An Jen Chiang - Academia.edu (original) (raw)
Papers by An Jen Chiang
Biomedicines
Infection-induced chronic inflammation is common in patients with endometriosis. Although microbi... more Infection-induced chronic inflammation is common in patients with endometriosis. Although microbial communities in the reproductive tracts of patients have been reported, little was known about their dynamic profiles during disease progression and complication development. Microbial communities in cervical mucus were collected by cervical swabs from 10 healthy women and 23 patients, and analyzed by 16S rRNA amplicon sequencing. The abundance, ecological relationships and functional networks of microbiota were characterized according to their prevalence, clinical stages, and clinical features including deeply infiltrating endometriosis (DIE), CA125, pain score and infertility. Cervical microbiome can be altered during endometriosis development and progression with a tendency of increased Firmicutes and decreased Actinobacteria and Bacteroidetes. Distinct from vaginal microbiome, upregulation of Lactobacillus, in combination with increased Streptococcus and decreased Dialister, was fr...
Biomedicines, 2022
Ribosome biogenesis is a cellular process critical for protein homeostasis during cell growth and... more Ribosome biogenesis is a cellular process critical for protein homeostasis during cell growth and multiplication. Our previous study confirmed up-regulation of ribosome biogenesis during endometriosis progression and malignant transition, thus anti-ribosome biogenesis may be effective for treating endometriosis and the associated complications. A mouse model with human endometriosis features was established and treated with three different drugs that can block ribosome biogenesis, including inhibitors against mTOR/PI3K (GSK2126458) and RNA polymerase I (CX5461 and BMH21). The average lesion numbers and disease frequencies were significantly reduced in treated mice as compared to controls treated with vehicle. Flow cytometry analyses confirmed the reduction of small peritoneal macrophage and neutrophil populations with increased large versus small macrophage ratios, suggesting inflammation suppression by drug treatments. Lesions in treated mice also showed lower nerve fiber density w...
Background It is often clinically useful to classify tumor markers into risk groups. This study w... more Background It is often clinically useful to classify tumor markers into risk groups. This study was aimed to investigate whether beginning with a statistically sound method would find cut points more reasonable than conventional ones. Methods We used data of endometrial cancer including 442 patients. The optimal number of cutoffs was based on the Akaike criterion and statistical algorithms were adapted to find the best locations. Codes were provided as a package. Results Myometrium invasion was an independent risk factor for lymph nodal metastasis when stratified into three groups by 0.41 and 0.89. Tumor size was an independent risk factor for overall survival when stratified into two groups by 4.11 cm. Both had better prediction than conventional choices and clinical relevance. Conclusion A statistically sound algorithm should be used to stratify patients into risk groups.
Journal of Clinical Sleep Medicine, 2008
We report two cases in which amnestic sleep related eating disorder (SRED) occurred with extended... more We report two cases in which amnestic sleep related eating disorder (SRED) occurred with extended-release zolpidem but not with the immediate-release formulation. These cases illustrate how even relatively small differences such as formulation can affect the likelihood of experiencing such events.
International Journal of Engineering Business Management, 2019
The managerial aspect of providing quality, cost-effective health services to hospital patients i... more The managerial aspect of providing quality, cost-effective health services to hospital patients is becoming increasingly important. However, merely focusing on cost reduction and quality improvement may jeopardize personnel satisfaction. Therefore, a balanced approach based on multiple considerations is necessary. Operating rooms (ORs) account for almost 33% of a hospital’s budget, and nursing labor costs represent more than 40% of a hospital’s budget. The concerns around health-care quality, personnel motivation, staff satisfaction, patient length of stay, and patient flow rate are greatly influenced by these two units with regard to day-to-day operations management. A possible approach is to look into the related essential problems, such as the nursing staff time scheduling in nursing units, and the doctor time scheduling in ORs. After surgery in the OR, patients stay in the subsequent ward for a period of time. This causes loading interdependency between the anterior OR and the p...
