Besides massive body weight loss, laparoscopic sleeve gastrectomy (LSG) causes massive lean mass, including fat-free mass (FFM) and skeletal muscle mass (SM) that present higher metabolic rates in males. This study examines sex... more
Besides massive body weight loss, laparoscopic sleeve gastrectomy (LSG) causes massive lean mass, including fat-free mass (FFM) and skeletal muscle mass (SM) that present higher metabolic rates in males. This study examines sex differences in FFM and SM changes of type 2 diabetes (T2D) remission at 12 months post-LSG. This cohort study recruited 119 patients (53.7% females) with T2D and obesity (body mass index 42.2 ± 7.0 kg/m2) who underwent LSG. Fat-mass (FM) loss was higher in males than in females (−12.8 ± 6.2% vs. −9.9 ± 5.0%, p = 0.02) after one-year post-operation. Regardless of the weight-loss difference, males had higher FFM and SM gain than did females (12.8 ± 8.0 vs. 9.9 ± 5.0% p = 0.02 and 6.5 ± 4.3% vs. 4.9 ± 6.2%, p = 0.03, respectively). Positive correlations of triglyceride reduction with FM loss (r = 0.47, p = 0.01) and SM gain (r = 0.44, p = 0.02) over 12 months post-operation were observed in males who achieved T2D remission. The T2D remission rate significantly i...
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Extracellular matrix (ECM) hydrogel can create a favorable regenerative microenvironment and act as a promising dressing for accelerating the healing of diabetic wound. In this study, a simple and effective decellularization technique was... more
Extracellular matrix (ECM) hydrogel can create a favorable regenerative microenvironment and act as a promising dressing for accelerating the healing of diabetic wound. In this study, a simple and effective decellularization technique was developed and optimized to obtain acellular extracellular matrix (aECM) from porcine skin. It was found that decellularization at 30% formic acid for 72 h effectively decellularized porcine skin while retaining >75% collagen and ~37% GAG in the aECM with no presence of nuclei of cellular remnants. aECM hydrogel was fabricated by digesting aECM with pepsin in various acidic solutions (0.1 N HCl, glycolic acid (GA) and 2-pyrrolidone-5-carboxylic acid (PCA)) and then treated with a pH-controlled neutralization and temperature-controlled gelation procedure. Based on physical characterizations, including SDS-PAGE, rheological analysis and SEM analysis, aECMHCl hydrogels fabricated at 25 mg/mL in 0.1 N HCl were selected. Four polymeric ECM-mimic hydro...
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Background: Insulin resistance (IR), considered a hallmark of diabetes at the cellular level, is implicated in pre-diabetes, results in type 2 diabetes, and negatively affects mitochondrial function. Diabetes is increasingly associated... more
Background: Insulin resistance (IR), considered a hallmark of diabetes at the cellular level, is implicated in pre-diabetes, results in type 2 diabetes, and negatively affects mitochondrial function. Diabetes is increasingly associated with enhanced risk of developing Parkinson’s disease (PD); however, the underlying mechanism remains unclear. This study investigated the probable culpability of IR in the pathogenesis of PD. Methods: Using MitoPark mice in vivo models, diabetes was induced by a high-fat diet in the in vivo models, and IR was induced by protracted pulse-stimulation with 100 nM insulin treatment of neuronal cells, in vitro to determine the molecular mechanism(s) underlying altered cellular functions in PD, including mitochondrial dysfunction and α-synuclein (SNCA) aberrant expression. Findings: We observed increased SNCA expression in the dopaminergic (DA) neurons of both the wild-type and diabetic MitoPark mice, coupled with enhanced degeneration of DA neurons in the ...
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In recent decades, the decellularized extracellular matrix (ECM) has shown potential as a promising scaffold for tissue regeneration. In this study, an organic acid decellularized lymph node (dLN) was developed as a carrier for dendritic... more
In recent decades, the decellularized extracellular matrix (ECM) has shown potential as a promising scaffold for tissue regeneration. In this study, an organic acid decellularized lymph node (dLN) was developed as a carrier for dendritic cells (DCs) to induce antitumor immunity. The dLNs were prepared by formic acid, acetic acid, or citric acid treatment. The results showed highly efficient removal of cell debris from the lymph node and great preservation of ECM architecture and biomolecules. In addition, bone marrow dendritic cells (BMDCs) grown preferably inside the dLN displayed the maturation markers CD80, CD86, and major histocompatibility complex (MHC)-II, and they produced high levels of interleukin (IL)-1β, IL-6, and IL-12 cytokines when stimulated with ovalbumin (OVA) and CpG oligodeoxynucleotides (CPG-ODN). In an animal model, the BMDC-dLN completely rejected the E.G7-OVA tumor. Furthermore, the splenocytes from BMDC-dLN-immunized mice produced more interferon gamma, IL-4,...
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Obesity is a pandemic health problem. Bariatric surgery is the only efficient method for long-term effective weight loss in subjects with severe obesity. Laparoscopic adjustable gastric banding (LAGB) has been widely applied for weight... more
Obesity is a pandemic health problem. Bariatric surgery is the only efficient method for long-term effective weight loss in subjects with severe obesity. Laparoscopic adjustable gastric banding (LAGB) has been widely applied for weight loss. However, a novel technique called laparoscopic adjustable gastric banded plication (LAGBP) has been proposed as an alternative to LAGB. Surgeons generally consider LAGBP to have a relative advantage on weight loss than that derived from LAGB. This initial study applied various biostatistical models and considered a relative longer observation period to compare the effects of LAGB and LAGBP. A total of 340 obese patients (290 who underwent LAGB and 50 who underwent LAGBP) with a body mass index of ≥35 kg/m and ages 20 to 55 y were recruited from the Division of General Surgery, Taipei Medical University Hospital in Taipei, Taiwan and observed for 24 to 36 mo postoperatively. Both surgical procedures resulted in significant weight loss, ameliorati...
