariates,and the different therapy schemes were statistically tested in terms of OS as well as *** addition,frequencies of discontinuation and adverse events were compared among the therapy ***:Of the primary patterns of treatment sequences(24 sequences),“sunitinib epazopanib”and“sunitinibeeverolimuseimmunotherapy”showed the most beneficial results in both OS and PFS with significantly lower hazards than“sunitinib”,which is the most commonly treated agent in *** that the“TKIeTKI”structure showed relatively higher discontinuation rates with higher adverse effects,the overall beneficial sequence would be“sunitinibeeverolimuseimmunotherapy”.Conclusion:Among several sequential therapy starting with TKIs,“sunitinibeeverolimuse immunotherapy”was found to be the best scheme for mRCC patients with“favorable”or“intermediate”risks.

关键词： Tyrosine kinase inhibitor Metastatic renal cell carcinoma Overall survival Progression-free survival

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Prostate calculi in cancer and BPH in a cohort of Korean men：presence of calculi did not correlate with cancer risk

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Asian Journal of Andrology 2010年第2期12卷 215-220页

作者： eu-chang Hwang Hyang-Sik Choi chang-Min Im Seung-II Jung Sun-Ouck Kim Tack-Won Kang Dong-Deuk Kwon Kwang-Sung Park Soo-Bang Ryu Department of Urology Chonnam National University Medical School Gwangju 501-75 7 Korea

Prostatic calculi are common and are associated with inflammation of the prostate. Recently,it has been suggested that this inflammation may be associated with prostate carcinogenesis. The aim of this study was to investigate the relationship between prostatic calculi and prostate cancer （PCa） in prostate biopsy specimens. We retrospectively analyzed 417 consecutive patients who underwent transrectal ultrasonography （TRUS） and prostate biopsies between January 2005 and January 2008. Based on the biopsy findings,patients were divided into benign prostatic hyperplasia and PCa groups. TRUS was used to detect prostatic calculi and to measure prostate *** correlations between PCa risk and age,serum total PSA levels,prostate volume,and prostatic calculi were analyzed. Patient age and PSA,as well as the frequency of prostatic calculi in the biopsy specimens,differed significantly between both the groups （P〈0.05）. In the PCa group,the Gleason scores （GSs） were higher in patients with prostatic calculi than in patients without prostatic calculi （P = 0.023）. Using multivariate logistic regression analysis,we found that patient age,serum total PSA and prostate volume were risk factors for PCa （P = 0.001）,but that the presence of prostatic calculi was not associated with an increased risk of PCa （P = 0.13）. In conclusion,although the presence of prostatic calculi was not shown to be a risk factor for PCa,prostatic calculi were more common in patients with PCa and were associated with a higher GS among these men.

关键词： calculi prostate prostatic neoplasms risk factors

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A Remark on the Generalized Second Order Toda System

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Acta Mathematica Sinica,English Series 2013年第9期29卷 1691-1702页

作者： Rui chang PEI School of Mathematics and Statistics Tianshui Normal University

In this paper, we establish a priori estimates to the generalized second order Toda system{-Δu1（x）=2R1（x）eu1-R2eu2,-Δu2（x）=R1（x）eu1＋2R2eu2 in R2 , and discuss the convergence and asymptotic behavior of its solutions, where Ri（x）, i=1, 2, is bounded function in R2 . Consequently, we prove that all the solutions satisfy an identity, which is somewhat a generalization of the well-known Kazdan-Warner condition.

关键词： Second order Toda system asymptotic behavior priori estimates convergence

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