Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience.

BACKGROUND: Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) worldwide. It remains incompletely understood in the real world how anti-viral therapy affects survival after HCC diagnosis. METHODS: This was an international multicentre cohort study of 2518 HBV-related HCC cases diagnosed between 2000 and 2015. Cox proportional hazards models were utilised to estimate hazard ratios (HR) with 95% (CI) for anti-viral therapy and cirrhosis on patients' risk of death. RESULTS: Approximately, 48% of patients received anti-viral therapy at any time, but only 17% were on therapy at HCC diagnosis (38% at US centres, 11% at Asian centres). Anti-viral therapy would have been indicated for >60% of the patients not on anti-viral therapy based on American criteria. Patients with cirrhosis had lower 5-year survival (34% vs 46%; P < 0.001) while patients receiving anti-viral therapy had increased 5-year survival compared to untreated patients (42% vs 25% with cirrhosis and 58% vs 36% without cirrhosis; P < 0.001 for both). Similar findings were seen for other patient subgroups by cancer stages and cancer treatment types. Anti-viral therapy was associated with a decrease in risk of death, whether started before or after HCC diagnosis (adjusted HR 0.62 and 0.79, respectively; P < 0.001). CONCLUSIONS: Anti-viral therapy improved overall survival in patients with HBV-related HCC across cancer stages and treatment types but was underutilised at both US and Asia centres. Expanded use of anti-viral therapy in HBV-related HCC and better linkage-to-care for HBV patients are needed.

The relationship of the anterior articular capsule to the adjacent subscapularis: An anatomic and histological study.

INTRODUCTION: The purpose of this study was to delineate the anatomic relationship between the anterior articular capsule and the adjacent subscapularis by measuring the dimensions of the anterior articular capsule attachment and the subscapularis footprint on the humerus, as well as investigating the interface between the two structures. MATERIALS AND METHODS: Three shoulder specimens underwent histological analysis; for histological analysis, cross-sections through the subscapularis-capsule complex were harvested at the tendinous and muscular insertion sites. The dimensions of the anterior articular capsule attachment and the subscapularis footprint (including the tendinous and muscular insertions) were measured in thirteen cadaveric shoulder specimens. RESULTS: Histologically, the articular capsule has thin and loosely arranged collagen fibers with many interspersing fibroblast nuclei, whereas the outer layer of the articular capsule blends into a layer of more loosely spaced and less organized collagen fibers. This interface between the subscapularis and the underlying articular capsule is filled with more loosely spaced and less organized collagen fibers. The macroscopic evaluation showed that the minimum articular capsule width (4.2mm, SD 2.2mm) was located at its initiation 4.9mm (SD, 2.1mm) inferior to the superior margin of the subscapularis; the corresponding subscapularis footprint width measured 10.1mm (SD, 4.9mm). The maximum articular capsule width was11.1 mm (SD, 3.7mm) and was located 5mm distal to the inferior margin of the tendinous footprint. The maximum subscapularis footprint width was 15.8mm (SD, 2.9mm); the corresponding articular capsule attachment measured 5.2mm (SD, 1.8mm). CONCLUSIONS: Our results suggest that the anterior articular capsule attachment of the glenohumeral joint complements the footprint of the subscapularis and occupies a larger area of the lesser tubercle and metaphysis of the humerus than previously documented. The histological study confirms the presence of a demarcation between the subscapularis and articular capsule, specifically more significant at the region medial to the tendon insertion and at the muscular insertion of the subscapularis.

Increased carrier mobility in end-functionalized oligosilanes.

We show that a class of oligosilane-arene σ, π-hybrid materials exhibits distinct and enhanced solid-state electronic properties relative to its parent components. In the single crystal structure, the σ-conjugation axis of one molecule points towards the π-face of a neighboring molecule due to an unusual gauche conformation. This organization is hypothesized to be beneficial for charge transport. We show that solution-deposited crystalline films of the hybrid materials show up to a 100-fold increase in space-charge limited current (SCLC) mobility relative to literature reports of photoinduced hole transport in oligosilane films. The discovery that σ, π-hybrids are more than the sum of their parts offers a design opportunity for new materials.

Transplantation of autologous endothelial progenitor cells in porous PLGA scaffolds create a microenvironment for the regeneration of hyaline cartilage in rabbits.

