Biomedical subjects

Yue-Cune Chang

Publications and source records attributed to Yue-Cune Chang.

32 records · Page 2Linked to original sources

PubMed2003

Prognostic prediction of the immunohistochemical expression of p53 and p16 in resected non-small cell lung cancer.

OBJECTIVE: p53 and p16(INK4) are the common and important tumor suppressor genes. Aberrant expression of p53 or p16 protein has been reported in various malignancies including lung cancer. Our aim was to investigate the association of p53 and p16 expression in resected non-small cell lung carcinoma (NSCLC) and evaluated their correlation with clinocopathologic features and survival. METHODS: p16 and p53 expression were detected by immunohistochemical analysis of 90 paraffin specimens of resected NSCLC, including 35 squamous cell carcinoma, 47 adenocarcinoma, and eight large cell carcinoma, between stages I and IV. The immunohistochemical study was performed using the labeled streptavidine-biotin method with anti-p53 and anti-p16 monoclonal antibodies. RESULTS: Fifty-two (57.8%) and 36 (40%) of 90 patients revealed aberrant immunostaining for p53 (p53+) and p16 (p16+), respectively. While 19 cases (21.1%) showed abnormal immunoreactivity for both p16 and p53. (p53+/p16+). There was no correlation of p53 or p16 expression with the clinicopathologic features. The Kaplan-Meier survival analysis demonstrated that patients with p16+, p53+, late stages, and nodal or distal metastasis had poor survival status (P = 0.006, 0.013, <0.001, <0.001 and 0.018, respectively). Further analysis demonstrated that p53 status was a significant prognostic factor in stage I NSCLCs (P < 0.001), and p16 status in stage I and II NSCLCs (P < 0.001, P = 0.003, respectively). Furthermore, patients whose tumors were both p53 and p16 aberrant expression had worse outcome compared with those whose tumors were both normal expression of p53 and p16 (5-year survival rate: 5 vs. 76%, P < 0.001). In Cox's regression model, the aberrant expression of p16, p53, advanced stages and combined aberrant expression of p53/p16 survived for a significant shorter period. CONCLUSIONS: The results indicated that aberrant expression of p16 and p53 are significant and independent, predictable prognostic factors for resected NSCLC, especially in early stage of NSCLCs. The worst prognosis was seen in patients whose tumors had both aberrant expression of p53 and p16. Further prospective trials may be aimed at confirming and validating these results.

Adult↗

PubMed2003

Neurourological changes before and after radical hysterectomy in patients with cervical cancer.

BACKGROUND: The severity of bladder dysfunction in patients receiving radical hysterectomy for cervical cancer has been related to the delicacy and the degree of radicality of the hysterectomy. Our goal was to evaluate the effect of modified radical hysterectomy on the storage and evacuation of the lower urinary tract. METHODS: In this prospective study, 18 patients underwent radical hysterectomy for cervical cancer with FIGO stages Ia, Ib and IIa. These patients participated in a pudendal motor nerve conduction study and a urodynamic study, including urethral pressure profile (UPP), cystometry (CMG) and uroflowmetry (UFR). These were carried out at preoperative baseline and at 2 weeks, 6 weeks, 3 months and 6 months following surgery. We used generalized linear models to evaluate, over time, the relationship between the different parameters marked in these profiles. RESULTS: The average pudendal nerve motor latency was prolonged at 2 and 6 weeks after surgery but recovered to baseline at 3 months postsurgery. Maximal urethral closing pressure revealed a tendency to decrease, and the CMG showed a significant increase in maximum intravesical filling pressure and a marked decrease in compliance throughout the investigative course. Increased residual urine volume and decreased uroflow rates were detected in a series of UFR. However, these values headed for baseline at 6 months after surgery. CONCLUSION: Transient neurological changes in the majority of our patients suggested that both somatic and autonomic demyelination with or without denervation might be responsible for the temporal changes in vesicourethral function after radical hysterectomy and recovery to baseline condition within 6 months.

