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Morphological and microcirculatory evaluation of the rat testis after detorsion with or without a capsular release with a tunica vaginalis flap

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Asian Journal of Andrology 2016年第3期18卷 462-466,I0010,I0011页

作者： Tamas Jozsat Zoltan Klarik Ferenc Kiss Eniko Toth Anita Mester Zoltan Hargitai yi-che changchien Magdalena Fossum Norbert Nemeth Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden Department of Pediatric Surgery Division of Urology Astrid Lindgren Children's Hospital. Karolinska University Hospital Stockholm Sweden Department of Operative Techniques and Surgical Research Institute of Surgery Faculty ot MedicineUniversity of Debrecen Hungary Department of Pathology Kenezy Gyula Hospital Uebrecen Hungary

Testicular torsion may lead to serious ischemia, and the viability depends on the duration of torsion and the effect of ischemia-reperfusion. Testicular decompression and tunica vaginalis flap application technique were introduced in 2008 by Kutikov et al. We aimed to examine the impact of this method on the testicular microcirculation and hemorheological parameters in a rat model. Six adult rats underwent bilateral scrotal exploration. Intravaginal torsion of the testis was created by 720° rotation on both sides for 2 h. After detorsion, the right testes underwent tunica albuginea incision and tunica vaginalis flap application. Testicular microcirculation was monitored and hematological parameters, erythrocyte deformability, and aggregation were determined. Measurements were performed before and after torsion, directly after detorsion, on the 1^st-2^nd and 8^th postoperative day. After the last sampling, testicles were removed to determine their volume for histological examinations. The microcirculatory parameters demonstrated slight differences between testicles. Apical zone of the left （nondecompressed） testicles had elevated compared to the middle zone （P 〈 0.05）. On the 2^nd and 8^th day, the microcirculation of the testes normalized but not equally. The erythrocyte aggregation and deformability decreased by the 8^th day. Both testicles underwent atrophy and epithelial necrosis, but the volume of the decompressed ones was lower （1.07±0.08 vs 1.25 ± 0.31）. Histologically, there was no significant difference in epithelial damage score between decompressed and nondecompressed testes. In conclusion, 2-h ischemia led to alteration in testicular microcirculation, reduction in volume, changes in hemorheological parameters and serious epithelial necrosis both in decompressed and nondecompressed testicles without remarkable differences.

关键词： ischemia rat model reperfusion spermatic cord torsion surgical flaps testicular compartment syndrome testis

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Endosonographic surveillance of 1-3 cm gastric submucosal tumors originating from muscularis propria

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World Journal of Gastroenterology 2017年第12期23卷 2194-2200页

作者： ming-luen hu keng-liang wu chi-sin changchien seng-kee chuah yi-chun chiu division of hepato-gastroenterology department of internal medicine kaohsiung chang gung memorial hospital and chang gung university college of medicine

AIM To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria(SMTMPs).METHODS By reviewing the computerized medical records over a period of 14 years(2000-2013), patients with 1-3 cm gastric SMTMPs who underwent at least two endoscopic ultrasound(EUS) examinations were enrolled. Tumor progression was defined as a ≥ 1.2 times enlargement in tumor diameter observed during EUS surveillance. All patients were divided into stationary and progressive subgroups and further analyzed. We also reviewed the patients in the progressive subgroup again in *** A total of 88 patients were studied, including 25 in the progressive subgroup. The mean time of EUS surveillance was 24.6 mo in the stationary subgroup and 30.7 mo in the progressive subgroup. Risk factors for tumor progression included larger tumor size and irregular border. Initial tumor size > 14.0 mm may be considered a cut-off size for predicting tumor progression. Seventeen patients underwent surgery, of whom 13 had gastrointestinal stromal tumors(GISTs) and 4 had leiomyomas. Tumor progression was found only in patients with GISTs. All of the tumors exhibited benign behaviors without metastasis until *** Most 1-3 cm gastric SMTMPs(71.6%) are indolent. Tumor progression was found only in GISTs, and it is a good predictor for differentiating GISTs from leiomyomas. Predictors of tumor progression include larger tumor size(> 14.0 mm) and irregular border.

