Chung-Hsien Chen

Factors affecting operative efficiency and post-operative convalescence in laparoendoscopic single-site (LESS) adrenalectomy

BackgroundLaparoendoscopic single-site (LESS) adrenalectomy is a novel challenging technique which is still under clinical evaluation. Initial reports have revealed its superiority in patient convalescence. In addition, it has been reported that some patient or anatomic factors might affect the ergonomics of LESS adrenalectomy. The aim of this study is to investigate the possible factors that might affect procedural efficiency and patient convalescence in LESS adrenalectomy.MethodsBetween October 2009 and July 2015, 105 consecutive adult patients with benign adrenal tumors, who underwent LESS retroperitoneal adrenalectomy were enrolled in this study. All the relevant peri-operative parameters were prospectively collected for later analysis. By using stepwise linear regression and stepwise selection of these peri-operative parameters, those that might affect the operative efficiency and patient convalescence were analyzed.ResultsFinally, 78 patients who completed follow-up and were eligible for stepwise linear regression were enrolled for final analysis. For parameters affecting operative efficiency, the fitted model revealed that patients with a pre-operative diagnosis of pheochromocytoma, a higher BMI, and an associated co-morbidity of heart disease are associated with a longer operative time. In addition, the fitted model revealed that patients with a lower post-operative pain score, a delayed oral intake, and a diagnosis of non-functioning adrenal tumor were associated with a lengthier period before returning to normal activity.ConclusionA higher BMI is the only anatomic factor that affects procedural efficiency in LESS adrenalectomy. In addition, post-operative pain score, time to oral intake, and a diagnosis of non-functioning adrenal tumor are the factors affecting patient convalescence.

Laparoscopic nephroureterectomy for upper tract urothelial carcinoma – Update

Upper urinary tract urothelial carcinomas (UTUCs) are uncommon and account for only 5%–10% of urothelial carcinomas. Pyelocaliceal tumors are about twice as common as ureteral tumors. Sixty percent of UTUCs are invasive at diagnosis. Radical nephroureterectomy, including the excision of the distal ureter and bladder cuff is standard of care for treatment of localized UTUCs, because of the high potential for recurrence, multifocality, and progression. Since first laparoscopic nephroureterectomy (LNU) was introduced by Clayman et al. in 1991 and improvement of laparoscopic technique and equipment, LNU has been reported to be equivalent to conventional open method. We reviewed the current literature of patients with UTUCs treated by LNU focusing on technical aspects, peri-operative and oncological outcomes. Laparoscopic radical nephroureterectomy offers the advantages of minimally invasive surgery without deteriorating the oncological outcome for treatment of UTUCs. Indications tend to increase as operator skills increase. Indications for laparoscopic or open nephroureterectomy are in principle the same. The basic requirement for laparoscopic surgery in UTUCs is to achieve benefits of minimal invasive surgery and maintain oncologic principles.

Synergic anti-tumor effect of pterostilbene, an inhibitor of type I insulin-like growth factor receptor, and trastuzumab against HER2-overexpressing bladder cancer cells

背景及目的：二苯乙烯（stilbene）在各面都被廣泛的研究，包括對抗惡性腫瘤的能力。此研究希望證明紫檀芪（pterostilbene），一個強力的二苯乙烯，可做為新一代類胰島素生長因子1受體抑制劑並且對於膀胱癌細胞有毒殺的加乘作用。方法：我們使用紫檀芪治療膀胱癌細胞，並且利用西方墨點法分析細胞增殖試驗以及利用流式細胞技術分析癌細胞之增生及細胞週期。我們分析紫檀芪在類胰島素生長因子1受體膀胱癌的細胞並嘗試找尋下游路徑。周塔氏藥物合併指數（Chou and Talalays combination index）被用來檢驗紫檀芪對於賀癌平（trastuzumab）在治療HER-2過度表現的膀胱癌上之成效影響。結果：在此試驗中，紫檀芪顯現出隨著劑量上升可以激發G0/G1期細胞的數量上升並且降低G2/M以及S期的細胞數量。更甚者，紫檀芪可以引發p27的表現上升以及降低p21的表現。除此之外，此藥物更能下降在HER-2過度表現的T24細胞中磷酸化蛋白激酵素（Akt）的濃度，藉此引發其凋亡。紫檀芪合併賀癌平治療膀胱癌的協同作用在此試驗中被明顯地觀察到。結論：紫檀芪可作為新一代的類胰島素生長因子1受體抑制劑並且可以對於賀癌平在抑制HER-2過度表現的膀胱癌細胞增生上有協同作用。這個結果可以驗證像紫檀芪這類抗類胰島素生長因子1受體之藥物，可以與賀癌平合併使用達到對其有抗性之膀胱癌有更好的療效。

Explore the Roles of Urothelial Dysfunction and Chronic Inflammation in the Pathophysiology of Recurrent Bacterial Cystitis

Background and purpose: The aim of the study is to explore the roles of urothelial dysfunction and chronic inflammation in the pathophysiology of recurrent bacterial cystitis. Methods: A total of 30 women with recurrent bacteria cystitis at least twice in one year consecutivelywere enrolled in this study. 10 women with stress urinary incontinence without irritative bladder symptoms or any episode of UTI served as the control group. Urothelial dysfunction markers (TUNEL for apoptosis, Ki-67 for proliferation, tryptase staining for mast cell activity, E-cadherin and ZonulaOccludens-1 for junction protein expression) were assessed to explore the possibility of urothelial dysfunction in the bladder mucosa. Results: Compared to those in the controlled group, the bladder mucosa in the experimental group had reduced expression of immuno-fluorescent markers in detecting E-cadherin, but increased expression of mast cell and urothelial dysfunction (TUNEL). The expression of immune-histochemical (IHC) stain with E-cadherin, mast cell and TUNEL of recurrent group had significantdifference when compared to the controlled group, respectively. (p＜ 0.05) Western blot analysis for phospho-p38 and trypatse to confirm the inflammatory events and Bax protein expression to confirm the apoptotic process, which showed that the expressions of phospo-p38 (about 3.6 folds), tryptase (about 2.0 folds) and Bax (about 2 folds) increased in the recurrent UTI specimens compared with the normal control specimens. Conclusion: Increased expression related to chronic inflammation and apoptosis in bladder mucosa of the patients with recurrent urinary tract infection was observed when compared to those in normal control group. This evidence demonstrates that chronic inflammation and urothelial dysfunction are present in most women with recurrent UTI.