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Leroy J.,University of Strasbourg | Diana M.,University of Strasbourg | Barry B.,University of Strasbourg | Mutter D.,University of Strasbourg | And 3 more authors.
Surgical Innovation | Year: 2012

Introduction. A transanal, posterior, retrorectal approach has been demonstrated as a feasible natural orifice transluminal endoscopic surgery (NOTES) total mesorectal excision (TME) procedure. The aim was to assess the feasibility of a transrectal approach with a completely retroperitoneal mobilization of the left colon and mesenteric vessels in an acute porcine model. Materials and methods. Eight pigs were used. A purse-string suture was made 3 cm above the anal sphincter. Next, the retroperitoneal, perirectal space was entered with an endoscope through a single (or twin) anterior lateral, transrectal viscerotomy. A retroperitoneal tunnel was created using pneumodissection or endoscopically guided dissection to the inferior mesenteric artery (IMA). The IMA was skeletonized and lymph nodes retrieved using the IsisScope or other instruments. The IMA was divided with the Ligasure, clips, or ligature performed with the IsisScope. The rectum was dissected transanally in the "Holy" plane. After achieving mobilization using a completely retroperitoneal approach, the peritoneal attachments were then divided and the rectosigmoid specimen exteriorized through the anus. An explorative laparoscopy was then performed to evaluate the quality of the mobilization. Results. The procedure was successfully completed and the IMA correctly identified and ligated in all cases. In all but one case, no further mobilization was possible, even by a laparoscopic approach. Conclusions. Perirectal oncologic gateway to retroperitoneal endoscopic single-site surgery for left-sided colonic resections using both flexible and rigid surgical endoscopic platforms was feasible and reproducible in an acute porcine model. This technique might represent a step toward pure NOTES left-sided colorectal procedures. © 2012 The Author(s).


Chen Y.-Y.,Taipei City Hospital | Chen Y.-Y.,National Yang Ming University | Liao S.-F.,National Taiwan University | Teng P.-R.,Show Chwan Health Care System | And 4 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2012

Purpose To examine if widespread media reporting of the suicide of a young female singer by charcoal burning increased suicide rates, and to examine whether the suicide induced a high risk of imitation suicide by this method among the young female group. Methods Poisson time series autoregression model was applied to examine the relative risk of overall and subgroup (age, gender and method) suicides during the 2-week period after the initiation of media reporting of the celebrity suicide. Results We found a significant increase (adjusted relative risk = 1.17, p = 0.04) in suicide deaths following media reporting of the celebrity suicide. The increase in suicides was particularly significant among female and young age groups. A marked increase in suicide by charcoal burning among females (adjusted relative risk = 1.44, p < 0.0001) was further observed. Conclusions Detailed description of a specific suicide method following celebrity suicides may induce extensive modeling effect, attracting wider age/sex groups to model the method. Our finding provides further support for restraining media reporting of celebrity suicide in suicide prevention. © Springer-Verlag 2010.


D'Agostino J.,University of Strasbourg | Diana M.,University of Strasbourg | Vix M.,University of Strasbourg | Nicolau S.,University of Strasbourg | And 5 more authors.
World Journal of Surgery | Year: 2013

