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Biomedical subjects

C H Lai

Publications and source records attributed to C H Lai.

At least 73 records · Page 4Linked to original sources

Neuronal response sensitivity to bidirectional off-vertical axis rotations: a dimension of imbalance in the bilateral vestibular nuclei of cats after unilateral labyrinthectomy.

In decerebrate cats after acute hemilabyrinthectomy, the response sensitivity of extracellularly recorded vestibular nuclear neurons on the lesioned and labyrinth-intact sides were examined quantitatively during constant velocity off-vertical axis rotations with an aim to elucidate the functional contribution of otolithic inputs to the ipsilateral and contralateral vestibular nuclei. The bidirectional response sensitivity, delta, was determined as the ratio of the gain during clockwise to that during counterclockwise rotations. A continuum of response sensitivity was identified: one-dimensional neurons showed symmetrically bidirectional response patterns, while two-dimensional neurons showed asymmetrically bidirectional patterns that in some cases approached unidirectional patterns with change in velocity. The proportion of two-dimensional neurons was significantly increased after acute hemilabyrinthectomy. Two-dimensional neurons that responded only to one direction of rotation in at least one of the velocities tested were described as unidirectional neurons. This unidirectional response pattern was observed in one-third of the entire neuronal population studied, but not in cats with both labyrinths intact, thus suggesting that such prominent broadly tuned responses are normally masked by converging otolithic inputs from the contralateral side. These neurons were found in higher proportion on the lesioned side than on the labyrinth-intact side. Among the 70% of unidirectional neurons that exhibited bidirectional response at some velocities and unidirectional response at others, prominent shifts in delta values (i.e. between 0/infinity and finite values) with velocity can be computed for each neuron. The shifts in delta values correlated with large shifts in the response dynamics and spatial orientation as the response pattern changed with velocity. The response orientations of the unidirectional neurons pointed in all directions on the horizontal plane. When all the two-dimensional neurons (i.e. both the unidirectionally and bidirectionally responsive ones) were pooled, imbalances in the distribution of the response orientations and in response gain were found between the ipsilateral-side-down/head-down half-circle and the contralateral-side-down/head-up half-circle on the labyrinth-intact side, but not on the lesioned side. These results, derived from spatiotemporal processing of gravitational signals, reveal a novel dimension of imbalance between neuronal populations in the two vestibular nuclear complexes after acute lesion of one labyrinth. This feature would provide, on the one hand, deranged cues of spatial orientation and direction during slow head excursions and, on the other, a framework for the dynamic behavioral deficits associated with hemilabyrinthectomy.

Animals↗

Phase II trial of neoadjuvant chemotherapy in early-stage small cell cervical cancer.

Clinical complete response (CR) to chemotherapy is not uncommon in small cell carcinoma. To understand its pathologic response, we conducted a phase II trial with neoadjuvant chemotherapy followed by hysterectomy in patients with small cell cervical cancer and reviewed all reported cases receiving neoadjuvant chemotherapy followed by hysterectomy through a MEDLINE search. From December 1993 to December 1997, the enrolled patients were treated with two to three courses of vincristine, adriamycin and cyclophosphamide alternating with cisplatin and etoposide (VAC/PE) before hysterectomy. Another three courses of chemotherapy were added after surgery. A total of seven patients was enrolled. Clinical CR was observed in six patients, but microscopic residual tumor was present in all. Lymphatic permeation, scattered residual tumor clusters and residual superficial invasive adenocarcinoma over the cervix presented in five cases, and another had a metastatic pelvic node with no residual cervical tumor. Three of these seven patients have been alive with no evidence of disease for 16.2, 45.2 and 56.6 months, respectively. The other four died from disease 10.3-23.6 months after diagnosis. These findings indicate the discrepancy between clinical and pathologic responses in small cell cervical cancer after chemotherapy and emphasize the necessity of local treatment.

Adult↗

Decoding information by following parameter modulation with parameter adaptive control.