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To assess the reduction of 6 and 12 months postoperatively of Framingham risk score in morbidly obese patients with laparoscopic sleeve gastrectomy (LSG). In total, 870 morbid obesity patients received LSG in Taipei Medical University... more
To assess the reduction of 6 and 12 months postoperatively of Framingham risk score in morbidly obese patients with laparoscopic sleeve gastrectomy (LSG). In total, 870 morbid obesity patients received LSG in Taipei Medical University Hospital from June 2007 to June 2014 were retrospectively studied preoperatively, 6 and 12 months after surgery. The coronary heart disease risk was calculated using Framingham risk score. The body mass index in men and women decreased from 43.3 ± 6.9, 39.2 ± 6.0 kg/m preoperatively to 32.9 ± 6.7, 31.0 ± 5.2 kg/m and to 30.4 ± 5.6 , 28.2 ± 4.7 kg/m, respectively, at 6 and 12 months after surgery (P < 0.0001). At 6 and 12 months after LSG, there was a marked improvement on lipid profile as well as a significant decline in the prevalence of diabetes mellitus, systemic hypertension, and smoking. The Framingham risk score in men and women reduced from 3.2 ± 5.7, 6.1 ± 5.7 preoperatively to 1.4 ± 5.9, 3.3 ± 5.9 and 0.1 ± 6.2, 2.8 ± 6.1, respectively, at ...
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Paclitaxel is a standard-of-care chemotherapy for breast cancer, despite the increasing recognition of its poor effectiveness in the treatment of patients with advanced disease. Here, we report that adenovirus-type 5 E1A-mediated... more
Paclitaxel is a standard-of-care chemotherapy for breast cancer, despite the increasing recognition of its poor effectiveness in the treatment of patients with advanced disease. Here, we report that adenovirus-type 5 E1A-mediated elevation of the miRNA-processing enzyme Dicer is sufficient to enhance paclitaxel sensitization and reduce cancer stem-like cell properties in this setting. Elevating Dicer expression increased levels of the AXL kinase targeting miRNA miR-494, thereby repressing AXL expression to increase paclitaxel sensitivity. We found that Dicer expression was regulated at the transcription level by E1A, through activation of an MAPK14/CEBPα pathway. Our findings define a mechanism of E1A-mediated chemosensitization for paclitaxel, which is based upon the suppression of breast cancer stem-like cells, with potential implications for the diagnosis and treatment of breast cancer patients. Cancer Res; 76(13); 3916-28. ©2016 AACR.
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Gastric bypass surgery is an effective and long-lasting treatment of morbidly obese patients. However, the bypass limb may need to be tailored in morbidly obese patients with a wide range of obesity. The aim of the present study was to... more
Gastric bypass surgery is an effective and long-lasting treatment of morbidly obese patients. However, the bypass limb may need to be tailored in morbidly obese patients with a wide range of obesity. The aim of the present study was to report clinical result of tailored bypass limb in a group of patients receiving laparoscopic mini-gastric bypass surgery. From Jan 2002 to Dec 2006, laparoscopic mini-gastric bypass was performed in 644 patients [469 women, 175 men: mean age 30.5 +/- 8.1 years; mean body mass index (BMI) 43.1 +/- 6.0] in our department. The gastric bypass limb was tailored according to the preoperative BMI. The clinical data and outcomes were analyzed. All the clinical data were prospectively collected and stored. Two hundred eighty-six patients belonged to lower BMI (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 40; mean 36.0), 286 patients moderate BMI (BMI 40-50; mean 43.2), and 72 patients higher BMI (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 50; mean 55.4). All procedures were completed laparoscopically. Mean operative time was 130 min, and mean hospital stay was 5.0 days. Twenty-three minor early complications (4.3%) and 13 major complications (2.0%) were encountered, with one death occurred (0.016%). There was no significant difference in operation time and complication rate between the groups. The mean bypass limb was 150 cm for the lower BMI group, 250 cm for moderate BMI group, and 350 cm for the higher BMI group. The mean BMI reduction 2 years after surgery was 10.7, 15.5, and 23.3 for the lower, moderate, and higher BMI group. The weight loss curves and resolution of obesity related comorbidities were compatible with the tailored bypass limbs between the groups. However, the lower BMI patients had more severe anemia than the other two groups. Morbidly obese patients receiving gastric bypass surgery may need to tailor the bypass limb according to BMI. The application of gastric bypass in lower BMI patients should be more carefully.
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Research Interests: Bariatric Surgery, Biopsy, Humans, Blood Glucose, Liver, and 15 moreFemale, Male, Alkaline phosphatase, Obesity Surgery, Clinical Sciences, Middle Aged, Fatty Liver, Adult, Morbid Obesity, Liver Disease, Laparoscopy, Chronic Liver Disease, non alcoholic fatty liver disease, Diagnostic Tool, and Liver biopsy
Gastrojejunostomy through laparotomy is a traditional procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. However, patients face pain and high rates of morbidity and... more
Gastrojejunostomy through laparotomy is a traditional procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. However, patients face pain and high rates of morbidity and mortality after this operation. We present two cases of gastrojejunostomy for unresectable and obstructing gastric antral cancer using a double scope technique. The operative time was approximately 90 minutes for each patient, and the postoperative hospital stays were 9 and 10 days, respectively. Operative results were good. Vomiting was relieved. There were no delays in gastric emptying. No recurrence of gastric outlet obstruction was noted in the first patient, who died 9 months postoperatively. The second patient survived without this problem 6 months postoperatively. Palliative gastrojejunostomy via the double scope technique is a safe and effective minimally invasive procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. It also provides accurate staging of the disease perioperatively. It should be considered the surgical choice for geriatric patients when clinically appropriate.