Background: The aim of this study was to assess the accuracy of a novel imaging modality, three-dimensional (3D) metabolic and radiologic gathered evaluation (MeRGE), for localizing parathyroid adenomas (PAs). Methods: Consecutive patients presenting with primary hyperparathyroidism who underwent both thin-slice cervical computed tomography (CT) and 99mTc-sestamibi (MIBI) scanning were included. 3D-CT reconstruction was obtained using VR-RENDER, which was used to perform 3D virtual neck exploration (3D-VNE). The MIBI scan was then fused with the 3D reconstruction to obtain 3D-MeRGE. Sensitivity, specificity, and accuracy were assessed. Parathyroid gland volume and preoperative parathormone (PTH) levels were analyzed as predictive factors of correct localization (i.e., correct quadrant). Results: A total of 108 cervical quadrants (27 patients) were analyzed. Sensitivities were 79.31, 75.86, 65.51, and 58.61 % with 3D-MeRGE, 3D-VNE, MIBI, and CT, respectively. Specificity was highest with CT (94.93 %) followed by 3D-VNE (92.4 %). MIBI and 3D-MeRGE had the same specificity (88.6 %). 3D-MeRGE and 3D-VNE achieved higher accuracy than MIBI or CT alone. Mean PTH values were significantly higher in patients with lesions that were correctly identified (true positive, TP) than in those whose lesions were missed (false negative, FN) with 3D-VNE (219.60 ± 212.77 vs. 98.75 ± 12.76 pg/ml; p = 0.01) and 3D-MeRGE (217.69 ± 213.76 vs. 09.75 ± 20.48 pg/ml; p = 0.02). The mean parathyroid gland volume difference between TP and FN was statistically significant with all modalities except CT. Conclusions: 3D-MeRGE and 3D-VNE showed high accuracy for localization of PAs. 3D-MeRGE performed better than MIBI or CT alone for detecting small adenomas and those with a low PTH level. © 2013 Société Internationale de Chirurgie.


Liu K.-H.,University of Strasbourg | Liu K.-H.,Chang Gung University | Diana M.,University of Strasbourg | Vix M.,University of Strasbourg | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2013

Background Revisional surgery may be required in a high percentage of patients (up to 30 %) after laparoscopic adjustable gastric banding (LAGB). We report our institutional experience with revisional surgery. Methods FromJanuary 1996 toNovember 2011, 90 patients underwent revisional surgery after failed LAGB. Both Rouxen- Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were proposed. In the presence of gastroesophageal reflux disease, esophageal dysmotility, hiatal hernia, or diabetes, RYGB was preferentially proposed. Results In two cases, revisional surgery was aborted due to local severe adhesions. Eighty-eight patients (74 females; mean age 42.79 ± 10.03 years;mean BMI 44.73 ± 6.19 kg/ m2) successfully underwent revisional SG(n = 48) orRYGB (n = 40). One-stage surgery was performed in 29 cases. Follow-up rate was 78.2 % (n = 61) and 40.9 % (n = 36) at 12 and 24 months respectively. One major complication after SG (staple-line leakage) was observed. Overall postoperative excess weight loss (%EWL) was 31.24, 40.92, 52.41, and 51.68 %at 3, 6, 12, and 24 months of follow-up respectively. Therewas a statistically significant higher%EWLat 1 year in patients≤50 years old (55.9 vs. 41.5 %in patients>50 years old; p = 0.01), of female gender (55.22 vs. 40.73 % in male; p = 0.04), and in patients in which the AGB was in place for ≤5 years (57.09 vs. 47.43 % if>5 years p = 0.02). Conclusions Revisional surgery is safe and effective. Patients≤50 years, of female gender, and with the AGB in place for ≤5 years had better %EWL after revisional surgery. © Springer Science+Business Media New York 2013.


Hsu Y.-H.,National Cheng Kung University | Wei C.-C.,Show Chwan Health Care System | Shieh D.-B.,National Cheng Kung University | Chan C.-H.,National Cheng Kung University | Chang M.-S.,National Cheng Kung University
Molecular Cancer Research | Year: 2012

Interleukin-20 (IL-20) is a proinflammatory cytokine involved in rheumatoid arthritis, atherosclerosis, and osteoporosis. However, little is known about the role of IL-20 in oral cancer. We explored the function of IL-20 in the tumor progression of oral cancer. IL-20 expression levels in tumorous and nontumorous oral tissue specimens from 40 patients with four different stages oral cancer were analyzed with immunohistochemistry (IHC) staining and quantitative real-timePCR(qRT-PCR). Expression of IL-20 and its receptor subunits was higher in clinical oral tumor tissue than in nontumorous oral tissue. The role of IL-20 was examined in two oral cancer cell lines (OC-3 and OEC-M1). In vitro, IL-20 promoted TNF-α, IL-1β, MCP-1, CCR4, and CXCR4 and increased proliferation, migration, reactive oxygen species (ROS) production, and colony formation of oral cancer cells via activated STAT3 and AKT/JNK/ERK signals. To evaluate the therapeutic potential of anti-IL-20 monoclonal antibody 7E for treating oral cancer, an ex vivo tumor growth model was used. In vivo, 7E reduced tumor growth and inflammation in oral cancer cells. In conclusion, IL-20 promoted oral tumor growth, migration, and tumor-associated inflammation. Therefore, IL-20 may be a novel target for treating oral cancer, and anti-IL-20 monoclonal antibody 7E may be a feasible therapeutic. ©2012 AACR.


