Chia-Cheng Lin - Academia.edu (original) (raw)

Papers by Chia-Cheng Lin

Research paper thumbnail of Clinical Outcome of Residual Liver Volume and Hepatic Steatosis After Right-Lobe Living-Donor Hepatectomy

Annals of Transplantation, 2020

Departmental sources Background: We examine how residual liver volume (RLV) and hepatic steatosis... more Departmental sources Background: We examine how residual liver volume (RLV) and hepatic steatosis (HS) of living liver donors affect the regeneration process and clinical outcomes. Material/Methods: We longitudinally studied 58 donors who underwent right-lobe hepatectomy during the period February 2014 to February 2015 at a single medical institution. The patients were classified based on RLV (30-35%, 35-40%, 40-50%) subgroups and HS (<10%, 10-30%, 30-50%) subgroups. Clinical parameters such as clinical outcome, liver volumetric recovery (LVR,%) rate and remnant left-liver (RLL,%) growth rate were collected for analysis. Results: The clinical features of postoperative peak total bilirubin (p=.024) were significant in the 3 RLV subgroups. Body mass index (p=.017), preoperative alanine transaminase (p<.001), and pleural effusion (p=.038) were significant in the 3 HS subgroups. The LVR rate and RLL growth rate equations showed significant variation in regeneration among the 3 RLV subgroups. The LVR rate and RLL growth rate equations did not show significant variation in regeneration among the 3 HS subgroups. Conclusions: Hyperbilirubinemia was a risk factor in the small-RLV group, and a large amount of pleural effusion was a risk factor in the steatosis 30-50% group. Hepatic steatosis subgroups did not show significantly different degrees of regeneration. The safety of living donors was a major concern while we compiled the extended living-donor criteria presented in this paper.

Research paper thumbnail of Hemodynamic Changes Are Predictive of Coagulopathic Hemorrhage After Living Donor Liver Transplant

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2017

Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver tran... more Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver transplant. We retrospectively evaluated 161 patients who had undergone living-donor liver transplant from July 2005 to April 2014 at a single medical institution. Of these patients, 32 developed hemorrhage after transplant. Patients were separated into those with coagulopathy-related hemorrhage (n=15) or noncoagulopathy-related hemorrhage (n=17) based on the results of computed tomography images. Predictors of hemorrhage after living-donor liver transplant evaluated in this study included preoperative, perioperative, and posttransplant factors and hemodynamic status. Patients who developed coagulopathy-related hemorrhage had significantly lower pretransplant platelet counts (P = .040), a longer cold-ischemia time (P = .045), more blood loss (P = .040), and earlier onset of hemorrhage (P = .048) than patients who had noncoagulopathy-related hemorrhage after transplant. Results of the general...

Research paper thumbnail of Portal venous velocity affects liver regeneration after right lobe living donor hepatectomy

PLOS ONE, 2018

Objectives We investigated whether chronological changes in portal flow and clinical factors play... more Objectives We investigated whether chronological changes in portal flow and clinical factors play a role in the liver regeneration (LR) process after right donor-hepatectomy. Materials and methods Participants in this prospective study comprised 58 donors who underwent right donor-hepatectomy during the period February 2014 to February 2015 at a single medical institution. LR was estimated using two equations: remnant left liver (RLL) growth (%) and liver volumetric recovery (LVR) (%). Donors were classified into an excellent regeneration (ER) group or a moderate regeneration (MR) group based on how their LR on postoperative day 7 compared to the median value. Results Multivariate analysis revealed that low residual liver volume (OR = .569, 95% CI: .367-.882) and high portal venous velocity in the immediate postoperative period (OR = 1.220, 95% CI: 1.001-1.488) were significant predictors of LR using the RLL growth equation; high portal venous velocity in the immediate postoperative period (OR = 1.325, 95% CI: 1.081-1.622) was a significant predictor of LR using the LVR equation. Based on the two equations, long-term LR was significantly greater in the ER group than in the MR group (p < .001).

Research paper thumbnail of Fully Digital Workflow for Planning Static Guided Implant Surgery: A Prospective Accuracy Study

Journal of Clinical Medicine, 2020

The accuracy of static guided implant surgery (sGIS) using conventional planning workflow has bee... more The accuracy of static guided implant surgery (sGIS) using conventional planning workflow has been extensively examined; however, more information is required to justify the application of fully digital planning protocol. The purpose of this study was to investigate the clinical accuracy of sGIS with a fully digital planning workflow. Twenty-one partially edentulous patients were enrolled in this prospective study. Cone-beam computed tomography (CBCT) and intraoral scans were taken and superimposed by matching the dental surface images directly (surface registration protocol) or by matching fiducial markers on a stereolithographic (SLA) radiographic template fabricated from the digital data of the intraoral scan (fiducial marker registration protocol). Virtual implant treatment plans were then determined, and tooth-supported SLA surgical guides were fabricated according to the plans. Twenty-six implant surgeries were performed via the surgical guide by one surgeon. Pre- and post-ope...

Research paper thumbnail of In Vitro Accuracy of Static Guided Implant Surgery Measured by Optical Scan: Examining the Impact of Operator Experience

Applied Sciences, 2020

Studies examining the effect of operator experience on the accuracy of static guided implant surg... more Studies examining the effect of operator experience on the accuracy of static guided implant surgery have used postoperative computed tomography (CT) images to measure the error, with inconsistent results. The purpose of this study was to try to clarify this issue by using a measurement method based on the postoperative optical scan. Thirty dentists were divided into an experienced group and an inexperienced group. On a partially edentulous mandibular model in the manikin head, each dentist placed three implants via the stereolithographic (SLA) surgical guide. The implant positions were identified by a desktop scanner and compared with the planned positions using a metrology software program. No statistically significant differences were observed for any of the measured positional and angular deviations of the three implant sites between experienced and inexperienced operators (p > 0.01). All the mean values of deviations of the inexperienced group, except the depth deviation, we...

