Clinicopathologic Evaluation of Prognostic Factors for Squamous Cell Carcinoma of the Buccal Mucosa

BackgroundThe purpose of this research was to evaluate the prognostic significance of clinicopathologic variables on the survival rate for squamous cell carcinoma of the buccal mucosa (BMSCC). We analyzed the outcomes of surgical therapy for this aggressive cancer and compared these results with those in the literature.MethodsWe reviewed the medical charts of 172 patients treated in our institution between 1990 and 2005. There were 22 patients excluded from our studies: 20 patients with advanced tumors who received no treatment or palliative treatment, and 2 patients who had received preoperative radiotherapy (RT). The remaining 150 patients were treated with surgeries and among them, 56 patients had undergone postoperative RT. The influence of clinicopathologic factors on the survival rate was analyzed with the Kaplan-Meier method and log-rank test. Multivariate analysis was assessed with Cox's regression model.ResultsThere were 148 males and 2 females, with a mean age of 53.5 years. The prevalence rate of habitual betel quid chewing documented in charts among 113 patients was 75%. The 5-year overall survival rate and disease-specific survival rate for all patients were 64% and 69%, respectively. For patients with stages I, II, III, and IV disease, the 5-year disease-specific survival rates were 90%, 77%, 52%, and 47%, respectively (p< 0.001). According to the multivariate analysis, the pathologic staging and histologic grading of the tumor were independently the important prognostic factors affecting survival rate. There were 80 patients who developed locoregional recurrence in lymph nodes in the follow-up diagnoses. Distant metastases occurred in 14 patients, with 11 of them also having locoregional recurrence. The distant metastases were found in the lungs (8/14), T-spine (3/14), liver (2/14) and brain (1/14).ConclusionPathologic stage and histologic grade are the most important prognostic factors

The nucleolar protein NIFK promotes cancer progression via CK1α/β-catenin in metastasis and Ki-67-dependent cell proliferation.

Nucleolar protein interacting with the FHA domain of pKi-67 (NIFK) is a Ki-67-interacting protein. However, its precise function in cancer remains largely uninvestigated. Here we show the clinical significance and metastatic mechanism of NIFK in lung cancer. NIFK expression is clinically associated with poor prognosis and metastasis. Furthermore, NIFK enhances Ki-67-dependent proliferation, and promotes migration, invasion in vitro and metastasis in vivo via downregulation of casein kinase 1α (CK1α), a suppressor of pro-metastatic TCF4/β-catenin signaling. Inversely, CK1α is upregulated upon NIFK knockdown. The silencing of CK1α expression in NIFK-silenced cells restores TCF4/β-catenin transcriptional activity, cell migration, and metastasis. Furthermore, RUNX1 is identified as a transcription factor of CSNK1A1 (CK1α) that is negatively regulated by NIFK. Our results demonstrate the prognostic value of NIFK, and suggest that NIFK is required for lung cancer progression via the RUNX1-dependent CK1α repression, which activates TCF4/β-catenin signaling in metastasis and the Ki-67-dependent regulation in cell proliferation

Risk Factors for Retinal Detachment After Cataract Surgery in Southern Taiwan

This study was designed to investigate potential risk factors for retinal detachment (RD) after cataract surgery in southern Taiwan. Methods: This was a prospective cohort study. Submitted charts and claimed records for insurance beneficiaries who underwent cataract extraction between August 1999 and December 2001 were collected from the Bureau of National Health Insurance. Data from these records were examined, including demographic characteristics, past history, refractive status, axial length, and type and complications of cataract extraction. At the end of 2002, any ophthalmologic diagnosis and related treatments, based on procedure and diagnosis codes listed in physician bills, were evaluated. Results: A total of 9,398 patients were evaluated. The cumulative risk of RD in our study group was 0.4% at the end of follow-up. The mean follow-up time was 25.5 ± 7.7 months. Age had a significant influence on the risk of RD after cataract surgery (p = 0.006), whereas gender did not. Axial length also had a significant effect on the risk of RD after cataract extraction (p < 0.001), whereas systemic disease or the type of operation did not correlate significantly with RD. Intraoperative complications had a significant influence on RD risk only in patients aged more than 60 years (p = 0.042). Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy significantly reduced the risk of RD only in patients aged 50 years or younger (p < 0.001). Conclusion: Our results show that young age and long axial length are both significantly associated with RD after cataract surgery. A more restrictive attitude towards early cataract extraction may therefore be appropriate, especially in highly myopic patients

Kawasaki Disease: An Update on Diagnosis and Treatment

Kawasaki disease (KD) is an acute multi-system vasculitis syndrome of unknown etiology occurring mostly in infants and children younger than 5 years of age. In developed countries, it is the leading cause of acquired heart disease in children. However, KD remains a mysterious disease. Some viruses potentially causing the condition have been isolated, but the results have not been able to be reproduced. This article reviews and summarizes different aspects of KD and provides updated information on diagnosis and treatment. The supplementary criteria for incomplete presentation of KD patients suggested by the American Heart Association, treatment (including tumor necrosis factor-alpha antagonist, methylprednisolone pulse therapy, statins, plasma exchange, and cytotoxic agents) for those with intravenous immunoglobulin treatment failure, and other experiences are also included in this review