OBJECTIVE: Repairing articular cartilage is clinically challenging. We investigated a simple, effective and clinically feasible cell-based therapeutic approach using a poly(lactide-co-glycolide) (PLGA) scaffold seeded with autologous endothelial progenitor cells (EPC) to repair a full-thickness osteochondral defect in rabbits using a one-step surgery. METHODS: EPC obtained by purifying a small amount of peripheral blood from rabbits were seeded into a highly porous, biocompatible PLGA scaffold, namely, EPC-PLGA, and implanted into the osteochondral defect in the medial femoral condyle. Twenty two rabbits were randomized into one of three groups: the empty defect group (ED), the PLGA-only group or the EPC-PLGA group. The defect sites were evaluated 4 and 12 weeks after implantation. RESULTS: At the end of testing, only the EPC-PLGA group showed the development of new cartilage tissue with a smooth, transparent and integrated articular surface. Moreover, histological analysis showed obvious differences in cartilage regeneration. At week 4, the EPC-PLGA group showed considerably higher TGF-ß2 and TGF-ß3 expression, a greater amount of synthesized glycosaminoglycan (GAG) content, and a higher degree of osteochondral angiogenesis in repaired tissues. At week 12, the EPC-PLGA group showed enhanced hyaline cartilage regeneration with a normal columnar chondrocyte arrangement, higher SOX9 expression, and greater GAG and collagen type II (COLII) content. Moreover, the EPC-PLGA group showed organized osteochondral integration, the formation of vessel-rich tubercular bone and significantly higher bone volume per tissue volume and trabecular thickness (Tb.Th). CONCLUSION: The present EPC-PLGA cell delivery system generates a suitable in situ microenvironment for osteochondral regeneration without the supplement of exogenous growth factors.

Fetal meconium peritonitis in single and twin pregnancy. Two cases report.

We present two cases of fetal meconium peritonitis in a single and twin pregnancy, respectively. The first case diagnosis was made at 30 weeks and was confirmed after delivery of the twins by cesarean section at 37 weeks. The second case diagnosis was made at 31 week and was confirmed at 37 weeks. Meconium peritonitis is a rare prenatal complication that results from intrauterine perforation of small bowel with spillage of sterile meconium into peritoneal cavity. We now report two cases of meconium peritonitis diagnosed at 30 and 31 weeks gestation.

A multidimensional assessment of insights in schizophrenic patients.

This study aims to construct a multidimensional instrument in assessing insight of schizophrenic patients and further to examine its relationships with other factors such as psychiatric symptoms, demographic characteristics, and course of illness. An instrument (the Schedule for assessment of Insight in Psychosis, SIP) with a 4-point rating scale was constructed to assess the insight of schizophrenic patients in five dimensions. One hundred schizophrenic patients were recruited for the study and all of them received a semi-structured interview using the SIP. Their demographic variables, length of illness and severity of psychotic symptoms were analyzed for insight. The reliability and validity of the SIP were satisfactory. Significant factors related to insight were psychotic symptoms, including both positive and negative symptoms. This study showed insight was affected by a multitude of factors, and it could be assessed quantitatively in various dimensions.

Prenatal diagnosis of meconium peritonitis in a twin pregnancy after intracytoplasmic sperm injection. A case report.

BACKGROUND: Meconium peritonitis occurring in pregnancies following artificial reproductive techniques (ART) is rare. We report the first case of meconium peritonitis following intracytoplasmic sperm injection (ICSI). CASE: A 37-year-old woman attended our in vitro fertilization (IVF) program because her husband suffered from hypospermatogenetic azoospermia due to cancer surgery and radiotherapy. The patient achieved a twin pregnancy through ICSI from testicular sperm extraction at our IVF center. Meconium peritonitis, fetal ascites, polyhydramnios, bowel dilatation, hydrocele and intraabdominal calcification were noted in one of the twins on ultrasound at 30 weeks' gestation. Cesarean section due to breech presentation in labor was performed at 36 weeks' gestation. A normal female and male infant with a distended abdomen were delivered. Emergency laparotomy was performed on the male twin because of dyspnea. A 0.2-cm perforation was found in the terminal ileum. Ileotomy was performed and closed after 27 days. CONCLUSION: Prenatal diagnosis of meconium peritonitis is possible through careful ultrasonographic examination, and early surgical intervention and intensive postoperative support are required to improve the prognosis.

Comparison of sexual behaviors between male homosexuals and male heterosexuals in Taiwan.