关键词： Gastrointestinal stromal tumor Submucosal tumors originating from the muscularis propria Stomach Endosonographic surveillance

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Benefit of prophylactic bronchodilator withβ2 adrenergic agonist in ischemia-reperfusion-induced lung injury

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BIOCELL 2021年第5期45卷 1201-1211页

作者： cheN-LIANG TSAI YU-HUEI LIN CHIH-yiNG changchien CHIH-FENG CHIAN CHI-HUEI CHIANG Division of Pulmonary and Critical Care Department of Internal MedicineTri-Service General HospitalNational Defense Medical CenterTaipei114Taiwan Post-Baccalaureate Program in Nursing College of NursingTaipei Medical UniversityTaipei110Taiwan Department of General Medicine Tri-Service General HospitalNational Defense Medical CenterTaipei114Taiwan Division of Pulmonary Immunology and Infectious Diseases Chest DepartmentTaipei Veterans General HospitalTaipei112Taiwan

Primary lung graft dysfunction could significantly attribute to ischemia-reperfusion lung injury(IRLI)during transplantation surgery.β2-adrenergic agonists were one of the bronchodilators that had been well-established in the management of asthma and chronic obstructive pulmonary disease(COPD)with anti-inflammatory *** applying the model of isolated rat lung,we evaluated the efficacy of short-actingβ2-agonist inhalation to ameliorate ischemia-reperfusion *** experiment protocol was 180 min of global ischemia and then reperfusion for 60 *** theβ2-agonist inhalation group,aerosolized albuterol was administrated prior ischemia *** weight ratios of wet to dry lung and microvascular permeability were characterized in the IRLI *** contrast,pre-inhaledβ2-agonist significantly mitigated the severity of pulmonary *** lavage from theβ2-agonist group presented decreased leukocyte counts and cytokines production,including interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),and macrophage inflammatory protein 2(MIP-2).Devastating oxidative stress was widely recognized during the ischemia-reperfusion process,whileβ2-agonist pretreatment revealed subsided H2O2,myeloperoxidase(MPO),and the cleavage of *** blotting from lung homogenates identified the blockade of NF-κB and MAPK activation in theβ2-agonist inhalation ***,there was no specific pharmacotherapy in IRLI *** results elucidated the protective effect ofβ2-agonist bronchodilator against ischemia-reperfusion induced oxidative stress,inflammation reaction,and pulmonary edema.

关键词： Ischemia-reperfusion lung injury β2-adrenergic agonist Bronchodilator Lung transplantation

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Role of body mass index in colon cancer patients in Taiwan

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World Journal of Gastroenterology 2012年第31期18卷 4191-4198页

作者： Chih-Chien Chin yi-Hung Kuo Chien-Yuh Yeh Jinn-Shiun chen Reiping Tang Chung-Rong changchien Jeng-yi Wang Wen-Shih Huang Division of Colon and Rectal Surgery Department of SurgeryChang Gung Memorial HospitalChiayi 613Taiwan Graduate Institute of Clinical Medical Science College of MedicineChang Gung UniversityTaoyuan 333Taiwan Division of Colon and Rectal Surgery Department of SurgeryChang Gung Memorial HospitalLinko 333Taiwan