OncoTargets and Therapy, 2019
Background: Non-small-cell lung cancer (NSCLC) remains the leading cause of cancer morbidity and ... more Background: Non-small-cell lung cancer (NSCLC) remains the leading cause of cancer morbidity and mortality worldwide. In the present study, we identified novel biomarkers associated with the pathogenesis of NSCLC aiming to provide new diagnostic and therapeutic approaches for NSCLC. Methods: The microarray datasets of GSE18842, GSE30219, GSE31210, GSE32863 and GSE40791 from Gene Expression Omnibus database were downloaded. The differential expressed genes (DEGs) between NSCLC and normal samples were identified by limma package. The construction of protein-protein interaction (PPI) network, module analysis and enrichment analysis were performed using bioinformatics tools. The expression and prognostic values of hub genes were validated by GEPIA database and real-time quantitative PCR. Based on these DEGs, the candidate small molecules for NSCLC were identified by the CMap database. Results: A total of 408 overlapping DEGs including 109 up-regulated and 296 downregulated genes were identified; 300 nodes and 1283 interactions were obtained from the PPI network. The most significant biological process and pathway enrichment of DEGs were response to wounding and cell adhesion molecules, respectively. Six DEGs (PTTG1, TYMS, ECT2, COL1A1, SPP1 and CDCA5) which significantly up-regulated in NSCLC tissues, were selected as hub genes according to the results of module analysis. The GEPIA database further confirmed that patients with higher expression levels of these hub genes experienced a shorter overall survival. Additionally, CMap predicted the 20 most significant small molecules as potential therapeutic drugs for NSCLC. DL-thiorphan was the most promising small molecule to reverse the NSCLC gene expression. Conclusions: Based on the gene expression profiles of 696 NSCLC samples and 237 normal samples, we first revealed that PTTG1, TYMS, ECT2, COL1A1, SPP1 and CDCA5 could act as the promising novel diagnostic and therapeutic targets for NSCLC. Our work will contribute to clarifying the molecular mechanisms of NSCLC initiation and progression.
Sleep, 2019
Supplement, 2019 (p=0.12 and 0.59 respectively). The ResMed ® estimated mean TST was slightly low... more Supplement, 2019 (p=0.12 and 0.59 respectively). The ResMed ® estimated mean TST was slightly lower than the Actiwatch ® (by 12.8 minutes, p=0.045). Users rated the disruptiveness of the devices at an average of 1.2 on a scale of 0 to 10 with a score of "0" being indicative of not being disruptive, while "10" was extremely disruptive. Conclusion: Commercially-available sleep tracking devices can reasonably estimate TST in adults with "good" sleep, although they tend to slightly underestimate TST compared to self-report. The devices tested do not seem to disrupt sleep. Clinicians and fitness professionals could review data from these devices, in conjunction with clinical data, to help ascertain whether healthy subjects are obtaining sufficient sleep. Support (If Any
Computers & Industrial Engineering, 2018
Journal of gynecologic oncology, Sep 15, 2018
Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obst... more Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors. The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival. Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including b...
Journal of gynecologic oncology, 2018
The objective was to identify risk factors that were associated with the progression from endomet... more The objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data. The study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated. A total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety...
Taiwanese Journal of Obstetrics and Gynecology, 2016
Journal of Biopharmaceutical Statistics, 2017
Classification measures play essential roles in the assessment and construction of classifiers. H... more Classification measures play essential roles in the assessment and construction of classifiers. Hence, determining how to prevent these measures from being affected by individual observations has become an important problem. In this paper, we propose several indexes based on the influence function and the concept of local influence to identify influential observations that affect the estimate of the area under the receiver operating characteristic curve (AUC), an important and commonly used measure. Cumulative lift charts are also used to equipoise the disagreements among the proposed indexes. Both the AUC indexes and the graphical tools only rely on the classification scores, and both are applicable to classifiers that can produce real-valued classification scores. A real data set is used for illustration.
