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Lee C.-H.,Chang Gung Memorial Hospital | Lin Y.-J.,Resource Center for Clinical Research | Lin C.-C.,Chang Gung Memorial Hospital | Yen C.-L.,Keelung Chang Gung Memorial Hospital | And 6 more authors.
Liver International | Year: 2015

Background & Aims: Thrombocytosis is associated with metastasis in many human cancers. Most hepatocellular carcinomas (HCC) develop in cirrhotic livers, which are characterized by thrombocytopenia. We aimed to elucidate the pretreatment platelet count in prediction of extrahepatic metastasis of HCC during the follow-up. Methods: Three cohorts containing 1660, 480 and 965 HCC patients enrolled from three hospitals were used for discovery and validation respectively. Pretreatment clinical factors associated with extrahepatic metastasis during follow-up up to 5 years were identified using multivariate Cox regression model. Results: In early-stage HCC (BCLC stage 0-A), pretreatment platelet count (hazard ratio [HR], 1.04 per 10,000/μl; 95% CI, 1.01-1.07; P = 0.010) and serum alpha-foetoprotein (AFP) >100 ng/ml (HR, 1.70; 95% CI, 1.04-2.78; P = 0.033) were the only two independent factors associated with extrahepatic metastasis. Receiver operating characteristic evidenced that pretreatment platelet count predicted metastasis better than AFP did. Survival tree analysis identified platelet counts <118,000/μl (HR, 0.49; 95% CI, 0.38-0.63; P < 0.001) or >212,000/μl (HR, 2.12; 95% CI, 1.67-2.70; P < 0.001) to categorize patients into low and high risk of metastasis subgroups, which were verified using both validation cohorts. Conclusions: Pretreatment platelet count is a reliable marker to predict extrahepatic metastasis of early-stage HCC following curative treatment. Cirrhotic thrombocytopenia contributes to relatively low metastasis incidence of HCC than many other cancers. High platelet count identifies a subgroup of HCC patients at high risk of metastasis, who might benefit from adjuvant therapies following initial curative treatment. © 2015 John Wiley & Sons A/S.

Hsieh S.-Y.,Liver Research Unit | Hsieh S.-Y.,Chang Gung University | Huang S.-F.,National Health Research Institute | Yu M.-C.,Chang Gung Memorial Hospital | And 7 more authors.
Molecular Carcinogenesis | Year: 2010

Frequent intrahepatic metastasis causes early tumor recurrence and dismaying prognosis of human hepatocellular carcinoma (HCC). We recently identified overexpression of stathmin1 (STMN1) in human HCC. This study was designed to elucidate the clinical and biological significance of overexpression of STMN1 in HCC. Expression of STMN1 was conducted by quantitative reverse transcription-polymerase chain reaction and immunoblotting assays on 58 pairs of HCC and para-tumor liver tissues from patients with HCC along with normal liver tissues as the controls. Association of STMN1 overexpression with tumor recurrence and prognosis was investigated by Kaplan-Meier cumulative survival and Cox Regression analyses. Roles of STMN1 in cell cycle, cell motility, and invasion were determined by in vitro assays. STMN1 overexpression in hepatoma was strongly associated with local invasion (P=0.031), early recurrence (P=0.002), and poor prognosis (P=0.005), and was an independent indicator for tumor recurrence (P=0.0045). STMN1 overexpression further identified subgroups of HCC patients with higher tumor recurrence and worse prognosis among HCC patients with early tumor stage (T1) or intermediate histological grades (G2 and G3), both of whom represent the majority of HCC patients receiving primary curative hepatectomy. Silencing STMN1 expression via RNA interference suppressed invasion activity, while ectopic expression of STMN1 enhanced cell invasion and caused polyploidy of cells. In conclusion, STMN1 overexpression could predict early tumor recurrence and poor prognosis, particularly at early stage of hepatoma. Overexpression of STMN1 promoted polyploidy formation, tumor-cell invasion, and intrahepatic metastasis, suggesting that STMN1 can be a target for anti-cancer therapy of human hepatoma. © 2010 Wiley-Liss, Inc.

