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Chinese Medical Journal 2009年第24期122卷 3091-3093页

作者： Nien-Chih Hu shih-chung hsieh Tong-Jong Chen Jun-Yih Chang Department of Family Medicine Shin Kong Wu Ho-Su Memorial Hospital Taipei 111 Taiwan China Department of Internal Medicine Shin Kong Wu Ho-Su Memorial Hospital Taipei 111 Taiwan China Department of Pathology Shin Kong Wu Ho-Su Memorial Hospital Taipei 111 Taiwan China

Multiple primary malignancies in a single patient are relatively rare but have increase in frequency in recent decades. This may be a result of medical advancements in diagnostic and therapeutic strategies, a possible effect of new carcinogens in the industrial environment, and longer life span allowing another primary cancer to develop. Among those with multiple primary malignancies, double cancer is commonly seen, while triple cancers occur in 0.5% of patients, and quadruple or quintuple cancers occur in only less than 0.1% of the population.

关键词： multiple primary malignancies, quadruple cancer quintuple cancer

Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients

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World Journal of Gastrointestinal Surgery 2022年第9期14卷 930-939页

作者： Hsiu-Lung Fan chung-Bao hsieh shih-Ming Kuo Teng-Wei Chen Division of General Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 11409Taiwan Division of Pediatric Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 11409Taiwan

BACKGROUND Splenectomy has previously been found to increase the risk of cancer development,including lung,non-melanoma skin cancer,leukemia,lymphoma,Hodgkin’s lymphoma,and ovarian *** risk of cancer development in liver transplantation(LT)with simultaneous splenectomy remains *** To compare hepatocellular carcinoma(HCC)recurrence and de novo malignancy between patients undergoing LT with and without simultaneous *** We retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with(n=35)and without(n=85)simultaneous splenectomy in the Tri-Service General *** and multivariate Cox regression analyses for cancer-free survival and mortality were *** comparison of the group survival status and group cancer-free status was done by generating Kaplan–Meier survival curves and log-rank *** The splenectomy group had more hepatitis C virus infection,lower platelet count,higher-fetoprotein level,and longer operating *** and age were both positive independent factors for prediction of cancer development[hazard ratio(HR):2.560 and 1.057,respectively,P<0.05].Splenectomy and hypertension were positive independent factors for prediction of mortality.(HR:2.791 and 2.813 respectively,P<0.05).The splenectomy group had a significantly worse cancer-free survival(CFS)and overall survival(OS)curve compared to the non-splenectomy group(5-year CFS rates:53.4%vs 76.5%,P=0.003;5-year OS rate:68.1 vs 89.3,P=0.002).CONCLUSION Our study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

关键词： Hepatocellular carcinoma Liver transplantation Splenectomy De novo malignancy Age Hypertension

A Tailored Finite Point Method for Solving Steady MHD Duct Flow Problems with Boundary Layers

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Communications in Computational Physics 2011年第6期10卷 161-182页

作者： Po-Wen hsieh Yintzer shih Suh-Yuh Yang Department of Mathematics National Central UniversityJhongli CityTaoyuan County 32001Taiwan Department of Applied Mathematics National Chung Hsing UniversityTaichung 40227Taiwan.

In this paper we propose a development of the finite difference method,called the tailored finite point method,for solving steady magnetohydrodynamic(MHD)duct flow problems with a high Hartmann *** the Hartmann number is large,the MHD duct flow is convection-dominated and thus its solution may exhibit localized phenomena such as the boundary *** conventional numerical methods can not efficiently solve the layer problem because they are lacking in either stability or ***,the proposed tailored finite point method is capable of resolving high gradients near the layer regions without refining the ***,we devise the tailored finite point method for the scalar inhomogeneous convectiondiffusion problem,and then extend it to the MHD duct flow which consists of a coupled system of convection-diffusion *** each interior grid point of a given rectangular mesh,we construct a finite-point difference operator at that point with some nearby grid points,where the coefficients of the difference operator are tailored to some particular properties of the *** examples are provided to show the high performance of the proposed method.