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Research Interests: Ion Channels, Gene Prediction, Humans, Female, Male, and 15 moreGene, Body Mass Index, Gastric banding, Obesity Surgery, Clinical Sciences, Middle Aged, Adult, Morbid Obesity, Gastric Bypass, Case Control Study, Genetic Susceptibility, Laparoscopy, Case Control Studies, Cohort Studies, and Mitochondrial Proteins
Single incision laparoscopic cholecystectomy (SILC) is a rapidly evolving field because of the reduced incisional morbidity, better cosmetic result, shorter hospital stay, and quicker return to activity. We report a technique and... more
Single incision laparoscopic cholecystectomy (SILC) is a rapidly evolving field because of the reduced incisional morbidity, better cosmetic result, shorter hospital stay, and quicker return to activity. We report a technique and retrospectively reviewed our initial experience on SILC. To evaluate the feasibility and safety of the SILC using standard laparoscopic instruments and complying with the conventional surgical principle and technique of minimally invasive cholecystectomy. From October 2008 to March 2009, 40 patients underwent SILC for the treatment of cholelithiasis at Taipei Medical University Hospital, Taipei, Taiwan. All these patients scheduled for an elective surgery underwent clinical evaluation and appropriate investigations. The exclusion criteria for SILC were acute cholecystitis, concomitant common bile duct stone, obstructive jaundice, previous upper abdominal surgery, and body mass index greater than 35 kg/m. The operation was completed laparoscopically through single 1.5 cm subumbilical incision, through which 3 separate fascitomies were made in triangular form and introduced three 5 mm trocars. A 5-mm 30-degree laparoscope was inserted through the trocar for visualization of the target area. A 5-mm clip was applied to ligate the cystic duct and artery through the others 2 ports alternatively after dissection. Finally, the gallbladder was taken out through the umbilicus and the fascial defect was closed with a direct suturing technique. SILC was performed in 40 patients, 22 (55%) females and 18 (45%) males with a mean age of 46.9+/-10.9 years (range: 28 to 76 y), the mean operative time was 54+/-21.2 minutes (range: 30 to 125 min), and the mean hospital stay was 1.85+/-0.72 days (range: 1.0 to 2.5 d); the mean dosage of the meperidine hydrochloride (Pethidine) was 0.23+/-0.4 mg/kg, the mean pain intensity (Universal Pain Assessment Tool) is mild at 8 hours after surgery, and no pain at 24 hours, the conversion rate for additional incision was 5% (2 of 40).There was no perioperative and postoperative complication. There was no mortality in this study. The results of our initial experience in SILC showed that it is technically feasible and safe. No additional incisions were used and virtually no scar remained. The established procedure shows that initially learning curve by experienced and well-trained team can be easily overcome by reduced operative duration, postoperative complications, and conversion rate.
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Research Interests: Bariatric Surgery, Obesity, Treatment Outcome, Laparoscopic Surgery, Adipose tissue, and 15 moreHumans, Weight Loss, Female, Male, Obesity Surgery, Clinical Sciences, Adult, Central Obesity, Morbid Obesity, Controlled Clinical Trial, Gastric Bypass, Blood Loss, Laparoscopy, Adverse effect, and Waist Hip Ratio
Background and purpose: The inverse relation between life expectancy and obesity is in large part due to multiple metabolic and cardiovascular comorbidities. Metabolic syndrome (MS) is defined as a cluster of these comorbidities. The... more
Background and purpose: The inverse relation between life expectancy and obesity is in large part due to multiple metabolic and cardiovascular comorbidities. Metabolic syndrome (MS) is defined as a cluster of these comorbidities. The prevalence of MS in obesity is not clear. This investigation assessed the prevalence and inter-relationships of MS with various demographic and clinical characteristics in patients with severe obesity. Methods: A total of 534 obese patients referred to a surgical center for weight reduction surgery were included in this retrospective study. Data collected included blood pressure, anthropometric measurements, and biochemical parameters associated with metabolic comorbidities and MS. The prevalence of MS in various subgroups was analyzed. Results: The frequency of metabolic comorbidities included hypertension in 29.8%, hyperglycemia in 29.0%, hyperlipidemia in 61.0%, hyperuricemia in 57.9%, and abnormal liver function in 60.9%. The presence of any of these 4 metabolic comorbidities in the absence of others was uncommon. Only 28 patients (5.2%) had no metabolic comorbidities. The criteria for MS were met by 217 patients (50.7%). Patients with MS were significantly older (32.9 years vs 29.5 years), more likely to be male (31.9% vs 20.5%) and more likely to have metabolic comorbidities compared with patients without MS. In the multivariate analysis, male gender, age, and abnormal liver function remained significantly associated with the development of MS, while body mass index (BMI) was not. Conclusions: Metabolic comorbidities were common in the obese patients referred for weight reduction surgery. The cluster of metabolic comorbidities in MS was significantly associated with male gender, and increased age but not with BMI.
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In children, neuroblastomas are the most common and deadly solid tumor. Our previous study showed that honokiol, a small-molecule polyphenol, can traverse the blood-brain barrier and kill neuroblastoma cells. In this study, we further... more
In children, neuroblastomas are the most common and deadly solid tumor. Our previous study showed that honokiol, a small-molecule polyphenol, can traverse the blood-brain barrier and kill neuroblastoma cells. In this study, we further investigated the mechanisms of honokiol-induced insults to neuroblastoma cells. Treatment of neuroblastoma neuro-2a cells with honokiol elevated levels of microtubule-associated protein light chain 3 (LC3)-II and induced cell autophagy in time- and concentration-dependent manners. Interestingly, pretreatment with 3-methyladenine (3-MA), an inhibitor of autophagy, led to the simultaneous attenuation of honokiol-induced cell autophagy and apoptosis but did not influence cell necrosis. As to the mechanisms, exposure of neuro-2a cells to honokiol time-dependently decreased amounts of phosphatidylinositol 3-kinase (PI3K). Sequentially, honokiol downregulated phosphorylation of protein kinase B (Akt) and mammalian target of rapamycin (mTOR) in neuro-2a cells...