Adult↗

PubMed2003

Treatment of centrally located hepatocellular carcinoma with central hepatectomy.

BACKGROUND: For treatment of centrally located hepatocellular carcinoma (HCC), central hepatectomy (including central trisegmentectomy [Couinaud's segments 4, 5, and 8] and anterior segmentectomy [Couinaud's segments 5 and 8]) may have an important advantage (ie, preservation of nontumorous parenchyma) over conventional lobectomy or extended lobectomy. For determination of the efficacy of this technique, we compared the outcomes of patients with HCC who underwent treatment with the central and conventional methods. PATIENTS AND METHODS: In our institute, 52 patients with HCC underwent treatment with central hepatectomy (group 1) and 63 patients with comparable tumor size underwent treatment with conventional major hepatectomy (group 2) from November 1993 to April 1999. Overall patient survival and disease-free survival rates were calculated and analyzed. The possible prognostic risk factors for patient and disease-free survival in group 1 were analyzed. RESULTS: Group 1 had comparable overall patient and disease-free survival rates with those of group 2. Vascular invasion, higher pathology grading, and resection margin less than 1 cm appeared to be the prognostic factors for overall patient survival, and vascular invasion was the only risk factor for disease-free survival. CONCLUSION: Central hepatectomy is a safe and effective operative procedure for the treatment of centrally located HCC. The patient and disease-free survival rates were the same as those of conventional major hepatectomy. Although it is technically more demanding, central hepatectomy preserves more nontumor liver parenchyma, which is important for the survival of those patients with liver cirrhosis.

Adult↗

PubMed2003

MR imaging of bone marrow edema and joint effusion in patients with osteonecrosis of the femoral head: relationship to pain.

OBJECTIVE: Our aim was to determine the occurrence of bone marrow edema and joint effusion and their relationship to pain in patients with osteonecrosis of the femoral head on the basis of MR imaging. MATERIALS AND METHODS: There were 71 patients with osteonecrosis of the femoral head based on characteristic radiographic and MR imaging findings. All patients had surgical confirmation of the disease. Both hips were affected with osteonecrosis in 39 patients, whereas only one hip was involved in 31 patients. The last patient underwent an arthroplasty of one hip during the study and had only one hip imaged. We evaluated a total of 110 hips in this study, of which 98 were painful. We staged osteonecrosis of the femoral head, using the classification of Steinberg et al. The 31 unaffected hips served as controls. Bone marrow edema and joint fluid were evaluated on MR images. Bone marrow edema was defined as an ill-defined area of low signal intensity on T1-weighted images with corresponding high signal intensity on T2-weighted or inversion recovery images localizing to the femoral head, neck, and intertrochanteric region. The amount of joint fluid was graded from 0 to 3. RESULTS: The peak of bone marrow edema occurred in stage III disease (72%); its odds ratio was seven times greater than that for stage I osteonecrotic hips. Effusions of a grade greater than or equal to 2 were seen most often in stage III disease (92%), compared with 10% in the control hips. With an effusion, bone marrow edema was 12.6 times greater when the hip was painful than when it was not. CONCLUSION: Both bone marrow edema and joint effusions existed with a peak occurrence in stage III disease. Bone marrow edema seems to have a stronger association with pain than does joint effusion in osteonecrosis of the femoral head.

Adolescent↗

PubMed2003

Effects of patient demographics, risperidone dosage, and clinical outcome on body weight in acutely exacerbated schizophrenia.