It has been proposed to realize secure communication using chaotic synchronization via transmission of a binary message encoded by parameter modulation in the chaotic system. This paper considers the use of parameter adaptive control techniques to extract the message, based on the assumptions that we know the equation form of the chaotic system in the transmitter but do not have access to the precise values of the parameters which are kept secret as a secure set. In the case in which a synchronizing system can be constructed using parameter adaptive control by the transmitted signal and the synchronization is robust to parameter mismatches, the parameter modulation can be revealed and the message decoded without resorting to exact parameter values in the secure set. A practical local Lyapunov function method for designing parameter adaptive control rules based on originally synchronized systems is presented.

Journal Article↗

Robustness of supersensitivity to small signals in nonlinear dynamical systems.

Nonlinear dynamical systems possessing an invariant subspace can display interesting dynamical behavior, such as on-off intermittency and bubbling. This Rapid Communication shows that a class of such systems has amazing features of (1) supersensitivity to small input signals and (2) robustness of the supersensitivity in the presence of noise. These features make the systems very promising as small signal detectors.

Journal Article↗

Extracting messages masked by chaotic signals of time-delay systems.

We show how to extract messages masked by a chaotic signal of a time-delay system with very high dimensions and many positive Lyapunov exponents. Using a special embedding coordinate, the infinite-dimensional phase space of the time-delay system is projected onto a special three-dimensional space, which enables us to identify the time delay of the system from the transmitted signal and reconstruct the chaotic dynamics to unmask the hidden message successfully. The message extraction procedure is illustrated by simulations with the Mackey-Glass time-delay system for two types of masking schemes and different kinds of messages.

Journal Article↗

Amplification of weak signals and stochastic resonance via on-off intermittency with symmetry breaking.

Nonlinear dynamical systems possessing reflection symmetry have an invariant subspace in the phase space. The dynamics within the invariant subspace can be random or chaotic. As a system parameter changes, the motion transverse to the invariant subspace can lose stability, leading to on-off intermittency. Under certain conditions, the bursting behavior is symmetry breaking. We demonstrate the possibility of observing multiplicative noise(chaos)-induced amplification of weak signal and stochastic resonance via on-off intermittency with symmetry breaking in a general class of symmetrical systems. Differences of this mechanism of stochastic resonance to that in noisy bistable or threshold systems are discussed.

Journal Article↗

Improvement of the local prediction of chaotic time series.

In this paper we explore the effect of pseudofalse neighbor points, which are true neighbor points in the reconstructed attractor, but which are considered not suitable to be used when local methods are adopted to predict the chaotic time series. In our approach, the epsilon(p) neighbor points are used to reduce the influence of the pseudofalse neighbor points, thereby improving the performance of the local prediction of the chaotic time series.

Journal Article↗

Comparative microbiological characteristics of failing implants and periodontally diseased teeth.

BACKGROUND: The purpose of this report was to compare the distribution of periodontal pathogens recovered from failing implants and teeth with adult and recurrent forms of periodontitis. METHODS: A total of 41 consecutive microbial samples from patients with failing implants (IMP) were received at the Microbiology Testing Laboratory (MTL) of the University of Pennsylvania over a 2-year period. Paired control samples were selected from samples received concurrently by MTL from 41 patients with a diagnosis of adult periodontitis (AP) and 41 with a diagnosis of recurrent or refractory periodontitis (RP). Patients' mean ages for the 3 categories were 59, 47, and 53 years, respectively. Samples were collected with paper points or scalers and shipped in prereduced medium by express mail to the laboratory where they were processed within 48 hours from the time of collection. Culture was used for detection of A. actinomycetemcomitans, C. rectus, P. intermedia/nigrescens, E. corrodens, P. micros, Capnocytophaga and Fusobacterium sp., enteric Gram-negative rods, Enterococcus and Staphylococcus sp., and yeast. P. gingivalis and B. forsythus were detected by indirect immunofluorescence. Morphotypes were enumerated by dark-field microscopy. RESULTS: The most frequently detected microorganisms from IMP were B. forsythus (59%), spirochetes (54%), Fusobacterium (41%), P. micros (39%), and P. gingivalis (27%). Recovery levels (mean +/- SD) were 1+/-1, 4+/-5, 4+/-5, 9+/-11, 1+/-2, respectively. The most frequently detected organisms for AP were B. forsythus (83%), Fusobacterium (80%), spirochetes (79%), P. gingivalis (59%), P. micros (51%), and E. corrodens (37%), at levels 2+/-2, 5+/-4, 9+/-6, 4+/-5, and 6+/-7, respectively. Corresponding data for RP were B. forsythus (85%), Fusobacterium (83%), P. gingivalis (60%), spirochetes (59%), C. rectus (56%), and P. micros (56%), at levels of 3+/-2, 8+/-8, 4+/-4, 2+/-2, 1+/-1, and 9+/-10, respectively. CONCLUSIONS: These results indicate that the detection frequency and levels of recovery of some periodontal pathogens in failing implants are significantly different from that of teeth with periodontitis; however, the detection frequency and levels of recovery are similar in teeth affected by adult and refractory (recurrent) forms of periodontitis.

