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Hualian, Taiwan

Hsieh Y.-S.,Chung Shan Medical University | Tsai C.-M.,Hualien Hospital | Yeh C.-B.,Chung Shan Medical University | Yang S.-F.,Chung Shan Medical University | And 2 more authors.
Annals of Surgical Oncology | Year: 2012

Background: Early detection of hepatocellular carcinoma (HCC) is seldom available because of the lack of reliable markers. Survivin is an anti-apoptotic protein that is implicated in the regulation of apoptosis and cell cycle, and it is undetectable in normal adult tissues but is overexpressed in various types of cancers. Survivin is thus commonly considered to be a marker of malignancy. The aim of this study was to explore the association between survivin gene polymorphisms and the risk and diagnostic progress of HCC. Methods: A total of 135 patients with HCC and 496 healthy control subjects were recruited. Five single nucleotide polymorphisms (SNPs) of survivin genes were determined by real-time polymerase chain reaction (real-time PCR) and further analyzed statistically. Results: We first found that the -241 C/T and -235 G/A genetic polymorphisms of survivin did not occur frequently enough or even lacked in Taiwanese population. The +9809 C/C polymorphism exhibited a significant (P < .05) low risk of 0.525-fold (95% confidence interval [95% CI] = 0.297-0.930) to have HCC compared with the wild-type homozygotes and a low ratio of 0.214-fold (95% CI = 0.051-0.890) for positive anti-HCV was shown in the individuals with survivin +9809 polymorphic CC allele compared with the TT/TC genotypic subgroup. Conclusions: Survivin +9809 polymorphic genotype is associated with the risk of HCC, and the HCC patients with survivin +9809 CC homozygotes might have a low risk of developing infected HCV-dependent HCC. The results suggest that the survivin T9809C SNP might contribute to the prediction of susceptibility and pathological development to HCC. © 2011 Society of Surgical Oncology.

Chen Y.-C.,Hualien Hospital | Kuo H.-C.,Tzu Chi University
LUTS: Lower Urinary Tract Symptoms | Year: 2012

Objectives: Intravesical injection of onabotulinumtoxinA (i.e. Botox) provides effective treatment for overactive bladder. However, treatment-related adverse events (AEs) remain problems. This study investigated the effect of AEs after onabotulinumtoxinA injection on the success rate for idiopathic detrusor overactivity (IDO). Methods: A total of 174 patients who received the first single intravesical onabotulinumtoxinA 100U injection for refractory IDO were included. The onabotulinumtoxinA related AEs including acute urinary retention (AUR), large postvoid residual (PVR, ≥150 mL), difficult urination, urinary tract infection, gross hematuria and general weakness were recorded. The success rate was determined based on patient perception of bladder condition improved by two scales. The short-term (3 months) and long-term (up to 24 months) success rates were analyzed according to the occurrence of these AEs. Results: A successful outcome was reported by 138 (79.3%) patients at 3 months. AUR occurred in 12 (6.9%) patients, large PVR developed in 81 (46.6%) and 73 (42%) needed straining to void. Gross hematuria occurred in 17 (9.8%) patients, urinary tract infection developed in 27 (15.5%) and general weakness was noted in 6 (3.4%). The occurrence of AUR did not affect the therapeutic results. Patients having large PVR and difficult urination had a significantly higher success rate at 3 months. Long-term success rates up to 24 months showed no significant difference between patients with and without AEs. Conclusions: AEs after intravesical 100U onabotulinumtoxinA for IDO were frequently encountered. However, the occurrence of AUR, large PVR or difficult urination did not affect the final therapeutic outcome. © 2011 Blackwell Publishing Asia Pty Ltd.

Wu H.-T.,National Dong Hwa University | Liu C.-C.,National Dong Hwa University | Lo M.-T.,National Central University | Hsu P.-C.,National Dong Hwa University | And 3 more authors.
Computational and Mathematical Methods in Medicine | Year: 2013

Complex fluctuations within physiological signals can be used to evaluate the health of the human body. This study recruited four groups of subjects: young healthy subjects (Group 1, n = 32), healthy upper middle-aged subjects (Group 2, n = 36), subjects with well-controlled type 2 diabetes (Group 3, n = 31), and subjects with poorly controlled type 2 diabetes (Group 4, n = 24). Data acquisition for each participant lasted 30 minutes. We obtained data related to consecutive time series with R-R interval (RRI) and pulse transit time (PTT). Using multiscale cross-approximate entropy (MCE), we quantified the complexity between the two series and thereby differentiated the influence of age and diabetes on the complexity of physiological signals. This study used MCE in the quantification of complexity between RRI and PTT time series. We observed changes in the influences of age and disease on the coupling effects between the heart and blood vessels in the cardiovascular system, which reduced the complexity between RRI and PTT series. © 2013 Hsien-Tsai Wu et al.