Yong S.-B.,Show Chwan Memorial Hospital | Yong S.-B.,Show Chwan Health Care System | Wu C.-C.,Chang Bing Show Chwan Memorial Hospital | Wu C.-C.,Show Chwan Health Care System | And 4 more authors.
Journal of Microbiology, Immunology and Infection | Year: 2013

Background/Purpose: Environmental factors, different ages, and detection methods might affect the profiles of allergy sensitization and confound the diagnosis of allergic diseases. The purpose of this study was to investigate the different profiles of allergen sensitization in different ages, geographic areas, and detection methods. Methods: We analyzed the patients who received allergen sensitization tests by the automated microfluidic-based immunoassay system (BioIC) method at Show Chwan Memorial Hospital in Changhua City and at Chang Bing Show Chwan Hospital in Lu-gang from January 2011 to December 2011. Results were compared in different ages (3-6, 7-18, and ≥19), different geographic areas, and different detection methods and analyzed by Chi-square or Fisher exact test depending on sample size. Results: A total of 1145 patients were analyzed. The younger the age, the higher the food allergy sensitization rate is found (26.6% vs. 14.7% vs.11.1% p<0.001). The older the age, the higher the sensitization of Blomia tropicalis occurs (33.4% vs.15.1% p<0.001). The food allergen specific IgE directed against egg white was higher in coast area than city (15.4% vs. 3%, p=0.015). A higher rate of pollen sensitization was found in the detection by BioIC method (Bermuda grass, 17.2%; Timothy, 12.3%; ragweed, 5.7%). The sensitization rates of cockroach and cat dander were lower in both city and coast areas. Conclusion: Children have higher food allergy sensitization and adults have higher Blomia tropicalis sensitization. Children living in Changhua area no matter in city or coast area had a higher pollen sensitization rate but lower cat or dog dander sensitization rate. Apparently, age, environmental factors, and different methods significantly affect the allergen sensitization in the different areas of Taiwan. © 2012 .


Yong S.-B.,Show Chwan Memorial Hospital | Wu C.-C.,Show Chwan Memorial Hospital | Wang L.,Kaohsiung Chang Gung Memorial Hospital | Yang K.D.,Show Chwan Health Care System
Pediatrics and Neonatology | Year: 2013

Perinatal nutrition has been implicated in the programming of diseases in children and adults. The prevalence of asthma has dramatically increased in the past few decades, particularly in children. This suggests that the perinatal environment, including maternal and infant diets, may be involved in the increase in the prevalence of asthma. Recent studies have demonstrated that certain maternal and infant diets have a protective or augmentative effect on the development of asthma. Maternal diets with higher vitamin D, vitamin E, or/and probiotics are related to asthma prevention. Infants with breast feeding for at least 4 months and/or complementary diets between 4 and 6 months may have regulatory effects on the prevention of asthma. In summary, diets may have epigenetic or immune regulatory effects on the promotion or prevention of asthma. This article analyzes recent reports on the potential mechanism and mechanism-driven early prevention of childhood asthma by modification of maternal and infant diets. Copyright © 2012, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.


