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Unexpected delayed reversal of rocuronium-induced neuromuscular blockade by sugammadex:A case report and review of literature

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World Journal of Clinical Cases 2022年第35期10卷 13138-13145页

作者： Hao-Chen Wang Cheng-Wei Lu Tzu-Yu Lin Ya-Ying Chang Department of Anesthesiology Far-Eastern Memorial HospitalNew Taipei City 220Taiwan Department of Mechanical Engineering Yuan Ze UniversityChung-Li 320Taiwan International Program in Engineering for Bachelor Yuan Ze UniversityChung-Li 320Taiwan

BACKGROUND Rocuronium,a nondepolarizing muscle relaxant,is usually administered during general anesthesia to facilitate endotracheal intubation and keep patients immobile during the ***,the selective reversal agent of rocuronium,fully reverses the neuromuscular blockade(NMB)at the end of *** reports show that sugammadex rapidly achieves a ratio of train-offour(TOF),a quantitative method of neuromuscular monitoring,of 0.9 which ensures adequate recovery for safe ***,very rare patients with neuromuscular diseases may respond poorly to *** SUMMARY A 69-year-old female presented with abdominal fullness and nausea,and was diagnosed with *** underwent gastric peroral endoscopic myotomy under general anesthesia with rocuronium(0.7 mg/kg).At the end of surgery,sugammadex 3.6 mg/kg was administered when TOF showed 2 ***,the TOF ratio recovered to 0.65 in 30 *** was awake but could not fully open her *** tidal volume during spontaneous breathing was *** additional doses of sugammadex(up to 7.3 mg/kg)in the following 3 h,the TOF ratio was 0.9,and the endotracheal tube was smoothly *** excluding possible mechanisms underlying the prolonged recovery course,we speculated our patient may have had an undiagnosed neuromuscular disease,hinted by her involuntary movement of the tongue and ***,her poor renal function and history of delayed recovery from general anesthesia may be related to the long duration of *** In our case,both prolonged rocuronium-induced NMB and poor response to sugammadex were *** optimize the dose of rocuronium,perioperative TOF combined with other neuromuscular monitoring is suggested.

关键词： Sugammadex Train-of-four Rocuronium Neuromuscular blockade General anesthesia Case report

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Optical biometry intraocular lens power calculation using different formulas in patients with different axial lengths

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International Journal of Ophthalmology(English edition) 2013年第2期6卷 150-154页

作者： Jia-Kang Wang Shu-Wen Chang Department of Ophthalmology Far Eastern Memorial Hospital Oriental Institute of Technology Department of Medicine National Yang Ming University

AIM: To investigate the predictability of intraocular lens (IOL) power calculation using the IOLMaster and different IOL power calculation formulas in eyes with various axial length (AL). METHODS: Patients were included who underwent uneventful phacoemulsification with IOL implantation in the Department of Ophthalmology, far eastern memorial hospital, Taipei, Taiwan, China from February 2007 to January 2009. Preoperative AL and keratometric values (Ks) were measured by IOLMaster optical biometry. Patients were divided into 3 groups based on AL less than 22mm (Group 1), 22-26mm (Group 2), and more than 26mm (Group 3). The power of the implanted IOL was used to calculate the predicted postoperative spherical equivalence (SE) by various formulas: the Haigis, Hoffer Q, Holladay 1, and SRK/T. The predictive accuracy of each formula was analyzed by comparing the difference between the actual and predicted postoperative SE (MedAE, median absolute error). All the patients had follow-up periods exceeding 3 months. RESULTS: Totally, there were 200 eyes (33 eyes in Group 1, 92 eyes in Group 2, 75 eyes in Group 3). In all patients, the Haigis had the significantly lower MedAE generated by the other formulas (P<0.05). In Group 1 to 3, the MedAE calculated by the Haigis was either significantly lower or comparable to those calculated by the other ***: Compared with other formulas using IOLMaster biometric data, the Haigis formula yields superior refractive results in eyes with various AL.

关键词： intraocular lens optical biometry calculation formula

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Do different bariatric surgical procedures influence plasma levels of matrix metalloproteinase-2,-7,and-9 among patients with type 2 diabetes mellitus?

