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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)

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Small intestine angioleiomyoma as a rare cause of perforation:A case report

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World Journal of Clinical Cases 2024年第12期12卷 2116-2121页

作者： Teng-Yuan Hou Wei-Juo Tzeng Pei-Hang Lee department of General Surgery Kaohsiung Chang Gung Memorial HospitalKaohsiung 833Taiwan department of Anatomical Pathology Kaohsiung Chang Gung Memorial HospitalKaohsiung 833Taiwan

BACKGROUND Angioleiomyoma is a rare and benign stromal tumor typically found in subcutaneous *** rarely occurs in the gastrointestinal *** the reported cases,the most common complication was gastrointestinal *** has only been reported as a complication in the last few *** SUMMARY This case report detailed the discovery of intestinal angioleiomyoma in a 47-yearold male presenting with abdominal pain that had persisted for 3 *** suspecting hollow organ perforation,surgical intervention involving intestinal resection and anastomosis was *** The report underscores the significance of early surgical intervention in effectively treating angioleiomyoma while emphasizing the pivotal role of timely and appropriate measures for favorable outcomes.

关键词： Angioleiomyoma Intestinal perforation Abdomen Acute Diarrhea Case report

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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,P<0.001)and shorter cold ischemia time(CIT)(45 vs.313 min,P<0.001).The 5-year survival was significantly better in the re-LDLT group than in the re-DDLT group(100%vs.70.8%,P=0.02).This difference was adjusted when only retransplantation after 2010 was *** analysis showed that the timing of retransplantation(early ***)did not affect patient *** 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

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Add-on perceptual learning on refractive amblyopia in children

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International Journal of Ophthalmology(English edition) 2024年第10期17卷 1850-1856页

作者： Heng-Chiao Huang Wan-Hua Cho Po-Chiung Fang Pei-Wen Lin Yi-Hao Chen Hsiu-Mei Huang department of Ophthalmology Chang Gung Memorial HospitalChiayi 613TaiwanChina department of Ophthalmology Chi-Mei Medical CenterTainan 710TaiwanChina department of Ophthalmology Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung City 833TaiwanChina School of Medicine Chang Gung UniversityTaoyuan City 333TaiwanChina

AIM:To evaluate the visual outcomes of standard amblyopic treatment add-on training via perceptual learning in refractive amblyopic children and to identify the risk factors for treatment ***:Retrospective charts were reviewed in children with refractive amblyopia who received standard treatment and add-on Cambridge Visual Stimulator(CAM)*** add-on CAM group that was enrolled had worn full-corrected glasses for at least 2mo before training.A control group received only the standard *** success was defined as best-corrected visual acuity(BCVA)≥20/*** age,sex,initial BCVA,refractive errors,sessions and duration of training,and final BCVA were ***:A total of 209 children(129 children in add-on CAM group and 80 children in control group)were ***-six percent of unilateral and 87%of bilateral amblyopic children achieved treatment *** children with unilateral or bilateral moderate amblyopia,the duration to reach BCVA≥20/25 was significantly shorter in add-on CAM group than in control *** initial BCVA(P<0.001)and high astigmatism(P=0.007)were risk factors for treatment failure after add-on CAM ***,sex,and types of refractive error were not associated with treatment ***:Add-on CAM training is an effective strategy for visual improvement and can shorten the treatment course when the effect of standard treatment is limited in amblyopic children.