BACKGROUND: Predictors for risperidone-related weight gain remain unclear. This study aimed to identify clinical factors influencing body weight in risperidone-treated patients. METHOD: One hundred forty-six newly hospitalized DSM-IV schizophrenia patients with acute exacerbation entered this prospective, 6-week, repeated-measures trial. The mean +/- SD risperidone dose was 4.3 +/- 1.4 mg/day at week 6. Efficacy, body weight, and tolerability were measured biweekly. Efficacy was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). For determining the impacts of possible prognostic factors on body weight, we utilized generalized estimating equation methods to control for other variables and the within-subject dependence over repeated assessments. RESULTS: After the effects of other factors (including baseline body weight) were adjusted, every 1-week increase in treatment duration raised body weight by 0.442 kg (p <.0001). Increasing baseline body weight by 1 kg reduced weight gain by 0.022 kg (p <.0001). Every 1-year increment in age decreased body weight by 0.052 kg (p <.001). Undifferentiated subtype predicted higher weight by around 0.9 kg than other sub-types (p <.05). Each 1-mg/day increment in risperidone dosage heightened body weight by 0.084 kg (p =.015). Responders (those with PANSS total-score reduction > or = 20%) also had higher weight by 0.513 kg on average (p =.007). Specifically, every 1-point diminution in score in PANSS total, PANSS positive, PANSS negative, PANSS cognitive, and NOSIE increased body weight, on average, by 0.029 kg, 0.057 kg, 0.079 kg, 0.079 kg, and 0.035 kg, respectively (p < or =.009). Other variables did not have significant influences. CONCLUSION: The results suggest that lower initial body weight, younger age, undifferentiated subtype, higher dosage, and treatment response (for positive, negative, and cognitive symptoms and social functioning) are associated with greater weight gain in acutely ill patients treated with risperidone. Further studies with longer observation and in other populations are needed.

Acute Disease↗

PubMed2002

Forelimb muscle activity following nerve graft repair of ventral roots in the rat cervical spinal cord.

Current research on the cellular mechanisms of nerve regeneration suggests the application of nerve growth factors at the repair sites to be beneficial. To test the effectiveness of this approach, we performed transections of the C6 and C7 ventral rootlets from their original sites in the spinal cord of 18 rats. We investigated the electrophysiological changes in three groups of rats operated on by different repair strategies. Six rats comprised the control group (G1). In the other 12 rats, 24 rootlets were implanted into the spinal cord by means of an intercostal nerve graft through the pia mater immediately after transection. Six rats (G2) had fibrin glue applied at the incision. The last 6 rats (G3) had grafts with acidic fibroblast growth factor (aFGF) added to the fibrin glue. The rats' functional recovery was evaluated electrophysiologically at 6 weeks and 6 months after the operation. Needle electromyography showed profound fibrillation potentials (Daube's scoring system) in the deltoid, biceps, and triceps of the operated forelimbs in all groups 6 weeks after the operation. After 6 months, there was a significant decrease in the amount of fibrillation potentials in all groups (G1, G2 and G3, p < 0.0001, 0.0001, 0.0009, respectively, generalized estimating equation, repeated measures) and a significantly high probability for motor units present in sampled muscles of G2 and G3 as compared to G1 (log odds ratio in G2 = 51.8316, G3 = 57.4262, generalized estimating equation). We conclude that several cervical roots can regenerate through intercostal nerve grafts applied using fibrin glue. Adding aFGF may increase the efficacy of sprouting.

Animals↗

PubMed2002

A phase III study of adjuvant chemotherapy in advanced nasopharyngeal carcinoma patients.