AIM： To determine the effect of body mass index （BMI） on the characteristics and overall outcome of colon cancer in Taiwan. METHODS： From January 1995 to July 2003, 2138 patients with colon cancer were enrolled in this study. BMI categories （in kg/m2） were established according to the classification of the Department of Health of Tai- wan. Postoperative morbidities and mortality, and survival analysis including overall survival （OS）, disease- free survival （DFS）, and cancer-specific survival （CSS） were compared across the BMI categories.27 kg/m2） patients. Being female, apparently anemic, hypoalbuminemic, and having body weight loss was more likely among underweight patients than among the other patients （P 〈 0.001）. Underweight patients had higher mortality rate （P = 0.00.7） and lower OS （P 〈 0.001） and DFS （P = 0.002） than the other pa- tients. OS and DFS did not differ significantly between normal-weight, overweight, and obese patients, while CSS did not differ significantly with the BMI category. CONCLUSION： In Taiwan, BMI does not significantly affect colon-CSS. Underweight patients had a higher rate of surgical mortality and a worse OS and DFS than the other patients. Obesity does not predict a worse survival.

关键词： Body mass index Colon cancer Survival IVlorbidity Outcome

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Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

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World Journal of Gastroenterology 2010年第4期16卷 411-417页

作者： Seng-Kee Chuah Tsung-Hui Hu Chi-Sin changchien Gastrointestinal Motility Unit Division of HepatogastroenterologyChang Gang Memorial HospitalKaohsiung Medical CenterNo.123Ta-Pei RoadNiaosung HsiangKaohsiung 833TaiwanChina Chang Gung University College of Medicine No.123Ta-Pei RoadNiaosung HsiangKaohsiung 833TaiwanChina

Pneumatic dilation(PD) is considered to be the first line nonsurgical therapy for *** principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial *** endoscope-guided procedure is done without fluoroscopic *** usually use a lowcompliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal *** has the advantage of determining mucosal injury during the dilation process,so that a repeat endoscopy is not needed to assess the mucosal *** studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment *** the results may be promising,long-term follow-up is required in the near future.

关键词： Esophagoscopy Dilatation Esophageal achalasia

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Expression and prognostic role of molecular markers in 99 KIT-positive gastric stromal tumors in Taiwan Residents

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World Journal of Gastroenterology 2006年第4期12卷 595-602页

作者： Tsung-Hui Hu Seng-Kee Chuah Jui-Wei Lin yi-Chun Chiu Chi-Sin changchien Chih-Chi Wang Yaw-Sen chen Li-Na yi King-Wah Chiu Chuan-Mo Lee Division of Gastroenterology Department of Internal MedicineChanggung Memorial Hospital Kaohsiung Taiwan China Department of Pathology Chang Gung Memorial Hospital Kaohsiung Taiwan China Department of Surgery Chang Gung Memorial Hospital Kaohsiung Taiwan China

AIM： TO elucidate the prognostic role and relationship of three molecular markers such as tumor suppressor gene p53, proliferating cell nuclear antigen （PCNA） and Ki-67 in gastric stromal tumor. METHODS： A total of 108 surgically resected gastric smooth muscle tumor specimens were collected from January 1987 to December 1999. Immunohistochemical studies were performed on the paraffin sections of 99 of 108 CDl17-positive tumors with antibodies of p53, PCNA, and Ki-67. Immunoreactivity of three molecular markers was recorded by labeling index （LI, %） and was analyzed for clinicopathologic and survival correlation. RESULTS： Of the 99 cases, immunostaining revealed that 52 patients （52.5%） had p53, and 37 patients （37.3%） had Ki-67 immunoreactivity （defined as 〉10% of LI）. All patients （100%） had PCNA immunoreactivity ranging from 12% to 93% of LI, divided into high or low by median. Statistics revealed that LI of three markers positively correlate to each other （P〈0.01） and to microscopic tumor mitotic counts （P〈0.001）. By combination, patients with ≥2 markers （positive or high） in tumors had early tumor recurrence （P〈0.001） and unfavorable outcome （P〈0.001）. Univariate analysis indicated that patients with tumor size 〉5 cm （P=0.003）, tumor mitosis 〉5/50 HPF （P〈0.001）, p53 immunoreactivity （P=0.001）, Ki-67 immunoreactivity （P=0.026）, high PCNA LI （P=0.015） and male gender （P=0.036） were six predictors for early disease recurrence. Subsequent multivariate analysis revealed that mitotic counts, tumor size, and p53 immunoreactivity were three independent prognostic factors for both disease free and overall survival of patients. By combination of three independent prognostic factors for grouping, we found higher tumor recurrence rate （P〈0.001） and shorter survival （P〈0.001） existed in groups with increasing factors. CONCLUSION： We first provide the prognostic value and linkage of three molecular markers in GISTs. The combination of three factors （p53, tumor size, and t