Aggregatibacter actinomycetemcomitans↗

Radical resection and intraoperative radiotherapy for a recurrent endometrial cancer after prolonged remission following aggressive salvage therapy: case report.

The prognosis of recurrent endometrial carcinomas is generally poor, except for isolated vaginal relapse. We report a case of recurrent endometrial cancer in a 58-year-old woman who initially received a type I extended hysterectomy with bilateral salpin-go-oophorectomy and bilateral para-aortic and pelvic lymph node dissection. The first recurrence occurred in the left parametrium 7 months after the primary surgery. The salvage therapy consisted of radiotherapy combined with hormonal therapy (tamoxifen and Megace). Complete remission was achieved initially. Subsequently, the patient accepted six courses of chemotherapy (cisplatin and Adriamycin) for progressive elevation of cancer antigen 125 (CA-125). The CA-125 levels remained elevated with titers fluctuating around 100 U/ml until a second recurrence at the left iliac 75 months following salvage therapy. The second salvage treatment consisted of maximal debulking of the pelvic mass and intraoperative radiotherapy (IORT) followed by four courses of chemotherapy with paclitaxel and carboplatin. Complete remission was again accomplished, with clinical investigations and molecular markers returning to normal. The patient has been clinically free of disease for more than 2 years since the second relapse of cancer. In this particular case, we found that repeated recurrence could occur after a long complete remission following salvage therapy; however, the disease could be recontrolled with further aggressive salvage efforts. A multimodality approach with combinations of radical resection, IORT, and paclitaxel-based chemotherapy can be offered to patients with localized recurrent or repeatedly recurrent endometrial carcinoma after previous cisplatin-based chemotherapy and pelvic radiation.

CA-125 Antigen↗

Prognostic factors in surgically treated small cell cervical carcinoma followed by adjuvant chemotherapy.

BACKGROUND: Small cell carcinoma of the uterine cervix is an uncommon tumor associated with high mortality even among patients with early stage disease. The role of adjuvant chemotherapy after surgery has been suggested by regimens used for small cell lung carcinoma. During the years 1980-1997, 19 cases in which various adjuvant chemotherapies were given after hysterectomy were reported in the literature published in English. METHODS: Adjuvant chemotherapy was administered consecutively to 23 patients with Stage Ib-II small cell cervical carcinoma who had been primarily treated with radical hysterectomy and had adequate bone marrow, renal, and hepatic functions. A combination of vincristine, doxorubicin, and cyclophosphamide alternating with cisplatin and etoposide (VAC/PE) was administered to 14 patients during the years 1988-1996 according to a prospective study protocol. A combination of cisplatin, vinblastine, and bleomycin (PVB) was administered to 8 patients, and another regimen was administered to 1 patient during the years 1984-1988. Prognostic factors were evaluated by analyzing both the data on these 23 patients and the pooled data on the cases retrieved from the literature and our own files. RESULTS: Ten of the 14 patients who received VAC/PE had no evidence of disease during a median follow-up of 41 months, whereas 3 of the 9 who received PVB or another regimen survived. Of the 10 patients who died of their disease, all died of distant metastasis within 10 months after recurrence. Meta-analysis of the pooled data showed that 68% of patients who received regimens containing VAC or PE survived, whereas 33% of patients who received regimens not containing VAC/PE survived (P = 0.0078, log rank test). Seventy percent of patients with no lymph node metastasis at hysterectomy and 35% with lymph node metastasis survived (P = 0.05). All patients who died of disease had extrapelvic metastasis. CONCLUSIONS: Chemotherapies containing VAC or PE are favorable regimens for patients with early stage small cell cervical carcinoma after radical hysterectomy.