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Thrombomodulin (TM), a natural anticoagulation factor, maintains circulation homeostasis in endothelial cells. TM has additional roles in modulating inflammation, thrombosis, and carcinogenesis. However, there is little information on the... more
Thrombomodulin (TM), a natural anticoagulation factor, maintains circulation homeostasis in endothelial cells. TM has additional roles in modulating inflammation, thrombosis, and carcinogenesis. However, there is little information on the role of TM in the progression and metastasis of ovarian cancer. RNA silencing and cDNA expression vectors were used to manipulate target gene expression in ovarian cancer cells. Cell growth and migration were evaluated by an MTT assay, a wound-healing migration assay, a transwell migration assay, and a biosensor system. In this study, we found that TM silencing may enhance the growth rate of cells. The migratory ability of ovarian cancer cells was enhanced dramatically after TM silencing. TM overexpression in ovarian cells suppressed the proliferation and migration capability. Furthermore, we found that skov-3 cells treated with TM shRNA expressed high levels of fibronectin and vimentin and that the expression of these markers correlated positively...
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Micro (mi) RNAs have been found to play an important role in the regulation of adipogenesis and insulin sensitivity. However, associations between miRNA and insulin signalling-related gene expressions in abdominal adipose tissues in obese... more
Micro (mi) RNAs have been found to play an important role in the regulation of adipogenesis and insulin sensitivity. However, associations between miRNA and insulin signalling-related gene expressions in abdominal adipose tissues in obese subjects remain unclear. We used a microarray platform to screen miRNA expressions in abdominal adipose tissues between genders in severely obese subjects and found that the top-ranking miRNA in abdominal omental adipose tissues was miRNA-125a-3p. MicroR-125a-3p and insulin signalling-related gene expressions in abdominal omental adipose tissues of all subjects (11 men and 10 women) were subsequently quantified by a real-time PCR. Also, associations of miR-125a-3p with insulin signalling-related gene expression and biochemical markers in obese subjects were analyzed by a linear regression analysis. miR-125a-3p expressed by abdominal omental adipose tissues was much higher in obese men than women. No gender difference was observed in abdominal subcu...
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Hepatic progenitor cells (HPCs) activation, proliferative ductular reaction (DR), replicative arrest and Notch signaling have been demonstrated in a variety of human liver diseases. The relationships are poorly understood in morbid... more
Hepatic progenitor cells (HPCs) activation, proliferative ductular reaction (DR), replicative arrest and Notch signaling have been demonstrated in a variety of human liver diseases. The relationships are poorly understood in morbid obesity. We investigated factors responsible for the HPCs/DR, replicative arrest and Notch signaling in non-NASH and NASH groups. Cytokeratin 7 (and 19), p21, CD34, Ki67 and different Notch receptors and ligands immunohistochemical stained biopsies from morbid obese patients with non-NASH (n=10) and NASH (n=25) were studied. These results were correlated with clinicopathological variables. NASH patients presented with abnormal liver function tests and had higher HbA1c percentage. Strong association between HPCs and DR was seen (r=0.785, p<0.000). BMI, interface activity and replicative arrest were associated with HPCs expansion and DR in NASH patients. A strong association between CD34 with HPCs and DR was found in non-NASH patients. In NASH group, Not...
Research Interests: Immunohistochemistry, Adolescent, Linear models, Biopsy, Signal Transduction, and 15 moreHumans, Liver, Female, Male, Clinical Sciences, Fatty Liver, Adult, Biological markers, Cell cycle checkpoints, Chi Square Distribution, Cell Proliferation, Liver function tests, Kupffer cells, Case Control Studies, and non alcoholic fatty liver disease
Our aim was to investigate whether appendix diameter is an independent risk factor for wound infection in laparoscopic appendectomy (LA). Patients who underwent LA (n = 582) were grouped into those with wound infections and those without.... more
Our aim was to investigate whether appendix diameter is an independent risk factor for wound infection in laparoscopic appendectomy (LA). Patients who underwent LA (n = 582) were grouped into those with wound infections and those without. Possible factors associated with wound infection were analyzed using univariate and multivariate logistic regression analysis. When the diameter of the appendix was greater than 15 mm, patients were 2.32 times as likely to have a wound infection (95% CI, 1.02 to 5.29; P = 0.045) than if the appendix was less than 10 mm in diameter. Patients with perforated appendices were 2.51 times as likely to have a wound infection (95% CI, 1.25 to 5.02; P = 0.010) than if the appendix was not perforated. Wound infection was associated with longer operation time, return to oral intake, and hospital stay. Appendix diameter may predict postoperative wound infection after laparoscopic appendectomy.
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Single incision laparoscopic cholecystectomy (SILC) is a rapidly evolving field because of the reduced incisional morbidity, better cosmetic result, shorter hospital stay, and quicker return to activity. We report a technique and... more
Single incision laparoscopic cholecystectomy (SILC) is a rapidly evolving field because of the reduced incisional morbidity, better cosmetic result, shorter hospital stay, and quicker return to activity. We report a technique and retrospectively reviewed our initial experience on SILC. To evaluate the feasibility and safety of the SILC using standard laparoscopic instruments and complying with the conventional surgical principle and technique of minimally invasive cholecystectomy. From October 2008 to March 2009, 40 patients underwent SILC for the treatment of cholelithiasis at Taipei Medical University Hospital, Taipei, Taiwan. All these patients scheduled for an elective surgery underwent clinical evaluation and appropriate investigations. The exclusion criteria for SILC were acute cholecystitis, concomitant common bile duct stone, obstructive jaundice, previous upper abdominal surgery, and body mass index greater than 35 kg/m. The operation was completed laparoscopically through ...
Research Interests:
Gastric cancer remains a leading cause of death worldwide. Post-operative complication is one important factor which causes mortality of gastric cancer patients after gastrectomy. Better prediction of post-operative complication before... more
Gastric cancer remains a leading cause of death worldwide. Post-operative complication is one important factor which causes mortality of gastric cancer patients after gastrectomy. Better prediction of post-operative complication before gastrectomy can significantly reduce post-operative mortality and morbidity. Therefore, 3 data mining techniques were applied in this study on improving prediction of post-operative complication. A retrospective study was performed on 521 patients from 3 over 2,000 acute-bed medical centers in Taiwan during February 2002 to October 2004. Pre- and post-operative clinical data were collected and analyzed by applying 3 data mining techniques, included Artificial Neural Networks (ANN), Decision Tree (DT) and Logistic Regression (LR). Results of this study indicated that ANN was a better technique than DT and LR in predicting post-operative complication. Nutritious status, pathological characteristics and operational characteristics were important predicto...