PURPOSE: To evaluate the role of adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma (NPC) patients, we conducted a randomized Phase III trial comparing radiotherapy (RT) followed by adjuvant chemotherapy to RT alone in patients with advanced NPC. METHODS AND MATERIALS: Between November 1994 and March 1999, 157 patients with Stage IV, M(0) (UICC/AJCC, 1992) advanced NPC disease were randomized to receive standard radiotherapy, as follows: 35-40 fractions, 1.8-2.0 Gy/fraction/day, 5 days/week, to a total dose 70-72 Gy with or without 9 weekly cycles of 24-h infusional chemotherapy (20 mg/m(2) cisplatin, 2,200 mg/m(2) 5-fluorouracil, and 120 mg/m(2) leucovorin) after RT. Of 157 patients enrolled, 154 (77 radiotherapy, 77 combined therapy) were evaluable for survival and toxicity analysis. RESULTS: With a median follow-up of 49.5 months, the 5-year overall survival and relapse-free survival rates were 60.5% vs. 54.5% (p = 0.5) and 49.5% vs. 54.4% (p = 0.38) for the radiotherapy-alone group and the combined radiotherapy and adjuvant chemotherapy group, respectively. The Cox regression showed that the hazard rates ratio of combined treatment to RT alone was 0.673 (p value = 0.232); the 95% confidence interval was 0.352 and 1.288, respectively. Patients who received combined treatment had a lower systemic relapse rate than radiotherapy-alone patients, according to relapse pattern analysis. The incidence of leukopenia (>or= Grade 3) occurred in 17 out of 819 (2.1%) cycles of weekly chemotherapy. No patient developed moderate to severe mucositis (>or= Grade 3). CONCLUSIONS: We conclude that adjuvant chemotherapy after RT for patients with advanced NPC has no benefit for overall survival or relapse-free survival.

Adult↗

PubMed2002

Overcoming patient-related barriers to cancer pain management for home care patients. A pilot study.

The purpose of this pilot study was to explore the effectiveness of a pain education program to overcome patient-related barriers in managing cancer pain for Taiwanese home care patients with cancer. The pain education program was developed based on previous studies of Taiwanese patient-related barriers to cancer pain management. The Barriers Questionnaire-Taiwan form, the Brief Pain Inventory, the Medication Adherence Questionnaire, and a demographic questionnaire were used for data collection. The sample consisted of 18 patients in the experimental group and 19 patients in the control group. Descriptive statistics, tests, and paired tests were used to analyze the data. Results of this study revealed that patients who received the pain educational program had significantly greater reduction in Barriers Questionnaire-Taiwan form scores and more improvement in medication adherence compared with patients who did not participate in the program. When compared to pretest scores, patients scores after receiving the pain education intervention showed significant improvement on the Barriers Questionnaire-Taiwan form, medication adherence, pain intensity, and pain interference. The results of this study support the effectiveness of the pain education program on overcoming the barriers to cancer pain management for Taiwanese home care patients with cancer.

Adolescent↗

PubMed2002

Shifting from haloperidol to risperidone for behavioral disturbances in dementia: safety, response predictors, and mood effects.

For agitated dementia showing insufficient response to conventional antipsychotics, the feasibility of transition to atypical agents remains unknown. Sixty-two Chinese inpatients with dementia and disruptive behaviors were recruited into an 8-week screening trial of haloperidol. Thirty-five (56%) of them responded insufficiently. They then entered a prospective, 16-week, open-labeled study. Haloperidol was abruptly shifted to risperidone 0.5 mg/day at weeks 1 to 4 and then 1 mg/day at weeks 5 to 12. At weeks 13 to 16, the regimen was shifted back to haloperidol at previous doses, mostly 1 mg/day. Safety, efficacy, cognition, and moods were evaluated at least every 4 weeks. Generalized estimating equation methods were used for determining the effects of the prognostic variables on the outcome values. Risperidone, particularly at 0.5 mg/day, was generally tolerable. The Brief Psychiatric Rating Scale (BPRS) score decreased progressively under risperidone treatment; at week 12, 16 (46%) patients showed response (>or=25% reduction in the BPRS). Patients with vascular dementia were more likely to respond than those with Alzheimer's disease ( p = 0.02). Haloperidol reinstitution resulted in no further improvement, except trend increments in motor symptoms. Risperidone also tended to benefit the performance on the Behavioral Pathology in Alzheimer's Disease Rating Scale. Six (17%) patients improved on moods and self-care with risperidone. These preliminary results suggest that crossover from haloperidol to risperidone is generally safe and effective and may produce favorable moods in agitated dementia patients. Vascular dementia is a predictor of treatment response. In contrast to the dose (1 mg/day) recommended for most white individuals, 0.5 mg/day could be tried at first in Chinese patients. Because of the design's limitations, further controlled studies are warranted.