关键词： Magnetohydrodynamic equations Hartmann numbers convection-dominated problems boundary layers tailored finite point methods finite difference methods

Isolated gastric variceal bleeding caused by splenic lymphoma-associated splenic vein occlusion

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World Journal of Gastroenterology 2013年第40期19卷 6939-6942页

作者： Bao-chung Chen Hong-Hau Wang Yu-Chieh Lin Yu-Lueng shih Wei-Kuo Chang Tsai-Yuan hsieh Division of Gastroenterology Department of Internal MedicineTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Radiology Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan

Isolated gastric varices(IGV) can occur in patients with left-sided portal hypertension resulting from splenic vein occlusion caused by thrombosis or stenosis. In left-sided portal hypertension,blood flows retrogradely through the short and posterior gastric veins and the gastroepiploic veins,leading to the formation of an IGV. The most common causes of splenic vein occlusion are pancreatic diseases,such as pancreatic cancer,pancreatitis,or a pseudocyst. However,various other cancers,such as colon,gastric,or renal cancers,have also been known to cause splenic vein occlusion. Our patient presented with a rare case of IGV bleeding induced by splenic lymphoma-associated splenic vein occlusion. Splenectomy,splenic artery embolization,and stenting of the splenic vein are the current treatment choices. Chemotherapy,however,is an alternative effective treatment for splenic vein occlusion caused by chemotherapy-sensitive tumors. Our patient responded well to chemotherapy with a cyclophosphamide,hydroxydaunorubicin,oncovin,and prednisolone regimen,and the splenic vein occlusion resolved after the lymphoma regressed.

关键词： Isolated gastric varices Splenic vein Lymphoma Occlusion Hematemesis

Characterization of horseshoe vortex in a developing scour hole at a cylindrical bridge pier

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International Journal of Sediment Research 2019年第2期34卷 118-124页

作者： Dawei Guan Yee-Meng Chiew Maoxing Wei shih-Chun hsieh College of Harbour Coastal and Offshore EngineeringHohai University School of Civil and Environmental Engineering Nanyang Technological University

Since local scour at bridge piers in rivers and estuaries is a major cause of bridge failure,estimation of the maximum local scour depth is of great importance to hydraulic and coastal *** numerous studies that focus on scour-depth prediction have been done and published,understanding of the flow and turbulence characteristics of the horseshoe vortex that drives the scour mechanism in a developing scour hole still is *** study aims to quantify the detailed turbulent flow field in a developing clear-water scour hole at a circular pier using Particle Image Velocimetry(PIV).The distributions of velocity fields,turbulence intensities,and Reynolds shear stresses of the horseshoe vortex that form in front of the pier at different scour stages(t = 0,0.5,1,12,24,and 48 h)are presented in this *** scour development,the horseshoe vortex system was found to evolve from one initially small vortex to three *** strength and size of the main vortex are found to increase with increasing scour *** regions of both the maximum turbulence intensity and Reynolds shear stress are found to form at a location upstream of the main vortex,where the large turbulent eddies have the highest possibility of *** from this study not only provide new insight into the complex flow-sediment interaction at bridge piers,but also provide valuable experimental databases for advanced numerical simulations.

关键词： Sediment transport Scour Bridge pier PIV Horseshoe vortex Turbulence Scour hole

Prognostic factors of short-term outcomes of intravitreal ranibizumab in diabetic macular edema

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International Journal of Ophthalmology(English edition) 2017年第5期10卷 765-771页

作者： I-An Lai Wei-Cherng Hsu chung-May Yang Yi-Ting hsieh Department of Ophthalmology Taipei Tzu Chi HospitalBuddhist Tzu Chi Medical Foundation New Taipei 231Taiwan China School of Medicine Tzu Chi University Hualien 970 Taiwan Department of Ophthalmology National Taiwan University Hospital Taipei 10002 Taiwan China

AIM：To evaluate the prognostic factors for short-term visual and anatomical improvement of intravitreal ranibizumab（IVR） for diabetic macular edema（DME）.METHODS：Fifty-one eyes from 35 patients that received three consecutive monthly IVR for DME with moderate visual loss were retrospectively recruited; all cases had their baseline best-corrected visual acuity（BCVA） between 20/400 and 20/40. BCVA and central subfield thickness（CST） at baseline and month 3 were collected. Linear mixed models were used to evaluate the prognostic factors for visual and anatomical improvement at month ***：Younger age, poorer baseline BCVA and proliferative diabetic retinopathy（PDR） were correlated with better visual improvement at month 3（P=0.002, 0.0001 and 0.007, respectively）. Thicker CST and the presence of subretinal fluid at baseline were correlated with a greater reduction in CST（P〈0.0001 and P=0.018, respectively）. The presence of epiretinal membrane or previous posterior subtenon injection of triamcinolone acetonide（PSTA） were associated with a smaller reduction in CST（P=0.029 and 0.018, respectively）, but had no significant effects in visual improvement at month 3（P〉0.05 for both）.CONCLUSION：For eyes with DME and moderate visual loss, those with younger age, poorer baseline BCVA or PDR tend to have better visual improvement after three consecutive monthly IVR. Epiretinal membrane or previous PSTA result in less resolution of CST, but do not significantly affect visual improvement.

