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The intragraft vascularized bone marrow component plays a critical role in tolerance induction after reconstructive transplantation

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Cellular & Molecular Immunology 2021年第2期18卷 363-373页

作者： Cheng-Hung Lin Madonna R.Anggelia Hui-Yun Cheng Aline Yen Ling Wang Wen-Yu Chuang Chih-Hung Lin W.P.Andrew Lee Fu-Chan Wei Gerald Brandacher center for Vascularized Composite Allotransplantation Department of Plastic and Reconstructive SurgeryChang Gung Memorial HospitalChang Gung Medical College and Chang Gung UniversityTaoyuanTaiwanChina Graduate Institute of Biomedical Sciences College of MedicineChang Gung UniversityTaoyuanTaiwanChina Department of Pathology Chang Gung Memorial HospitalChang Gung Medical College and Chang Gung UniversityTaoyuanTaiwanChina Department of Plastic and Reconstructive Surgery Chiayi Chang Gung Memorial HospitalChiayi CountyTaiwanChina Department of Plastic and Reconstructive Surgery Vascularized Composite Allotransplantation(VCA)LaboratoryJohns Hopkins University School of MedicineBaltimoreMDUnited States

The role of the vascularized bone marrow component as a continuous source of donor-derived hematopoietic stem cells that facilitate tolerance induction of vascularized composite allografts is not completely *** this study,vascularized composite tissue allograft transplantation outcomes between recipients receiving either conventional bone marrow transplantation(CBMT)or vascularized bone marrow(VBM)transplantation from Balb/c(H2d)to C57BL/6(H2b)mice were *** high-or low-dose CBMT(1.5×10^(8)or 3×10^(7)bone marrow cells,respectively)was *** addition,recipients were treated with costimulation blockade(1 mg anti-CD154 and 0.5 mg CTLA4Ig on postoperative days 0 and 2,respectively)and short-term rapamycin(3 mg/kg/day for the first posttransplant week and then every other day for another 3 weeks).Similar to high-dose conventional bone marrow transplantation,5/6 animals in the vascularized bone marrow group demonstrated long-term allograft survival(>120 days).In contrast,significantly shorter median survival was noted in the low-dose CBMT group(~64 days).Consistently high chimerism levels were observed in the VBM transplantation ***,low levels of circulating CD4^(+)and CD8^(+)T cells and a higher ratio of Treg to Teff cells were maintained in VBM transplantation and high-dose CBMT recipients(>30 days)but not in low-dose VBM transplant ***-specific hyporesponsiveness was shown in tolerant recipients in *** of the vascularized bone marrow component after secondary donor-specific skin transplantation did not affect either primary allograft or secondary skin graft survival.

关键词： Vascularized composite allotransplantation Costimulation blockade Donor-specific tolerance Vascularized bone marrow transplantation Chimerism

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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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Dextrose in the banked blood products does not seem to affect the blood glucose levels in patients undergoing liver transplantation

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World Journal of Gastroenterology 2005年第18期11卷 2789-2791页

作者： Kwok-Wai Cheng Chia-Chih Tseng Chih-Hsien Wang Yaw-Sen Chen Chih-Chi Wang Tung-Liang Huang Hock-Liew Eng King-Wah Chiu Shih-Hor Wang Chih-Che Lin Tsan-Shiun Lin Yueh-Wei Liu Bruno Jawan Department of Anesthesiology and Liver Transplantation Program chang gung Memorial Hospital Kaohsiung Medical Center Taiwan China Chang Gung University Ta-pei Taiwan China

AIM: Hyperglycemia commonly seen in liver transplantation (LT) has often been attributed to the dextrose in the storage solution of blood transfusion products. The purpose of the study is to compare the changes of the blood glucose levels in transfused and non-transfused patients during LT. METHODS: A retrospective study on 60 biliary pediatric patients and 16 adult patients undergoing LT was carried out. Transfused pediatric patients were included in Group Ⅰ (GⅠ), those not transfused in Group Ⅱ (GⅡ). Twelve adult patients were not given transfusion and assigned to Group Ⅲ(GⅢ); whereas, four adult patients who received massive transfusion were assigned to Group Ⅳ (GⅣ). The blood glucose levels, volume of blood transfused, and the volume of crystalloid infused were recorded, compared and analyzed. RESULTS: Results showed that the changes in blood glucose levels during LT for both non-transfused and minimally transfused pediatric groups and non-transfused and massively-transfused adult groups were almost the same. CONCLUSION: We conclude that blood transfusion does not cause significant changes in the blood glucose levels in this study.