Activities of Daily Living↗

PubMed2002

Influences of patient-related variables on risperidone efficacy for acutely exacerbated schizophrenia: analyses with rigorous statistics.

Response predictors of risperidone or other newer atypical antipsychotics for schizophrenia treatment remain unclear. This study aimed to investigate the influence of patient demographics on risperidone efficacy for schizophrenia. One hundred twenty-one newly hospitalized patients who had schizophrenia with acute exacerbation entered this prospective, 6-week risperidone trial. The target dose was 6 mg/day, or lower in case of side effects. Consequently, the mean +/- SD dose remained quite stable after week 2 and reached 4.4 +/- 1.3 mg/day at week 6. Efficacy and side effect assessments were conducted biweekly. The mean total score of the Positive and Negative Syndrome Scale (PANSS) declined during the trial, particularly within the first 4 weeks. Further, of the various efficacy scores (and their natural logarithm values) collected, only the logarithm of the PANSS total score was selected to serve as the response value, because it was normally distributed and thus suitable for regression analyses. After adjusting the effects of treatment duration (weeks 0-6) and other patient-related variables with the generalized estimating equation method, each 1-week increase in duration of prior hospitalizations raised the PANSS total by 0.04% (p = 0.002) and each 1-year increment in the education duration decreased the PANSS by 0.94% (p = 0.04). Gender, age, age at illness onset, duration of illness, diagnosis subtype, or number of prior hospitalizations, however, did not significantly impact the response value. These preliminary results suggest that longer hospitalization duration and shorter education predict higher symptomatology. Further studies with longer observation and larger samples in not only acutely ill patients but also other populations (e.g., first-episode patients) are warranted.

Adult↗

PubMed2002

Association of risperidone treatment response with a polymorphism in the 5-HT(2A) receptor gene.

OBJECTIVE: This study investigated the effect of the 102-T/C polymorphism in the 5-HT(2A) receptor gene on risperidone efficacy. METHOD: One hundred Han Chinese patients with acutely exacerbated schizophrenia were given risperidone for up to 42 days. The patients were genotyped for 5-HT(2A) polymorphisms. Psychopathology was measured biweekly with the Positive and Negative Syndrome Scale while the patients were taking risperidone. Generalized estimating equation methods were used to analyze the effects of treatment duration, T/C genotypes, and other prognostic factors on Positive and Negative Syndrome Scale performance. RESULTS: Patients with the C/C genotype had lower total scores, negative subscale scores, and general psychopathology scores but not positive subscale scores on the Positive and Negative Syndrome Scale than patients with the 102-T/C genotype. Patients with the T/C and T/T genotypes had comparable total and subscale scores. The number of previous hospitalizations and the dose of risperidone also affected Positive and Negative Syndrome Scale total scores. CONCLUSIONS: These results suggest that variations in the 5-HT(2A) receptor gene may influence individual responses to risperidone.

Adult↗

PubMedDate not supplied

Symptom distress changes during first postoperative month in newly diagnosed Taiwanese breast cancer patients: a longitudinal study.

The purpose of this longitudinal study was to explore changes in symptom distress in newly diagnosed Taiwanese breast cancer patients during the initial 4-week postoperative period. The research instruments, including a demographic questionnaire and the Symptom Distress Scale, were used to obtain data on postoperative day 2 and at weeks 2, 3, and 4. In total, 39 patients with a mean age of 48 years participated in this study. Data were analyzed using descriptive statistics, t tests, one-way ANOVA, and repeated-measures ANOVA. Results revealed that the level of symptom distress significantly decreased from postoperative day 2 to week 4. Loss of appetite and a poor outlook increased; nausea frequency, fatigue, and insomnia decreased then increased; and frequency and the level of pain, coughing, tightness/tenderness in the chest wall, weakness, and numbness in the arm of the operative side all decreased over the 4-week study period. Age, stage of disease, and type of surgery were all related to symptom distress. Results of this study may provide reassurances about what can be expected after breast cancer surgery.