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World Journal of Diabetes 2020年第6期11卷 252-260页

作者： Wen-Chi Wu Wei-Jei Lee Tzong-His Lee Shu-Chun Chen Chih-Yen Chen Department of Medicine Taipei Veterans General HospitalTaipei 11217Taiwan Department of Surgery Min-Sheng General HospitalTaoyuan 330Taiwan Taiwan Society for Metabolic and Bariatric Surgery Taipei 11031Taiwan Division of Gastroenterology and Hepatology Department of Internal MedicineFar Eastern Memorial HospitalNew Taipei City 220Taiwan Department of Nursing Chang-Gung Institute of TechnologyGuishanTaoyuan 333Taiwan Division of Gastroenterology and Hepatology Department of MedicineTaipei Veterans General HospitalTaipei 11217Taiwan Faculty of Medicine and Institute of Emergency and Critical Medicine National Yang-Ming University School of MedicineTaipei 11221Taiwan Association for the Study of Small Intestinal Diseases GuishanTaoyuan 33305Taiwan Chinese Taipei Society for the Study of Obesity Taipei 110Taiwan

BACKGROUND Bariatric surgery is an efficient strategy for body weight and type 2 diabetes mellitus(T2 DM) management. Abnormal lipid deposition in visceral organs,especially the pancreas and liver, might cause beta-cell dysfunction and insulin resistance. Extracellular matrix(ECM) remodeling allows adipose expansion, and matrix metalloproteinases(MMPs) play essential roles in ECM ***-2 and MMP-9 are the substrates of MMP-7. Different studies have reported that MMP-2,-7, and-9 increase in patients with obesity and metabolic syndromes or T2 DM and are considered biomarkers in obesity and hyperglycemia *** prospectively investigate whether MMP-2, MMP-7, and MMP-9 differ after two bariatric surgeries: Gastric bypass(GB) and sleeve gastrectomy(SG).METHODS We performed GB in 23 and SG in 19 obese patients with T2 DM. We measured body weight, waist circumference, body mass index(BMI), and serum concentrations of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood sugar(FBS),hemoglobin A1 c(Hb A1 c), C-peptide, homeostasis model assessments of insulin resistance, and MMP-2, MMP-7, and MMP-9 levels at baseline and at 3, 12, and 24 mo *** Twenty-three patients aged 44.7 ± 9.7 years underwent GB, and 19 patients aged40.1 ± 9.1 years underwent SG. In the GB group, BMI decreased from 30.3 ± 3.4 to24.4 ± 2.4 kg/m2, Hb A1 c decreased from 9.2% ± 1.5% to 6.7% ± 1.4%, and FBS decreased from 171.6 ± 65.0 mg/d L to 117.7 ± 37.5 mg/d L 2 years post-operation(P < 0.001). However, the MMP-2, MMP-7, and MMP-9 levels pre-and post-GB were similar even 2 years post-operation(P = 0.107, 0.258, and 0.466,respectively). The SG group revealed similar results: BMI decreased from 36.2 ±5.1 to 26.9 ± 4.7 kg/m2, Hb A1 c decreased from 7.9% ± 1.7% to 5.8% ± 0.6%, and FBS decreased from 138.3 ± 55.6 mg/d L to 95.1 ± 3.1 mg/d L(P < 0.001). The serum MMP-2,-7, and-9 levels pre-and post-SG we

关键词： Matrix metalloproteinases Extracellular matrix Obesity Type 2 diabetes mellitus Gastric bypass Sleeve gastrectomy

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Aldo-keto reductase family member C3(AKR1C3)promotes hepatocellular carcinoma cell growth by producing prostaglandin F2α

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Oncology Research 2024年第1期32卷 163-174页

作者： KUO-SHYANG JENG PO-YU CHENG YUEH-HSIEN LIN PO-CHUN LIU PING-HUI TSENG YU-CHAO WANG CHIUNG-FANG CHANG CHUEN-MIIN LEU Division of General Surgery Far Eastern Memorial HospitalNew Taipei City22060Taiwan Institute of Microbiology and Immunology National Yang Ming Chiao Tung UniversityTaipei City11221Taiwan Institute of Biochemistry and Molecular Biology National Yang Ming Chiao Tung UniversityTaipei City11221Taiwan Institute of Biomedical Informatics National Yang Ming Chiao Tung UniversityTaipei City11221Taiwan Department of Medical Research Far Eastern Memorial HospitalNew Taipei City22060Taiwan