关键词： Organ Liver surgery Transplantation Anesthesia General monitoring Blood glucose transfusion Bank blood component Infusion 5% dextrose in 1/4 saline

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Sunitinib for Taiwan Residents patients with gastrointestinal stromal tumor after imatinib treatment failure or intolerance

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World Journal of Gastroenterology 2011年第16期17卷 2113-2119页

作者： Yen-Yang Chen Chun-Nan Yeh Chi-Tung Cheng Tsung-Wen Chen Kun-Ming Rau Yi-Yin Jan Miin-Fu Chen Division of Hematology-Oncology Department of Internal MedicineChang Gung Memorial HospitalKaohsiung Medical Center GIST team Department of SurgeryChang Gung Memorial Hospital and University

AIM:To report preliminary results of the efficacy and safety of sunitinib in the management of Taiwan Residents gastrointestinal stromal tumors (GIST) patients facing imatinib mesylate (IM) intolerance or ***:Between 2001 and May 2010,199 Taiwan Residents patients with metastatic GIST were treated at chang gung Memorial *** them,23 (11.6%) patients receiving sunitinib were ***:Sixteen male and 7 female patients with a median age of 59 years (range:24-83 years) received ***-two GIST patients changed to sunitinib because of IM failure and 1 because of *** median duration of sunitinib administration was 6.0 mo (range:2-29 mo).The clinical benefit was 65.2% [2 complete response (CR),4 partial response (PR),and 9 stationary disease (SD);15/23].In 12 patients harboring mutations of the kit gene at exon 11,the clinical benefit rate (CR,PR,and SD) was 75.0% and 6 patients with tumors containing kit exon 9 mutations had a clinical benefit of 50.0% (not significant,P=0.344).The progression free survival (PFS) and overall survival (OS) did not differ between patients whose GISTs had wild type,KIT exon 9,or KIT exon 11 ***-foot syndrome was the most common cause of grade Ⅲ adverse effect (26.1%),followed by anemia (17.4%),and neutropenia (13.0%).During the median 7.5-mo follow-up after sunitinib use,the median PFS and OS of these 23 GIST patients after sunitinib treatment were 8.4 and 14.1 mo,***:Sunitinib appears to be an effective treatment for Taiwan Residents with IM-resistant/intolerant GISTs and induced a sustained clinical benefit in more than 50% of Taiwan Residents advanced GIST patients.

关键词： Suintinib Gastrointestinal stromal tumors Imaitinib Failure or intolerance

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Glasgow prognostic score after concurrent chemoradiotherapy is a prognostic factor in advanced head and neck cancer

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Chinese Journal of Cancer Research 2017年第3期29卷 172-178页

作者： Pei-Hung chang Cheng-Hsu Wang Eric Yen-Chao Chen Shih-Wei Yang Wen-Chi Chou Jason Chia-Hsun Hsieh Feng-Che Kuan Kun-Yun Yeh Division of Hemato-oncology Department of Internal MedicineChang Gung Memorial HospitalKeelung&Chang Gung UniversityCollege of MedicineKeelung 20445 TaiwanChina Cancer center Chang Gung Memorial HospitalKeelung 20445TaiwanChina Department of Radiation Oncology Chang Gung Memorial HospitalKeelung&Chang Gung UniversityCollege of MedicineKeelung 20445TaiwanChina Otolaryngology Head and Neck SurgeryChang Gung Memorial HospitalKeelung&Chang Gung UniversityCollege of MedicineKeelung 20445TaiwanChina Division of Medical Oncology Department of Internal MedicineChang Gung Memorial Hospital at LinkouTaoyuan 33305TaiwanChina Department of Hematology and Oncology Department of MedicineChang-Gung Memorial HospitalChiayi 61363TaiwanChina

Objective: This study aims to evaluate the impact and potential prognostic roles of the pre- and post-treatment Glasgow prognostic score (GPS) and the change thereof in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy (CCRT). Methods: We collected GPS and clinicopathological data of 139 stage III, IVA, and IVB head and neck cancer patients who underwent CCRT between 2008 and 2011. Their GPSs pre- and post-CCRT and the change thereof were analyzed for correlations with recurrence and survival. Results: The GPS changed in 72 (51.8%) patients, with worse scores observed post-CCRT in 65 (90.3%) of the GPS changed patients. Patients in the improved GPS group showed a tendency toward better survival. From the multivariate analysis, the post-CCRT GPS level was an independent prognostic factor in addition to tumor stage. Conclusions: After CCRT, a high GPS was revealed to be an important predictor of survival for advanced head and neck cancer.

