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Biomedical subjects

Jaw-Town Lin

Publications and source records attributed to Jaw-Town Lin.

At least 19 recordsLinked to original sources
PubMed2007

Factors associated with myocardial infarction after emergency endoscopy for upper gastrointestinal bleeding in high-risk patients: a prospective observational study.

BACKGROUND: Because myocardial infarction (MI) after emergency endoscopy for upper gastrointestinal bleeding carries high mortality, we investigated factors associated with procedure-related MI in high-risk patients. METHODS: Consecutive patients with coronary artery disease or age-based risk for coronary artery disease (men, age >45 years; women, >55 years) who underwent emergency endoscopy were enrolled at a single ED. Demographic, laboratory, and outcome data were recorded. Patients fit 1 of 3 groups: MI before endoscopy (pre-panendoscopy [PES] MI), MI after endoscopy (post-PES MI), or non-MI. RESULTS: We enrolled 108 high-risk patients, including 5 (4.6%) with MI diagnosed preendoscopy. Five patients (4.6%) had MIs postendoscopy. Compared with non-MI patients, significantly more post-PES MI patients had heart disease (60.0% vs 12.2%; P = .021), lower systolic pressure on arrival (86.2 +/- 16.6 vs 128.0 +/- 27.2 mm Hg; P = .002), lower diastolic pressure on arrival (50.0 +/- 6.3 vs 69.5 +/- 15.8 mm Hg; P = .003), lower hemoglobin on arrival (6.7 +/- 1.1 vs 9.1 +/- 2.4 g/dL; P = .021), and more persistent shock status preendoscopy (80.0% vs 13.3%; P = .002). There was no significant difference in factors including duration of procedure and rates of recurrent bleeding, postprocedure complication, and mortality. CONCLUSIONS: Heart disease, lower blood pressure or hemoglobin level on arrival, and persistent shock before endoscopy are associated with increased risk for procedure-related MI.

Aged↗
PubMed2006

Elevated plasma osteopontin associated with gastric cancer development, invasion and survival.

OBJECTIVE: Osteopontin (OPN) has been found to be valuable in diagnosis and predicting the prognosis of a variety of malignancies. The aims of the present study are to evaluate the usefulness of plasma OPN level for predicting gastric cancer development, invasion and survival. PATIENTS AND METHODS: One hundred and thirty two gastric cancer patients and 93 healthy controls were enrolled. Real-time quantitative reverse-transcription polymerase chain reaction and immunohistochemical staining were used to detect OPN expression in gastric cancer tissues. Plasma levels of OPN were measured by enzyme-linked immunosorbent assay. Plasma OPN levels were compared with gastric cancer development, clinicopathological features and outcomes. RESULTS: Expression of OPN mRNA was significantly higher in gastric cancer tissues compared with non-tumour tissues. Most OPN immunoactivity was localised to cancer cells. The median plasma OPN level was significantly higher in patients than in controls (p<0.0001), and significantly higher in patients with advanced stages, serosal invasion, lymph node metastasis, lymphatic invasion, venous invasion and liver metastasis. Logistic regression showed that high plasma OPN level (greater than 67.3 ng/ml) is significantly associated with advanced stages, serosal invasion, lymph node metastasis, lymphatic invasion, venous invasion and liver metastasis. Plasma OPN level demonstrated significant association with patient survival (p<0.0001), especially in the subgroups with invasive phenotypes. On Cox multivariate analysis, elevated plasma OPN level was an independent risk factor for poor survival (p<0.0001). CONCLUSIONS: Elevated plasma OPN level is significantly associated with gastric cancer development, invasive phenotypes and survival. Plasma OPN level may have potential usefulness as a diagnostic and prognostic factor for gastric cancer.

Adenocarcinoma↗
PubMed2006

The impact of colon preparation timing on colonoscopic detection of colorectal neoplasms--a prospective endoscopist-blinded randomized trial.