关键词： amblyopia amblyopic children add-on Cambridge Visual Stimulator training astigmatism

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World Journal of Clinical Cases 2024年第1期12卷 176-179页

作者： Hsin-Chia Angela Lin Kam-Fai Lee Tzu Hao Huang Division of General Surgery Department of SurgeryChang Gung Memorial HospitalChiayi 613Taiwan department of Anatomic Pathology Chang Gung Memorial HospitalChiayi 613Taiwan

BACKGROUND Gastric IgG4-related disease(IgG4-RD)is rarely encountered in clinical practice,and especially more so among pediatric *** our knowledge,this is the first report of IgG4-RD presenting as a calcifying gastric mass in a *** describe how this entity was difficult to differentiate from a gastrointestinal stromal tumor(GIST)imaging-based ***,this case highlights the importance of considering IgG4-RD in the differential diagnosis of gastric tumor before performing surgical resection,especially to distinguish it from malignancy to avoid unnecessary *** SUMMARY The patient suffered from epigastric pain for several *** and computed tomography scan revealed a submucosal *** diagnoses included GIST,leiomyoma,teratoma,and mucinous ***,laparoscopic proximal gastrectomy allowed for the definitive diagnosis of IgG4-related stomach *** We emphasize the importance of considering IgG4-RD in the differential diagnosis of gastric submucosal tumors before performing surgical resection.

关键词： IgG4-related disease Gastrointestinal stromal tumor Child Pediatric Case report

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Hepatocellular Carcinoma with Gastric Metastasis Mimicking a 4 cm Gastrointestinal Stromal Tumor After a 3-year Disease-free Interval

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Journal of Clinical and Translational Hepatology 2024年第2期12卷 218-221页

作者： Wei-Ting Chen Shiu-Feng Kathy Huang Ming-Ling chang Yun-Fan Liaw Division of Hepatology Department of Gastroenterology and HepatologyChang Gung Memorial HospitalTaoyuan department of Medicine College of MedicineChang Gung UniversityTaoyuan Division of Molecular and Genomic Medicine National Health Research InstitutesMiaoli

Hepatocellular carcinoma(HCC)is an aggressive tumor that usually occurs in patients with chronic liver disease and *** resection is an optimal treatment for HCC,but the 5-year recurrence rates are significantly *** majority of recurrent HCCs occur through intrahepatic metastasis with local tumor progression,and less than 20%of recurrences are extrahepatic *** with gastric metastasis is extremely rare,and it is easily misdiagnosed as primary gastric cancer with liver *** 80-yearold male chronic hepatitis B virus carrier had received lamivudine and entecavir for years and was regularly followed up in the *** had a 3.5 cm solitary HCC with microvascular invasion and received curative surgical resection in *** 2013,he developed a 1.3 cm solitary HCC again and was treated with combination therapy with radiofrequency ablation and pure ethanol ***,he was followed every 3–6 months and was *** years later,in 2016,endoscopy for intermittent epigastralgia showed a solitary 4 cm intraluminal gastric subepithelial tumor without mucosal ulcers or erosions over the gastric *** imaging studies,including computed tomography,favored the diagnosis of gastrointestinal stromal tumor(GIST),but the pathology of the tumor proved to be *** patient did not receive any systemic anticancer therapy but only wedge resection of the stomach and remained tumor-and HCC-free until his latest clinic visit in *** current case is unique and indicates the possibility of HCC with late solitary gastric metastasis mimicking *** gastric tumor resection ensured an extremely good outcome for the patient,which is different from the devastating prognosis of most cases of HCC with gastric metastasis.

关键词： Hepatocellular carcinoma Hepatitis B virus Gastric Gastrointestinal stromal tumor

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Retinal vein occlusion coinciding with paracentral acute middle maculopathy in patient with menorrhagia causing life-threatening anemia

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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

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Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

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International Journal of Ophthalmology(English edition) 2024年第4期17卷 665-669页

作者： Wei-Yu Huang Yung-Jen Chen department of Ophthalmology Chi Mei Medical CenterTainan City 710TaiwanChina department of Ophthalmology Chang Gung Memorial HospitalKaohsiung City 833TaiwanChina

AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June *** patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular *** of intraoperative and postoperative surgical complications was ***:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±*** acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,*** was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 *** mean spherical equivalent at the 3-month follow-up was-0.1±0.94 *** major complications were noted during the follow-up ***:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.