Adult↗

The prognostic significance of pre- and posttreatment SCC levels in patients with squamous cell carcinoma of the cervix treated by radiotherapy.

PURPOSE: To investigate the prognostic significance of the pre- and posttreatment serum squamous cell carcinoma antigen (SCC) levels in patients with Stage I-IVA squamous cell carcinoma of the cervix primarily treated by radiotherapy. MATERIALS AND METHODS: 401 patients with squamous cell carcinoma of cervix primarily treated with radiotherapy (RT) were included in this study. All had preRT, and 249 patients had postRT serum SCC values. The association of pretreatment SCC level with the clinical parameters, including stage, hemoglobin (Hb) level, age, cell differentiation, and lymph node status, was assessed by univariate and multivariate analysis. The prognostic significance of pretreatment SCC level and these clinical parameters were evaluated. The impact of postRT residual induration and SCC levels on survival was analyzed. RESULTS: 1. PreRT SCC level strongly correlated with stage. After controlling for stage, only SCC levels higher than 10 ng/ml were associated with enlarged lymph nodes shown in CT scan. No association of preRT SCC level with other clinical parameters was found. 2. SCC level higher than 10 ng/ml, but not between 2-10 ng/ml, had significant impact on survival in a multivariate analysis. Stage, Hb levels (<10 g/dl) and positive lymph node shown by CT scan were also independent prognostic factors for survival. No significant difference in failure pattern in terms of local and/or distant sites was found in patients with different SCC levels. 3. Patients with residual induration and/or persistently elevated SCC level at 2-3 months after RT had a significantly higher incidence of treatment failure. Persistently elevated SCC level is a stronger predictor for treatment failure than residual induration by pelvic examination, and is associated with a higher incidence of distant metastasis. One third of patients with initial SCC level higher than 10 ng/ml had persistently elevated SCC. CONCLUSION: Pretreatment SCC levels higher than 10 ng/ml are an independent predictor for poor prognosis in patients included in this study, and can be used as one of the prognostic factors for selection of patients for intensive treatment. Persistently elevated SCC levels after RT is a strong predictor for treatment failure. A combination of clinical pelvic examination and SCC levels provides useful information for the need of further work-up and management.

Adult↗

The binding and utilization of hemoglobin by Prevotella intermedia.

Prevotella intermedia, a putative periodontopathic microorganism, requires iron for growth. Hemoglobin can be a major source of iron for bacterial growth in vivo since it is present in the crevicular fluid collected from periodontitis sites. Experiments studying the growth of P. intermedia in iron-depleted Todd-Hewitt broth supplemented with human hemoglobin showed that the bacteria were able to utilize human hemoglobin as a source of iron. The uptake of iron from hemoglobin by P. intermedia appears to be initiated by the binding of hemoglobin to the bacteria as shown by direct binding studies using 125I-labeled human hemoglobin. Scatchard analysis of saturation binding data revealed that 125I-labeled human hemoglobin had a dissociation constant (Kd) of 2.53 x 10(-8) M for the receptor on P. intermedia. Binding of labeled hemoglobin to P. intermedia was competitively inhibited by unlabeled human hemoglobin showing that the binding was specific. The ability of bovine hemoglobin, but not hemin or non-hemoglobin heme-containing compounds, to inhibit binding competitively suggested that the globin moiety of the hemoglobin molecule is recognized by the hemoglobin binding receptors.

Animals↗

High frequency of cytotoxin-associated gene A in Helicobacter pylori isolated from asymptomatic subjects and peptic ulcer patients in Taiwan.