Chung S.-D.,Far Eastern Memorial Hospital | Liao C.-H.,Fu Jen Catholic University | Chen Y.-C.,Hualien Hospital | Kuo H.-C.,Far Eastern Memorial Hospital
Neurourology and Urodynamics | Year: 2011

Aims To evaluate the correlation between an urgency severity scale (USS) based on a voiding diary with detrusor overactivity (DO) in a videourodynamic study in patients with an overactive bladder (OAB). Methods We prospectively enrolled 190 consecutive patients with OAB. All patients were assessed using a USS and completed a 3-day voiding diary that recorded urgency and urgency urinary incontinence (UUI) episodes and the degree of urgency severity. The highest recorded USS score in the voiding diary was considered as the USS score. A videourodynamic study was performed, and the presence of increased bladder sensation (IBS) or DO was recorded. These clinical findings and videourodynamic data were analyzed. Results This study enrolled 65 men and 125 women. The mean patient age was 66.4 years (21-88). Among them, 82.6% had urodynamic DO, 7.9% had IBS, and 9.5% had normal urodynamic findings. The prevalence of DO was 50%, 76%, and 94% in patients with a USS = 2, 3, and 4, respectively. Multivariate analysis indicated that OAB wet, high USS and UUI were significantly associated with the presence of DO. Urodynamic DO was present in most patients with OAB wet (94.1%) or USS = 4 (95.5%); however, only 63.9% of OAB dry patients had DO. In the OAB dry patients, 11/25 (44%) with USS = 2, 30/42 (71%) with USS = 3, and 5/5 (100%) with USS = 4 had DO. Conclusions A high USS recorded in conjunction with a voiding diary and OAB wet were strongly associated with urodynamic DO. Copyright © 2011 Wiley-Liss, Inc.

Wu H.-T.,National Dong Hwa University | Lee C.-H.,National Dong Hwa University | Chen C.-J.,Hualien Hospital | Sun C.-K.,I - Shou University
Annals of Biomedical Engineering | Year: 2011

Not only does erectile dysfunction (ED) reflect penile vascular disorder in the majority of patients, but it also implicates their high systemic cardiovascular risk. Based on the principle of reactive hyperemia after a brief period of penile ischemia, in this study, we tested the validity of a new Penile Arterial Waveform Analyzer (PAWA) in assessing the relative increase in post-ischemic penile perfusion. Twenty young adult males (mean age 24.24 ± 2.45) without known history of cardiovascular diseases were recruited, whose anthropometric characteristics were recorded and their serum testosterone levels as well as biochemical profiles were determined. A penile cuff was applied to each subject, with cuff pressure being increased from 80 to 250 mmHg, each for 4 min, followed by reperfusion for 7 min. By dividing the area under waveform contour of hyperemic and baseline signals after Ensemble Empirical Mode Decomposition (EEMD), a Penile Perfusion Index (PPI) was calculated. Penile Brachial Index (PBI) was also obtained for comparison. The results not only showed a significant agreement between PPI and serum testosterone levels, but also a superiority of PPI to PBI in distinguishing the high- and low-risk groups for potential ED (PPI: p = 0.039 vs. PBI: p = 0.147). PPI was also demonstrated to show significant correlations with waist circumference (p < 0.001), body mass index (p = 0.005), body weight, total triglyceride, high-density lipoprotein, and systolic and diastolic pressures (all p < 0.05). In conclusion, we proposed a portable and easy-to-operate system in assessing the relative increase in penile perfusion after brief ischemia. The PPI thus obtained correlated significantly with serum testosterone levels as well as key anthropometric and serum biochemical parameters even in apparently healthy young adults, suggesting its potential as a sensitive tool in monitoring penile vascular function and risk for ED. © 2011 Biomedical Engineering Society.

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