Research paper thumbnail of Porosity Structure Offering Improved Biomechanical Stress Distribution and Enhanced Pain-Relieving Potential

Applied Sciences, 2020

In this study, we developed a three-dimensional (3D) human body model and a body sculpting clothi... more In this study, we developed a three-dimensional (3D) human body model and a body sculpting clothing (BSC) which was fitted onto that body to simulate the biomechanical stress variations of the BSC with different porosity structures using the finite element method. The mechanical properties of the BSC with different porosity structures were also examined through the tensile testing. Analytical results indicated that the Von Mises stress of the BSC with a porosity structure of 10.28% varied from 0.076 MPa to 337.79 MPa. As compared with a porosity structure of 35.18%, the von Mises stress varied from 0.067 MPa to 207.30 MPa. The von Mises stress decreased as the porosity increasing. Based on the statistical analysis findings, we obtained a formula to predict the biomechanical relationships (von Mises stress and strain) between the human body and porosity of the BSC. Therefore, these findings could offer potential information in the modification of BSC for pain-relieving applications.

Research paper thumbnail of Risk factors for seizures after cranioplasty

Seizure, 2018

Cranioplasty can improve a patient's psychosocial and cognitive functions after decompressive cra... more Cranioplasty can improve a patient's psychosocial and cognitive functions after decompressive craniectomy, however seizures are a common complication after cranioplasty. The risk factors for early and late seizures after cranioplasty are unclear. This study is to evaluate the risk factors for early and late seizure after cranioplasty. Methods: Two hundred and thirty-eight patients who received cranioplasty following craniectomy between January 2012 and December 2014 were included in this study. The risk factors of the patients with early and late post-cranioplasty seizures were compared to those with no post-cranioplasty seizures. Results: Seizures (73/238, 30.3%) were the most common complication after cranioplasty. Of these 73 patients, 17 (7.1%) had early post-cranioplasty seizures and 56 (23.5%) had late post-cranioplasty seizures. Early postcranioplasty seizures were related to a longer interval between craniectomy and cranioplasty (P = 0.006), artificial materials (P < 0.001), and patients with late post-craniectomy seizures (P = 0.001). Late post-cranioplasty seizures were related to the presence of neurological deficits (P = 0.042). After stepwise logistic regression analysis, a longer interval between craniectomy and cranioplasty (P = 0.012; OR: 1.004, 95% CI: 1.001-1.007) and late post-craniectomy seizures (P = 0.033; OR: 4.335, 95% CI: 1.127-16.675) were independently associated with early post-cranioplasty seizures. Conclusion: Delayed cranioplasty procedures and seizures before cranioplasty were significantly associated with early post-cranioplasty seizures. Further studies are warranted to investigate whether early surgery after craniectomy can reduce the risk of early post-cranioplasty seizures. Adult patients (age: 15-85 years) who received cranioplasty between 2012-2014 at the Department of Neurosurgery of Kaohsiung Chang Gung Memorial Hospital were enrolled in this observational study. We excluded patients who had previously undergone cranioplasty for facial reconstruction, craniectomy and cranioplasty in one procedure, or cranioplasty at a different institution. The study protocol was approved by the local Institutional Review Committee on Human

Research paper thumbnail of A Follow-Up Study on the Renal Protective Efficacy of Telbivudine for Hepatitis B Virus-Infected Taiwanese Patients After Living Donor Liver Transplant

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 22, 2016

Preservation of renal function is an important issue after living donor liver transplant. We aime... more Preservation of renal function is an important issue after living donor liver transplant. We aimed to examine the renal protective efficacy of telbivudine in hepatitis B virus-infected patients after living donor liver transplant. In this retrospective study, we compared 18 patients who received telbivudine 600 mg once per day and 23 patients who received entecavir 1 mg once per day after living donor liver transplant. Clinical data were obtained through chart review and included Model for End-Stage Liver Disease score and pre- and postoperative aspartate aminotransferase, alanine aminotransferase, and creatinine levels and estimated glomerular filtration rate. Posttransplant estimated glomerular filtration rates and creatinine levels were calculated, and improvement of renal function was found in the group of patients who received telbivudine. Significant improvements were shown in estimated glomerular filtration rates started after 9 months of administration and creatinine levels ...

Research paper thumbnail of Presence of Fibrosis is Predictive of Postoperative Survival in Patients with Small Hepatocellular Carcinoma

Hepato-gastroenterology

The aim of this study was to evaluate whether liver fibrosis is predictive of survival in patient... more The aim of this study was to evaluate whether liver fibrosis is predictive of survival in patients who require hepatectomy for small hepatocellular carcinoma. In this retrospective study, we enrolled 174 patients with small HCC who underwent major or minor hepatectomy at the Changhua Christian Hospital during the period January 2001 to June 2007. Patients were classified into two subgroups depending on whether tumor recurrence after surgery. Factors influencing overall survival and recurrence were analyzed and compared between the two subgroups. Univariate and multivariate logistic regression analyses were performed to determine the most significant predictors of tumor recurrence or death. The Kaplan-Meier method and the log-rank test were used to detect differences in cumulative survival between the two subgroups based on histopathologic fibrosis scores. Results of the univariate analysis revealed these variables that tumor margin, type of resection, and degree of fibrosis were ind...

Research paper thumbnail of Kallistatin Ameliorates Influenza Virus Pathogenesis by Inhibition of Kallikrein-Related Peptidase 1-Mediated Cleavage of Viral Hemagglutinin

Antimicrobial agents and chemotherapy, Jan 6, 2015

Proteolytic cleavage of the hemagglutinin (HA) of influenza virus by host trypsin-like proteases ... more Proteolytic cleavage of the hemagglutinin (HA) of influenza virus by host trypsin-like proteases is required for viral infectivity. Some serine proteases are capable of cleaving influenza virus HA, whereas some serine protease inhibitors (serpins) inhibit the HA cleavage in various cell types. Kallikrein-related peptidase 1 (KLK1, also known as tissue kallikrein) is a widely distributed serine protease. Kallistatin, a serpin synthesized mainly in the liver and rapidly secreted into the circulation, forms complexes with KLK1 and inhibits its activity. Here we investigated the roles of KLK1 and kallistatin in influenza virus infection. We show that the levels of KLK1 increased, whereas those of kallistatin decreased in the lung of mice during influenza infection. KLK1 cleaved H1, H2, and H3 HA molecules and consequently enhanced viral production. By contrast, kallistatin inhibited KLK1-mediated HA cleavage and reduced viral production. Cells transduced with the kallistatin gene secret...