Cytotoxin-associated gene A (CagA), expressed in about 60% of H. pylori isolates in Western countries, may play a role in the pathogenesis of peptic ulcer. In this study, we determined the prevalence and significance of the H. pylori cagA gene and protein expression in Taiwan. Genomic DNA from antrum biopsies and H. pylori isolates were analyzed for cagA using polymerase chain reaction, Southern hybridization, or colony hybridization. CagA seropositivity was analyzed using Helico blots. In addition, Western blotting was performed to detect the CagA protein. About 94% of antrum tissues from both asymptomatic subjects and duodenal ulcer patients and all 76 H. pylori isolates (21 asymptomatic subjects, 39 with duodenal ulcers, 13 with gastric ulcers, 2 with gastric cancers, and 1 with mucosa-associated lymphoid tissue [MALT] lymphoma) were positive for the cagA gene. Moreover 77 out of 78 H. pylori-positive serum and all 27 H. pylori lysates had anti-CagA antibodies or CagA protein, respectively. H. pylori isolated from patients with various upper gastrointestinal diseases in Taiwan contained the cagA gene and expressed CagA protein at high frequencies.

Aged↗

Evaluation of blood loss during tumescent liposuction in Orientals.

BACKGROUND: There are high risks from general anesthesia and excessive bleeding associated with traditional liposuction using the dry or wet method. The blood loss has been estimated to be between 15% and 45%. The tumescent technique permits liposuction of more than 3,000 ml of fat totally by local anesthesia without sedation. The blood loss is reported to be less than 1% of aspirate. OBJECTIVE: To examine the blood loss during liposuction using tumescent technique in Chinese patients compared with that of Caucasians as published in the literature. METHODS: Hemoglobin values of patient's preoperative venous blood and infranatant of aspirate were measured in 45 consecutive cases of liposuction using the tumescent technique from May 1996 to June 1997. RESULTS: A total of 30 patients completed the study. The average blood loss was estimated to be 1.08% of aspirate. CONCLUSION: From this study, we found the blood loss in Chinese patients is comparable with that in Caucasians. Tumescent liposuction is a safe dermatologic cosmetic surgical procedure without the need of blood transfusion and general anesthesia.

Adult↗

Porphyromonas gingivalis, Prevotella intermedia and Bacteroides forsythus in plaque subjacent to bridge pontics.

This study examined the distribution of P. gingivalis, P. intermedia and B. forsythus in plaque on metallic and porcelain pontics adjacent to healthy and inflamed mucosa. Subpontic plaque was collected from 33 inflamed and 31 healthy sites. Plaque suspension was incubated with specific rabbit antisera to P. gingivalis (FDC 381), P. intermedia (ATCC 25261) and B. forsythus (FDC 335), and the labelled cells disclosed with fluorescein-labelled goat-anti-rabbit IgG by indirect immunofluorescence microscopy. Mean proportions of P. gingivalis, P. intermedia, and B. forsythus at inflamed sites were 0.60+/-0.75, 2.48+/-2.28, and 0.44+/-0.64% respectively, and at healthy sites 0.21+/-0.43, 1.27+/-1.05, and 0.15+/-0.18% respectively. These differences were statistically significant. Almost all sites were positive for P. intermedia, whereas only 12/31 healthy and 21/33 inflamed sites were positive for P. gingivalis. 18/31 healthy and 28/33 inflamed sites were positive for B. forsythus. P. intermedia was recovered in higher proportions from metallic pontics adjacent to inflamed sites (MI) than healthy sites (MH) or porcelain pontics next to inflamed (PI) or healthy sites (PH). P. gingivalis is was recovered in higher proportions from MI than PH. We conclude that both the nature of the pontic material and the health status of the mucosa affect the composition of the associated microbiota.

Adult↗

Kadish stage C olfactory neuroblastoma successfully treated by chemoradiotherapy: report of two cases.