Chiu H.-H.E.,Chang Gung University | Chiu H.-H.E.,Kaohsiung Medical Center | Wei Y.-C.,Chang Gung Memorial Hospital at Keelung | Sun M.-F.,China Medical University at Taichung | And 6 more authors.
Evidence-based Complementary and Alternative Medicine | Year: 2011

To reduce the health care burden of strokes, the Taiwan Department of Health launched the Pilot Scheme of the Health Policy in Stroke Adjuvant Acupuncture Therapy (HPSAAT) in 2006. This cross-sectional, hospital-based, match-controlled study at Chang Gung Memorial Hospital-Kaohsiung Medical Center during 2006μ2008 retrospectively evaluated the clinical characteristics of acute and subacute ischemic stroke patients who electively joined the HPSAAT. The study also evaluated the safety and clinical benefits of adjuvant acupuncture in treating acute and subacute ischemic stroke patients. Twenty-six HPSAAT participants and 52 age-sex matched random controls were enrolled. The stroke baseline of the HPSAAT participants was more severe than the non-HPSAAT controls. Although the stroke severity closely correlates to mortality and comorbidity, this study noted no significant complications in the HPSAAT participants during the acupuncture treatment course. Adjuvant acupuncture was considered safe at the acute and subacute stages of ischemic stroke. Due to uneven baseline severity, the clinical benefits in reducing neurological deficits and functional recovery were not concluded in this study. Copyright © 2011 Yi-Chia Wei et al.

Chung C.-Y.,Chang Gung Memorial Hospital | Chung C.-Y.,Chang Gung University | Liu W.-Y.,Chang Gung University | Chang C.-J.,Chang Gung University | And 7 more authors.
Journal of Child Neurology | Year: 2011

Parental concern is a useful screening approach for early detection of children with developmental delay. We investigated the relationships among parental concerns, functional impairment, and final diagnosis of children (n = 273) with developmental delays. Of these, motor, language, and global delay were most common. Parental concerns, especially in language and motor development, were good predictors of children with language or motor delay, and provided reliable information for detection of children with delays in these domains. Parents were less likely to identify children with cognitive problems, global delay, or associated behavioral problems. Co-occurrence of developmental disorders was also recognized, especially in children with global delay. We conclude that parental concerns are useful information for detection of specific developmental problems in children. Because co-occurrence of developmental disorders is common, their early recognition would be helpful for better care of these children. © 2011 The Author(s).

Cheng C.-H.,Chang Gung Childrens Hospital | Cheng C.-H.,Chang Gung University | Tsau Y.-K.,National Taiwan University Hospital | Chang C.-J.,Chang Gung University | And 8 more authors.
Pediatric Infectious Disease Journal | Year: 2010

Background: Acute lobar nephronia (ALN) is a severe nonliquefactive inflammatory renal bacterial infection, and requires a longer duration of treatment. The aim of this prospective study was to investigate renal scarring after ALN and to examine the risk factors for renal scarring in children with ALN compared with those with acute pyelonephritis (APN). Methods: Patients with computed tomography-diagnosed ALN were enrolled and randomly allocated, with serial entry, to either a 2-or 3-week antibiotic treatment regimen. Age-and gender-matched APN patients served as comparators. Patients underwent dimercaptosuccinic acid scintigraphy at least 6 months later to assess renal scarring. Results: A total of 218 children (109 ALN, 109 APN) were enrolled. The incidence of renal scarring was similar between 2-and 3-week treatment groups and was higher in ALN patients than in APN patients (89.0% vs. 34.9%, P < 0.001). Renal scarring was prone to occur in children with higher inflammatory indices and longer duration of fever before and after treatment. Multiple regression analysis on independent variables showed that only ALN was significantly associated with a higher incidence of renal scarring. Conclusions: Our results showed a new finding that ALN is associated with a very high incidence of renal scarring, in comparison to APN, irrespective of the duration of antibiotic treatment. © 2010 by Lippincott Williams & Wilkins.

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