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International Journal of Ophthalmology(English edition) 2024年第9期17卷 1760-1762页

作者： wen-Yun Lin Jin-Jhe Wang chien-Hsiung Lai School of Medicine College of MedicineChang Gung UniversityTaoyuan 33302TaiwanChina Department of Ophthalmology Chang Gung Memorial HospitalChiayi 61363TaiwanChina Department of Nursing Chang Gung University of Science and TechnologyChiayi 61363TaiwanChina School of Traditional Chinese Medicine College of MedicineChang Gung UniversityTaoyuan 33302TaiwanChina

Dear Editor,We present two cases of retinal vein occlusion,one central retinal vein occlusion(CRVO)and one branch retinal vein occlusion(BRVO)respectively,coinciding with paracentral acute middle maculopathy(PAMM)on optical coherence tomography(OCT)in patients with menorrhagia causing life-threatening *** is considered a manifestation of acute ischemia affecting the deep macular capillary plexus.

关键词： anemia occlusion acute

Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 622-627页

作者： Cheng-Ken Huang Ruey-Hwa Lu chien-Cheng Chen Po-Chun Chen wen-chang Hsu Meng-Jui Tsai Chin-Tsung Ting Division of Gastrointestinal Surgery Department of SurgeryRen-Ai BranchTaipei City HospitalTaipei 106TaiwanChina Division of General Surgery Department of SurgeryZhongxing BranchTaipei City HospitalTaipei 103TaiwanChina School of Medicine Institute of Traditional MedicineNational Yang-Ming UniversityTaipei 112TaiwanChina Department of Health and Welfare University of TaipeTaipe 104TaiwanChina

BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation *** gallstones may sometime be spilled into the peritoneal cavity,resulting in intra-abdominal ab-scess if the gallstones were not *** diagnosis of intra-abdominal ab-scess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies,such as abdominal ultrasonography or computed tomo-graphy(CT).Here we present a case of abscess formation from unretrieved gall-stone following laparoscopic cholecystectomy,which mimics the imaging findings of metastatic gallbladder *** SUMMARY This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after *** adjuvant chemotherapy,the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is *** laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder *** Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic *** spilled gall bladder stones,surgeons may consider regular computerized tomography follow-up,and if necessary,laparoscopic examination can be used as a means of confirming the diagnostic and treatment.

关键词： Laparoscopic cholecystectomy Gallstone spillage Gallbladder cancer Mimicked cancerous Case report

Assessment and Visualization of Ki67 Heterogeneity in Breast Cancers through Digital Image Analysis

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Advances in Breast Cancer Research 2024年第2期13卷 11-26页

作者： chien-Hui Wu Min-Hsiang chang Hsin-Hsiu Tsai Yi-Ting Peng Department of Anatomical Pathology Far Eastern Memorial Hospital New Taipei AI Lab Quanta Computer Inc. Taoyuan

The Ki67 index (KI) is a standard clinical marker for tumor proliferation;however, its application is hindered by intratumoral heterogeneity. In this study, we used digital image analysis to comprehensively analyze Ki67 heterogeneity and distribution patterns in breast carcinoma. Using Smart Pathology software, we digitized and analyzed 42 excised breast carcinoma Ki67 slides. Boxplots, histograms, and heat maps were generated to illustrate the KI distribution. We found that 30% of cases (13/42) exhibited discrepancies between global and hotspot KI when using a 14% KI threshold for classification. Patients with higher global or hotspot KI values displayed greater heterogenicity. Ki67 distribution patterns were categorized as randomly distributed (52%, 22/42), peripheral (43%, 18/42), and centered (5%, 2/42). Our sampling simulator indicated analyzing more than 10 high-power fields was typically required to accurately estimate global KI, with sampling size being correlated with heterogeneity. In conclusion, using digital image analysis in whole-slide images allows for comprehensive Ki67 profile assessment, shedding light on heterogeneity and distribution patterns. This spatial information can facilitate KI surveys of breast cancer and other malignancies.

关键词： Ki67 Heterogeneity Breast Cancer Digital Image Analysis

A single center analysis of long-term outcomes and survival related risk factors in liver retransplantation

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 425-443,I0011页

作者： Zhihao Li Yi Ping Sng Chao-Long Chen Chih-Che Lin Shih-Ho Wang Chee-chien Yong Liver Transplantation Center and Department of Surgery Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung

Background:Liver retransplant is the only option to save a patient with liver graft ***,it is controversial due to its poor survival outcome compared to primary *** deceased organ donation in Taiwan leads to high waitlist ***,living-donor grafts offer a valuable alternative for *** study aims to analyze the single center’s outcome in living donor liver retransplantation(re-LDLT)and deceased donor liver retransplantation(re-DDLT)as well as the survival related confounding risk ***:This is a single center retrospective study including 32 adults who underwent liver retransplantation(re-LT)from June 2002 to April *** cohort was divided into a re-LDLT and a re-DDLT group and survival outcomes were *** outcomes over different periods,the effect of timing on survival,and multivariate analysis for risk factors were also demonstrated Results:Of the 32 retransplantations,the re-LDLT group(n=11)received grafts from younger donors(31.3 vs.43.75 years,P=0.016),with lower graft weights(688 vs.1,457.2 g,Ptient *** analysis revealed that prolonged warm ischemia time(WIT)and intraoperative blood transfusion were related to poor long-term ***:Retransplantation with living donor graft demonstrated good long-term outcomes with acceptable complications to both recipient and *** may serve as a choice in areas lacking deceased *** timing of retransplantation did not affect the long-term *** effort should be made to reduce WIT and massive blood transfusion as they contributed to poor survi

关键词： Retransplantation living donor liver retransplantation(re-LDLT) deceased donor liver retransplantation(re-DDLT) timing of retransplantation long-term outcome

Re-evaluating the role of pelvic radiation in the age of modern precision medicine and systemic therapy

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World Journal of Clinical Oncology 2024年第1期15卷 1-4页

作者： Tao-Wei Ke Yu-Min Liao Sheng-Chi chang Che-Hung Lin William Tzu-Liang Chen Ji-An Liang Chun-Ru chien Department of Colorectal Surgery China Medical University HospitalTaichung 40402Taiwan School of Chinese Medicine College of Chinese MedicineChina Medical UniversityTaichung 40402Taiwan Division of Hematology and Oncology Department of Internal MedicineChina Medical University HospitalTaichung 40402Taiwan Department of Colorectal Surgery China Medical University Hsinchu HospitalHsinchu 30272Taiwan School of Medicine College of MedicineChina Medical UniversityTaichung 40402Taiwan Department of Radiation Oncology China Medical University HospitalTaichung 40402Taiwan

The efficacy of pelvic radiation in the management of locally advanced stage rectal cancer has come under scrutiny in the context of modern precision medicine and systemic therapy as evidenced by recent clinical trials such as FOWARC(J Clin Oncol 2019;37:3223-3233),NCT04165772(N Engl J Med 2022;386:2363-2376),and PROSPECT(N Engl J Med 2023;389:322-334).In this review,we comprehensively assess these pivotal trials and offer additional insights into the evolving role of pelvic radiation in contemporary oncology.

关键词： Radiotherapy Locally advanced stage rectal cancer Precision medicine Systemic therapy Clinical trial

Hepatitis B and C viruses are not risks for pancreatic adenocarcinoma

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World Journal of Gastroenterology 2014年第17期20卷 5060-5065页

作者： Ming-Chu chang chien-Hung Chen Ja-Der Liang Yu-wen tien Chiun Hsu Jau-Min Wong Yu-Ting chang Department of Internal Medicine National Taiwan University HospitalCollege of MedicineNational Taiwan University Department of Surgery National Taiwan University HospitalCollege of MedicineNational Taiwan University Graduate Institute of Oncology College of MedicineNational Taiwan University

AIM: To investigate whether hepatitis B virus (HBV) and hepatitis C virus (HCV) increase risk of pancreatic ductal adenocarcinoma (PDAC).

关键词： Hepatitis B virus Hepatitis C virus Pancreatic ductal adenocarcinoma Risk Endemic disease Diabetes mellitus

Can rifaximin for hepatic encephalopathy be discontinued during broad-spectrum antibiotic treatment?

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World Journal of Hepatology 2024年第2期16卷 115-119页

作者： chien-Hao Huang Piero Amodio Division of Hepatology Department of Gastroenterology and HepatologyChang-Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan Department of Clinical and Experimental Medicine University of PaduaPadova 35122Italy

Hepatic encephalopathy(HE)is a formidable complication in patients with decompensated cirrhosis,often necessitating the administration of rifaximin(RFX)for effective ***,is a gut-restricted,poorly-absorbable oral rifamycin derived antibiotic that can be used in addition to lactulose for the secondary prophylaxis of *** has shown notable reductions in infection,hospital readmission,duration of hospital stay,and ***,limited data exist about the concurrent use of RFX with broad-spectrum antibiotics,because the patients are typically excluded from studies assessing RFX efficacy in HE.A pharmacist-driven quasi-experimental pilot study was done to address this *** argue against the necessity of RFX in HE during broad-spectrum antibiotic treatment,particularly in critically ill patients in intensive care unit(ICU).The potential for safe RFX discontinuation without adverse effects is clearly illuminated and valuable insight into the optimization of therapeutic strategies is *** findings also indicate that RFX discontinuation during broadspectrum antibiotic therapy was not associated with higher rates of delirium or coma,and this result remained robust after adjustment in multivariate ***,rates of other secondary clinical and safety outcomes,including ICU mortality and 48-hour changes in vasopressor requirements,were ***,since the activity of RFX is mainly confined to the modulation of gut microbiota,its potential utility in patients undergoing extensive systemic antibiotic therapy is debatable,given the overlapping antibiotic ***,this suggests that the action of RFX on HE is class-specific(related to its activity on gut microbiota),rather than drug-specific.A recent double-blind randomized controlled(ARiE)trial provided further evidence-based support for RFX withdrawal in critically ill cirrhotic ICU patients receiving broad-spectrum *** studies prompt further discussion about