The inverse relation between life expectancy and obesity is in large part due to multiple metabolic and cardiovascular comorbidities. Metabolic syndrome (MS) is defined as a cluster of these comorbidities. The prevalence of MS in obesity... more
The inverse relation between life expectancy and obesity is in large part due to multiple metabolic and cardiovascular comorbidities. Metabolic syndrome (MS) is defined as a cluster of these comorbidities. The prevalence of MS in obesity is not clear. This investigation assessed the prevalence and inter-relationships of MS with various demographic and clinical characteristics in patients with severe obesity. A total of 534 obese patients referred to a surgical center for weight reduction surgery were included in this retrospective study. Data collected included blood pressure, anthropometric measurements, and biochemical parameters associated with metabolic comorbidities and MS. The prevalence of MS in various subgroups was analyzed. The frequency of metabolic comorbidities included hypertension in 29.8%, hyperglycemia in 29.0%, hyperlipidemia in 61.0%, hyperuricemia in 57.9%, and abnormal liver function in 60.9%. The presence of any of these 4 metabolic comorbidities in the absence...
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Nitric oxide (NO) has biphasic effects on regulating osteoblast survival and death. This study was aimed to evaluate the effects of NO pretreatment on hydrogen peroxide (HP)-induced insults of rat osteoblasts and the possible mechanisms.... more
Nitric oxide (NO) has biphasic effects on regulating osteoblast survival and death. This study was aimed to evaluate the effects of NO pretreatment on hydrogen peroxide (HP)-induced insults of rat osteoblasts and the possible mechanisms. Exposure of osteoblasts prepared from rat calvarias to HP significantly increased intracellular reactive oxygen species levels, decreased alkaline phosphatase activity and cell survival, and ultimately induced cell apoptosis. However, NO pretreatment lowered HP-induced oxidative stress and apoptotic insults. In parallel, HP increased Bax levels and its translocation from the cytoplasm to mitochondria. NO pretreatment caused significant attenuations in HP-induced modulations in Bax synthesis and translocation. In contrast, pretreatment with NO enhanced levels and translocation of antiapoptotic Bcl-XL protein in rat osteoblasts. RNA analyses further revealed that HP inhibited Bcl-XL mRNA expression without affecting Bax mRNA levels. In comparison, NO ...
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The aim of the study is to investigate the efficacy of different dosages of single bolus propofol administered on the basis of total body weight or corrected body weight for the intravenous induction of anesthesia in obese patients... more
The aim of the study is to investigate the efficacy of different dosages of single bolus propofol administered on the basis of total body weight or corrected body weight for the intravenous induction of anesthesia in obese patients undergoing bariatric surgery. Thirty-eight obese patients with a body mass index (BMI) of 30 kg/m(2) or greater were randomly divided into two groups. They received single-bolus propofol (2 mg/kg) for intravenous induction of anesthesia based on either total body weight (TBW; 20 patients) or corrected body weight 60% (CBW60; 18 patients). Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; characteristics, biochemical data, monitored bispectral index (BIS) values, and hemodynamic parameters were compared between the two groups. The propofol dose was significantly lower in the CBW60 group than in the TBW group (189.5 ± 36.3 mg vs. 217.3 ± 39.1 mg, respectively; p = 0.03). The highest BIS value, representing potential awareness after intubation, was relatively higher in the CBW60 group, but this difference was not statistically significant (CBW60 group, 53.6 ± 11.1; TBW group, 48.6 ± 8.1; p = 0.22). Eighty-three percent of patients experienced hypotension during induction and at least 44% patients showed marked hypotension. There was no significant difference between the TBW and CBW60 groups in blood pressure after intubation. When using single bolus propofol, the CBW60 group showed similar BIS values and hemodynamic effects as the TBW group during the intravenous induction of general anesthesia for obese patients.
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Intussusception seldom occurs naturally in adults, but is frequently found due to an underlying disease. We present the case of a 46-year-old man with the chief complaint of repeated abdominal cramping pain, especially in the right lower... more
Intussusception seldom occurs naturally in adults, but is frequently found due to an underlying disease. We present the case of a 46-year-old man with the chief complaint of repeated abdominal cramping pain, especially in the right lower quadrant, and diarrhea of 1 year&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s duration. Abdominal sonography and computed tomography showed ileocecal intussusception, and colonoscopy found one protruding tumor at the cecum. Biopsy of the tumor revealed malignant lymphoma cells. Due to persistent symptoms, fear of intestine obstruction caused by further intussusception, and the possibility of mesenteric vascular compression, the patient underwent laparoscopic right hemicolectomy before systemic chemotherapy. The symptoms were relieved successfully after surgery. We emphasize that the majority of adults with intussusception may have an underlying malignancy. The most important rule in treatment is avoidance of tumor emboli spread during manipulation. Therefore, a trial of reduction of the intussuscepted intestine should be prohibited.
