Yih-Huei Uen

The E2F Transcription Factor 1 Transactives Stathmin 1 in Hepatocellular Carcinoma

BackgroundThrough data mining the Stanford Microarray Database, the stathmin 1 (STMN1) transcript was found to be frequently upregulated in the hepatocellular carcinoma (HCC) with low alpha-fetoprotein level. The molecular mechanism of STMN1 upregulation in HCCs remained unclear.MethodsQuantitative RT-PCR, immunoblotting, immunohistochemistry, and transfection of expression or small hairpin RNA interference plasmids, chromatin immunoprecipitation (ChIP), and quantitative ChIP assays were performed in HCC specimens or 2 distinct HCC-derived cell lines. Dual luciferase assay and site-directed mutagenesis were applied to analyze the activities of STMN1 proximal promoter region.ResultsSTMN1 mRNA and proteins were significantly associated with several clinicopathological features. High STMN1 or E2F1 immunoexpression was predictive of poor overall survival (OS) rate (Pxa0<xa0.01). In HCC-derived cell lines, E2F1 was elevated before STMN1 mRNA during the cell cycle. Exogenous expression of E2F1 or both transcription factor DP-1 (TFDP1) and E2F1 genes induced E2F1 and STMN1 mRNA (Pxa0<xa0.01). Knockdown of the E2F1 gene suppressed E2F1 and STMN1 mRNA and E2F1 and STMN1 protein levels (Pxa0<xa0.05). The promoter activity of STMN1 gene increased with overexpression of both E2F1 and TFDP1 genes (Pxa0<xa0.05); however, it decreased when mutations were introduced in the E2F1-binding sites (Pxa0<xa0.05).ConclusionsUpregulation of E2F1 and STMN1 proteins associate with worse outcomes in patients with HCC. E2F1 significantly correlates with STMN1 protein level in HCC lesions and in vitro transactivation assays, suggesting that STMN1 gene is transactivated by the E2F1 protein.

Feasibility of single-port laparoscopic cholecystectomy using a homemade laparoscopic port: a clinical report of 50 cases

AimTo report the clinical experience of transumbilical single-port laparoscopic cholecystectomy (TUSPLC), using a homemade laparoscopic access port composed of two inexpensive and common pieces of equipment readily available in the operating room.MethodsFifty consecutive patients with gallstones, including ten patients (20%) with acute cholecystitis, underwent single-port laparoscopic cholecystectomy (LC) using a homemade single port composed of a segment of corrugated breathing tube and a pair of surgical gloves. The port was inserted into the umbilicus for simultaneous placement of multiple conventional instruments into the abdominal cavity. All patients underwent dome-down LC using traditional instruments with manually angulated shafts; dissection was done using electrocautery or harmonic scalpel.ResultsAll but two procedures were completed uneventfully. Two patients with acute cholecystitis due to dense adhesions in the triangle of Calot necessitated conversion to two- and four-port laparoscopic procedures, respectively. Operative time averaged 73xa0±xa02xa0min for chronic cholecystitis and 95xa0±xa05xa0min for acute cholecystitis. There were no perioperative port-related or surgical complications, except for two patients who developed wound seroma and recovered after conservative treatment. We found that healing of the umbilical wound left virtually no scar in all patients.ConclusionThe homemade umbilical port reported in this study is useful for multiple instrument access and allows TUSPLC to be performed safely, with its inherent cosmetic and cost advantages. Further studies of this technique are ongoing.

Long-term outcomes of laparoscopic cholecystectomy: a prospective piecewise linear regression analysis

BackgroundThe objectives of this study were to examine longitudinal time trends, to predict thresholds of improvement in each dimension of health-related quality of life (HRQoL), and to identify long-term predictors of HRQoL.MethodsThis study analyzed 353 laparoscopic cholecystectomy (LC) patients. Disease-specific Gastrointestinal Quality-of-Life Index (GIQLI) and generic Short-Form 36-Item Health Survey (SF-36) scores were obtained immediately before surgery, then 3, 6, 12, and 24xa0months after surgery. Generalized estimating equations and piecewise linear regression models were used.ResultsThe examined population significantly (pxa0<xa00.05) improved in both SF-36 and GIQLI subscale scores. The HRQoL dimensions were substantially improved the sixth month after surgery and continued improving until they reached a plateau at 54.93 to 73.18xa0months. The data also showed the following explanatory variables for HRQoL: time, age, gender, Charlson Comorbidity Index, and preoperative GIQLI and SF-36 subscale scores.ConclusionsAs shown by the findings, the HRQoL scores improved substantially by the sixth month after surgery and continued improving until they reached a 4- to 7-year threshold, indicating that change trends in HRQoL dimensions may vary. Although HRQoL scores were substantially improved after cholecystectomy, the improvements were associated with preoperative functional status and demographic characteristics.