关键词： Rifaximin discontinuation Hepatic encephalopathy Broad-spectrum antibiotics Crit-ically ill Medical intensive care unit Pharmacist-driven protocol

Prognostic factors of early recurrence after complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

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World Journal of Clinical Cases 2024年第27期12卷 6057-6069页

作者： Chao-Yu Chen Tzu-Hao Huang Li-wen Lee Jrhau Lung Yu-Che Ou chien-Hui Hung Huei-Chieh Chuang Min-Chi Chen Ting-Yao Wang Department of Obstetrics and Gynecology Chang Gung Memorial HospitalChiayi 613Taiwan Graduate Institute of Clinical Medical Sciences College of MedicineChang Gung UniversityTaoyuan 333Taiwan Department of Early Childhood Care and Education Shu-Zen Junior College of Medicine and ManagementKaohsiung 821Taiwan Division of General Surgery Department of SurgeryChang Gung Memorial HospitalChiayi 613Taiwan Department of Diagnostic Radiology Chang Gung Memorial HospitalChiayi 613Taiwan College of Medicine Chang Gung UniversityTaoyuan 333Taiwan Department of Medical Research and Development Chang Gung Memorial HospitalChiayi 613Taiwan Department of Obstetrics and Gynecology Kaohsiung Chang Gung Memorial HospitalKaohsiung 833Taiwan Department of Anatomic Pathology Chang Gung Memorial HospitalChiayi 613Taiwan Department of Public Health Chang Gung UniversityTaoyuan 333Taiwan Division of Hematology and Oncology Department of Internal MedicineChang Gung Memorial HospitalChiayi 613Taiwan

BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary *** To identify the clinical factors associated with progression-free survival(PFS)after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal,ovarian,and gastric *** We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival(OS)in patients recruited between 2015 and *** regression models were used to assess the prognostic factors for the risk of recurrence within 1 ***–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and *** Of the 80 enrolled patients,39 had an unfavorable PFS(tients with a completeness of cytoreduction score of 0(CC-0)or length of CRS≤6 h had a favorable PFS[odds ratio(OR)=0.141,P=0.004;and OR=0.361,P=0.027,respectively].In multiple logistic regression,achieving CC-0 was the strongest prognostic factor for a favorable PFS(OR=0.131,P=0.005).A peritoneal cancer index score>12 was associated with a lower rate of achieving CC-0(P=0.027).The favorable PFS group had a significantly longer OS(median 81.7 mo vs 17.0 mo,P<0.001).CONCLUSION Achieving CC-0 was associated with a lower early recurrence rate and improved long-term *** study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.

关键词： Peritoneal metastasis Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Predictor Recurrence

Beyond the Rex: an innovative meso-intrahepatic portal vein bypass for late-onset extrahepatic portal vein occlusion after living donor liver transplantation

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Hepatobiliary Surgery and Nutrition 2024年第4期13卷 662-668页

作者： Chee-chien Yong Hsu-Ting Yen Yu-Fan Cheng Leona Bettina Dungca Raymond Joseph De Vera Itsuko Chih-Yi Chen Chao-Long Chen Department of Surgery Liver Transplantation CenterKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiung Department of Cardiovascular Surgery Liver Transplantation CenterKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiung Department of Diagnostic Radiology Liver Transplantation CenterKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiung

The Meso-Rex bypass(MRB)is recognized as an effective treatment for portal hypertension secondary to extrahepatic portal vein occlusion(EHPVO)both in the pediatric and adult population,within or outside the context of liver *** is the preferred surgical treatment in most centers because not only does it addresses the portal hypertension,but also restores physiologic portal hepatopetal ***,the Rex recess,the landmark for this technique,may not be safely accessible in some *** present a 22-year-old male who underwent living donor liver transplant(LDLT)for neonatal *** presented with variceal bleeding due to EHPVO at 13 years after *** endoscopic,radiologic,and surgical interventions were employed to address the recurrent gastrointestinal bleeding,but results have been *** performed a meso-intrahepatic portal vein bypass(MIPVB),an innovative alternative to the MRB,for this patient with extensive post-operative adhesions,perihilar collaterals,and cavernous *** creation in patients where the Rex recess is inaccessible is technically *** with a multidisciplinary team approach,meticulous preoperative planning,and close follow-up,the authors have demonstrated that it is a safe and feasible option for patients with late-onset EHPVO after liver transplantation.

关键词： Meso-Rex bypass(MRB) portal vein occlusion liver transplantation(LT)