Journal of lower genital tract disease, 2016
This study analyzed the risk factors for their possible association with overall survival and pro... more This study analyzed the risk factors for their possible association with overall survival and progression-free survival in cervical cancer, with a flexible model that allowed time-varying effects. Information about patients with cervical cancer from 2002 to 2012 was collected in the Kaohsiung Veterans General Hospital. All available biological and clinicopathologic factors were tested for the assumption of the Cox proportional hazard model, that is, whether they had time-varying effect on survival. The factors were also analyzed in univariate and multivariate statistics to identify independent risk factors. The multivariate analysis was performed with an extended Cox model so that those factors that failed the assumption test were allowed to vary with time. Approximately 797 patients were included in the final analysis. Most factors tested passed the Cox assumption test, except tumor size and body mass index in the event of recurrence and preoperative CA125 values in the event of de...
Taiwanese journal of obstetrics & gynecology, 2016
Uterine sarcomas account for 3-7% of all uterine cancers. Because of their rarity, unknown etiolo... more Uterine sarcomas account for 3-7% of all uterine cancers. Because of their rarity, unknown etiology, and highly divergent genetic aberration, there is a lack of consensus on risk factors for occurrence and predictive poor outcomes as well as optimal therapeutic choices. Tumor types according to the World Health Organization classification include leiomyosarcoma, endometrial stroma sarcoma, and undifferentiated sarcoma. Staging is done using the 2014 Federation International Gynecology and Obstetrics and 2010 American Joint Committee on Cancer tumor, lymph node, and metastases systems. Tumor grade can be classified based on the French Federation of Cancer Centers Sarcoma Group system or the Broder's system that incorporates tumor differentiation, mitotic count, and tumor necrosis. This review is a series of articles discussing uterine sarcoma, and this is Part I, which focuses on one of the subtypes of uterine sarcomas-uterine leiomyosarcoma. The clinical characteristics, diagnos...
Taiwanese journal of obstetrics & gynecology, 2016
Endometrial stromal tumors are rare uterine tumors (<1%). Four main categories include endomet... more Endometrial stromal tumors are rare uterine tumors (<1%). Four main categories include endometrial stromal nodule, low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and uterine undifferentiated sarcoma (UUS). This review is a series of articles discussing the uterine sarcomas. LG-ESS, a hormone-dependent tumor harboring chromosomal rearrangement, is an indolent tumor with a favorable prognosis, but characterized by late recurrences even in patients with Stage I disease, suggesting the requirement of a long-term follow-up. Patients with HG-ESS, based on the identification of YWHAE-NUTM2A/B (YWHAE-FAM22A/B) gene fusion, typically present with advanced stage diseases and frequently have recurrences, usually within a few years after initial surgery. UUS is, a high-grade sarcoma, extremely rare, lacking a specific line of differentiation, which is a diagnosis of exclusion (the wastebasket category, which fails to fulfill the morphological...
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, Jan 6, 2016
The objective of this study was to identify clinical and pathologic factors that are significant ... more The objective of this study was to identify clinical and pathologic factors that are significant to relapse in borderline ovarian tumours (BOT). All patients with BOTs from 1997 to 2012 in our institute were identified. 115 patients were included in the study. The Cox proportional hazards model was used to identify significant factors. The median age was 42 years (range 14-85 years). The majority of the patients were at FIGO stage I (88.7%), and most of the patients had mucinous histology (66.1%), reflecting the predominant distribution of mucinous BOTs in East Asia. The median follow-up was 3.3 years (range 0-4.1 years). Twelve patients (10.4%) relapsed and two died consequently. Advanced stage, invasive implants and restaging surgery were significant factors of recurrence. Serous tumours had slightly higher risk than mucinous tumours, but the difference was not significant. As the study was performed in an area where mucinous BOTs are predominant, the results may complement curren...
Journal of the Chinese Medical Association : JCMA, Jan 20, 2016
Endometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can ... more Endometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long-term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, fou...