Research Interests: Treatment Outcome, Risk assessment, Lymphoma, Humans, Male, and 11 moreIntussusception, Clinical Sciences, Middle Aged, Gastrointestinal Endoscopy, Prognosis, Internal medicine Doppler ultrasonography, Risk Assessment, Surgical, X ray Computed Tomography, Laparoscopy, and minimally invasive surgical procedures
Mini-laparoscopic appendectomy (mini-LA) can be performed safely and efficiently. It is the first treatment choice for patients with acute, uncomplicated appendicitis in our hospital. To evaluate the feasibility of mini-LA for simple and... more
Mini-laparoscopic appendectomy (mini-LA) can be performed safely and efficiently. It is the first treatment choice for patients with acute, uncomplicated appendicitis in our hospital. To evaluate the feasibility of mini-LA for simple and ruptured appendicitis in children, we retrospectively compared the outcomes between mini-LA and open appendectomy for appendicitis in children. From October 1998 to August 2000, the medical records of 585 patients with appendicitis were retrospectively reviewed. Children were defined as patients younger than 15 years of age. The percentage of mini-LA, operation time, time to first flatus passage, duration of hospital stay, and demand for intra-muscular pethidine injection were compared between the mini-LA and open appendectomy. The complications among simple and ruptured appendicitis and the cost of mini-LA and open appendectomy were also analyzed. The operation was performed with one infra-umbilical 10-mm incision, and pneumoperitoneum was established at 12 to 15 mm Hg. A 2-mm laparoscope was inserted via the supra-pubic port, and another 2-mm working port was set-up between the other two ports. Statistical testing using the Whitney-Mann U test and Fisher exact test was performed as appropriate. Of the 585 patients, there were 100 children. The youngest patient was 4 years of age and only 7 patients were younger than 5 years. Among children, 18% had a perforated appendix. Mini-LA accounted for 83% of appendectomies in the pediatric group, but it increased yearly (from 41.7% in 1998 to 92.5% in 2000). The operation time of mini-LA and open appendectomy were 57.32 minutes and 49.12 minutes. There was significant improvement in mini-LA from 1998 to 1999. Flatus passage, hospital stay, and pethidine use all favored the mini-LA. For pediatric appendicitis involving a ruptured appendix, postoperative ileus and length of hospital stay were significantly shortened in the mini-LA group. The postoperative complication was not significantly different between mini-LA and open appendicitis. Mini-LA can be safely performed in pediatric patients and it provides early postoperative recovery and short hospital stay. Even for a ruptured appendix, the mini-LA can be the treatment of choice in a well-equipped hospital with well-trained surgeons.
Research Interests: Nonparametric Statistics, Treatment Outcome, Risk assessment, Probability, Humans, and 14 moreChild, Female, Male, Follow-up studies, Clinical Sciences, Retrospective Studies, Age Factors, Risk Assessment, Appendectomy, Laparoscopy, Acute Disease, Child preschool, Appendicitis, and minimally invasive surgical procedures
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Triple-negative breast cancer (TNBC) is defined by reduced expression of the estrogen receptor, progesterone receptor, and HER2. TNBC is an especially aggressive group of breast cancers with poor prognosis. There are currently no... more
Triple-negative breast cancer (TNBC) is defined by reduced expression of the estrogen receptor, progesterone receptor, and HER2. TNBC is an especially aggressive group of breast cancers with poor prognosis. There are currently no validated molecular targets to effectively treat this disease. Thus, it is necessary to identify effective molecular targets and therapeutic strategies for TNBC patients. The expression of HSPA5 in patients with breast cancer was examined by immunohistochemistry. The association of HSPA5 expression with tumor grade and metastatic events in TNBC patients was analyzed using the Oncomine database. The knockdown and overexpression of HSPA5 protein were performed to investigate the effects on E1A-suppressed cell migration/invasion of TNBC using in vitro transwell assays and tumor growth/experimental metastasis studies in animal models. The expression of HSPA5 was positively correlated with high-grade tumors, metastatic events, and poor overall survival in breast cancer patients with TNBC. E1A-inhibited HSPA5 expression suppressed cell migration/invasive ability of TNBC cell lines. Moreover, E1A significantly abolished lung metastases from breast cancer cells by inhibiting HSPA5 expression in a xenograft tumor model. The overexpression of HSPA5 is critical for high-risk metastasis of breast cancer and TNBC. The results of our study suggest that HSPA5 may be a crucial mediator of E1A-suppressed metastatic ability of breast cancer cells. Thus, E1A may be a potential target for diagnosis and individualized treatment in clinical practice.
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Thrombomodulin (TM), a natural anticoagulation factor, maintains circulation homeostasis in endothelial cells. TM has additional roles in modulating inflammation, thrombosis, and carcinogenesis. However, there is little information on the... more
Thrombomodulin (TM), a natural anticoagulation factor, maintains circulation homeostasis in endothelial cells. TM has additional roles in modulating inflammation, thrombosis, and carcinogenesis. However, there is little information on the role of TM in the progression and metastasis of ovarian cancer. RNA silencing and cDNA expression vectors were used to manipulate target gene expression in ovarian cancer cells. Cell growth and migration were evaluated by an MTT assay, a wound-healing migration assay, a transwell migration assay, and a biosensor system. In this study, we found that TM silencing may enhance the growth rate of cells. The migratory ability of ovarian cancer cells was enhanced dramatically after TM silencing. TM overexpression in ovarian cells suppressed the proliferation and migration capability. Furthermore, we found that skov-3 cells treated with TM shRNA expressed high levels of fibronectin and vimentin and that the expression of these markers correlated positively with their migratory ability. Our results demonstrate that TM expression may regulate cell growth and migration in ovarian cancer cells. This finding suggests that TM may be a novel prognostic and therapeutic target for ovarian cancer.
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Thrombomodulin (TM) is highly expressed in endothelial cells and plays the key role in maintaining physical homeostasis. In addition, many pieces of evidence also show that TM contains the diagnostic value for malignant diseases. TM has... more
Thrombomodulin (TM) is highly expressed in endothelial cells and plays the key role in maintaining physical homeostasis. In addition, many pieces of evidence also show that TM contains the diagnostic value for malignant diseases. TM has been found to correlate with metastatic status in multiple cancers, but its role in prostate cancer progression remains unclear. TM expression was determined in prostate cancer cells (DU-145 and PC-3 cells) using real-time PCR and Western blotting. TM expression was manipulated in prostate cancer cells using TM-specific shRNA and an overexpression system. The proliferation, adhesion, and migratory ability of prostate cancer cells expressing various TM levels were determined using the x&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;Celligence biosensor system and a transwell migration assay. Higher levels of TM transcription and translation were found in DU-145 cells and were negatively correlated with the low migratory ability of DU-145 cells. After silencing TM expression in DU-145 cells, cell growth decreased, but cell adhesion and migration dramatically increased. TM overexpression in PC-3 cells reduced their metastatic ability. We investigated the possible mechanisms of this phenomenon and determined that the enhanced cell migration was mediated through the expression of E-cadherin and vimentin. TM may be a modulator of hormone-independent prostate cancer (HIPC) metastasis. The downregulation of TM expression enhanced the migratory ability of these cells via an increase in vimentin expression and a decrease in E-cadherin expression.