Research paper thumbnail of Comparison of concomitant and subsequent cholangiocarcinomas associated with hepatolithiasis: Clinical implications

World journal of gastroenterology : WJG, Jan 21, 2013

To compare the outcomes of concomitant cholangiocarcinoma (C-CCA) and subsequent cholangiocarcino... more To compare the outcomes of concomitant cholangiocarcinoma (C-CCA) and subsequent cholangiocarcinoma (S-CCA) associated with hepatolithiasis. From December 1987 to December 2007, 276 patients underwent hepatic resection for hepatolithiasis in Changhua Christian Hospital. Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base. Ten patients were diagnosed with C-CCA based on the preoperative biopsy or postoperative pathology. During the follow-up period, 12 patients developed S-CCA. The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out. Patient charts were reviewed to collect clinical information. Parameters such as CCA incidence, interval from operation to CCA diagnosis, interval from CCA diagnosis to disease-related death, follow-up time, and mortality rate were calculated for both the C-CCA and S-CCA groups. The outcomes of the C-CCA and S-CCA g...

Research paper thumbnail of Development of the novel ferrous-based stainless steel for biomedical applications, Part I: High-temperature microstructure, mechanical properties and damping behavior

Journal of the Mechanical Behavior of Biomedical Materials, 2011

Research paper thumbnail of Relative Translucency and Surface Roughness of Four Yttrium-stabilized Tetragonal Zirconia Polycrystalline-based Dental Restorations

Journal of Experimental & Clinical Medicine, 2013

Research paper thumbnail of Enhancement of Biocompatibility on Bioactive Titanium Surface by Low-Temperature Plasma Treatment

Japanese Journal of Applied Physics, 2005

The surface of implantable biomaterials directly contacts the host tissue and is critical in dete... more The surface of implantable biomaterials directly contacts the host tissue and is critical in determining biocompatibility. To improve implant integration, interfacial reactions must be controlled to minimize nonspecific adsorption of proteins, and tissue-healing phenomena can be controlled. The purpose of this study was to develop a new method of functionalizing titanium surfaces by plasma treatment. The covalent immobilization of bioactive organic molecules and the bioactivities in vitro were assessed by transmission electron microscopy (TEM), atomic force spectroscopy (AFM), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay as indices of cellular cytotoxicity. Argon plasma removed all of the adsorbed contaminants and impurities. Plasma-cleaned titanium surfaces showed better bioactive performances than untreated titanium surfaces. The analytical results reveal that plasma-cleaned titanium surfaces provide a clean and reproducible starting condition for further plasma treatments to create well-controlled surface layers. Allylamine was ionized by plasma treatment, and acted as a medium to link albumin. Cells demonstrated a good spread, and a wide attachment was attained on the Albu-Ti plate. Cell attachment and growth were shown to be influenced by the surface properties. The plasma treatment process plays an important role in facilitating tissue healing. This process not only provides a clean titanium surface, but also leads to surface amination on plasma-treated titanium surfaces. Surface cleaning by ion bombardment and surface modification by plasma polymerization are believed to remove contamination on titanium surfaces and thus promote tissue healing.

Research paper thumbnail of Great saphenous vein harvesting for venous outflow reconstruction in living donor liver transplantation – A minimally invasive refinement of the conventional procedure

International Journal of Surgery, 2013

Background: With the popularization of living donor liver transplantation (LDLT), it has been dis... more Background: With the popularization of living donor liver transplantation (LDLT), it has been discovered that adequate venous outflow from the transplanted liver is crucial for proper graft function. Recently, the harvesting of the LDLT recipient's autologous great saphenous vein (GSV) has been increasingly adopted as a solution to the shortage of cadaveric vascular grafts. Minimally invasive GSV harvesting for coronary artery bypass grafting was shown to improve the cosmetic result and reduce leg wound pain and other complications. For immunosuppressed patients such as LDLT recipients, these benefits could be especially valuable. Materials and methods: From April to August 2012, eleven LDLT recipients underwent either minimally invasive or short-incision harvesting of GSV. The patient profiles, operative and postoperative information regarding operation time, estimated blood loss, harvested GSV graft length, serum tacrolimus (FK506) levels and postoperative complications were recorded prospectively. Results: The only wound complication was a subcutaneous hematoma, in our fourth patient. The mean operation time and the mean estimated blood loss were 33.9 min and 7.3 ml respectively. The mean incision length divided by the mean vein graft length was 31.6%. Two patients had poorly controlled diabetes mellitus. The mean serum FK506 level during the first postoperative week was 6.4 ng/ml (therapeutic range 5e10 ng/ml according to our protocol). No patient had surgical site infection in this series. Conclusions: GSV harvesting from LDLT recipients for hepatic venous outflow reconstruction is feasible without the need for expensive endoscopic systems, and an adequate length of vein can be obtained through a single 3 cm incision.

Research paper thumbnail of Oct-3/4 Expression Reflects Tumor Progression and Regulates Motility of Bladder Cancer Cells

Cancer Research, 2008

Cancer and embryonic stem cells exhibit similar behavior, including immortal, undifferentiated, a... more Cancer and embryonic stem cells exhibit similar behavior, including immortal, undifferentiated, and invasive activities. Here, we show that in clinical samples bladder tumors with intense expression of stem cell marker Oct-3/4 (also known as POU5F1) are associated with further disease progression, greater metastasis, and shorter cancer-related survival compared with those with moderate and low expressions. Expression of Oct-3/4 is detected in human bladder transitional cell carcinoma samples and cell lines. Overexpression of Oct-3/4 enhances, whereas knockdown of Oct-3/4 expression by RNA interference reduces, migration and invasion of bladder cancer cells. Oct-3/4 can up-regulate fibroblast growth factor-4 and matrix metalloproteinase-2 (MMP-2), MMP-9, and MMP-13 production, which may contribute to tumor metastasis. Finally, we show that Ad5WS4, an E1B-55 kD–deleted adenovirus driven by the Oct-3/4 promoter, exerts potent antitumor activity against bladder cancer in a syngeneic mur...