关键词： intraocular lens dislocation intraocular lens subluxation lens dislocation lens subluxation scleral fixation

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Outcomes of combined mitochondria and mesenchymal stem cellsderived exosome therapy in rat acute respiratory distress syndrome and sepsis

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World Journal of Stem Cells 2024年第6期16卷 690-707页

作者： Kun-Chen Lin Wen-Feng Fang Jui-Ning Yeh John Y Chiang Hsin-Ju Chiang Pei-Lin Shao Pei-Hsun Sung Hon-Kan Yip department of Anesthesiology Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301TaiwanChina Division of Pulmonary and Critical Care Medicine Department of Internal MedicineKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiung 83301TaiwanChina department of Cardiology The First Affiliated Hospital of Jinan UniversityGuangzhou 510630Guangdong ProvinceChina department of Computer Science and Engineering National Sun Yat-sen UniversityKaohsiung 804201TaiwanChina department of Healthcare Administration and Medical Informatics Kaohsiung Medical UniversityKaohsiung 80708TaiwanChina School of Medicine Chung Shan Medical UniversityTaichung 40201TaiwanChina department of Nursing Asia UniversityTaichung 41354TaiwanChina Division of Cardiology Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiung 83301TaiwanChina Institute for Translational Research in Biomedicine Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301TaiwanChina Center for Shockwave Medicine and Tissue Engineering Kaohsiung Chang Gung Memorial HospitalKaohsiung 83301TaiwanChina department of Medical Research China Medical University HospitalChina Medical UniversityTaichung 40402TaiwanChina School of Medicine College of MedicineChang Gung UniversityTaoyuan 33302TaiwanChina

BACKGROUND The treatment of acute respiratory distress syndrome(ARDS)complicated by sepsis syndrome(SS)remains *** To investigate whether combined adipose-derived mesenchymal-stem-cells(ADMSCs)-derived exosome(EXAD)and exogenous mitochondria(mitoEx)protect the lung from ARDS complicated by *** In vitro study,including L2 cells treated with lipopolysaccharide(LPS)and in vivo study including male-adult-SD rats categorized into groups 1(sham-operated-control),2(ARDS-SS),3(ARDS-SS+EXAD),4(ARDS-SS+mitoEx),and 5(ARDS-SS+EXAD+mitoEx),were included in the present *** In vitro study showed an abundance of mitoEx found in recipient-L2 cells,resulting in significantly higher mitochondrial-cytochrome-C,adenosine triphosphate and relative mitochondrial DNA levels(P<0.001).The protein levels of inflammation[interleukin(IL)-1β/tumor necrosis factor(TNF)-α/nuclear factor-κB/toll-like receptor(TLR)-4/matrix-metalloproteinase(MMP)-9/oxidative-stress(NOX-1/NOX-2)/apoptosis(cleaved-caspase3/cleaved-poly(ADP-ribose)polymerase)]were significantly attenuated in lipopolysaccharide(LPS)-treated L2 cells with EXAD treatment than without EXAD treatment,whereas the protein expressions of cellular junctions[occluding/β-catenin/zonula occludens(ZO)-1/E-cadherin]exhibited an opposite pattern of inflam-mation(all P<0.001).Animals were euthanized by 72 h post-48 h-ARDS induction,and lung tissues were *** 72 h,flow cytometric analysis of bronchoalveolar lavage fluid demonstrated that the levels of inflam-matory cells(Ly6G+/CD14+/CD68+/CD11b/c+/myeloperoxidase+)and albumin were lowest in group 1,highest in group 2,and significantly higher in groups 3 and 4 than in group 5(all P<0.0001),whereas arterial oxygen-saturation(SaO2%)displayed an opposite pattern of albumin among the *** findings of lung injury/fibrosis area and inflammatory/DNA-damaged markers(CD68+/γ-H2AX)displayed an identical pattern of SaO2%among the groups(all P<0.0001).The pro

关键词： Acute respiratory distress syndrome Sepsis syndrome Exosomes Mitochondria Adipose tissue-derived mesenchymal stem cells Inflammation

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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(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

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