Annals of surgical oncology, Jan 17, 2015
To explore the risk factors in ovarian cancer with respects of time-varying effects on recurrence... more To explore the risk factors in ovarian cancer with respects of time-varying effects on recurrence and survival. Two hundred and ninety-eight patients with epithelial ovarian cancer in the Kaohsiung Veterans' General Hospital from January 1995 to the end of 2011 were included in the study. The assumption of the Cox proportional hazard model, i.e., the hazard ratio is a constant with time, was tested for available prognostic factors. An extended Cox model was then applied, and a statistical package was constructed to perform multivariate analysis in presence of both time-varying and time-independent factors. Most prognostic factors met the assumption of the Cox proportional hazard model (p > 0.05) except for cancer-associated antigen (CA) 125 nadir concentration during first-line chemotherapy (p = 0.02). Multivariate analysis, where CA125 nadir was allowed to change with time while other factors remained constant, showed that International Federation of Gynecology and Obstetric...
Toxicology in vitro : an international journal published in association with BIBRA, 2006
Capsazepine has been widely used as a selective antagonist of vanilloid type 1 receptors; however... more Capsazepine has been widely used as a selective antagonist of vanilloid type 1 receptors; however, its other in vitro effect on most cell types is unknown. In human PC3 prostate cancer cells, the effect of capsazepine on intracellular Ca(2+) concentrations ([Ca(2+)](i)) and cytotoxicity was investigated by using fura-2 and tetrazolium, respectively. Capsazepine caused a rapid rise in [Ca(2+)](i) in a concentration-dependent manner with an EC(50) value of 75 microM. Capsazepine-induced [Ca(2+)](i) rise was reduced by 60% by removal of extracellular Ca(2+), suggesting that the capsazepine-induced [Ca(2+)](i) rise was contributed by extracellular Ca(2+) influx and intracellular Ca(2+). Consistently, the capsazepine (200 microM)-induced [Ca(2+)](i) rise was decreased by La(3+) by half. In Ca(2+)-free medium, thapsigargin, an inhibitor of the endoplasmic reticulum Ca(2+)-ATPase, caused a monophasic [Ca(2+)](i) rise, after which the effect of capsazepine on [Ca(2+)](i) was inhibited by 80...
PLoS ONE, 2010
Objectives: To develop a sleep hypoxia (SH) in emphysema (SHE) rat model and to explore whether S... more Objectives: To develop a sleep hypoxia (SH) in emphysema (SHE) rat model and to explore whether SHE results in more severe hepatic inflammation than emphysema alone and whether the inflammation changes levels of coagulant/ anticoagulant factors synthesized in the liver. Methods: Seventy-five rats were put into 5 groups: SH control (SHCtrl), treated with sham smoke exposure (16 weeks) and SH exposure (12.5% O 2 , 3 h/d, latter 8 weeks); emphysema control (ECtrl), smoke exposure and sham SH exposure (21% O 2); short SHE (SHEShort), smoke exposure and short SH exposure (1.5 h/d); mild SHE (SHEMild), smoke exposure and mild SH exposure (15% O 2); standard SHE (SHEStand), smoke exposure and SH exposure. Therefore, ECtrl, SHEShort, SHEMild and SHEStand group were among emphysematous groups. Arterial blood gas (ABG) data was obtained during preliminary tests. After exposure, hepatic inflammation (interleukin-6 [IL-6] mRNA and protein, tumor necrosis factor a [TNFa] mRNA and protein) and liver coagulant/anticoagulant factors (antithrombin [AT], fibrinogen [FIB] and Factor VIII [F VIII]) were evaluated. SPSS 11.5 software was used for statistical analysis. Results: Characteristics of emphysema were obvious in emphysematous groups and ABGs reached SH criteria on hypoxia exposure. Hepatic inflammation parameters and coagulant factors are the lowest in SHCtrl and the highest in SHEStand while AT is the highest in SHCtrl and the lowest in SHEStand. Inflammatory cytokines of liver correlate well with coagulant factors positively and with AT negatively. Conclusions: When SH is combined with emphysema, hepatic inflammation and coagulability enhance each other synergistically and produce a more significant liver-derivative inflammatory and prothrombotic status.