Research paper thumbnail of Hepatic resection for bilateral hepatolithiasis: a 20-year experience

ANZ Journal of Surgery, 2012

There is increasing evidence showing that hepatic resection is probably the best definitive treat... more There is increasing evidence showing that hepatic resection is probably the best definitive treatment for unilateral hepatolithiasis. However, the role of hepatic resection for bilateral hepatolithiasis is rarely mentioned in the literature. We retrospectively reviewed 197 patients who underwent hepatic resection for hepatolithiasis in Changhua Christian Hospital from December 1987 to December 2007. A total of 156 patients with unilateral hepatolithiasis were defined as the UNI group (control group), and 41 patients with bilateral hepatolithiasis were defined as the BI group (study group). The short- and long-term outcomes were measured. The BI group had longer operating time (200 min versus 173 min, P = 0.006), lower immediate stone clearance rate (56.1% versus 91.7%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), lower final stone clearance rate (75.6% versus 94.9%, P = 0.001), higher rate of stone recurrence (22.6% versus 6.1%, P = 0.009) and higher disease-related mortality (19.5% versus 5.1%, P = 0.006). Thirty patients with bilateral peripheral stones were indicated for bilateral hepatectomy, but only 20 (66.7%) of them actually underwent the proposed procedure. Of the patients who did not achieve immediate stone clearance, bilateral peripheral stones represented 88.9% (P = 0.044). Of the patients who had stone recurrence, patients less than 35 years old represented 42.9% (P = 0.007). Bilateral hepatolithiasis has worse outcomes than unilateral hepatolithiasis after being treated with hepatic resection. Regarding bilateral peripheral stones, there is often a discrepancy between the extent of stone-affected parenchyma and that of final liver resection, resulting in a lower immediate stone clearance rate. A higher stone recurrence rate was observed among younger population.

Research paper thumbnail of Comparative Factor Analysis of the Effect of Postoperative Peripheral Parenteral Nutrition on Recovery of Right Lobe Liver Donors

Intensive nutritional support can reduce the catabolic response, improve protein synthesis, and p... more Intensive nutritional support can reduce the catabolic response, improve protein synthesis, and promote liver regeneration. This study examined whether postoperative peripheral parenteral nutrition may improve recovery and reduce the length of hospital stay in right lobe liver donors. In this retrospective study, we enrolled liver donors with residual liver volume < 50%. Donors were classified into 2 groups: donors who received (n = 44) or did not receive (n = 40) postoperative peripheral parenteral nutrition. Liver function tests included alanine aminotransferase and total bilirubin levels, and postoperative complications included pleural effusion, atelectasis, and wound complications. Hospital length of stay was included as a potential risk factor for the evaluation of the effect of postoperative peripheral parenteral nutrition on recovery of right lobe liver donors. Male sex (β, 22.04; 95% confidence interval: 6.22 - 37.86) was a significant predictor of changes in postoperati...

Research paper thumbnail of Predictors of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation

International Journal of Surgery, 2013

Background: Results of preoperative conventional coagulation assays are a poor predictor of hemor... more Background: Results of preoperative conventional coagulation assays are a poor predictor of hemorrhage after liver transplantation. In this study, we evaluated the factors that are predictive of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation surgery. Methods: During the period from January 2009 to December 2012, 118 adults underwent living donor liver transplantation (LDLT) in our institution. Of those patients, 18 (15.3%) developed intra-abdominal coagulopathic hemorrhage (n ¼ 7) or hemorrhage due to non-coagulopathic causes (n ¼ 11) that required emergency medical, radiological, or surgical intervention within the first month after LDLT. Possible predictors of postoperative coagulopathic hemorrhage included donor-related factors, age, body mass index, MELD score, INR value, intra-operative blood transfusion, graft/recipient weight ratio, anhepatic phase, cold ischemia time, operative time, APACHE II score, onset of re-bleeding, and hemoglobin levels during rebleeding episodes. Results: There were no differences in any of the variables between the two groups (coagulopathic and noncoagulopathic hemorrhage) except for cold ischemia time. We found that cold ischemia time was significantly longer in patients with postoperative coagulopathic hemorrhage (160.50 AE 45.02 min) than in patients with hemorrhage due to non-coagulopathic causes (113.55 AE 29.31 min; P ¼ 0.027). Conclusion: Prolonged cold ischemia time is associated with postoperative intra-abdominal coagulopathic hemorrhage in patients after LDLT. It is, therefore, necessary to shorten the cold ischemia time in order to reduce the risk of postoperative intra-abdominal hemorrhage due to coagulopathic causes.

Research paper thumbnail of Portal Vein Thrombosis and Arterioportal Shunting Due To Chronic Cholangitis: A Rare Complication of Living-Donor Liver Transplant

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 20, 2016

We present a patient with portal vein thrombosis due to chronic cholangitis after undergoing a li... more We present a patient with portal vein thrombosis due to chronic cholangitis after undergoing a living-donor liver transplant. A 52-year-old woman with a history of hepatitis B virus-related liver cirrhosis underwent a living-donor liver transplant. After the surgery, the patient had recurrent episodes of cholangitis because of common and intrahepatic bile duct stricture. Biliary stricture because of cholangitis eventually resulted in acute portal vein thrombosis. A stent was inserted by percutaneous transluminal portography. Blood flow through the portal vein progressively improved from the third through the 10th day after stent placement. The anticoagulation regimen was change to acetylsalicylic acid and clopidogrel hydrogen sulfate (Plavix). On poststenting day 10, a follow-up computed tomographic scan showed good patency of the main portal vein and no evidence of arterioportal shunting. Cholangitis after living-donor liver transplant is a rare cause of portal vein thrombosis. Reg...