OBJECTIVES: Timing of colon preparation might influence the cleansing condition of the colon and therefore affect the quality and diagnostic yield of colonoscopy. This study compared two different timings of colon preparation to assess the efficacy of colon cleansing and diagnostic yield of colorectal neoplasms during colonoscopy. METHODS: One hundred twenty-one eligible subjects who had colorectal neoplasms detected at a screening colonoscopy were randomly assigned to receive colon preparation with polyethylene glycol electrolyte lavage solution (PEG-ELS) either on the day of (on the day group) or the night before (previous night group) a second colonoscopy. The condition of colon preparation and the diagnostic yield of colorectal neoplasms were recorded and compared between the two groups for the initial and second colonoscopies. RESULTS: Fifty-nine subjects received colon preparation on the night before and 60 subjects received colon preparation the day of a second colonoscopy. Colon preparation for the second colonoscopy was better in the on-the-day group than in the previous night group (P= 0.003). Colon preparation for the second colonoscopy was better for each group in comparison with the initial colonoscopy (P < 0.0001). An interobserver variability analysis using 20 randomly selected colonoscopies from the two groups revealed good correlation among four colonoscopists. More lesions were detected in group A during the second colonoscopy (P= 0.028). CONCLUSION: Colon preparation on the day of colonoscopy has a better cleansing quality and higher diagnostic yield. Subjects who had lesions detected during the initial screening colonoscopy had better colon cleansing for the second colonoscopy regardless of the timing of preparation.

Aged↗
PubMed2006

A prospective comparative study of narrow-band imaging, chromoendoscopy, and conventional colonoscopy in the diagnosis of colorectal neoplasia.

BACKGROUND: Discrimination between neoplastic and non-neoplastic lesions is crucial in colorectal cancer screening. Application of narrow-band imaging (NBI) in colonoscopy visualises mucosal vascular networks in neoplastic lesions and may improve diagnostic accuracy. AIM: To compare the diagnostic efficacy of NBI in differentiating neoplastic from non-neoplastic colorectal lesions with diagnostic efficacies of standard modalities, conventional colonoscopy, and chromoendoscopy. METHODS: In this prospective study, 180 colorectal lesions from 133 patients were observed with conventional colonoscopy, and under low-magnification and high-magnification NBI and chromoendoscopy. Lesions were resected for histopathological analysis. Endoscopic images were stored electronically and randomly allocated to two readers for evaluation. Sensitivity, specificity and diagnostic accuracy of each endoscopic modality were assessed by reference to histopathology. RESULTS: NBI and chromoendoscopy scored better under high magnification than under low magnification in comparison with conventional colonoscopy. The diagnostic accuracy of NBI with low or high magnification was significantly higher than that of conventional colonoscopy (low magnification: p = 0.0434 for reader 1 and p = 0.004 for reader 2; high magnification: p<0.001 for both readers) and was comparable to that of chromoendoscopy. CONCLUSION: Both low-magnification and high-magnification NBI were capable of distinguishing neoplastic from non-neoplastic colorectal lesions; the diagnostic accuracy of NBI was better than that of conventional colonoscopy and equivalent to that of chromoendoscopy. The role of NBI in screening colonoscopy needs further evaluation.

Adenoma↗
PubMed2006

Association of metabolic syndrome with proximal and synchronous colorectal neoplasm.

BACKGROUND & AIMS: Metabolic syndrome and its associated morbidities have become a major public health problem in both developed and developing countries. Insulin resistance, the core mechanism of metabolic syndrome, has been associated with the development of colorectal neoplasm, but the interrelation between metabolic syndrome and colon cancer is rarely addressed. Our study aimed to determine whether metabolic syndrome is associated with the risk and clinical presentation of colorectal neoplasia. METHODS: Consecutive 4277 ethnic Chinese who received complete total colonoscopy and thorough health checkups were enrolled. Both National Cholesterol Education Program's Adult Treatment Panel III and modified Asian criteria were used for defining metabolic syndrome. Logistic regression modeling was used to elucidate the association between colorectal neoplasia and metabolic syndrome. The impact of metabolic syndrome on distribution and number of colorectal neoplasia was also assessed. RESULTS: Of all those enrolled, 27.1% of men and 18.9% of women met the criteria of metabolic syndrome, and 9.8% had colorectal neoplasia. Metabolic syndrome was associated with odds ratio (OR) of 1.35 (95% confidence interval [CI], 1.05-1.73) for colorectal neoplasia. OR was 0.96 (95% CI, 0.67-1.38) for distal lesions, 1.62 (95% CI, 1.14-2.30) for proximal lesions, 2.15 (95% CI, 1.40-3.31) for synchronous lesions, and 2.30 (95% CI, 1.42-3.72) for synchronous lesions located at both sides of colon. CONCLUSIONS: Subjects with metabolic syndrome have a higher risk of colon neoplasia at the proximal colon and synchronous lesions at both sides of the colon. These findings will help future colon cancer screening and prevention in patients with metabolic syndrome.