BACKGROUND: Homosexuality and sexual behavior have attracted great attention in the acquired immunodeficiency syndrome (AIDS) epidemic. This study primarily explores the risky behaviors and patterns of sexual behavior of male homosexuals in Taiwan. METHODS: Comparison study methodology was adopted. Ninety-two male homosexuals, as the study group, were recruited from gay bars and gay organizations, and 91 male heterosexuals, with similar ages and educational levels, were recruited as a control group for comparison. Semi-structured interviews were carried out and anonymous questionnaires were self-administered. RESULTS: (1) The mean age at the time of first sexual intercourse of the study group was younger than that of the control group. (2) The rate of having two or more sexual partners in the study group was significantly higher. (3) However, the rate of condom use during recent intercourse was higher in the control group than in the study group. (4) Sexual knowledge and attitudes toward sexuality in the study group were more open, but their sexual desires, as rated by the questionnaire, were more suppressed than those of the control group. (5) In terms of courtship, the study group was less constrained by the social values of marriage and tended to separate sex from love. CONCLUSION: Similar to western studies, our study found that the study group in Taiwan adopted more risky sexual behaviors. Each group had its particular sexual behavioral pattern and subculture of sexuality. However, a longitudinal follow-up study with ethnographic perspective is necessary for a more sophisticated understanding of the trends and changes of sexual behavior in homosexuals.

Prenatal and neonatal intussusception.

Intussusception found in the 1st month of life is rare and usually discussed as one entity, neonatal intussusception, but in fact, includes the intussusceptions occurring both prenatally and neonatally, of which the clinical presentations and results are different. Four full-term babies with prenatal intussusception presenting as intestinal atresia (IA) and three premature babies with neonatal intussusception mimicking necrotizing enterocolitis (NEC) are presented. Prenatal intussusception, as one of the causes of IA produces prominent signs of intestinal obstruction immediately after birth. Preoperative evaluation usually fails to yield a definitive diagnosis, but surgery is usually performed in time and is successful. In neonatal intussusception, full-term infants usually have a pathological lead point and the colon is almost always involved. A barium enema is thus useful in diagnosis. Premature babies, on the other hand, rarely have a colonic component, and the clinical features are insidious and similar to NEC. This results in diagnostic confusion that may lead to a dangerous delay in appropriate surgical correction. A high level of suspicion about this condition in cases diagnosed presumptively with NEC is important. Serial abdominal sonograms may be helpful in the early diagnosis of neonatal intussusception.

Experience with distal circular myotomy for long-gap esophageal atresia.

From 1980 to 1994, the authors treated 65 cases of esophageal atresia (with or without tracheoesophageal fistula). Among these patients, 15 (23%) underwent pure proximal circular myotomies and five (8%) underwent both proximal and distal circular myotomies. Of the latter five cases, three were Gross type C and two were Gross type A. The gap ranged from 4.5 cm to 6.5 cm (mean, 5 cm). Surgical complications in these five patients included two anastomotic leaks (40%), one anastomotic stricture (20%), and four gastroesophageal refluxes (80%). Three patients eventually underwent fundoplication as an antireflux procedure. Mucosal outpouching was noted in all cases. The myotomy did not adversely affect the esophageal peristalsis and motility on the esophagogram. Esophageal function was similar to that of other children who had esophageal atresia without myotomy. All patients could eat food typical for their age. This limited experience suggests that distal circular myotomy might be a safe adjuvant procedure to achieve primary anastomosis in long-gap esophageal atresia.

Characterization of monoclonal antibody B7, which neutralizes the cytotoxicity of Pseudomonas aeruginosa exotoxin A.

A nontoxic Pseudomonas aeruginosa exotoxin A (PE), which has the carboxyl-terminal 38 amino acid residues of native PE deleted, was used as an antigen to immunize BALB/c mice, which were then challenged with native PE in order to raise monoclonal antibodies (MAbs) that can neutralize PE cytotoxicity. A murine MAb against PE, designated MAb B7, was established. MAb B7 was characterized in terms of its ability to neutralize PE cytotoxicity, epitope mapping, inhibition of PE receptor binding, and influence on cellular processing of PE and ADP-ribosylation activities. We found that MAb B7 could neutralize PE cytotoxicity in cell culture and in BALB/c mice. The epitope recognized by MAb B7 was mapped to the carboxyl-terminal amino acid residues 575 to 595 of PE. Consistent with the results of epitope mapping, MAb B7 did not block PE receptor-binding activity or the cellular processing of PE but strongly inhibited the ADP-ribosylating activity of PE. In addition, MAb B7 retained strong binding to PE even at pH 4.0, indicating that the complex of MAb B7 and PE is stable in the phagolysosome. On the basis of these observations, the neutralization of PE cytotoxicity by MAb B7 could be due to its binding to the carboxyl terminus of PE. As a result, MAb B7 may interfere with the interaction of the carboxyl-end amino acid residues REDLK of PE with cellular factors. However, we could not rule out the possibility that MAb B7 directly blocks the ADP-ribosylation activity of PE in the cytosol.