Research paper thumbnail of Clinical Outcome of Residual Liver Volume and Hepatic Steatosis After Right-Lobe Living-Donor Hepatectomy

Annals of Transplantation, 2020

Departmental sources Background: We examine how residual liver volume (RLV) and hepatic steatosis... more Departmental sources Background: We examine how residual liver volume (RLV) and hepatic steatosis (HS) of living liver donors affect the regeneration process and clinical outcomes. Material/Methods: We longitudinally studied 58 donors who underwent right-lobe hepatectomy during the period February 2014 to February 2015 at a single medical institution. The patients were classified based on RLV (30-35%, 35-40%, 40-50%) subgroups and HS (<10%, 10-30%, 30-50%) subgroups. Clinical parameters such as clinical outcome, liver volumetric recovery (LVR,%) rate and remnant left-liver (RLL,%) growth rate were collected for analysis. Results: The clinical features of postoperative peak total bilirubin (p=.024) were significant in the 3 RLV subgroups. Body mass index (p=.017), preoperative alanine transaminase (p<.001), and pleural effusion (p=.038) were significant in the 3 HS subgroups. The LVR rate and RLL growth rate equations showed significant variation in regeneration among the 3 RLV subgroups. The LVR rate and RLL growth rate equations did not show significant variation in regeneration among the 3 HS subgroups. Conclusions: Hyperbilirubinemia was a risk factor in the small-RLV group, and a large amount of pleural effusion was a risk factor in the steatosis 30-50% group. Hepatic steatosis subgroups did not show significantly different degrees of regeneration. The safety of living donors was a major concern while we compiled the extended living-donor criteria presented in this paper.

Research paper thumbnail of Hemodynamic Changes Are Predictive of Coagulopathic Hemorrhage After Living Donor Liver Transplant

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2017

Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver tran... more Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver transplant. We retrospectively evaluated 161 patients who had undergone living-donor liver transplant from July 2005 to April 2014 at a single medical institution. Of these patients, 32 developed hemorrhage after transplant. Patients were separated into those with coagulopathy-related hemorrhage (n=15) or noncoagulopathy-related hemorrhage (n=17) based on the results of computed tomography images. Predictors of hemorrhage after living-donor liver transplant evaluated in this study included preoperative, perioperative, and posttransplant factors and hemodynamic status. Patients who developed coagulopathy-related hemorrhage had significantly lower pretransplant platelet counts (P = .040), a longer cold-ischemia time (P = .045), more blood loss (P = .040), and earlier onset of hemorrhage (P = .048) than patients who had noncoagulopathy-related hemorrhage after transplant. Results of the general...

Research paper thumbnail of Portal venous velocity affects liver regeneration after right lobe living donor hepatectomy

PLOS ONE, 2018

Objectives We investigated whether chronological changes in portal flow and clinical factors play... more Objectives We investigated whether chronological changes in portal flow and clinical factors play a role in the liver regeneration (LR) process after right donor-hepatectomy. Materials and methods Participants in this prospective study comprised 58 donors who underwent right donor-hepatectomy during the period February 2014 to February 2015 at a single medical institution. LR was estimated using two equations: remnant left liver (RLL) growth (%) and liver volumetric recovery (LVR) (%). Donors were classified into an excellent regeneration (ER) group or a moderate regeneration (MR) group based on how their LR on postoperative day 7 compared to the median value. Results Multivariate analysis revealed that low residual liver volume (OR = .569, 95% CI: .367-.882) and high portal venous velocity in the immediate postoperative period (OR = 1.220, 95% CI: 1.001-1.488) were significant predictors of LR using the RLL growth equation; high portal venous velocity in the immediate postoperative period (OR = 1.325, 95% CI: 1.081-1.622) was a significant predictor of LR using the LVR equation. Based on the two equations, long-term LR was significantly greater in the ER group than in the MR group (p < .001).

Research paper thumbnail of Fully Digital Workflow for Planning Static Guided Implant Surgery: A Prospective Accuracy Study

Journal of Clinical Medicine, 2020

The accuracy of static guided implant surgery (sGIS) using conventional planning workflow has bee... more The accuracy of static guided implant surgery (sGIS) using conventional planning workflow has been extensively examined; however, more information is required to justify the application of fully digital planning protocol. The purpose of this study was to investigate the clinical accuracy of sGIS with a fully digital planning workflow. Twenty-one partially edentulous patients were enrolled in this prospective study. Cone-beam computed tomography (CBCT) and intraoral scans were taken and superimposed by matching the dental surface images directly (surface registration protocol) or by matching fiducial markers on a stereolithographic (SLA) radiographic template fabricated from the digital data of the intraoral scan (fiducial marker registration protocol). Virtual implant treatment plans were then determined, and tooth-supported SLA surgical guides were fabricated according to the plans. Twenty-six implant surgeries were performed via the surgical guide by one surgeon. Pre- and post-ope...

Research paper thumbnail of In Vitro Accuracy of Static Guided Implant Surgery Measured by Optical Scan: Examining the Impact of Operator Experience

Applied Sciences, 2020

Studies examining the effect of operator experience on the accuracy of static guided implant surg... more Studies examining the effect of operator experience on the accuracy of static guided implant surgery have used postoperative computed tomography (CT) images to measure the error, with inconsistent results. The purpose of this study was to try to clarify this issue by using a measurement method based on the postoperative optical scan. Thirty dentists were divided into an experienced group and an inexperienced group. On a partially edentulous mandibular model in the manikin head, each dentist placed three implants via the stereolithographic (SLA) surgical guide. The implant positions were identified by a desktop scanner and compared with the planned positions using a metrology software program. No statistically significant differences were observed for any of the measured positional and angular deviations of the three implant sites between experienced and inexperienced operators (p > 0.01). All the mean values of deviations of the inexperienced group, except the depth deviation, we...