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MicroRNAs (miRNAs) play an essential role in regulating gene expression in normal and malignant cells. Expression of the microRNA-200 (miR-200) family has been correlated with malignancy in cancers. However, whether miR-200a/b plays a... more
MicroRNAs (miRNAs) play an essential role in regulating gene expression in normal and malignant cells. Expression of the microRNA-200 (miR-200) family has been correlated with malignancy in cancers. However, whether miR-200a/b plays a role in curcumin-mediated treatment of hepatocellular carcinoma (HCC) is unknown. We performed miRNA array analyses in two different HCC cell lines (HepG2 and HepJ5). The expression patterns of miR-200 family members were assessed with real-time PCR. We overexpressed miR-200 family members using a lentiviral system and selected stably transduced clones with antibiotics. The anticancer effects of curcumin on J5-200a, J5-200b, and J5-control cells were assessed by MTT assay, flow cytometry cell cycle analysis, and TUNEL assay. We found that HepG2 cells, which were more resistant to curcumin treatment than HepJ5 cells, expressed higher levels of miR-200a/b. The MTT assay revealed that the overexpression of miR-200a/b in HepJ5 cells conferred enhanced resistance to curcumin treatment compared with the control cells. By cell cycle analysis and TUNEL assay, we found that apoptosis was increased dramatically in J5-control cells compared with J5-200a and J5-200b cells after curcumin treatment. Finally, we evaluated the levels of Bcl-2, Bax, and Bad, and found a decrease of Bcl-2 levels and increase of Bad levels in the J5-control cells treated with curcumin. The expression levels of miR-200a/b might determine the therapeutic efficacy of curcumin on HCC cells.
Research Interests:
Laparoscopically assisted distal gastrectomy has been used for distal part early gastric cancer resection. However, use of totally laparoscopic gastric cancer resection remains limited because of technical problems, especially when... more
Laparoscopically assisted distal gastrectomy has been used for distal part early gastric cancer resection. However, use of totally laparoscopic gastric cancer resection remains limited because of technical problems, especially when standard D2 nodal dissection was applied. We had reported the first totally laparoscopic Billroth II (BII) subtotal gastrectomy with lymphadenectomy for early gastric cancer in the year 1998. The aim of this study is to determine whether this procedure is superior to conventional open technique. The clinical course of 34 consecutive patients who underwent totally laparoscopic BII gastrectomy using an upper to lower, right to left, and clockwise quadrant-to-quadrant technique was compared with 34 sex-matched and age-matched patients who underwent open gastrectomy. Main outcome measures included operative time, blood loss, length of stay, morbidity and mortality, adequacy of lymphadenectomy, and long-term outcome. In the laparoscopic group, all the operations were completed by laparoscopic technique, but 1 patient required secondary laparotomy for total gastrectomy owing to inadequate resection margin. There was no operation mortality in this study. The postoperative complication rates were similar in these 2 groups. The mean operative time for laparoscopic group was 283+/-122 minutes (range: 186 to 480 min), significantly longer than the 195+/-26 minutes in the conventional group (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Laparoscopic group was associated with less intraoperative blood loss (74 vs. 190 mL; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), early flatus passage (2.9 vs. 4.9 d; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), less usage of analgesics (3.5 vs. 5.8 doses; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05), and a shorter postoperative hospital stay (8.5 vs. 12.1 d; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). There was no significant difference between laparoscopic and conventional open radical gastrectomy with regard to ratio of free margin, number of harvested lymph nodes, and survival. Although totally laparoscopic BII gastrectomy using the upper to lower technique required a longer surgical time and was technically more demanding than conventional open surgery, it resulted in shorter recovery time, less analgesic use, and less severe physical discomfort without compromising the operative curability and oncologic outcomes.
Research Interests:
Research Interests: Quality of life, Treatment Outcome, Humans, Old Age, Female, and 15 moreMale, Young Adult, Length of Stay, Clinical Sciences, Aged, Middle Aged, Questionnaires, Adult, Retrospective Studies, Indexation, Laparoscopy, Gastroesophageal Reflux, Gastroesophageal Reflux Disease, Elderly patient, and fundoplication
To report our experience of performing laparoscopic drainage of liver abscesses in patients who failed to respond to conservative treatment. We retrospectively compared the results and complications of 18 patients who underwent... more
To report our experience of performing laparoscopic drainage of liver abscesses in patients who failed to respond to conservative treatment. We retrospectively compared the results and complications of 18 patients who underwent laparoscopic liver abscess drainage with those of 5 patients who underwent open drainage between June 1999 and October 2002. The operation times were shorter and oral intake was recommenced earlier in the laparoscopic group, which also tended to have less blood loss and shorter hospitalization. One case of recurrence, which developed 1 month postoperatively, was successfully treated with percutaneous drainage. There was no mortality in either group. Laparoscopic drainage of liver abscesses, combined with intravenous antibiotics, is a safe alternative for patients requiring surgical drainage when medical treatment has failed.