Torticollis: a long-term follow-up study.

To achieve better guidelines for the future management of torticollis, this study analyzed surgical and nonsurgical management of 253 torticollis patients who were treated in this hospital from 1971 to 1993. Of those, 37 cases received operation only, 78 cases were operated after failed physical therapy, and 138 cases were treated only at the Rehabilitation Department. If free neck movement was considered to be the primary goal of treatment, most parents were satisfied with the results. However, if facial and skull deformities were the serious sequelae of torticollis, then only less than half of the surgical and nonsurgical groups of patients were graded as normal. Further, 10.9% of physical therapy group and 7% of the surgical patients need further operation to release the fibrotic bundle which limited their neck movement. Therefore, it is suggested that torticollis treatment should include early interventions such as adjusting sleep position, careful planning of physical therapy and/or operation and a long term follow-up period as essential for better management of torticollis.

Neonatal-onset chronic intestinal pseudo-obstruction syndrome.

Between January 1985 and January 1990, six cases of neonatal-onset chronic intestinal pseudo-obstruction syndrome (CIPS) were identified. Failure to gain weight in six cases, abdominal distention in five, and vomiting in five were the most common presenting symptoms. The contrast studies of the gastrointestinal tract demonstrated delayed transit time in 6/6, jejunal or ileal dilatation in 1/6, megaduodenum in 1/6, dilatation of the colon with barium retention in 4/6, and microcolon in 1/6. Urinary tract involvement was noted in three patients. Laparotomy, performed in three patients, revealed no mechanical obstruction. Except for hypoganglionosis in Patient 4, no recognizable neuropathy or myopathy was noted histopathologically. Four patients expired within 2 months after discharge. We conclude that CIPS with neonatal onset should be suspected when infants have urinary retention and abdominal distention or constipation beginning at birth or soon after. The prognosis of CIPS presenting in the newborn period appears worse than that presenting in childhood or adulthood.

[Effects of air pollutants on pulmonary function and bronchial reactivity in patients with chronic obstructive pulmonary disease].

Exposure to polluted air can cause respiratory symptoms in subjects with airflow limitation. Twelve COPD (chronic obstructive pulmonary disease) patients with mild to moderate obstructive ventilatory defects were exposed on separate occasions to fresh ambient air and polluted air collected from the Lin-Sun S. Road tunnel in Taipei City. Concentrations of SO2 and NO2 were 85-121 ppb and 449-502 ppb, respectively, and were 4-fold and 10-fold, respectively, higher than those of out-door air in the city. Twenty healthy adult volunteers served as the control group. Maximal expiratory flow-volume determination, respiratory resistance (Rrs) and methacholine bronchial challenges were completed before and after inhalation of polluted air for 20 minutes. No difference in FVC (forced vital capacity), FEV1 (1 second forced expiratory volume), Rrs and bronchial reactivity was noted for normal subjects after inhaling polluted air and ambient air. For patients with COPD, there was a small but significant decrease in FEV1 after exposure. The elevation in Rrs was prominent, and there was also a significant increase in bronchial sensitivity to methacholine (decrease in cumulative provocation dose, DA) in positive responders. We conclude that short-term exposures to moderate polluted air can affect lung function and increase bronchial sensitivity to methacholine in COPD patients.

Coping in spouses of patients with acute myocardial infarction in Taiwan.

OBJECTIVE: The purpose of this study was to determine the usage and perceived effectiveness of coping strategies of spouses of patients with acute myocardial infarction in Taiwan, the Republic of China, during the acute phase of the illness. DESIGN: Survey. SETTING: Visitors room for a coronary care unit in Taiwan, the Republic of China. SUBJECTS: Twenty-one female and 10 male spouses of patients with acute myocardial infarction. OUTCOME MEASURES: The Revised Ways of Coping Scale was modified to assess both frequency of use and perceived effectiveness of coping strategies. It was also translated into Chinese. RESULTS: Seeking Social Support was the most frequently used coping strategy, whereas Confrontive Coping was used the least. There were significant positive relationships between the extent of usage of coping strategies and their perceived effectiveness. Men used Planful Problem-Solving more often and found it be more effective than did women; they also found the Self-Controlling and Accepting Responsibility strategies to be more effective than did women. Older spouses reported the Planful Problem-Solving strategy to be more effective than did younger subjects. The more family members living with a spouse, the less Accepting Responsibility was used as a coping strategy. CONCLUSIONS: Spouses of patients with acute myocardial infarction in Taiwan, the Republic of China, report using a variety of coping strategies. Those used most often are perceived to be the most effective.