关键词： Gastrointestinal stromal tumor GIST p53 PCNA Ki-67 Prognosis

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Current status in the treatment options for esophageal achalasia

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World Journal of Gastroenterology 2013年第33期19卷 5421-5429页

作者： Seng-Kee Chuah Chien-Hua Chiu Wei-chen Tai Jyong-Hong Lee Hung-I Lu Chi-Sin changchien Ping-Huei Tseng Keng-Liang Wu Gastrointestinal Motility Unit Division of HepatogastroenterologyKaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine Division of General Medicine Department of MedicineKaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine Digestive Disease Center Department of Medical ResearchShow-Chwan Memorial Hospital Division of Thoracic and Cardiovascular Surgery Kaohsiung Chang Gung Memorial Hospital Department of Internal Medicine Graduate Institute of Clinical MedicineNational Taiwan University Hospital and College of MedicineNational Taiwan University

Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy(POEM).The first multicenter randomized,controlled,2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy(LHM)was not superior to pneumatic dilations(PD).Publications on the long-term success of laparoscopic surgery continue to *** addition,laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior *** optimal treatment option is an ongoing matter of *** this review,we provide an update of the current progress in the treatment of esophageal *** new conclusive data prove otherwise,LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated ***,PD is the first choice for non-surgical treatment and is more *** PD according to an"on-demand"strategy based on symptom recurrence can achieve long-term *** making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment *** has shown promise but its long-term efficacy and safety need to be assessed further.

关键词： Esophageal achalasia Endoscopic pneumatic dilations Botulinum injection Peroral endoscopic myotomy Minimally invasive Heller myotomy

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Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy

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World Journal of Gastroenterology 2012年第27期18卷 3595-3601页

作者： Chien cheng Liu cheng Yuan Lu Chih Fang changchien Ping Hsin Liu Daw Shyong Perng Department of Anesthesiology E-DA HospitalI-Shou UniversityKaohsiung 82445TaiwanChina Department of Gastroenterology E-DA HospitalI-Shou UniversityKaohsiung 82445TaiwanChina

AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy;BDE) with sedation is different from those without sedation in terms of quantity,duration and typical onset ***:Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups:EGD without sedation (Group A) and BDE with sedation (Group B).The use of sedation was based on the patients' *** participated in this study by administrating sedative drugs as usual.A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the *** incidence,duration and onset time of hiccups were measured in both *** addition,the association between clinical variables and hiccups were ***:A total of 435 patients were enrolled in the *** incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%,respectively).The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio:8.79,P < 0.001) after *** incidence of hiccups in males under sedation was high (67.4%).The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028).The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).CONCLUSION:Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without *** was significantly associated with an increased risk of ***,patients with GERD are prone to develop hiccups.