Research Interests:
Hyperuricemia is associated with obesity. Few studies have reported the effects of different types of bariatric surgery on uric acid metabolism. The aim of our study was to determine the relationships between serum uric acid reduction and... more
Hyperuricemia is associated with obesity. Few studies have reported the effects of different types of bariatric surgery on uric acid metabolism. The aim of our study was to determine the relationships between serum uric acid reduction and estrogen receptor-α (ESR1) gene polymorphism, as well as the type of bariatric surgery received. The potential physiological pathways involved in postsurgery serum uric acid reduction were also discussed. A total of 508 severely obese Han Chinese patients, aged 20 to 50 years, with a body mass index (BMI)≥35 kg/m(2) were selected. Patients received either laparoscopic adjustable gastric banding (LAGB; n = 164) or laparoscopic mini-gastric bypass (LMGB; n = 344). A 12-month follow-up was performed to explore the effects of the type of bariatric surgery and ESR1 polymorphism on serum uric acid reduction. The rs712221 polymorphism of ESR1 affects serum uric acid reduction after bariatric surgery. The LMGB group exhibited a greater reduction in serum uric acid level compared with the LAGB counterpart after adjusting for sex, age, and metabolic confounders (-2.3 ± 2.1 mg/dL versus-1.2 ± 1.1 mg/dL; P = .002). Patients with the rs712221 genotype exhibited better glycemic control and a greater serum uric acid reduction at 12 months after surgery. The effects of the rs712221 polymorphism in LMGB patients resulted in the greatest serum uric acid reduction (-2.7 ± 1.4 mg/dL). For severely obese Han Chinese patients, bariatric surgery appears to reduce serum uric acid levels, potentially mediated by synergic effects of surgery type, BMI reduction, rs712221 locus, insulin sensitivity, and changed dietary factors via an unknown mechanism.
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Research Interests:
This study investigated the impacts of two different bariatric surgeries on the body composition of morbidly obese patients in Taiwan. Also, the differences in body composition changes between genders were compared. In total, 198 patients... more
This study investigated the impacts of two different bariatric surgeries on the body composition of morbidly obese patients in Taiwan. Also, the differences in body composition changes between genders were compared. In total, 198 patients who underwent bariatric surgery were included, with 130 receiving a sleeve gastrectomy (SG) and 68 receiving adjusted gastric banding (AGB). The weight and body composition were measured by bioelectrical impedance. Follow-up examinations were performed at subsequent visits after surgery and at 1 year. Only 81 SG and 40 AGB patients continued follow-up for the entire 12 months. All patients experienced significant weight loss beginning from 3 months after surgery. Compared to patients with AGB, SG patients had a greater extent of body mass index (BMI) loss, whereas a greater muscle weight percentage increase was found compared to AGB patients. Female patients had a higher body fat mass and lower muscle weight percentage and BMI than did males. There were no differences in changes in BMI, or percentages of body fat and muscle mass between male and female patients for 12 months after surgery. However, the waist/hip ratio (WHR) decrement and percentage of excess weight loss (ExWL%) were significantly greater in female than male patients with both bariatric surgeries. These findings suggest that although females had greater extents of WHR decrement and ExWL% than male patients with both surgical procedures, patients who received SG had higher BMI changes and body fat losses than SGB patients regardless of differences in the gender distribution.
Research Interests: Adipose tissue, Humans, Weight Loss, Taiwan, Female, and 15 moreBody Composition, Male, Young Adult, Follow-up studies, Body Mass Index, Obesity Surgery, Clinical Sciences, Middle Aged, Adult, Morbidity, Public health systems and services research, Asian Continental Ancestry Group, Weight Gain, Electric Impedance, and Gastrectomy
Research Interests: Bariatric Surgery, Laparoscopic Surgery, Humans, Male, Gastric banding, and 14 moreObesity Surgery, Clinical Sciences, Intestinal Obstruction, Public health systems and services research, Retrospective Studies, Morbid Obesity, SURGICAL TECHNIQUE, Gastric Bypass, Abdominal Surgery, Hernia, Minimally Invasive, Laparoscopy, Surgical Instruments, and Postoperative Complications
Research Interests: Bariatric Surgery, Obesity, Treatment Outcome, Laparoscopic Surgery, Adipose tissue, and 15 moreHumans, Weight Loss, Female, Male, Obesity Surgery, Clinical Sciences, Adult, Central Obesity, Morbid Obesity, Controlled Clinical Trial, Gastric Bypass, Blood Loss, Laparoscopy, Adverse effect, and Waist Hip Ratio
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Research Interests: Bariatric Surgery, Biopsy, Humans, Blood Glucose, Liver, and 15 moreFemale, Male, Alkaline phosphatase, Obesity Surgery, Clinical Sciences, Middle Aged, Fatty Liver, Adult, Morbid Obesity, Liver Disease, Laparoscopy, Chronic Liver Disease, non alcoholic fatty liver disease, Diagnostic Tool, and Liver biopsy
Gastric bypass surgery is an effective and long-lasting treatment of morbidly obese patients. However, the bypass limb may need to be tailored in morbidly obese patients with a wide range of obesity. The aim of the present study was to... more
Gastric bypass surgery is an effective and long-lasting treatment of morbidly obese patients. However, the bypass limb may need to be tailored in morbidly obese patients with a wide range of obesity. The aim of the present study was to report clinical result of tailored bypass limb in a group of patients receiving laparoscopic mini-gastric bypass surgery. From Jan 2002 to Dec 2006, laparoscopic mini-gastric bypass was performed in 644 patients [469 women, 175 men: mean age 30.5 +/- 8.1 years; mean body mass index (BMI) 43.1 +/- 6.0] in our department. The gastric bypass limb was tailored according to the preoperative BMI. The clinical data and outcomes were analyzed. All the clinical data were prospectively collected and stored. Two hundred eighty-six patients belonged to lower BMI (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 40; mean 36.0), 286 patients moderate BMI (BMI 40-50; mean 43.2), and 72 patients higher BMI (BMI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 50; mean 55.4). All procedures were completed laparoscopically. Mean operative time was 130 min, and mean hospital stay was 5.0 days. Twenty-three minor early complications (4.3%) and 13 major complications (2.0%) were encountered, with one death occurred (0.016%). There was no significant difference in operation time and complication rate between the groups. The mean bypass limb was 150 cm for the lower BMI group, 250 cm for moderate BMI group, and 350 cm for the higher BMI group. The mean BMI reduction 2 years after surgery was 10.7, 15.5, and 23.3 for the lower, moderate, and higher BMI group. The weight loss curves and resolution of obesity related comorbidities were compatible with the tailored bypass limbs between the groups. However, the lower BMI patients had more severe anemia than the other two groups. Morbidly obese patients receiving gastric bypass surgery may need to tailor the bypass limb according to BMI. The application of gastric bypass in lower BMI patients should be more carefully.