关键词： diabetic macular edema anti-vascular endothelial growth factor ranibizumab diabetic retinopathy epiretinal membrane

Hepatic hemodynamic changes during liver transplantation: A review

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World Journal of Gastroenterology 2014年第32期20卷 11131-11141页

作者： An-Chieh Feng Hsiu-Lung Fan Teng-Wei Chen chung-Bao hsieh Division of General Surgery Department of SurgeryTri-Service General Hospital National Defense Medical Center Neihu

Liver transplantation is performed in the recent decades with great improvements not only technically but also conceptually. However, there is still lack of consensus about the optimal hemodynamic characteristics during liver transplantation. The representative hemodynamic parameters include portal vein pressure, portal vein flow, and hepatic venous pressure gradient; however, there are still others potential valuable parameters, such as total liver inflow and hepatic artery flow. All the parameters are correlated closely and some internal modulating mechanisms, like hepatic arterial buffer response, occur to maintain stable hepatic inflow. To distinguish the unique importance of each hepatic and systemic parameter in different states during liver transplantation, we reviewed the published data and also conducted two transplant cases with different surgical strategies applied to achieve ideal portal inflow and pressure.

关键词： Liver transplantation Hemodynamics Graft inflow modulation Liver circulation Small-for-size syndrome

Methylation of IRAK3 is a novel prognostic marker in hepatocellular carcinoma

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World Journal of Gastroenterology 2015年第13期21卷 3960-3969页

作者： Chih-Chi Kuo Yu-Lueng shih Her-Young Su Ming-De Yan chung-Bao hsieh Chin-Yu Liu Wei-Ting Huang Mu-Hsien Yu Ya-Wen Lin Graduate Institute of Medical Sciences National Defense Medical Center Division of Gastroenterology Department of Internal MedicineTri-Service General HospitalNational Defense Medical Center Department of Obstetrics and Gynecology Tri-Service General HospitalNational Defense Medical Center Cancer Center Wan Fang HospitalTaipei Medical University Division of General Surgery Department of SurgeryTri-Service General HospitalNational Defense Medical Center Department of Nutritional Science Fu Jen Catholic University Department and Graduate Institute of Microbiology and Immunology Graduate Institute of Medical SciencesNational Defense Medical Center Graduate Institute of Life Sciences National Defense Medical Center

AIM: To examine the methylation levels of interleukin-1 receptor-associated kinase 3(IRAK3) and GLOXD1 and their potential clinical applications in hepatocellular carcinoma(HCC).METHODS: m RNA expression and promoter methylation of IRAK3 and GLOXD1 in HCC cells were analyzed by reverse transcription-polymerase chain reaction(RTPCR) and methylation-specific PCR(MSP), respectively. Using pyrosequencing results, we further established a quantitative MSP(Q-MSP) system for the evaluation of IRAK3 and GLOXD1 methylation in 29 normal controls and 160 paired HCC tissues and their adjacent nontumor tissues. We also calculated Kaplan-Meier survival curves to determine the applications of gene methylation in the prognosis of ***: IRAK3 and GLOXD1 expression was partially restored in several HCC cell lines after treatment with 5-aza-2′-deoxycytidine(DNA methyltransferase inhibitor; 5DAC). A partial decrease in the methylated band was also observed in the HCC cell lines after 5DAC treatment. Using GLOXD1 as an example, we found a significant correlation between the data obtained from the methylation array and from pyrosequencing. The methylation frequency of IRAK3 and GLOXD1 in HCC tissues was 46.9% and 63.8%, respectively. Methylation of IRAK3 was statistically associated with tumor stage. Moreover, HCC patients with IRAK3 methylation had a trend toward poor 3-year disease-free survival(P < 0.05). CONCLUSION: IRAK3 and GLOXD1 were frequently methylated in HCC tissues compared to normal controls and nontumor tissues. IRAK3 methylation was associated with tumor stage and poor prognosis of patients. These data suggest that IRAK3 methylation is a novel prognostic marker in HCC.