Post-cholecystectomy Quality of Life: A Prospective Multicenter Cohort Study of Its Associations with Preoperative Functional Status and Patient Demographics

PurposeThis study analyzed patient demographics and preoperative functional status for associations with post-cholecystectomy quality of life (QOL).MethodsThis prospective study analyzed 159 cholecystectomy patients at two tertiary academic hospitals. All patients completed the SF-36 and the gastrointestinal quality of life index (GIQLI) at baseline and at 3 and 6xa0months postoperatively. The 95% confidence intervals for differences in responsiveness estimates were derived by bootstrap estimation. Scores derived by these instruments were interpreted by generalized estimating equation (GEE) before and after cholecystectomy.ResultsThe examined population significantly (pu2009<u20090.05) improved in both SF-36 subscales and GIQLI subscales. After adjusting for time effects (time, and time2) and baseline predictors, GEE approaches revealed the following explanatory variables for QOL: time, time2, age, gender, preoperative GIQLI score, body mass index, and number of comorbidities.ConclusionThe data revealed dramatically improved post-cholecystectomy QOL. However, QOL change was simultaneously associated with preoperative functional status and demographic characteristics.

Response shift effect on gastrointestinal quality of life index after laparoscopic cholecystectomy

PurposeTraditional pre- and post-surgery quality of life assessments are inadequate for assessing change in health-related quality of life (HRQoL) after laparoscopic cholecystectomy (LC). This study examined whether a response shift, a change in the internal standards of a patient, occurs in patients who have received LC.MethodsSelf-administered gastrointestinal quality of life index (GIQLI) was used to evaluate preoperative, postoperative, and retrospective postoperative HRQoL. Response shifts, unadjusted treatment effects, adjusted treatment effects, and their effect sizes were calculated.ResultsIn all GIQLI domains, a significant response shift was indicated by the significantly higher pre-test scores compared to then-test scores (Pxa0<xa00.05). The effect size of the response shift ranged from 0.19 for the physical impairment domain of the GIQLI to 0.49 for the total GIQLI score. It was observed the treatment effect was greater after adjusting for the presence of response shift.ConclusionPatients who have received LC undergo a response shift that affects their outcome measurement at 6xa0months postoperative. Response shift is a potentially confounding factor and should be considered when designing clinical studies that employ self-administered HRQoL measures. This evidence of confounding effects warrants further study of response shift at longer intervals after LC, after other health care interventions, and in patients with varying preoperative health status.

Liver abscess secondary to fish bone migration from the duodenum.

A 59-year-old woman was admitted with persistent fever for 2 weeks in spite of medication treatment and progressive persistent epigastric dullness after fever onset 10 days later. Abdominal computed tomography revealed a linear high-density lesion between the liver abscess and the duodenal bulb. Percutaneous abscess drainage and antibiotics treatment were performed. The panendoscopy demonstrated a healed duodenal ulcer without any foreign body. Therefore, she underwent the lateral segmentectomy, fistulectomy and duodenorrhaphy. Operative findings revealed one 4-cm fish bone within the duodenohepatic fistula, which was located at the duodenal bulb attached to the liver (Fig. 1). She was discharged on post-operative day 12 and felt well during outpatient department follow-up. Liver abscess combined with hepato-enteric fistula is a rare clinical manifestation. There are two mechanisms of relation between liver abscess and hepato-enteric fistula. One is liver abscess rupture into alimentary tract. The other is perforated bowel wall leading to liver abscess formation. Intestinal perforation by foreign body ingestion is one of the bowel perforation factors and the incidence is approximately 1%. In the past, liver abscess secondary to foreign body penetrating from the alimentary tract was a surgical indication. Recently, some reports suggest non-operative treatment by abscess drainage, antibiotics administration and endoscopic removal of foreign body. We combined operative and non-operative therapy for this complicated case. According to the patient’s history, the process by which this fish bone penetrated through the duodenal wall may be slow ongoing and migration is more likely. When it ‘migrated’ out of the duodenal serosa and then the fistular orifice was covered by new growing mucosa, this duodenohepatic fistula and the fish bone became invisible. This is the possible mechanism of the liver abscess secondary to fish bone migration from the duodenum.