Adult↗
PubMed2006

Association of T-cell regulatory gene polymorphisms with susceptibility to gastric mucosa-associated lymphoid tissue lymphoma.

PURPOSE: Helicobacter pylori infection and host susceptibility interact to develop gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and activation of specific T cells might play a crucial role in this process. Recent investigations show that the CTLA4, CD28, and ICOS genes are located on chromosome 2q33 and their polymorphisms confer susceptibility to infectious and immune diseases through deregulation of T-cell stimulation. We aimed to determine the role of CTLA4, CD28, and ICOS polymorphisms in gastric MALT lymphoma. PATIENTS AND METHODS: Genotyping for CTLA4 (49 A/G, -318 C/T, and CT60 A/G), CD28 (IVS3+ 17T/C), and ICOS (c.602 A/C and c.1624C/T) was performed for 62 patients with gastric MALT lymphoma and compared with 250 unrelated healthy controls. RESULTS: H pylori infection was significantly higher in patients with gastric MALT lymphoma (90.3%) compared with controls (66.4%; P < .001). The CTLA4 -318 C/T genotype was associated with a lower risk of developing gastric MALT lymphoma (odds ratio [OR] = 0.3; P = .022), whereas CTLA4 49 G/G genotype was linked to a higher risk (OR = 4.1; P = .044). In patients with H pylori infection, CTLA4 49 G/G genotype was associated with an even higher risk (OR = 6.4; P = .047). Carriage of the tightly linked -318C -49G haplotype conferred a four-fold higher susceptibility to MALT lymphoma (OR = 4.2; P = .042). Complete remission after H pylori eradication was related to tumor stage but not to genotypes or haplotypes. CONCLUSION: These results indicate a genetic link of CTLA4 gene polymorphisms to development of gastric MALT lymphoma and indirectly support the crucial role of host activated T cells in the MALT lymphomagenesis.

Anti-Bacterial Agents↗
PubMed2006

Comparative immunoproteomics of identification and characterization of virulence factors from Helicobacter pylori related to gastric cancer.

Helicobacter pylori is an important risk factor of gastric cancer (GC). Although many H. pylori virulence factors have been reported, the pathogenic mechanism by which H. pylori infection causes GC remains unclear. The aims of this study were to identify GC-related antigens from H. pylori and characterize their roles in the development of GC. As GC and duodenal ulcer (DU) are considered clinically divergent, we compared two-dimensional immunoblots of an acid-glycine extract of H. pylori probed with serum samples from 15 patients with GC and 15 with DU to find GC-related antigens, which were subsequently identified by mass spectrometry. Many protein spots were recognized by more than one serum, and 24 of these were better recognized by GC sera. The proteins showing higher frequency of recognition in GC group are threonine synthase, rod shape-determining protein, S-adenosylmethionine synthetase, peptide chain release factor 1, DNA-directed RNA polymerase alpha subunit, co-chaperonin GroES (monomeric and dimeric forms), response regulator OmpR, and membrane fusion protein. Of these proteins, GroES was identified as a dominant GC-related antigen with a much higher seropositivity of GC samples (64.2%, n = 95) compared with 30.9% for gastritis (n = 94) and 35.5% for DU (n = 124). GroES seropositivity was more commonly associated with antral GC than with non-antral GC (odds ratio = 2.7; 95% confidence interval, 1.1-6.7). In peripheral blood mononuclear cells, GroES stimulated production of interleukin (IL)-8, IL-6, granulocyte macrophage colony-stimulating factor, IL-1beta, tumor necrosis factor-alpha, cyclooxygenase-2, and prostaglandin E(2). Moreover when incubated with gastric epithelial cells, GroES induced expression of IL-8, cell proliferation, and up-regulation of c-jun, c-fos, and cyclin D1 but caused down-regulation of p27(Kip1). We conclude that GroES of H. pylori is a novel GC-associated virulence factor and may contribute to gastric carcinogenesis via induction of inflammation and promotion of cell proliferation.

