Hung-Bun Lam

The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review

The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale. Using pre-determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008. They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points. Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made. Very few minor adverse events were observed, and only in five trials. APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms.

Effect of cholinergic denervation on hepatic fibrosis induced by carbon tetrachloride in rats

Various factors involved in the development of liver fibrosis, including hepatic stellate cells (HSCs), cholinergic nervous activity and fibrogenetic cytokines. The present study aims to investigate the role of cholinergic regulation in the promoting of liver fibrogenesis relating to bone morphogenetic protein-6 (BMP-6) and/or transforming growth factor-beta1 (TGFbeta1). We treated carbon tetrachloride (CCl(4)) into rats for eight weeks to induce liver fibrosis and arranged these rats for cholinergic denervation, hepatic branch vagotomy or atropine administration. Acetylcholinesterase (AChE) staining showed the distribution of cholinergic nerve around fibrosis scaring septa. The immunohistochemical staining for alpha smooth muscle actin (alphaSMA) indicated the less HSCs in CCl(4) treated rat liver with cholinergic denervation as compared to the sham-operated CCl(4) treated rats. It seems that cholinergic nerve not only innervates around the fibrosis area but also promotes HSCs. We also detected TGFbeta1 and BMP-6 expressions using RT-PCR and immunohistochemistry. The obtained results show that cholinergic denerveration decreases BMP-6 and TGF-beta1 expressions in CCl(4) induced liver fibrosis of rats. In conclusion, cholinergic nerve may influence HSCs in addition to the lowering of BMP-6 and TGF-beta1 gene expressions to modify liver fibrosis.

Habitual sleep–wake behaviors and lifestyle as predictors of diurnal cortisol patterns in young breast cancer survivors: A longitudinal study

OBJECTIVE This study aimed to identify predictors of changes in diurnal cortisol patterns during the 8-month follow up period for young breast cancer survivors. Among the potential predictors were tumor size, lymph node metastasis, changes in sleep problems, habitual time of awakening and bedtime, physical activity levels, body mass index (BMI), and depressive levels across 8 months. METHODS The participants were 62 breast cancer women who were aged 40 years and below, and had completed active breast cancer treatment. The longitudinal data were collected at four points: baseline assessment (T0) and three follow-ups after baseline: T1 (in the 2nd month), T2 (in the 5th month), and T3 (in the 8th month). The participants collected their salivary cortisol at home at six time points: upon waking, 30 and 45min after waking, and at 1200h, 1700h, and 2100h. They also completed several questionnaires: the Medical Outcomes Study Sleep scale; the Beck Depression Inventory-II, physical activity levels on a 10-point scale, time of going to bed, time of awakening, and total sleep hours. RESULTS This study found that the main predictors of changes toward flatter diurnal cortisol patterns during the 8-month follow ups were greater tumor sizes, increases of BMI scores, and habitually later times of awakening. CONCLUSIONS While greater tumor sizes represent biological vulnerability of disruption of cortisol circadian rhythm, maintaining an appropriate BMI and good sleep habits could be a protective factor for normal cortisol regulation, which likely helps to reduce early mortality in young breast cancer survivors.

Ruptured Pancreaticoduodenal Artery Pseudoaneurysm with Chronic Pancreatitis Presenting as Recurrent Upper Gastrointestinal Bleeding

Pancreaticoduodenal artery (PDA) aneurysms are extremely rare, accounting for only 2% of all visceral artery aneurysms [1]. PDA aneurysms may be either pseudoaneurysms— secondary to pancreatitis or trauma—or true aneurysms, mainly due to hemodynamic disorders of vessels, arteriosclerosis, congenital vascular disease, or occlusion or stenosis of the celiac trunk [2–5]. Rupture is the major complication, occurring in two-thirds of reported cases of PDA aneurysm and is fatal in half of the patients in whom it occurs [3]. We report a case of ruptured PDA pseudoaneurysm presenting with recurrent upper gastrointestinal bleeding.