The minimal clinically important difference in the Gastrointestinal Quality-of-Life Index after cholecystectomy

BackgroundThe minimal clinically important difference (MCID) for the Gastrointestinal Quality of Life Index (GIQLI) is unknown, which limits its application and interpretation. This study aimed to estimate MCIDs for the GIQLI scores of patients after they had undergone cholecystectomy.MethodsThis study had 267 participants. All the participants completed the GIQLI and four anchor items, namely, “How would you describe your overall symptoms, emotions, physical functions, and social functions since your last visit?” The response options were “much worse,” “somewhat worse,” “same,” “somewhat better” and “much better.” The MCID was defined according to those who responded with “somewhat better.”ResultsThe mean age of the participants was 57.81 ± 14.93xa0years, and 37.08% of the patients were women. The MCID group included 67, 78, 44, and 22 patients with MCIDs of 6.42, 6.86, 7.64 and 6.46 points respectively for scores on the symptoms, emotions, physical functions, and social functions subscales, respectively. The effect sizes of four anchors in the “somewhat better” group (0.38–0.49) exceeded those of the same group (0.25–0.38).ConclusionsThis study showed that after patients had undergone cholecystectomy, the clinically significant mean changes in their scores on the GIQLI subscales for symptoms, emotions, physical functions, and social function were respectively 6.42, 6.86, 7.64, and 6.46 points. After patients have undergone cholecystectomy, the MCIDs for the GIQLI subscales can play an important role in interpretation of the scores, application of them in clinical practice, and verification of treatment effects.

Molecular Detection of Circulating Tumor Cells in Colorectal Cancer Patients: From Laboratory Investigation to Clinical Implication

The first recorded evidence of the presence of circulating tumor cells (CTCs) in the peripheral blood of cancer patients was documented in 1869. In the past few decades, experiments have shown that cancer-related alterations can be detected at the DNA and RNA levels. Both DNA and mRNA molecular markers can be used for the detection of CTCs in patients with various malignancies. Currently, modern molecular biological and cell sorting techniques make their detection and characterization more practicable. These recent advances in our understanding should lead to the development of new molecular markers for predicting micrometastasis, as well as the identification of new targets for anti-metastatic therapies. This article reviews recent advances in molecular and clinical aspects of CTCs, especially by DNA and mRNA markers, for an early detection of colorectal cancer and other conditions.

Changing Approaches to Cholecystectomy in Elderly Patients: A 10-Year Retrospective Study in Taiwan

BackgroundThe prevalence of symptomatic gallbladder diseases increases with age. The present study evaluated cholecystectomy risk factors and hospital resource utilization in an elderly (aged 60xa0years and older) population of patients who had undergone open cholecystectomy (OC) or laparoscopic cholecystectomy (LC).MethodsThe study analyzed 20,538 OC and 29,318 LC procedures performed in Taiwan from 1996 to 2007. Odds ratio (OR) and 95% confidence interval were calculated to assess the relative change rate. Regression models were employed to predict length of stay (LOS) and total surgical cost.ResultsPatient characteristics associated with increased likelihood of undergoing LC were age 60–69xa0years, female gender, and lack of current co-morbidities. Length of stay associated with both OC and LC decreased during the study period. Total surgical cost for elderly OC patients increased during the study period, whereas that for elderly LC patients declined. Compared to OC patients, LC patients had significantly larger changes in LOS (−2.27xa0days) and total surgical cost (

Huge Dermatofibrosarcoma Protuberans Mimicking a Breast Malignant Tumor with Abscess

−368.64 U.S. dollars) (pxa0<xa00.001). The following factors were associated with considerable increases in both LOS and total surgical cost: advanced age, female gender, presence of one or more co-morbidities, treatment in a regional or a district hospital, and long LOS.ConclusionsDecreases in hospital resource utilization were larger in elderly LC patients than in elderly OC patients. Health care providers and patients should observe that hospital resource utilization may depend on hospital attributes as well as patient attributes. These analytical results should be applicable to similar elderly populations in other countries.