Research paper thumbnail of Porosity Structure Offering Improved Biomechanical Stress Distribution and Enhanced Pain-Relieving Potential

Applied Sciences, 2020

In this study, we developed a three-dimensional (3D) human body model and a body sculpting clothi... more In this study, we developed a three-dimensional (3D) human body model and a body sculpting clothing (BSC) which was fitted onto that body to simulate the biomechanical stress variations of the BSC with different porosity structures using the finite element method. The mechanical properties of the BSC with different porosity structures were also examined through the tensile testing. Analytical results indicated that the Von Mises stress of the BSC with a porosity structure of 10.28% varied from 0.076 MPa to 337.79 MPa. As compared with a porosity structure of 35.18%, the von Mises stress varied from 0.067 MPa to 207.30 MPa. The von Mises stress decreased as the porosity increasing. Based on the statistical analysis findings, we obtained a formula to predict the biomechanical relationships (von Mises stress and strain) between the human body and porosity of the BSC. Therefore, these findings could offer potential information in the modification of BSC for pain-relieving applications.

Research paper thumbnail of Risk factors for seizures after cranioplasty

Seizure, 2018

Cranioplasty can improve a patient's psychosocial and cognitive functions after decompressive cra... more Cranioplasty can improve a patient's psychosocial and cognitive functions after decompressive craniectomy, however seizures are a common complication after cranioplasty. The risk factors for early and late seizures after cranioplasty are unclear. This study is to evaluate the risk factors for early and late seizure after cranioplasty. Methods: Two hundred and thirty-eight patients who received cranioplasty following craniectomy between January 2012 and December 2014 were included in this study. The risk factors of the patients with early and late post-cranioplasty seizures were compared to those with no post-cranioplasty seizures. Results: Seizures (73/238, 30.3%) were the most common complication after cranioplasty. Of these 73 patients, 17 (7.1%) had early post-cranioplasty seizures and 56 (23.5%) had late post-cranioplasty seizures. Early postcranioplasty seizures were related to a longer interval between craniectomy and cranioplasty (P = 0.006), artificial materials (P < 0.001), and patients with late post-craniectomy seizures (P = 0.001). Late post-cranioplasty seizures were related to the presence of neurological deficits (P = 0.042). After stepwise logistic regression analysis, a longer interval between craniectomy and cranioplasty (P = 0.012; OR: 1.004, 95% CI: 1.001-1.007) and late post-craniectomy seizures (P = 0.033; OR: 4.335, 95% CI: 1.127-16.675) were independently associated with early post-cranioplasty seizures. Conclusion: Delayed cranioplasty procedures and seizures before cranioplasty were significantly associated with early post-cranioplasty seizures. Further studies are warranted to investigate whether early surgery after craniectomy can reduce the risk of early post-cranioplasty seizures. Adult patients (age: 15-85 years) who received cranioplasty between 2012-2014 at the Department of Neurosurgery of Kaohsiung Chang Gung Memorial Hospital were enrolled in this observational study. We excluded patients who had previously undergone cranioplasty for facial reconstruction, craniectomy and cranioplasty in one procedure, or cranioplasty at a different institution. The study protocol was approved by the local Institutional Review Committee on Human

Research paper thumbnail of A Follow-Up Study on the Renal Protective Efficacy of Telbivudine for Hepatitis B Virus-Infected Taiwanese Patients After Living Donor Liver Transplant

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 22, 2016

Preservation of renal function is an important issue after living donor liver transplant. We aime... more Preservation of renal function is an important issue after living donor liver transplant. We aimed to examine the renal protective efficacy of telbivudine in hepatitis B virus-infected patients after living donor liver transplant. In this retrospective study, we compared 18 patients who received telbivudine 600 mg once per day and 23 patients who received entecavir 1 mg once per day after living donor liver transplant. Clinical data were obtained through chart review and included Model for End-Stage Liver Disease score and pre- and postoperative aspartate aminotransferase, alanine aminotransferase, and creatinine levels and estimated glomerular filtration rate. Posttransplant estimated glomerular filtration rates and creatinine levels were calculated, and improvement of renal function was found in the group of patients who received telbivudine. Significant improvements were shown in estimated glomerular filtration rates started after 9 months of administration and creatinine levels ...

Research paper thumbnail of Presence of Fibrosis is Predictive of Postoperative Survival in Patients with Small Hepatocellular Carcinoma

Hepato-gastroenterology

The aim of this study was to evaluate whether liver fibrosis is predictive of survival in patient... more The aim of this study was to evaluate whether liver fibrosis is predictive of survival in patients who require hepatectomy for small hepatocellular carcinoma. In this retrospective study, we enrolled 174 patients with small HCC who underwent major or minor hepatectomy at the Changhua Christian Hospital during the period January 2001 to June 2007. Patients were classified into two subgroups depending on whether tumor recurrence after surgery. Factors influencing overall survival and recurrence were analyzed and compared between the two subgroups. Univariate and multivariate logistic regression analyses were performed to determine the most significant predictors of tumor recurrence or death. The Kaplan-Meier method and the log-rank test were used to detect differences in cumulative survival between the two subgroups based on histopathologic fibrosis scores. Results of the univariate analysis revealed these variables that tumor margin, type of resection, and degree of fibrosis were ind...

Research paper thumbnail of Kallistatin Ameliorates Influenza Virus Pathogenesis by Inhibition of Kallikrein-Related Peptidase 1-Mediated Cleavage of Viral Hemagglutinin

Antimicrobial agents and chemotherapy, Jan 6, 2015

Proteolytic cleavage of the hemagglutinin (HA) of influenza virus by host trypsin-like proteases ... more Proteolytic cleavage of the hemagglutinin (HA) of influenza virus by host trypsin-like proteases is required for viral infectivity. Some serine proteases are capable of cleaving influenza virus HA, whereas some serine protease inhibitors (serpins) inhibit the HA cleavage in various cell types. Kallikrein-related peptidase 1 (KLK1, also known as tissue kallikrein) is a widely distributed serine protease. Kallistatin, a serpin synthesized mainly in the liver and rapidly secreted into the circulation, forms complexes with KLK1 and inhibits its activity. Here we investigated the roles of KLK1 and kallistatin in influenza virus infection. We show that the levels of KLK1 increased, whereas those of kallistatin decreased in the lung of mice during influenza infection. KLK1 cleaved H1, H2, and H3 HA molecules and consequently enhanced viral production. By contrast, kallistatin inhibited KLK1-mediated HA cleavage and reduced viral production. Cells transduced with the kallistatin gene secret...