Biomedicines
Infection-induced chronic inflammation is common in patients with endometriosis. Although microbi... more Infection-induced chronic inflammation is common in patients with endometriosis. Although microbial communities in the reproductive tracts of patients have been reported, little was known about their dynamic profiles during disease progression and complication development. Microbial communities in cervical mucus were collected by cervical swabs from 10 healthy women and 23 patients, and analyzed by 16S rRNA amplicon sequencing. The abundance, ecological relationships and functional networks of microbiota were characterized according to their prevalence, clinical stages, and clinical features including deeply infiltrating endometriosis (DIE), CA125, pain score and infertility. Cervical microbiome can be altered during endometriosis development and progression with a tendency of increased Firmicutes and decreased Actinobacteria and Bacteroidetes. Distinct from vaginal microbiome, upregulation of Lactobacillus, in combination with increased Streptococcus and decreased Dialister, was fr...
Biomedicines, 2022
Ribosome biogenesis is a cellular process critical for protein homeostasis during cell growth and... more Ribosome biogenesis is a cellular process critical for protein homeostasis during cell growth and multiplication. Our previous study confirmed up-regulation of ribosome biogenesis during endometriosis progression and malignant transition, thus anti-ribosome biogenesis may be effective for treating endometriosis and the associated complications. A mouse model with human endometriosis features was established and treated with three different drugs that can block ribosome biogenesis, including inhibitors against mTOR/PI3K (GSK2126458) and RNA polymerase I (CX5461 and BMH21). The average lesion numbers and disease frequencies were significantly reduced in treated mice as compared to controls treated with vehicle. Flow cytometry analyses confirmed the reduction of small peritoneal macrophage and neutrophil populations with increased large versus small macrophage ratios, suggesting inflammation suppression by drug treatments. Lesions in treated mice also showed lower nerve fiber density w...
Background It is often clinically useful to classify tumor markers into risk groups. This study w... more Background It is often clinically useful to classify tumor markers into risk groups. This study was aimed to investigate whether beginning with a statistically sound method would find cut points more reasonable than conventional ones. Methods We used data of endometrial cancer including 442 patients. The optimal number of cutoffs was based on the Akaike criterion and statistical algorithms were adapted to find the best locations. Codes were provided as a package. Results Myometrium invasion was an independent risk factor for lymph nodal metastasis when stratified into three groups by 0.41 and 0.89. Tumor size was an independent risk factor for overall survival when stratified into two groups by 4.11 cm. Both had better prediction than conventional choices and clinical relevance. Conclusion A statistically sound algorithm should be used to stratify patients into risk groups.
Journal of Clinical Sleep Medicine, 2008
We report two cases in which amnestic sleep related eating disorder (SRED) occurred with extended... more We report two cases in which amnestic sleep related eating disorder (SRED) occurred with extended-release zolpidem but not with the immediate-release formulation. These cases illustrate how even relatively small differences such as formulation can affect the likelihood of experiencing such events.
International Journal of Engineering Business Management, 2019
The managerial aspect of providing quality, cost-effective health services to hospital patients i... more The managerial aspect of providing quality, cost-effective health services to hospital patients is becoming increasingly important. However, merely focusing on cost reduction and quality improvement may jeopardize personnel satisfaction. Therefore, a balanced approach based on multiple considerations is necessary. Operating rooms (ORs) account for almost 33% of a hospital’s budget, and nursing labor costs represent more than 40% of a hospital’s budget. The concerns around health-care quality, personnel motivation, staff satisfaction, patient length of stay, and patient flow rate are greatly influenced by these two units with regard to day-to-day operations management. A possible approach is to look into the related essential problems, such as the nursing staff time scheduling in nursing units, and the doctor time scheduling in ORs. After surgery in the OR, patients stay in the subsequent ward for a period of time. This causes loading interdependency between the anterior OR and the p...