Antigens, Bacterial↗
PubMed2006

Mechanisms for Helicobacter pylori CagA-induced cyclin D1 expression that affect cell cycle.

Particular Helicobacter pylori genotypes differentially induce epithelial cell proliferation, but the mechanisms are not characterized. We explored the effect of H. pylori CagA on expression of cyclin D1, an important cell cycle regulator. H. pylori-induced cell survival and cyclin D1 expression were attenuated in a cagA mutant. AP1 and cAMP response element (CRE), but not NF-kappaB, were involved in the induced cyclin D1 expression. Diminished mitogen-activated protein kinase (MAPK) activation, especially involving p38, with downstream effects on AP1 and CRE activation, was observed for the cagA mutant. In total, these data show that cagA+ H. pylori strains are enhanced in their ability to activate MAPKs and downstream transcription factors, increasing cyclin D1 expression, G1-S phase progression, and host cell survival, explaining both the preferential survival of affected host cells, and the enhanced oncogenesis by these bacteria.

Antigens, Bacterial↗
PubMed2006

The antioxidant protein alkylhydroperoxide reductase of Helicobacter pylori switches from a peroxide reductase to a molecular chaperone function.

Helicobacter pylori, an oxygen-sensitive microaerophilic bacterium, contains many antioxidant proteins, among which alkylhydroperoxide reductase (AhpC) is the most abundant. The function of AhpC is to protect H. pylori from a hyperoxidative environment by reduction of toxic organic hydroperoxides. We have found that the sequence of AhpC from H. pylori is more homologous to mammalian peroxiredoxins than to eubacterial AhpC. We have also found that the protein structure of AhpC could shift from low-molecular-weight oligomers with peroxide-reductase activity to high-molecular-weight complexes with molecular-chaperone function under oxidative stresses. Time-course study by following the quaternary structural change of AhpC in vivo revealed that this enzyme changes from low-molecular-weight oligomers under normal microaerobic conditions or short-term oxidative shock to high-molecular-weight complexes after severe long-term oxidative stress. This study revealed that AhpC of H. pylori acts as a peroxide reductase in reducing organic hydroperoxides and as a molecular chaperone for prevention of protein misfolding under oxidative stress.

Amino Acid Sequence↗
PubMed2006

Prospective, randomized, and active controlled study of the efficacy of alginic acid and antacid in the treatment of patients with endoscopy-negative reflux disease.

AIM: To assess the efficacy and safety of a compound containing alginic acid plus antacid (Topaal) compared to equal-strength antacid (Nacid) in patients with endoscopy-negative reflux disease (ENRD). METHODS: A total of 121 patients with ENRD were randomized to receive Topaal (65 patients) or Nacid (56 patients) for 6 weeks, with a consultation every 3 weeks. The primary end-point assessment was the change in the severity of heartburn as evaluated using a visual analog scale (VAS) at 6 weeks. The secondary end-point assessments were the VAS at 3 weeks, the change of frequency of the reflux symptom, the change of quality of life and the adverse effects. RESULTS: Demographics of randomized subjects in each treatment group were comparable except that the Topaal group included more males. The baseline characteristics between the groups were similar. After 6 weeks of treatment, the reduction of VAS of heartburn was more prominent in the Topaal group (-6.29 cm vs -4.11 cm). At the 3rd week, Topaal group showed greater reduction of VAS for heartburn (P=0.0016), regurgitation (P=0.0006), vomiting (P=0.0373), and belching (P<0.0001). The patients of the Topaal group had lower frequency of heartburn (P=0.0015) and pain (P=0.0163) at the end of the 6-week treatment period. From the doctor's point of view, the Topaal group also showed significant reduction in the severity of heartburn (P=0.0020), regurgitation (P=0.0081), vomiting (P=0.0182), and belching (P=0.0018) at the end of the treatment. The improvement of the quality of life was more remarkable in the Topaal group at the end of the 6-week treatment period (P<0.0001). For the adverse effect, there was no difference in both the groups. CONCLUSION: Topaal is more effective than Nacid for the treatment of symptoms presented by patients with ENRD.