关键词： IRAK3 GLOXD1 Hepatocellular carcinoma DNA methylat

Comprehensive risk assessment for early neurologic complications after liver transplantation

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World Journal of Gastroenterology 2016年第24期22卷 5548-5557页

作者： Si-Yuan Wu Teng-Wei Chen An-Chieh Feng Hsiu-Lung Fan chung-Bao hsieh Kuo-Piao chung Division of Organ Transplantation Surgery Department of Surgery Tri-Service General Hospital National Defense Medical Center Institute of Health Policy and Management College of Public Health National Taiwan University

AIM: To determine risk factors for early neurologic complications(NCs) after liver transplantation from perspective of recipient, donor, and surgeon. METHODS: In all, 295 adult recipients were enrolled consecutively between August 2001 and February 2014 from a single medical center in Taiwan. Any NC in the first 30 d post-liver transplantation, and perioperative variables from multiple perspectives were collected and analyzed. The main outcome was a 30-d NC. Generalized additive models were used to detect the non-linear effect of continuous variables on outcome, and to determine cut-off values for categorizing risk. Risk factors were identified using multiple logistic regression analysis. RESULTS: In all, 288 recipients were included, of whom 142(49.3%) experienced at least one NC, with encephalopathy being the most common 106(73%). NCs prolonged hospital stay(35.15 ± 43.80 d vs 20.88 ± 13.58 d, P 27.6 kg/m^2, Child-Pugh class C, history of preoperative hepatoencephalopathy or mental disorders, day 7 tacrolimus level > 8.9 ng/m L, and postoperative intraabdominal infection were more likely associated with NCs. Novel risk factors for NCs were donor age < 22 or ≥ 40 years, male-to-male gender matching, graftrecipient weight ratio 0.9%-1.9%, and sequence of transplantation between 31 and 174. CONCLUSION: NCs post- liver transplantation occurs because of factors related to recipient, donor, and surgeon. Our results provide a basis of risk stratification for surgeon to minimize neurotoxic factors during transplantation.

关键词： Risk Liver transplantation Neurotoxicity syndromes Donor Learning curve

Different hemodynamic responses by color Doppler ultrasonography studies between sildenafil non-responders and responders

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Asian Journal of Andrology 2007年第1期9卷 129-133页

作者： shih-Tsung Huang Ming-Li hsieh Section of Andrology and Female Urology Division of Urology Department of Surgery Chang Gung MemorialHospital-Linkou Chang Gung University College of Medicine Taoyuan 333 Taiwan China

Aim： To determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography. Methods： A total of 69 erectile dysfunction （ED） patients aged 22-79 years were enrolled into the present study. Thirty-eight （55.1%） men with ED who did not respond to four attempts of treatment with 100 mg sildenafil after re-education were classified as sildenafil non-responders. A com- bination of three vasodilator drugs, 1.25 mg papaverine, 0.4 mg phentolamine and 5 ug prostaglandin E1, was given by intracavernous injection before penile Doppler ultrasonography was carried out. The erectile response to intracavernous injection and vascular parameters including peak systolic velocity （PSV）, resistance index （RI）, end diastolic velocity （EDV） and cavernosa artery diameter （CD） were measured and the results between sildenafil nonresponders and responders were compared. Results： No statistical difference in vascular parameters measured by Doppler ultrasonography studies between non-responders and responders was noted. Sildenafil non-responders had a poorer penile rigidity response to intracavernous injection than responders （P 〈 0.05）. Among patients with adequate PSV （〉 30 cm/s） and abnormal EDV （〉 5 cm/s）, individuals in the non-responder group had fewer positive responses to intracavernous vasodilator injection than in the responder group （35.3% vs. 72.2%, P 〈 0.05）. Advanced age and comorbidity with diabetes mellitus were significantly associated with sildenafil non-response （P 〈 0.05）. Conclusion： Sildenafil non-responders were characterized by a poorer penile rigidity response to intracavernous injection and had an associated impaired veno-occlusive mechanism. Advanced age and comorbidity with diabetes mellitus were two common factors associated with non-response.

关键词： color Doppler ultrasonography erectile dysfunction impotence sildenafil citrate ultrasonography