Hepatocellular carcinoma(HCC)is a leading cause of death *** therapies are effective for HCC patients with early disease,but many patients suffer recurrence after surgery and have a poor response to ***,new therapeutic targets are *** analyzed gene expression profiles between HCC tissues and normal adjacent tissues from public databases and found that the expression of genes involved in lipid metabolism was significantly *** analysis showed that AKR1C3 was upregulated in tumors,and high AKR1C3 expression was associated with a poorer prognosis in HCC *** vitro,assays demonstrated that the knockdown of AKR1C3 or the addition of the AKR1C3 inhibitor indomethacin suppressed the growth and colony formation of HCC cell *** of AKR1C3 in Huh7 cells reduced tumor growth in *** explore the mechanism,we performed pathway enrichment analysis,and the results linked the expression of AKR1C3 with prostaglandin F2 alpha(PGF2a)downstream target *** of AKR1C3 activity reduced the production of PGF2a,and supplementation with PGF2a restored the growth of indomethacin-treated Huh7 *** of the PGF receptor(PTGFR)and treatment with a PTGFR inhibitor significantly reduced HCC *** showed that indomethacin potentiated the sensitivity of Huh7 cells to *** summary,our results indicate that AKR1C3 upregulation may promote HCC growth by promoting the production of PGF2α,and suppression of PTGFR limited HCC ***,targeting the AKR1C3-PGF2a-PTGFR axis may be a new strategy for the treatment of HCC.

关键词： Hepatocellular carcinoma Aldo-keto reductase family member C3 Prostaglandin F2 alpha Prostaglandin F receptor

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Factors Affecting Corneal Hysteresis in Taiwan Residents Adults

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Eye Science 2015年第3期30卷 89-93页

作者： Jia-Kang Wang Tzu-Lun Huang Pei-Yuan Su Pei-Yao Chang Department of Ophthalmology Far Eastern Memorial Hospital Department of Medicine National Yang Ming University Department of Healthcare Administration and Department of Nursing Oriental Institute of Technology Department of Medicine National Taiwan University Institute of Medical Sciences Tzu Chi University Department of Medicine Fu Jen Catholic University

Purpose: To investigate the correlation of various corneal hysteresis(CH) factors in Chinese ***: From January 2009 to November 2011, the healthy right eyes of a total of 292 adults were recruited into the study. Goldmann-correlated intraocular pressure(IOPG) and CH were measured using an ocular response analyzer(ORA).Central corneal thickness was measured using the ORA's integrated handheld ultrasonic pachymeter. The IOLMaster was used to obtain the ocular biometric measurements including axial length, anterior chamber depth, and keratometric *** Pearson correlation coefficient was used to test correlations between CH and quantitative factors. The chi-square test was used to detect differences in categorical ***: Longer axial length(P =0.0001), lower IOPG(P =0.03), older age(P=0.003),and thinner central corneal thickness(P=0.0001) were significantly associated with lower *** anterior chamber depth(P=0.34), gender(P =0.23), and corneal curvature(P=0.18) had no relationship to ***: Various factors including axial length, intraocular pressure, age, and central corneal thickness can affect measurement of corneal biomechanical properties in Chinese *** the anterior chamber depth, gender, and corneal curvature were irrelevant to CH.

关键词：角膜影响因素滞后成人台湾地区生物测量生物力学特性超声测厚仪

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Liver collision tumor of primary hepatocellular carcinoma and neuroendocrine carcinoma:A rare case report

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World Journal of Clinical Cases 2022年第35期10卷 13129-13137页

作者： Kuo-Shyang Jeng Chun-Chieh Huang Chen-Shuan Chung Chiung-Fang Chang Department of General Surgery Far Eastern Memorial HospitalNew Taipei 220Taiwan Department of Radiology Far Eastern Memorial HospitalNew Taipei 220Taiwan Department of Internal Medicine Far Eastern Memorial HospitalNew Taipei 220Taiwan Department of Medical Research Far Eastern Memorial HospitalNew Taipei 220Taiwan

BACKGROUND Hepatocellular carcinoma(HCC)can occasionally develop with other non-HCC cell types,either in a combined type or collision type.A collision tumor is defined as two histopathologically distinct tumors of the same organ lacking a clear transition *** collision tumors are *** them,“hepatocellular carcinoma-hepatic neuroendocrine carcinoma”(HCC-NEC)collision tumors are especially rare and information about them is rarely *** SUMMARY A 48-year-old man with typical findings of HCC underwent consecutive therapies,including radiofrequency ablation and embolization prior to *** of the HCC-NEC collision tumor in the right liver and another HCC in the left liver was established following surgical *** patient displayed NEC metastasis following resection and succumbed to septicemia after 2 more rounds of *** our knowledge,this is the 25th reported case of mixed HCC-NEC *** rarity of HCC-NEC collision tumors and the absence of diagnostic criteria make it difficult to differentiate this condition from simple liver tumors,especially in patients with chronic liver *** Our case highlights the difficulty in accurately diagnosing HCC-NEC in the absence of histological *** prognosis is poor for this condition,although ultrasound-guided liver biopsy can be helpful to establish a prompt *** accumulation of such cases could help establish an accurate diagnosis *** discovery of NEC may allow for better treatment strategies and better prognoses.

关键词： Collision tumor Combined tumor Hepatocellular carcinoma Neuroendocrine tumor Case report

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