Adult↗
PubMed2006

Subcellular and functional proteomic analysis of the cellular responses induced by Helicobacter pylori.

Helicobacter pylori infection is a crucial factor in the pathogenesis of several digestive disorders, including peptic ulcers, chronic gastritis, and gastric cancer. Moreover H. pylori induces disease-specific protein expression in gastric epithelial cells. The aim of the present study was to characterize proteins differentially expressed in H. pylori-infected gastric epithelial AGS cells. An in vitro model was established using a multiplicity of infection of 100 and evaluating the effectiveness of H. pylori infection by functional analyses. Changes in protein patterns were identified using a proteomic approach consisting of two-dimensional fluorescence difference gel electrophoresis and mass spectrometry. The expression of many proteins was found to be altered, and 28 of these were identified and classified as protein synthesis- and folding-related proteins, cytoskeleton proteins, metabolic enzymes, transcription- and translation-related proteins, angiogenesis/metastasis-related proteins, cell communication/signal transduction-related proteins, or others (oxygen-regulated protein and oncoprotein). The expression profiles of eight of these proteins, laminin gamma-1 chain precursor, valosin-containing protein, heat shock 70-kDa protein, mitochondrial matrix protein P1, FK506-binding protein 4, T-complex protein 1, enolase alpha, and 14-3-3 beta were further examined in cancerous and paired surrounding normal tissues by immunoblot assay and immunohistochemical staining to identify molecular targets that may be involved in the pathogenesis of H. pylori-induced gastric diseases. On the basis of our results, valosin-containing protein, mitochondrial matrix protein P1, T-complex protein 1, enolase alpha, and 14-3-3 beta may play a crucial role in H. pylori-induced gastric carcinogenesis by mediating antiapoptotic and proliferative responses.

Blotting, Western↗
PubMed2006

Sonographic diagnosis of a toothpick traversing the duodenum and penetrating into the liver.

Ingested foreign bodies rarely cause gastrointestinal perforation, because the majority are passed out uneventfully in the feces. However, long, sharp, slender, hard, indigestible objects such as toothpicks are dangerous and may lead to potentially life-threatening complications. We report a case of duodenal perforation caused by a toothpick and complicated by liver abscess and methicillin-resistant Staphylococcus aureus sepsis. Although laparotomy was not performed because of the patient's refusal to undergo surgery, the liver abscess and sepsis were controlled successfully with antibiotics. We also conducted a literature search for reports on injuries caused by ingested toothpicks.

Anti-Bacterial Agents↗
PubMed2006

Appendiceal intussusception diagnosed with endoscopic sonography.

Intussusception of the appendix vermiformis is an uncommon cause of abdominal pain. Several imaging modalities are of limited value in diagnosing this rare condition, including barium enema, transabdominal sonography, and CT. We report a case of intussusception of the appendix vermiformis with the clinical presentation of intermittent abdominal pain in the right lower quadrant. Colonoscopy revealed an erythematous polypoid lesion at the cecal base. Endoscopic sonography demonstrated a multiconcentric structure and enabled the tentative diagnosis of intussusception of the appendix vermiformis. Laparoscopic surgery with a reduction of the appendix and appendectomy was performed and confirmed the diagnosis.

Abdominal Pain↗
PubMed2006

Phase I study of biweekly gemcitabine followed by oxaliplatin and simplified 48-h infusion of fluorouracil/leucovorin for advanced pancreatic cancer.