Parents’ Views About the Vaccination Program in Taiwan

To investigate parents’ views about new vaccines, we surveyed the attitudes and awareness toward immunization program among parents of children younger than 14 years in Taiwan. Methods: Parents of children were invited to complete a questionnaire in a tertiary referral medical center in Kaoshiung, southern Taiwan from 2006 to 2008. A total of 535 questionnaires were completed. We used descriptive data for the analysis of parents’ views and attitudes toward the current vaccination program in Taiwan. Results: Of the 535 respondents, most parents (93%) did not think the current vaccination program was satisfactory. Few (approximately 8%) preferred self-paid vaccines. About 63% of parents believed that the new (self-paid) vaccines provided more protection, whereas 48% deemed them too expensive. The most popular reason for preferring the new vaccines was greater protection (73%). One-half of parents considered the new vaccines to be expensive. Regarding parental awareness of side effect of vaccination, fever was the most well known and of greatest concern (91%). Most parents (68%) had good awareness of conjugated pneumococcal vaccines, and only few (13%) had heard of the human papilloma virus vaccine. Most parental information of vaccines came from pamphlets at the hospital (56%). Conclusion: We found the awareness of parents about new vaccines to be insufficient. They also considered the new vaccines to be expensive

Clinical Risk Factors of ECMO Support in Older Adults

A total of 99 patients (mean age: 76.4±6.4 years) were included. The most common condition requiring VA-ECMO support was cardiogenic shock. Among survivors on VA-ECMO, 28 (28.3%) patients were successfully weaned from support. Thirteen (13.1%) patients were successfully discharged. We found that cardiogenic shock (OR=3.158, P=0.013), acute physiology and chronic health evaluation II (APACHE II) score (OR=1.147, P<0.001), and simplified acute physiology score II (SAPS II) score (OR=1.054, P=0.001) were risk factors associated with survival on VA-ECMO

Long-term use of opioids in 210 officially registered patients with chronic noncancer pain in Taiwan: A cross-sectional study

Prescribing opioids for chronic noncancer pain has been strictly regulated for two decades in Taiwan. The aim of this study was to survey the patients' perspectives and potential drawbacks following long-term use of opioids. Methods: An observational cross-sectional survey using the Taiwanese version of Brief Pain Inventory was conducted among outpatients with chronic noncancer pain registered by the Taiwan Food and Drug Administration. Patients were also asked about their sexual behavior, depression, opioid misuse behaviors, and use of complementary and alternative medicine. Results: For 210 of 328 outpatients (64.0%), the median pain duration was 96 months and opioid treatment duration was 57 months. The median morphine equivalent dose was 150 mg/d, with 30.5% of patients exceeding the daily watchful dose, defined as 200 mg of morphine equivalent dose. Pain reduction after taking opioids was ∼50% in the past week. The top three diagnoses were chronic pancreatitis, spinal cord injury, and neuralgia. The leading side effects were constipation (46.7%), and decreased sexual desire (69.5%) and satisfaction (57.9%). Depression was currently diagnosed in 55.2% of patients. Twenty patients (9.5%) displayed at least one aberrant behavior in the past month. Only 76 (36.2%) patients had ever received nerve block procedures, and 118 (56.2%) tried complementary and alternative medicine. Conclusion: This nationwide survey described the concurrent pain intensity, daily function, and various adverse effects by long-term opioids among 210 monitored outpatients with chronic noncancer pain in Taiwan. More efforts are suggested to reduce opioid prescriptions in the 30% of patients exceeding daily watchful dose

Reappraisal of the Prostaglandin E1 Dose for Early Newborns with Patent Ductus Arteriosus-Dependent Pulmonary Circulation

The usual initial dose of prostaglandin E1 (PGE1) for ductal-dependent congenital heart disease (CHD) is 50–100 ng/kg/minute. The aim of this study was to review our experience of a low initial dose of PGE1 treatment in early newborns with congenital heart disease and patent ductus arteriosus (PDA)-dependent pulmonary flow. Methods: We reviewed the clinical data of 33 newborns with CHD and PDA-dependent pulmonary circulation who were admitted from January 2005 to December 2010. Clinical parameters were collected, including, PGE1 dosage, oxygenation condition, vital signs, and other related clinical parameters during admission. Echocardiography was employed to assess the status of the PDA as clinically indicated. Results: Thirty-three newborns, including 17 males and 16 females, with CHD and PDA-dependent pulmonary circulation were enrolled in the study. Their mean age was 2.9 ± 5.1 (within the range of 1–26) days with a median of 1.0 day. Among the 33 cases, 25 were diagnosed with pulmonary atresia and eight with critical pulmonary stenosis. Twenty-five of our patients were treated with the initial low-dosage regimen of 20.0 ± 7.4 ng/kg/minute in our neonatal intensive care unit. None of these 25 patients with had significant apnea necessitating intubation and none had hypotension, fever, convulsion or cortical hyperostosis. Three of the eight patients who were treated with high-dose PGE1 (39 ± 13.2 ng/kg/minute) before referral to our unit had apnea and intubation after PGE1 use. All patients had adequate PDA patency with a low maintenance dose of 10.5 ± 5.3 ng/kg/minute before operation under our protocol. Conclusion: In our experience, adequate PDA flows in early newborns with CHD and PDA-dependent pulmonary circulation could be achieved at a much lower dose than recommended in the literature. The lower dose of PGE1 also causes much fewer complications, such as apnea, fever, and hypotension. For early newborns with CHD and PDA-dependent pulmonary circulation, treatment with a lower initial dose of PGE1 of 20 ng/kg/minute and a maintenance dose of 10 ng/kg/minute is recommended