Tsai K.-N.,Academia Sinica, Taiwan | Tsai K.-N.,Show Chwan Health Care System | Lin S.-H.,Academia Sinica, Taiwan | Liu W.-C.,Academia Sinica, Taiwan | Wang D.,Academia Sinica, Taiwan
BMC Systems Biology | Year: 2015

Background: Microbial interactions are ubiquitous in nature. Recently, many similarity-based approaches have been developed to study the interaction in microbial ecosystems. These approaches can only explain the non-directional interactions yet a more complete view on how microbes regulate each other remains elusive. In addition, the strength of microbial interactions is difficult to be quantified by only using correlation analysis. Results: In this study, a rule-based microbial network (RMN) algorithm, which integrates regulatory OTU-triplet model with parametric weighting function, is being developed to construct microbial regulatory networks. The RMN algorithm not only can extrapolate the cooperative and competitive relationships between microbes, but also can infer the direction of such interactions. In addition, RMN algorithm can theoretically characterize the regulatory relationship composed of microbial pairs with low correlation coefficient in microbial networks. Our results suggested that Bifidobacterium, Streptococcus, Clostridium XI, and Bacteroides are essential for causing abundance changes of Veillonella in gut microbiome. Furthermore, we inferred some possible microbial interactions, including the competitive relationship between Veillonella and Bacteroides, and the cooperative relationship between Veillonella and Clostridium XI. Conclusions: The RMN algorithm provides the reconstruction of gut microbe networks, and can shed light on the dynamical interactions of microbes in the infant intestinal tract. © 2015 Tsai et al.


Chen R.-F.,Show Chwan Health Care System | Wang L.,Chang Gung University | Cheng J.-T.,National Sun Yat - sen University | Yang K.D.,Show Chwan Health Care System
BMC Infectious Diseases | Year: 2012

Background: Appropriate induction of the early Th1 cytokine IL-12 is a critical defense directed against viral infection. We have previously shown that different viruses elicited either IL-12 or IFNα dependent Th1 reactions. Using dengue-2 virus, we sought to explore how dengue-2 induced IL-12 or IFNα expression by monocytic and its derived dendritic cells.Methods: We employed human monocytic cell line, THP-1, to investigate whether differentiation of monocytic cells is involved in the switch between IFNα and IL-12 induction. Flow cytometry, RT-PCR and ELISA were respectively used to determine cell differentiation, IL-12 and IFNα mRNA expression and protein production.Results: THP-1, expressing CD123, which is a plasmacytoid dendritic cell marker, but not CD14, CD11b or CD11c revealed IFNα mRNA expression while stimulated by dengue-2. In contrast, PMA-induced THP-1 differentiation toward monocytic cells expressed CD11b+, and CD14+, but not CD123, and revealed exclusively IL-12 expression while stimulated by dengue-2. Further studies showed that CD123+expressing THP-1 cells elicited higher IFNα expression in dose and time dependent induction after infection, and PMA-induced monocytic differentiation of THP-1 cells revealed IL-12 expression. Antibody-dependent enhancement of DEN-2 infection significantly suppressed the DEN-2 induced IL-12 p40 expression in monocytic differentiated THP-1 cells.Conclusions: Clarification and modulation of the early Th1 reaction in different monocytic cells may change or prevent complication from dengue infection. © 2012 Chen et al.; licensee BioMed Central Ltd.


PubMed | Show Chwan Health Care System
Type: Journal Article | Journal: International reviews of immunology | Year: 2014

Adenovirus is a common infectious pathogen in both children and adults. It is a significant cause of morbidity in immunocompetent people living in crowded living conditions and of mortality in immunocompromised hosts. It has more recently become a popular vehicle for gene therapy applications. The host response to wild-type infection and gene therapy vector exposure involves both virus entry receptor and the innate immune systems. Cell-mediated recognition of viruses via capsid components has received significant attention, principally thought to be regulated by the coxsackievirus-adenovirus receptor (CAR), CD46, integrins and heparin sulfate-containing proteoglycans. Antiviral innate immune responses are initiated by the infected cell, which activates the interferon response to block viral replication, while simultaneously releasing chemokines to attract neutrophils and NK cells. This review discusses the innate immune response primarily during wild-type adenovirus infection because this serves as the basis for understanding the response during both natural infection and exposure to adenovirus vectors.

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