OBJECTIVES: To evaluate the feasibility and maximal tolerated dose (MTD) of oxaliplatin of a triplet regimen consisting of gemcitabine, oxaliplatin and infusional fluorouracil (5-FU)/leucovorin (LV) (GOFL) for advanced pancreatic cancer. PATIENTS AND METHODS: Patients with histologically proven metastatic or unresectable, locally advanced pancreatic adenocarcinoma were eligible to take part in the study. The treatment consisted of fixed-rate infusion (10 mg/m2/minute) of 800 mg/m2 gemcitabine followed by 2-h infusion of oxaliplatin and then 48-h infusion of 5-FU/LV day 1 and day 15 every 4 weeks. The oxaliplatin would be evaluated at three dose levels, 65, 75 and 85 mg/m2. RESULTS: A total of 15 patients were enrolled at three dose levels. Dose-limiting toxicity of neutropenic fever and grade 4 thrombocytopenia occurred in one of each six patients at oxaliplatin dose level of 65 mg/m2 and 85 mg/m2, respectively. The MTD of oxaliplatin for this combination was 85 mg/m2. After a median four cycles of treatment, grade 3/4 neutropenia occurred in 46.7% of patients and thrombocytopenia in 13.3%. Non-hematological toxicities were generally of grade 1/2. Objective tumor response was observed in five patients (33.3%, 95% confidence interval, 6.3-60.4%). CONCLUSION: Biweekly GOFL is a feasible regimen for advanced pancreatic cancer. For further phase II studies, the recommended dose of oxaliplatin is 85 mg/m2.

Adult↗
PubMed2006

Comparative analysis between psychological and endoscopic profiles in patients with gastroesophageal reflux disease: a prospective study based on screening endoscopy.

BACKGROUND: Associations between psychological and endoscopic profiles are not clearly validated among the heterogeneous patients with gastroesophageal reflux disease (GERD). The purpose of the present paper was therefore to identify any associations by means of cross-sectional study. METHODS: Consecutive participants in a health screening program were enrolled. Definition and severity of erosive esophagitis were assessed with Los Angeles classification. Frequency and severity of psychological symptoms were measured with a 30-item Brief Symptom Rating Scale (BSRS) and personality traits with a short form of the Maudsley Personality Inventory (MPI). Statistic analyses were performed based on the presence of GERD symptoms or endoscopic esophagitis. RESULTS: A total of 4600 participants were recruited. There were 1331 subjects (29%) with manifestations suggesting GERD, including non-erosive reflux disease (NERD) in 488 (10.6%), symptomatic erosive esophagitis (SEE) in 164 (3.6%), and asymptomatic erosive esophagitis (AEE) in 679 (14.8%). The BSRS parameters were significantly higher in symptomatic subjects (i.e. NERD and SEE subjects; P < 0.001); neuroticism scores were also higher (P < 0.001), but extroversion scores (P < 0.001) were lower than those of asymptomatic subjects. Following logistic regression analysis, independent risk factors for GERD symptoms were female gender (odds ratio [OR]: 1.596; 95% confidence interval [CI]: 1.303-1.955) and higher neuroticism scores (OR: 1.046; 95%CI: 1.032-1.06). For erosive esophagitis, independent risk factors were male gender (OR: 2.943; 95%CI: 2.359-3.671) and higher body mass index scores (OR: 1.098; 95%CI: 1.069-1.127). CONCLUSIONS: Psychological characteristics predict likelihood of GERD symptoms but not structural state of esophagus. Male gender and obesity are risk factors for erosive esophagitis; whereas female gender and neuroticism are more likely to be associated with GERD symptoms.

Adolescent↗
PubMed2006

Multiple hepatic nodules: rare manifestation of clonorchiasis.

A 38-year-old man was admitted due to intermittent right upper quadrant pain for 1 month. Leukocytosis with marked eosionphilia and elevated serum alkaline phosphatase were noted. Stool examinations revealed no parasites or ova. Ultrasonography and computed tomography disclosed multiple hepatic tumors. Biopsy of the hepatic tumor was performed due to non-conclusive imaging studies and revealed eosinophil infiltration in portal areas only. Endoscopic retrograde cholangiography showed mild dilatation with irregularity of bilateral intrahepatic ducts, compatible with chronic cholangitis. Bile was aspirated and biliary lavage with normal saline was performed during endoscopy-guided biliary cannulation. Microscopic examination of the aspirate showed the characteristic ova of Clonorchis sinensis. The patient received Praziquantel therapy for 1 day. Abdominal pain reduced in intensity gradually. Eosinophilia and multiple hepatic lesions resolved after adequate treatment of Clonorchis sinensis. The rare manifestation of multiple hepatic tumors in Clonorchis sinensis should be differentiated from other primary or metastatic neoplasms, while biliary lavage for parasite ova is a valuable diagnostic tool when stool examination is negative.

Adult↗