OncoTargets and Therapy, 2019
Background: Non-small-cell lung cancer (NSCLC) remains the leading cause of cancer morbidity and ... more Background: Non-small-cell lung cancer (NSCLC) remains the leading cause of cancer morbidity and mortality worldwide. In the present study, we identified novel biomarkers associated with the pathogenesis of NSCLC aiming to provide new diagnostic and therapeutic approaches for NSCLC. Methods: The microarray datasets of GSE18842, GSE30219, GSE31210, GSE32863 and GSE40791 from Gene Expression Omnibus database were downloaded. The differential expressed genes (DEGs) between NSCLC and normal samples were identified by limma package. The construction of protein-protein interaction (PPI) network, module analysis and enrichment analysis were performed using bioinformatics tools. The expression and prognostic values of hub genes were validated by GEPIA database and real-time quantitative PCR. Based on these DEGs, the candidate small molecules for NSCLC were identified by the CMap database. Results: A total of 408 overlapping DEGs including 109 up-regulated and 296 downregulated genes were identified; 300 nodes and 1283 interactions were obtained from the PPI network. The most significant biological process and pathway enrichment of DEGs were response to wounding and cell adhesion molecules, respectively. Six DEGs (PTTG1, TYMS, ECT2, COL1A1, SPP1 and CDCA5) which significantly up-regulated in NSCLC tissues, were selected as hub genes according to the results of module analysis. The GEPIA database further confirmed that patients with higher expression levels of these hub genes experienced a shorter overall survival. Additionally, CMap predicted the 20 most significant small molecules as potential therapeutic drugs for NSCLC. DL-thiorphan was the most promising small molecule to reverse the NSCLC gene expression. Conclusions: Based on the gene expression profiles of 696 NSCLC samples and 237 normal samples, we first revealed that PTTG1, TYMS, ECT2, COL1A1, SPP1 and CDCA5 could act as the promising novel diagnostic and therapeutic targets for NSCLC. Our work will contribute to clarifying the molecular mechanisms of NSCLC initiation and progression.
Sleep, 2019
Supplement, 2019 (p=0.12 and 0.59 respectively). The ResMed ® estimated mean TST was slightly low... more Supplement, 2019 (p=0.12 and 0.59 respectively). The ResMed ® estimated mean TST was slightly lower than the Actiwatch ® (by 12.8 minutes, p=0.045). Users rated the disruptiveness of the devices at an average of 1.2 on a scale of 0 to 10 with a score of "0" being indicative of not being disruptive, while "10" was extremely disruptive. Conclusion: Commercially-available sleep tracking devices can reasonably estimate TST in adults with "good" sleep, although they tend to slightly underestimate TST compared to self-report. The devices tested do not seem to disrupt sleep. Clinicians and fitness professionals could review data from these devices, in conjunction with clinical data, to help ascertain whether healthy subjects are obtaining sufficient sleep. Support (If Any
Computers & Industrial Engineering, 2018
Journal of gynecologic oncology, Sep 15, 2018
Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obst... more Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors. The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival. Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including b...
Journal of gynecologic oncology, 2018
The objective was to identify risk factors that were associated with the progression from endomet... more The objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data. The study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated. A total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety...
Taiwanese Journal of Obstetrics and Gynecology, 2016
Journal of Biopharmaceutical Statistics, 2017
Classification measures play essential roles in the assessment and construction of classifiers. H... more Classification measures play essential roles in the assessment and construction of classifiers. Hence, determining how to prevent these measures from being affected by individual observations has become an important problem. In this paper, we propose several indexes based on the influence function and the concept of local influence to identify influential observations that affect the estimate of the area under the receiver operating characteristic curve (AUC), an important and commonly used measure. Cumulative lift charts are also used to equipoise the disagreements among the proposed indexes. Both the AUC indexes and the graphical tools only rely on the classification scores, and both are applicable to classifiers that can produce real-valued classification scores. A real data set is used for illustration.