关键词： Glasgow prognostic score (GPS) head and neck cancer chemoradiation inflammation cachexia nutrition

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Image Reconstructions from Limit Views and Angle Coverage Data for a Stationary Multi-Pinhole SPECT System

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Tsinghua Science and Technology 2010年第1期15卷 44-49页

作者： HSIEH Hohui HSIAO Ingtsung Department of Medical Imaging and Radiological Sciences Chang Gung UniversityTaoyuan 333 Molecular Imaging center Chang Gung Memorial HospitalTaoyuan 333

The goal of this paper is to investigate different reconstruction methods for solving the limited angle problem in reconstructing the projection data from a stationary multi-pinhole system based on a three-head clinical single photon emission computed tomography （SPECT） camera. Three iterative recon- struction approaches were studied including maximum likelihood expectation maximization （MLEM）, maximum a posteriori expectation maximization （MAPEM） with a smoothing prior, and an alternating optimization schemes from MLEM and total variation （TV） optimization. A three-headed multipinhole SPECT was simulated with apertures of nine 1-mm pinholes each, and covered scanning volume of 6-mm diameter. The reconstructions were optimized for various iterations based on visual inspections, and finally 20 iterations were applied for each method. For both MLEM-TV and MAPEM-TV, various initial reconstructions before TV optimization were studied. The smoothing parameter for MAPEM and the gradient descent constant for TV were also investigated through visual comparison. The preliminary results showed the 3 reconstruction methods generated compatible images, and can restore the images from projection data suffering limited angular sampling. However, MLEM was noisy for low-count and highly limited angle data, and thus suitable smoothing in MAPEM alleviated this problem, initial reconstructions were necessary for better edge enhancement in TV. The conclusion is that TV might be potential in producing more edge-enhanced images if all parameters were optimized.

关键词： multipinhole single photon emission computed tomography (SPECT) iterative reconstruction total variation (TV) optimization

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Proton beam therapy to bridge or downstage locally advanced hepatocellular carcinoma to living donor liver transplantation

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Hepatobiliary Surgery and Nutrition 2022年第1期11卷 103-111页

作者： Chao-Long Chen Aldwin D.Ong Jen-Yu Cheng Chee-Chien Yong Chih-Che Lin Chih-Yi Chen Yu-Fan Cheng Liver Transplantation center Department of SurgeryKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwanChina Liver Transplantation center Department of Radiation OncologyKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwanChina Liver Transplantation center Department of Diagnostic RadiologyKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwanChina

Introduction Within the last decade,progress in transplant and surgical oncology has been *** liver oncology alone,there has been concurrent technological innovation across the different adjunct fields and tiers of oncology related to hepatocellular carcinoma(HCC),progressing in quite an unprecedented *** improvements in our capacity to diagnose and prognosticate HCC with increasing sensitivity,specificity,and predictability is being *** now better understand that staging,treatment and prognostication cannot be determined on a static basis of tumor burden(i.e.,tumor size and number)alone and a“one size fits all”*** individualized assessment is now mandatory in consideration of intra-and intertumoral heterogeneity and tumor biology in order to more precisely guide diagnostics and treatment options(1).

关键词： hepatocellular alone donor

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Amniotic membrane transplantation in a patient with impending perforated corneal ulcer caused by Streptococcus mitis: A case report and review of literature

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World Journal of Clinical Cases 2022年第12期10卷 3923-3929页

作者： Fang-Chi Hsiao Yaa-Jyuhn James Meir Lung-Kun Yeh Hsin-Yuan Tan Ching-Hsi Hsiao David Hui-Kang Ma Wei-Chi Wu Hung-Chi Chen Department of Ophthalmology Chang Gung Memorial HospitalTaoyuan 333423Taiwan Biomedical Sciences College of MedicineChang Gung UniversityTaoyuan 33305Taiwan Department of Medicine College of MedicineChang Gung UniversityTaoyuan 33305Taiwan center for Tissue Engineering Chang Gung Memorial HospitalTaoyuan 333423Taiwan

BACKGROUND Streptococcus mitis(***)is an opportunistic pathogen that can lead to severe ocular *** previous reports,penetrating keratoplasty(PK)was usually adopted for the treatment of persistent corneal *** report describes an unusual case of nonhealing descemetocele caused by *** treated by antibiotics plus amniotic membrane transplantation(AMT).CASE SUMMARY A 63-year-old woman presented with a right persistent corneal ulcer that she had suffered from for the past 9 *** culture of a corneal scraping yielded *** right eye descemetocele decreased in diameter from 3 to 0.8 mm after the continuous administration of topical vancomycin and ceftriaxone for 2 *** to the slow healing,AMT was *** corneal erosion healed and gradually became *** visual acuity recovered from initially counting fingers to 100/200 at the last follow-up,67 mo after *** Antibiotics plus AMT may be an effective alternative treatment other than PK to promote epithelializationand to reduce inflammation in the corneas complicated by S. mitis keratitis.