Research paper thumbnail of Comparison of concomitant and subsequent cholangiocarcinomas associated with hepatolithiasis: Clinical implications

World journal of gastroenterology : WJG, Jan 21, 2013

To compare the outcomes of concomitant cholangiocarcinoma (C-CCA) and subsequent cholangiocarcino... more To compare the outcomes of concomitant cholangiocarcinoma (C-CCA) and subsequent cholangiocarcinoma (S-CCA) associated with hepatolithiasis. From December 1987 to December 2007, 276 patients underwent hepatic resection for hepatolithiasis in Changhua Christian Hospital. Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base. Ten patients were diagnosed with C-CCA based on the preoperative biopsy or postoperative pathology. During the follow-up period, 12 patients developed S-CCA. The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out. Patient charts were reviewed to collect clinical information. Parameters such as CCA incidence, interval from operation to CCA diagnosis, interval from CCA diagnosis to disease-related death, follow-up time, and mortality rate were calculated for both the C-CCA and S-CCA groups. The outcomes of the C-CCA and S-CCA g...

Research paper thumbnail of Development of the novel ferrous-based stainless steel for biomedical applications, Part I: High-temperature microstructure, mechanical properties and damping behavior

Journal of the Mechanical Behavior of Biomedical Materials, 2011

Research paper thumbnail of Relative Translucency and Surface Roughness of Four Yttrium-stabilized Tetragonal Zirconia Polycrystalline-based Dental Restorations

Journal of Experimental & Clinical Medicine, 2013

Research paper thumbnail of Enhancement of Biocompatibility on Bioactive Titanium Surface by Low-Temperature Plasma Treatment

Japanese Journal of Applied Physics, 2005

The surface of implantable biomaterials directly contacts the host tissue and is critical in dete... more The surface of implantable biomaterials directly contacts the host tissue and is critical in determining biocompatibility. To improve implant integration, interfacial reactions must be controlled to minimize nonspecific adsorption of proteins, and tissue-healing phenomena can be controlled. The purpose of this study was to develop a new method of functionalizing titanium surfaces by plasma treatment. The covalent immobilization of bioactive organic molecules and the bioactivities in vitro were assessed by transmission electron microscopy (TEM), atomic force spectroscopy (AFM), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay as indices of cellular cytotoxicity. Argon plasma removed all of the adsorbed contaminants and impurities. Plasma-cleaned titanium surfaces showed better bioactive performances than untreated titanium surfaces. The analytical results reveal that plasma-cleaned titanium surfaces provide a clean and reproducible starting condition for further plasma treatments to create well-controlled surface layers. Allylamine was ionized by plasma treatment, and acted as a medium to link albumin. Cells demonstrated a good spread, and a wide attachment was attained on the Albu-Ti plate. Cell attachment and growth were shown to be influenced by the surface properties. The plasma treatment process plays an important role in facilitating tissue healing. This process not only provides a clean titanium surface, but also leads to surface amination on plasma-treated titanium surfaces. Surface cleaning by ion bombardment and surface modification by plasma polymerization are believed to remove contamination on titanium surfaces and thus promote tissue healing.

Research paper thumbnail of Great saphenous vein harvesting for venous outflow reconstruction in living donor liver transplantation – A minimally invasive refinement of the conventional procedure

International Journal of Surgery, 2013

Background: With the popularization of living donor liver transplantation (LDLT), it has been dis... more Background: With the popularization of living donor liver transplantation (LDLT), it has been discovered that adequate venous outflow from the transplanted liver is crucial for proper graft function. Recently, the harvesting of the LDLT recipient's autologous great saphenous vein (GSV) has been increasingly adopted as a solution to the shortage of cadaveric vascular grafts. Minimally invasive GSV harvesting for coronary artery bypass grafting was shown to improve the cosmetic result and reduce leg wound pain and other complications. For immunosuppressed patients such as LDLT recipients, these benefits could be especially valuable. Materials and methods: From April to August 2012, eleven LDLT recipients underwent either minimally invasive or short-incision harvesting of GSV. The patient profiles, operative and postoperative information regarding operation time, estimated blood loss, harvested GSV graft length, serum tacrolimus (FK506) levels and postoperative complications were recorded prospectively. Results: The only wound complication was a subcutaneous hematoma, in our fourth patient. The mean operation time and the mean estimated blood loss were 33.9 min and 7.3 ml respectively. The mean incision length divided by the mean vein graft length was 31.6%. Two patients had poorly controlled diabetes mellitus. The mean serum FK506 level during the first postoperative week was 6.4 ng/ml (therapeutic range 5e10 ng/ml according to our protocol). No patient had surgical site infection in this series. Conclusions: GSV harvesting from LDLT recipients for hepatic venous outflow reconstruction is feasible without the need for expensive endoscopic systems, and an adequate length of vein can be obtained through a single 3 cm incision.

Research paper thumbnail of Oct-3/4 Expression Reflects Tumor Progression and Regulates Motility of Bladder Cancer Cells

Cancer Research, 2008

Cancer and embryonic stem cells exhibit similar behavior, including immortal, undifferentiated, a... more Cancer and embryonic stem cells exhibit similar behavior, including immortal, undifferentiated, and invasive activities. Here, we show that in clinical samples bladder tumors with intense expression of stem cell marker Oct-3/4 (also known as POU5F1) are associated with further disease progression, greater metastasis, and shorter cancer-related survival compared with those with moderate and low expressions. Expression of Oct-3/4 is detected in human bladder transitional cell carcinoma samples and cell lines. Overexpression of Oct-3/4 enhances, whereas knockdown of Oct-3/4 expression by RNA interference reduces, migration and invasion of bladder cancer cells. Oct-3/4 can up-regulate fibroblast growth factor-4 and matrix metalloproteinase-2 (MMP-2), MMP-9, and MMP-13 production, which may contribute to tumor metastasis. Finally, we show that Ad5WS4, an E1B-55 kD–deleted adenovirus driven by the Oct-3/4 promoter, exerts potent antitumor activity against bladder cancer in a syngeneic mur...