Journal of lower genital tract disease, 2016
This study analyzed the risk factors for their possible association with overall survival and pro... more This study analyzed the risk factors for their possible association with overall survival and progression-free survival in cervical cancer, with a flexible model that allowed time-varying effects. Information about patients with cervical cancer from 2002 to 2012 was collected in the Kaohsiung Veterans General Hospital. All available biological and clinicopathologic factors were tested for the assumption of the Cox proportional hazard model, that is, whether they had time-varying effect on survival. The factors were also analyzed in univariate and multivariate statistics to identify independent risk factors. The multivariate analysis was performed with an extended Cox model so that those factors that failed the assumption test were allowed to vary with time. Approximately 797 patients were included in the final analysis. Most factors tested passed the Cox assumption test, except tumor size and body mass index in the event of recurrence and preoperative CA125 values in the event of de...
Taiwanese journal of obstetrics & gynecology, 2016
Uterine sarcomas account for 3-7% of all uterine cancers. Because of their rarity, unknown etiolo... more Uterine sarcomas account for 3-7% of all uterine cancers. Because of their rarity, unknown etiology, and highly divergent genetic aberration, there is a lack of consensus on risk factors for occurrence and predictive poor outcomes as well as optimal therapeutic choices. Tumor types according to the World Health Organization classification include leiomyosarcoma, endometrial stroma sarcoma, and undifferentiated sarcoma. Staging is done using the 2014 Federation International Gynecology and Obstetrics and 2010 American Joint Committee on Cancer tumor, lymph node, and metastases systems. Tumor grade can be classified based on the French Federation of Cancer Centers Sarcoma Group system or the Broder's system that incorporates tumor differentiation, mitotic count, and tumor necrosis. This review is a series of articles discussing uterine sarcoma, and this is Part I, which focuses on one of the subtypes of uterine sarcomas-uterine leiomyosarcoma. The clinical characteristics, diagnos...
Taiwanese journal of obstetrics & gynecology, 2016
Endometrial stromal tumors are rare uterine tumors (<1%). Four main categories include endomet... more Endometrial stromal tumors are rare uterine tumors (<1%). Four main categories include endometrial stromal nodule, low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and uterine undifferentiated sarcoma (UUS). This review is a series of articles discussing the uterine sarcomas. LG-ESS, a hormone-dependent tumor harboring chromosomal rearrangement, is an indolent tumor with a favorable prognosis, but characterized by late recurrences even in patients with Stage I disease, suggesting the requirement of a long-term follow-up. Patients with HG-ESS, based on the identification of YWHAE-NUTM2A/B (YWHAE-FAM22A/B) gene fusion, typically present with advanced stage diseases and frequently have recurrences, usually within a few years after initial surgery. UUS is, a high-grade sarcoma, extremely rare, lacking a specific line of differentiation, which is a diagnosis of exclusion (the wastebasket category, which fails to fulfill the morphological...
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, Jan 6, 2016
The objective of this study was to identify clinical and pathologic factors that are significant ... more The objective of this study was to identify clinical and pathologic factors that are significant to relapse in borderline ovarian tumours (BOT). All patients with BOTs from 1997 to 2012 in our institute were identified. 115 patients were included in the study. The Cox proportional hazards model was used to identify significant factors. The median age was 42 years (range 14-85 years). The majority of the patients were at FIGO stage I (88.7%), and most of the patients had mucinous histology (66.1%), reflecting the predominant distribution of mucinous BOTs in East Asia. The median follow-up was 3.3 years (range 0-4.1 years). Twelve patients (10.4%) relapsed and two died consequently. Advanced stage, invasive implants and restaging surgery were significant factors of recurrence. Serous tumours had slightly higher risk than mucinous tumours, but the difference was not significant. As the study was performed in an area where mucinous BOTs are predominant, the results may complement curren...
Journal of the Chinese Medical Association : JCMA, Jan 20, 2016
Endometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can ... more Endometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long-term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, fou...