关键词： Persistent corneal ulcer Amniotic membrane transplantation Streptococcus mitis Case report

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Tracheostomy and venovenous extracorporeal membrane oxygenation for difficult airway patient with carinal melanoma:A case report and literature review

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World Journal of Clinical Cases 2022年第35期10卷 13088-13098页

作者： I-Liang Liu An-Hsun Chou Chien-Hung Chiu Yu-Ting Cheng Huan-Tang Lin Department of Anesthesiology Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan College of Medicine Chang Gung UniversityTaoyuan 333Taiwan Division of Thoracic and Cardiovascular Surgery Department of SurgeryChang Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan Graduate Institute of Clinical Medical Sciences Chang Gung UniversityTaoyuan 333Taiwan

BACKGROUND Anesthesia for tracheal tumor resection is challenging,particularly in patients with a difficult upper *** report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total left bronchial obstruction and requiring emergency tracheostomy and venovenous extracorporeal membrane oxygenation(VV-ECMO)support for rigid bronchoscopy-assisted tumor *** SUMMARY A 41-year-old man with a history of right retromolar melanoma treated by tumor excision and myocutaneous flap reconstruction developed progressive dyspnea on exertion and syncope *** computed tomography revealed a 3.0-cm tracheal mass at the carinal level,causing 90%tracheal lumen *** bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal *** of aggravated symptoms,emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby *** to limited mouth opening,tracheostomy was necessary for rigid bronchoscopy *** transferring the patient to the operating table,sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation *** and internal jugular vein were catheterized to facilitate possible VV-ECMO *** tracheostomy,progressive desaturation developed and VV-ECMO was instituted *** tumor resection and tracheal stenting,VV-ECMO was weaned smoothly,and the patient was sent for intensive postoperative *** days later,he was transferred to the ward for palliative immunotherapy and subsequently discharged *** In a difficult airway patient with severe airway obstruction,emergency tracheostomy for rigid bronchoscopy access and standby VV-ECMO can be life-saving,and ECMO can be weaned smoothly after tumor *** anesthesia for patients with tracheal tumors causing critical airway obstruction,spontaneous ventilation should be maintaine

关键词： Tracheostomy Extracorporeal membrane oxygenation Tracheal tumor Melanoma Case report

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Identifying survival protective factors for chronic dialysis patients with surgically confirmed acute mesenteric ischemia

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World Journal of Gastrointestinal Surgery 2022年第8期14卷 809-820页

作者： Shuh-Kuan Liau George Kuo Chao-Yu Chen Yueh-An Lu Yu-Jr Lin Cheng-Chia Lee Cheng-Chieh Hung Ya-Chung Tian Hsiang-Hao Hsu Department of Nephrology Kidney Research CenterChang Gung Memorial HospitalLinkou BranchCollege of MedicineChang Gung UniversityTaoyuan 333Taiwan Research Services center for Health Information Chang Gung UniversityTaoyuan 333Taiwan

BACKGROUND Mesenteric ischemia is significantly more common in end-stage kidney disease patients undergoing chronic dialysis than in the general population and is associated with high morbidity and mortality. However, reports on prognostic factors in this population are *** To elucidate the in-hospital outcomes of acute mesenteric ischemia in chronic dialysis patients and to analyze protective factors for *** The case data of 426 chronic dialysis patients who were hospitalized in a tertiary medical center for acute mesenteric ischemia over a 14-year period were retrospectively reviewed. Of these cases, 103 were surgically confirmed, and the patients were enrolled in this study. A Cox regression analysis was used to evaluate the protective factors for *** The in-hospital mortality rate among the 103 enrolled patients was 46.6%.Univariate analysis was performed to compare factors in survivors and nonsurvivors, with better in-hospital outcomes associated with a surgery delay(defined as the time from onset of signs and symptoms to operation) < 4.5 d, no shock, a higher potassium level on day 1 of hospitalization, no resection of the colon, and a total bowel resection length < 110 cm. After 1 wk of hospitalization, patients with lower white blood cell count and neutrophil counts, higher lymphocyte counts, and lower C-reactive protein levels had better in-hospital outcomes. Following multivariate adjustment, a higher potassium level on day 1 of hospitalization(HR 1.71, 95%CI 1.19 to 2.46;P = 0.004), a lower neutrophil count(HR 0.91, 95%CI 0.84 to 0.99;P = 0.037) at 1 wk after admission, resection not involving the colon(HR 2.70, 95%CI 1.05 to 7.14;P = 0.039), and a total bowel resection length < 110 cm(HR 4.55,95%CI 1.43 to 14.29;P = 0.010) were significantly associated with *** A surgery delay < 4.5 d, no shock, no resection of the colon, and a total bowel resection length <110 cm predicted better outcomes in chronic dial

关键词： Mesenteric ischemia Chronic dialysis End-stage kidney disease Surgery Protective factors Survival

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