Research paper thumbnail of Hepatic resection for bilateral hepatolithiasis: a 20-year experience

ANZ Journal of Surgery, 2012

There is increasing evidence showing that hepatic resection is probably the best definitive treat... more There is increasing evidence showing that hepatic resection is probably the best definitive treatment for unilateral hepatolithiasis. However, the role of hepatic resection for bilateral hepatolithiasis is rarely mentioned in the literature. We retrospectively reviewed 197 patients who underwent hepatic resection for hepatolithiasis in Changhua Christian Hospital from December 1987 to December 2007. A total of 156 patients with unilateral hepatolithiasis were defined as the UNI group (control group), and 41 patients with bilateral hepatolithiasis were defined as the BI group (study group). The short- and long-term outcomes were measured. The BI group had longer operating time (200 min versus 173 min, P = 0.006), lower immediate stone clearance rate (56.1% versus 91.7%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), lower final stone clearance rate (75.6% versus 94.9%, P = 0.001), higher rate of stone recurrence (22.6% versus 6.1%, P = 0.009) and higher disease-related mortality (19.5% versus 5.1%, P = 0.006). Thirty patients with bilateral peripheral stones were indicated for bilateral hepatectomy, but only 20 (66.7%) of them actually underwent the proposed procedure. Of the patients who did not achieve immediate stone clearance, bilateral peripheral stones represented 88.9% (P = 0.044). Of the patients who had stone recurrence, patients less than 35 years old represented 42.9% (P = 0.007). Bilateral hepatolithiasis has worse outcomes than unilateral hepatolithiasis after being treated with hepatic resection. Regarding bilateral peripheral stones, there is often a discrepancy between the extent of stone-affected parenchyma and that of final liver resection, resulting in a lower immediate stone clearance rate. A higher stone recurrence rate was observed among younger population.

Research paper thumbnail of Comparative Factor Analysis of the Effect of Postoperative Peripheral Parenteral Nutrition on Recovery of Right Lobe Liver Donors

Intensive nutritional support can reduce the catabolic response, improve protein synthesis, and p... more Intensive nutritional support can reduce the catabolic response, improve protein synthesis, and promote liver regeneration. This study examined whether postoperative peripheral parenteral nutrition may improve recovery and reduce the length of hospital stay in right lobe liver donors. In this retrospective study, we enrolled liver donors with residual liver volume < 50%. Donors were classified into 2 groups: donors who received (n = 44) or did not receive (n = 40) postoperative peripheral parenteral nutrition. Liver function tests included alanine aminotransferase and total bilirubin levels, and postoperative complications included pleural effusion, atelectasis, and wound complications. Hospital length of stay was included as a potential risk factor for the evaluation of the effect of postoperative peripheral parenteral nutrition on recovery of right lobe liver donors. Male sex (β, 22.04; 95% confidence interval: 6.22 - 37.86) was a significant predictor of changes in postoperati...

Research paper thumbnail of Predictors of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation

International Journal of Surgery, 2013

Background: Results of preoperative conventional coagulation assays are a poor predictor of hemor... more Background: Results of preoperative conventional coagulation assays are a poor predictor of hemorrhage after liver transplantation. In this study, we evaluated the factors that are predictive of intra-abdominal coagulopathic hemorrhage after living donor liver transplantation surgery. Methods: During the period from January 2009 to December 2012, 118 adults underwent living donor liver transplantation (LDLT) in our institution. Of those patients, 18 (15.3%) developed intra-abdominal coagulopathic hemorrhage (n ¼ 7) or hemorrhage due to non-coagulopathic causes (n ¼ 11) that required emergency medical, radiological, or surgical intervention within the first month after LDLT. Possible predictors of postoperative coagulopathic hemorrhage included donor-related factors, age, body mass index, MELD score, INR value, intra-operative blood transfusion, graft/recipient weight ratio, anhepatic phase, cold ischemia time, operative time, APACHE II score, onset of re-bleeding, and hemoglobin levels during rebleeding episodes. Results: There were no differences in any of the variables between the two groups (coagulopathic and noncoagulopathic hemorrhage) except for cold ischemia time. We found that cold ischemia time was significantly longer in patients with postoperative coagulopathic hemorrhage (160.50 AE 45.02 min) than in patients with hemorrhage due to non-coagulopathic causes (113.55 AE 29.31 min; P ¼ 0.027). Conclusion: Prolonged cold ischemia time is associated with postoperative intra-abdominal coagulopathic hemorrhage in patients after LDLT. It is, therefore, necessary to shorten the cold ischemia time in order to reduce the risk of postoperative intra-abdominal hemorrhage due to coagulopathic causes.

Research paper thumbnail of Portal Vein Thrombosis and Arterioportal Shunting Due To Chronic Cholangitis: A Rare Complication of Living-Donor Liver Transplant

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, Jan 20, 2016

We present a patient with portal vein thrombosis due to chronic cholangitis after undergoing a li... more We present a patient with portal vein thrombosis due to chronic cholangitis after undergoing a living-donor liver transplant. A 52-year-old woman with a history of hepatitis B virus-related liver cirrhosis underwent a living-donor liver transplant. After the surgery, the patient had recurrent episodes of cholangitis because of common and intrahepatic bile duct stricture. Biliary stricture because of cholangitis eventually resulted in acute portal vein thrombosis. A stent was inserted by percutaneous transluminal portography. Blood flow through the portal vein progressively improved from the third through the 10th day after stent placement. The anticoagulation regimen was change to acetylsalicylic acid and clopidogrel hydrogen sulfate (Plavix). On poststenting day 10, a follow-up computed tomographic scan showed good patency of the main portal vein and no evidence of arterioportal shunting. Cholangitis after living-donor liver transplant is a rare cause of portal vein thrombosis. Reg...