Olfactory neuroblastoma is an uncommon tumor. It is usually diagnosed at advanced stages. Most of the patients have an indolent clinical course with slow progression, late recurrence and relative infrequency of distant metastasis. Because of the rarity and lack of a randomized clinical trial of patients with olfactory neuroblastoma, there is no standard treatment for the disease. The survival period has increased as treatments have been improved since 1980. Conventional treatments mainly consist of surgery and/or radiotherapy. Chemotherapy was only administered to a few patients; however, it achieved good response. More clinical experience is needed to improve the treatment strategy in order to reduce the possibility of disease recurrence, and also for rescue therapy. We present 2 patients with Kadish C tumors treated using chemotherapy followed by radiotherapy. Both patients demonstrated rapid and excellent response to induction chemotherapy, and have been free of disease for more than 5 years and 2 years after treatment, respectively.

Adult↗

Implications of a failed prospective trial of adjuvant therapy after radical hysterectomy for stage Ib-IIa cervical carcinoma with pelvic node metastases.

BACKGROUND: Lymph node metastasis is established as a poor prognostic factor in cervical carcinoma patients undergoing primary surgery. However the optimal postoperative therapy for node-positive patients remains to be defined. MATERIALS AND METHODS: To determine the role of adjuvant therapy in stage Ib-IIa cervical carcinoma patients who had pelvic node metastases after radical hysterectomy, a single institutional randomized controlled trial with factorial design, comparing concurrent chemo-radiotherapy (CT + RT) versus chemotherapy (CT) or radiotherapy (RT) alone was conducted. Study endpoints included site of recurrence, time to recurrence, relapse-free and overall survivals, and toxicity of treatment. RESULTS: At a median follow-up of 61 months, the 6-year relapse-free and overall survival rates of the 39 patients entered into this trial were 78.2% and 85.2%, respectively. This trial was prematurely closed due to suboptimal accrual and protocol violation. It is inconclusive regarding the efficacy of CT because of the limitation of the sample size and the imbalance of prognostic features by actual treatment. A model for risk group classification of patients with stage Ib-II cervical carcinoma with pelvic node metastases from a retrospective analysis was validated by this prospective cohort. The results of this failed trial suggest that adjuvant CT alone seemed comparable to RT alone or CT + RT in survival but was associated with significantly less morbidity. CONCLUSION: It is warranted to consider a CT alone arm in comparison with either observation or CT + RT according to risk of recurrence in future prospective trials. However, this important issue can only be addressed by a large multicenter trial.

Adult↗

Lymphoepithelioma-like carcinoma of the uterine cervix: association with Epstein-Barr virus and human papillomavirus.

BACKGROUND: The presence of Epstein-Barr virus (EBV) has not been documented in previous reports of lymphoepithelioma-like carcinoma (LELC) of the uterine cervix by either polymerase chain reaction or in situ hybridization, and the histogenesis of the tumor remains unknown. Additionally, a relationship between human papillomavirus (HPV) and cervical LELC also has not been reported. METHODS: In this article, the authors describe the clinical and histopathologic findings for 15 patients with cervical carcinoma that had a histologic pattern of LELC. The polymerase chain reaction detected the presence of EBV and HPV DNA sequences in cervical LELC. RESULTS: All 15 tumors showed a typical syncytial growth pattern of undifferentiated cells with prominent lymphocytic infiltration. The detection rate of the EBV gene sequence in tissue samples from patients with LELC was more frequent than that in control patients with squamous cell carcinoma of the cervix (11 of 15 patients, 73.3%, vs. 4 of 15 patients, 26.7%; P = 0.01). However, the detection rate of HPV-16 and HPV-18 DNA was significantly lower in patients with LELC tumors than in patients with cervical squamous cell carcinoma (3 of 15 patients, 20.0%, vs. 12 of 15 patients, 80.0%; P = 0.001). After a median follow-up of 3.9 years (range, 1.8-5.3 years), the 15 patients showed no evidence of disease or metastasis after radical hysterectomy or radiotherapy. CONCLUSIONS: The finding of EBV associations in cervical LELC supports the hypothesis that EBV may be involved in the pathogenesis of tumors that arise in the cervix. It is possible that cervical LELC may follow a different pathway in the pathogenesis of LELC in Asian women as compared with the more common forms of squamous cell carcinoma.

Adult↗