Adaptation, Psychological↗

PubMedDate not supplied

Prognostic factors for hepatocellular carcinoma < or = 3 cm in diameter.

BACKGROUND/AIMS: As surgical morbidity and mortality for hepatocellular carcinoma resection decline, we would like to analyze the possible prognostic factors for small hepatocellular carcinoma after curative resection. METHODOLOGY: A total of 170 patients receiving primary hepatectomies for small hepatocellular carcinoma (< or = 3 cm in diameter) at the National Taiwan University Hospital from December 1987 to February 1997 were enrolled as Group 1. The other 281 patients receiving hepatectomies for hepatocellular carcinoma larger than 3 cm were enrolled as the control group (Group 2). The overall patient and disease-free survival rates were calculated and the possible prognostic factors analyzed. RESULTS: The 1-, 3-, 5-, and 10-year patient survival rates in Group 1 were 89.6, 73.1, 55.7 and 34.0%, respectively. A safety margin > or = 1 cm (p = 0.0283), single tumor (p = 0.0324), and multiple hepatic resection (p = 0.0239) were factors favorable to patient survival by multivariate risk factor analysis. The disease-free survivals for Group 1 were 75.6, 41.4, 25.9 and 19.2% at 1, 3, 5, and 10 years, respectively. Significant factor for better disease-free survival included only euploid DNA content (p = 0.0026). The patient survival and disease-free survival rates of Group 1 were significantly better than those of Group 2. CONCLUSIONS: We conclude that patients with small hepatocellular carcinoma have better prognosis than those patients with larger tumors. Early detection of hepatocellular carcinoma and its recurrence are crucial for both patient and disease-free survival. The only prognostic factors that can be manipulated are the keeping of adequate safety margin and repeated resection for recurrent hepatocellular carcinoma.

Adult↗

PubMedDate not supplied

Toward normal perfusion after radiosurgery: perfusion MR Imaging with independent component analysis of brain arteriovenous malformations.

BACKGROUND AND PURPOSE: Brain perfusion is disturbed by cerebral arteriovenous malformations (AVMs). Our study was conducted to determine the radiosurgical effects on this disturbed perfusion. METHODS: MR perfusion imaging with independent component analysis was performed in five healthy subjects and 19 patients with AVM before and after radiosurgery (every 6 months up to 2 years). Perfusion map relative cerebral blood volume (rCBV), cerebral blood flow (rCBF), and mean transient time (rMTT) were assessed. Regions of interest (ROIs) on AVM target sections were defined as follows: N, AVM nidus; H, the rest of the ipsilateral hemisphere; P, immediately posterior to the nidus; A, immediately anterior to the nidus; Ar, anterior remote; Pr, posterior remote. Similar ROIs in the contralateral hemisphere (N1, H1, P1, A1, Pr1, and Ar1) served as internal references. Perfusion ratios of ROI-ROI1 were defined. Nonparameteric Mann-Whitney U tests and generalized linear models were used for statistical analysis. RESULTS: Before radiosurgery, patients' H/H1 rCBV and rCBF ratios were significantly higher than those of healthy subjects (P < .005), indicating AVM steal. Three types of perilesional perfusion disturbance were observed. From the first postradiosurgical follow-up at 6 months, N/N1 rCBV and rCBF ratios gradually decreased to 1.0 (both P < .001), whereas rMTT ratios gradually increased to 1.0 (P < .015); H/H1, A/A1, and P/P1 rCBV and rCBF ratios decreased after radiosurgery (P < .005), indicating reversal of steal toward normal perfusion. CONCLUSION: Initial high transnidal flow and perinidal perfusion disturbances were demonstrated. They gradually changed toward normal perfusion after radiosurgery. This explains, in part, the pathophysiologic factors of AVM and therapeutic effects.

Adult↗