A Single Institution Experience of Incorporation of Cisplatin into Adjuvant Chemotherapy for Patients With Triple-Negative Breast Cancer of Unknown BRCA Mutation Status

The clinical benefit of adding platinum to adjuvant chemotherapy for patients with triple-negative breast cancer (TNBC) has not been well investigated, although it was associated an improved response rate in neoadjuvant setting. We retrospectively analyzed the time to tumor progression (TTP) and overall survival (OS) of patients with resected stage I-III TNBC who were treated with or without cisplatin-containing chemotherapy (CisCT or noCisCT) during 2004 and 2010. Of 129 patients, 25 received CisCT. In univariate analysis, the mean TTP for CisCT and noCisCT was 4.42 and 5.88 years, respectively (P = .004). The mean OS for CisCT and noCisCT was 6.76 and 9.63 years, respectively (P = .24). After adjusting for other clinicopathologic factors, only clinical stage II/III disease was independently associated with worse OS. The adjusted hazard ratio for CisCT was 1.48 (P = .46) and was not statistically significant. In this small retrospective study, adding cisplatin to adjuvant chemotherapy for early TNBC with unknown BRCA mutation status did not benefit OS.

Association between neutrophil-to-lymphocyte ratio and parathyroid hormone in patients with primary hyperparathyroidism

Introduction Primary hyperparathyroidism (PHPT) is associated with adverse cardiovascular outcomes which may result from an increase in systemic inflammation. Previously we have shown that serum parathyroid hormone (PTH) levels are independently associated with inflammatory indicators. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive, widely available marker of inflammation. In the present study, we aimed to assess the longitudinal changes in NLR before and after parathyroidectomy. Material and methods This retrospective study included 95 patients diagnosed with PHPT who underwent parathyroidectomy between 2006 and 2016. Follow-up complete blood counts were available in 31 patients. Results At diagnosis, 43 (45%) patients presented with overt clinical symptoms and had higher serum calcium and PTH levels. Preoperative NLR was positively correlated with total white blood cell count (p = 0.001), serum calcium (p = 0.001), and PTH level (p = 0.013). The NLR was not associated with sex, age, comorbidities, or parathyroid weight. Among patients who were cured of PHPT, the median NLR decreased from 2.26 to 1.77 after parathyroidectomy (p = 0.037). There was no difference in hemoglobin, total white blood cells, or platelet count before and after surgery. Conclusions We found a positive correlation of preoperative NLR with calcium and PTH levels in PHPT patients. After curative parathyroidectomy, NLR modestly decreased without changes in other hematological parameters.

Acute gastric dilatation in a young woman

A 28-year-old woman presented with no history of psychiatric disorder or major systemic disease. She had abdominal distension with vomiting after a large meal in an ‘all you can eat’ restaurant. The abdomen plain film and CT demonstrated severe distension of stomach in …

Hand-Assisted Laparoscopic Splenectomy for Idiopathic Splenic Infarction: Report of a Case

Splenic infarction is an uncommon condition, and it is difficult diagnose the early stage of this disease. Most of these cases have obvious underlying etiologies, and these etiologies may provide the clues to their diagnoses. We present a case of idiopathic splenic infarction. A 40-year-old male was admitted because of fever and chills for 4 days. The abdominal computed tomography (CT) showed splenic infarction. Studies including blood culture, echocardiography and rheumatoid factor, were negative. Medical treatment was given first, but the symptoms did not improve. And the magnetic resonance imaging (MRI) revealed increased infarction areas. After failure of medical treatment, hand-assisted laparoscopic splenectomy was performed. Multiple infarction areas with abscess were seen in the specimen, and the culture of this abscess was negative. The post-operative course was smooth and the patient recovered well. We also review the medical literature. Precise diagnosis with adequate timing of surgical intervention will provide better prognosis for splenic infarction.