Annals of surgical oncology, Jan 17, 2015
To explore the risk factors in ovarian cancer with respects of time-varying effects on recurrence... more To explore the risk factors in ovarian cancer with respects of time-varying effects on recurrence and survival. Two hundred and ninety-eight patients with epithelial ovarian cancer in the Kaohsiung Veterans' General Hospital from January 1995 to the end of 2011 were included in the study. The assumption of the Cox proportional hazard model, i.e., the hazard ratio is a constant with time, was tested for available prognostic factors. An extended Cox model was then applied, and a statistical package was constructed to perform multivariate analysis in presence of both time-varying and time-independent factors. Most prognostic factors met the assumption of the Cox proportional hazard model (p > 0.05) except for cancer-associated antigen (CA) 125 nadir concentration during first-line chemotherapy (p = 0.02). Multivariate analysis, where CA125 nadir was allowed to change with time while other factors remained constant, showed that International Federation of Gynecology and Obstetric...
Toxicology in vitro : an international journal published in association with BIBRA, 2006
Capsazepine has been widely used as a selective antagonist of vanilloid type 1 receptors; however... more Capsazepine has been widely used as a selective antagonist of vanilloid type 1 receptors; however, its other in vitro effect on most cell types is unknown. In human PC3 prostate cancer cells, the effect of capsazepine on intracellular Ca(2+) concentrations ([Ca(2+)](i)) and cytotoxicity was investigated by using fura-2 and tetrazolium, respectively. Capsazepine caused a rapid rise in [Ca(2+)](i) in a concentration-dependent manner with an EC(50) value of 75 microM. Capsazepine-induced [Ca(2+)](i) rise was reduced by 60% by removal of extracellular Ca(2+), suggesting that the capsazepine-induced [Ca(2+)](i) rise was contributed by extracellular Ca(2+) influx and intracellular Ca(2+). Consistently, the capsazepine (200 microM)-induced [Ca(2+)](i) rise was decreased by La(3+) by half. In Ca(2+)-free medium, thapsigargin, an inhibitor of the endoplasmic reticulum Ca(2+)-ATPase, caused a monophasic [Ca(2+)](i) rise, after which the effect of capsazepine on [Ca(2+)](i) was inhibited by 80...
PLoS ONE, 2010
Objectives: To develop a sleep hypoxia (SH) in emphysema (SHE) rat model and to explore whether S... more Objectives: To develop a sleep hypoxia (SH) in emphysema (SHE) rat model and to explore whether SHE results in more severe hepatic inflammation than emphysema alone and whether the inflammation changes levels of coagulant/ anticoagulant factors synthesized in the liver. Methods: Seventy-five rats were put into 5 groups: SH control (SHCtrl), treated with sham smoke exposure (16 weeks) and SH exposure (12.5% O 2 , 3 h/d, latter 8 weeks); emphysema control (ECtrl), smoke exposure and sham SH exposure (21% O 2); short SHE (SHEShort), smoke exposure and short SH exposure (1.5 h/d); mild SHE (SHEMild), smoke exposure and mild SH exposure (15% O 2); standard SHE (SHEStand), smoke exposure and SH exposure. Therefore, ECtrl, SHEShort, SHEMild and SHEStand group were among emphysematous groups. Arterial blood gas (ABG) data was obtained during preliminary tests. After exposure, hepatic inflammation (interleukin-6 [IL-6] mRNA and protein, tumor necrosis factor a [TNFa] mRNA and protein) and liver coagulant/anticoagulant factors (antithrombin [AT], fibrinogen [FIB] and Factor VIII [F VIII]) were evaluated. SPSS 11.5 software was used for statistical analysis. Results: Characteristics of emphysema were obvious in emphysematous groups and ABGs reached SH criteria on hypoxia exposure. Hepatic inflammation parameters and coagulant factors are the lowest in SHCtrl and the highest in SHEStand while AT is the highest in SHCtrl and the lowest in SHEStand. Inflammatory cytokines of liver correlate well with coagulant factors positively and with AT negatively. Conclusions: When SH is combined with emphysema, hepatic inflammation and coagulability enhance each other synergistically and produce a more significant liver-derivative inflammatory and prothrombotic status.