关键词： Anesthesia Midazolam Hiccup Gastroeso-phageal reflux disease Esophagogastroduodenoscopy Bidirectional endoscopy

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Liu-stain quick cytodiagnosis of ultrasound-guided fine needle aspiration in diagnosis of liver tumors

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World Journal of Gastroenterology 2007年第3期13卷 448-451页

作者： Chi-Sin changchien Jing-Houng Wang Chao-Hung Hung Chien-Hung chen Chuan-Mo Lee Division of Hepato-Gastroenterology Department of Internal Medicine Chang-Gung Memorial Hospital Kaohsiung Medical Center Chang Gung University College of Medicine Taiwan China

AIM： To combine ultrasound-guided fine-needle aspiration （US-FNA） and Liu （Riu） stain to make a quick study on liver tumor lesions. METHODS： Two hundred and twenty-eight aspirations from 232 patients were completely studied. The operator himself made the quick cytodiagnosis of US-FNA smear stained by Liu method within thirty minutes. The US-FNA specimen was also sent to the pathological department for cytological study and cellblock histology. The result of our Uu-stain quick cytodiagnosis in each patient was confirmed by the final cytopathological diagnosis from pathological report. RESULTS： Among 228 samples, the quick cytodiagnosis revealed 146 malignancies, 81 benign lesions and one inadequate specimen. Cytopathological diagnosis from the pathological department revealed 150 malignancies, and 78 benign lesions. Four well-differentiated hepatocellular carcinomas （HCCs） were under-diagnosed by quick cytodiagnosis as benign and 3 benign lesions were over-diagnosed as well-differentiated HCCs. Compared with cytopathological diagnosis, quick cytodiagnosis correctly diagnosed 143 malignancies and 77 benign lesions. Except for the one inadequate specimen in quick cytodiagnosis, the accuracy of quick cytodiagnosis was 96.9% （220/227）, and its sensitivity, specificity and positive and negative predictive values were 97.9%, 95.1%, 97.3% and 96.3%, respectively. CONCLUSION： Liu-stain quick cytodiagnosis is a fast, convenient, safe and effective method for hepatologists in clinic practice to diagnose liver tumor. In few cases of well-differentiated HCC, Liu-stain quick cytodiagnosis has its limitation.

关键词： Liver tumor Cytology Ultrasound guided FNA Liu stain

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Clinical characteristics and prognostic factors of splenic abscess:A review of 67 cases in a single medical center of Taiwan

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World Journal of Gastroenterology 2006年第3期12卷 460-464页

作者： Kuo-Chin Chang Seng-Kee Chuah Chi-Sin changchien Tung-Lung Tsai Sheng-Nan Lu yi-Chun Chiu Yaw-Sen chen Chih-Chi Wang Jui-Wei Lin Chuan-Mo Lee Tsung-Hui Hu Division of Gastroenterology Department ofInternal Medicine Chang Gung Memorial Hospital KaohsiungTaiwan China Department of surgery ChangGung Memorial Hospital Kaohsiung Taiwan China Department of Pathology Chang Gung Memorial Hospital Kaohsiung Taiwan China

AIM： To analyze 67 cases of splenic abscess in a medica center of Taiwan during a period of 19 years. METHODS： From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APAche Ⅱ scores, and mortality rates were analyzed. RESULTS： There were 41 males and 26 females with the mean age of 54.14-14.1 years. Multiple splenic abscesses （MSA） account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixtyseven patients （35.8%） had extrasplenic abscesses, with leading site of liver （34.6%）, Microbiological cultures were positive in 58 patients （86.6%）, with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus （GNB） infection predominated （55.2%）, with leading pathogen of Klebslella pneumoniae （22.4%）, followed by gram positive coccus （GPC） infection （31%）. Splenectomy was performed in 26 patients （38.8%）, percutaneous drainage or aspiration in 21 （31.3%）, and antibiotic therapy alone in 20 patients （29.9%）. Eventually, 12 of 67 patients expired （17.9 %）. By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC （P=0.036）. Patients with GNB infection （P=0.009） and multiple abscesses （P=0.011） experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APAche Ⅱ score of 12 ex- pired patients （16.3±3.2） was significantly higher than that of the 55 survivals （7.2 ± 3.8）（P〈 0.001）. CONCLUSION： MSA, GNB infection, and high APAche Ⅱ scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.

关键词： Splenic abscess Prognosis Gram negative bacillus infection APAche Ⅱ scores

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