Meconium ileus-like condition in Chinese neonates.

Between January 1985 and May 1990, 16 neonates were treated for meconium ileus (MI) at this hospital. All babies were born to Chinese couples. Seven of them were premature, but none of them weighed less than 1,000 g. Eight patients underwent operations either because of mistaken diagnosis, as ileal atresia or long-segment Hirschsprung's disease, or because of complicated MI, including two meconium peritonitis and one associated with ileal atresia. Gastrograffin enema was successful in management of eight uncomplicated MI. The albumin content in the meconium of the last nine cases, including four complicated cases, ranged from 9.2 to 93.3 mg/g dry meconium. Usually, albumin is not present in normal meconium. All cases received sweat test, which were negative. Three patients died in the follow-up period. Sepsis of unknown origin, multiple congenital anomalies, and severe metabolic problems were the causes of death. The other 13 patients are doing well. They have exhibited no pulmonary or digestive problems during their follow-up period, which ranged from 11 months to 5 years. They are healthy and receive regular diets. Growth and development are appropriate for their age groups.

Experience with treatment of gastroschisis and omphalocele.

From 1982 to 1990, 31 neonates with omphalocele and 54 with gastroschisis were treated at Mackay Memorial Hospital. The overall survival rate for omphalocele was 71%, while it was 85% for gastroschisis. The rate of primary fascial closure for omphalocele (85%) and gastroschisis (87%) was similar. The mortality from omphalocele was almost exclusively due to the presence of serious associated congenital anomalies. Two cases of Cantrell's pentalogy and two of cloacal exstrophy were found. The incidence of major malformation with gastroschisis was 6%. Sepsis, inadequate perioperative resuscitation and prolonged gastrointestinal dysfunction were the major causes of death in gastroschisis. Among survivors, the hospital stay was significantly longer in the silon pouch group than in the primary fascial closure group (71.5 vs 31.3 days for gastroschisis, 41 vs 14 days for omphalocele). Advances in surgical technique, neonatal intensive care and ventilatory support have made primary fascial closure a superior approach without jeopardizing the babies' chance for survival. An improved survival rate and increased primary closure rate are the main features in the treatment of abdominal wall defects in the last decade.

The management of anorectal malformations.

From 1982 to 1990, 120 cases of anorectal malformation (84 males and 36 females) were admitted to Mackay Memorial Hospital; 101 cases were corrected surgically. Among these, 40 cases were high (H) or intermediate (I) type, and 61 cases were low (L) type. In the 40 cases of the H and I type, 13 (Group 1) received Stephens' procedure (SPR) and the remaining 27 (Group 2) received Peña's procedure (PSARP). For the L type, translocation anoplasty, cut-back anoplasty and limited PSARP were employed in 10, 45 and 6 cases, respectively. Anorectal continence results were evaluated by Kiesewetter's criteria. In Group 1, the results were good in 25%, fair in 17% and poor in 58%. In Group 2, the results were good in 70% and fair in 30%. In addition to better anorectal continence, the PSARP resulted in a lower rate of major complications. In the L type, the results were excellent without significant difference among the types of surgery employed.

Clinical observation of meconium peritonitis.

Twenty cases of meconium peritonitis were found between September 1980 and March 1988 at Mackay Memorial Hospital. The male to female ratio was 1.5 to 1. Six of the 20 cases involved premature babies. The great majority presented symptoms and signs before 5 days old, but one case was not diagnosed until 13 months of age. Polyhydramnios of the mother was found in six cases (30%). Abdominal distension was the universal symptom in all 20 cases. Hydrocele was noticed in 8 of the 12 male babies. In seven cases (35%) radiological examination showed abdominal calcifications. All patients underwent surgical intervention. Peritonitis was of cystic type in seven cases (35%); fibroadhesive in nine cases (45%); generalized in four cases (20%). Evident intestinal perforation was noted in 13 patients, and a mechanical obstructive lesion was found in 9 cases (45%) including intestinal diaphragm, atresia, volvulus, and Hirschsprung's disease. In only two patients (10%) was neither evident perforation nor obstructive lesion. The overall mortality rate was 30% (6/20), with no mortality after 1986 (0/6). The mortality seemed increased in those associated with perforation (4/13) and midgut volvulus (2/2) in particular, compared with non-perforation cases (1/7). It appears that early aggressive operation, and meticulous postoperative care, have contributed to the higher survival rate in recent years.