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Abstract This study investigated the relationship between body composition parameters and changes in future liver remnant volume (FLRV) in hepatocellular carcinoma (HCC) patients undergoing portal vein embolization (PVE) in preparation for right hepatectomy. This retrospective study enrolled 21 patients between May 2013 and October 2020. Body composition parameters, including skeletal muscle attenuation (SMA), skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral‐to‐subcutaneous adipose tissue area ratio (VSR), were measured by computed tomography (CT) prior to PVE. Liver volumetry was measured before and at least 5 weeks after PVE. The mean interval between two CT volumetries was 9.1 ± 4.9 weeks, the mean value of increase in FLRV (ΔFLRV) was 236.0 ± 118.3 cm3, the ratio of increased FLRV (ΔFLRV%) was 55.7 ± 29.4%, and the rate of increased FLRV was 31.0 ± 18.8 (cm3/week). Subjects with high IMAC showed significantly lower (p = 0.044) ΔFLRV% than those with normal IMAC. Furthermore, ΔFLRV% was linearly reduced (p for trend = 0.043) among those with low Ishak fibrosis stage (3) + normal IMAC (54.0 ± 24.1%), and those with high Ishak fibrosis stage (>3) + low IMAC (28.7 ± 1.6%) (p for trend = 0.043). Our data indicated that high IMAC with a high Ishak fibrosis stage (>3) had a significant negative effect on ΔFLRV%.

Abstract This study aimed to describe our experience and discuss the results, controversies, and the use of percutaneous transhepatic biliary drainage (PTBD) in patients with biliary complications after liver transplantation (LT). Between November 2009 and August 2020, 76 consecutive patients who underwent 77 LTs (44 deceased donor LTs and 33 living donor LTs [LDLT]) were enrolled retrospectively. Endoscopic therapy as initial approach and PTBD as rescue therapy were used for patients with biliary complications. There were 31 patients (31/76, 40.8%) with biliary complications, and two of them died (2/31, 6.5%). Clinical success rate of endoscopic therapy alone was 71.0% (22/31). The remaining nine patients received salvage PTBD and their clinical results were observed according to whether their intrahepatic bile ducts (IHBDs) was dilated (group A, n = 5) or not (group B, n = 4). In group A, the technical and long‐term clinical success rates of PTBD were 100% and 20%, respectively. These five patients received PTBD ranging from 75 to 732 days after their LTs, and no procedure‐related complications were encountered. In group B, the technical and long‐term clinical success rates of PTBD were 50% and 25%, respectively. Three group B patients (75%) underwent PTBD within 30 days after LDLT and had lethal complications. One patient had graft laceration and survived after receiving timely re‐transplantation. The other two patients died of sepsis due to PTBD‐related bilioportal fistula or multiple liver abscesses. Our experience showed salvage PTBD played a limited role in biliary complications without dilated IHBDs within 1 month after LT.

Sorafenib has been recommended as a new palliative therapy for advanced hepatocellular carcinoma (HCC). However, the clinical outcome of patients receiving sorafenib therapy varies. This study sought to identify which clinical method could be used to predict clinical outcome of sorafenib monotherapy in patients with advanced HCC. A total of 146 advanced HCC patients with Child-Pugh A liver function were enrolled from June 2011 to September 2015. Sorafenib doses ranged from 200 mg once daily to 400 mg twice daily. Clinical and pathological parameters were collected. There was no predefined primary endpoint. Tumor response rate, adverse events, overall survival (OS), and progression-free survival (PFS) were analyzed. The follow-up period was 1718 days (median: 859 days). The median dosage of sorafenib was 562.35 mg.Forty patients (27.4%) had stable disease and 106 patients (72.6%) had progression disease. The OS was 432.21 ± 360.52 days (median: 329 days) and PFS was 167.05 ± 166.50 days (median: 102.5 days). No sorafenib toxic effect-related mortality was encountered. The most common severe adverse events (≧grade 3) were hand-foot skin reactions (HFSR) (16, 11.0%), diarrhea (7, 4.8%), and alopecia (1, 0.7%). The following patients had longer median PFS (mPFS): those receiving total dosage > 55000 mg (217 vs.63 days; HR = 0.20,95%CI = 0.11–0.38; p 112 days (231vs.64 days; HR = 0.37, 95%CI = 0.19–0.74; p

Background: Multiport laparoscopic cholecystectomy is the standard surgical procedure for symptomatic gallbladder diseases. The latest evolution is single incision laparoscopic cholecystectomy (SILC). Single-site robotic cholecystectomy (SSRC) overcomes several limitations of manual SILC. The aim of this study is to present our initial experiences in SSRC and to compare its clinical outcomes with those of SILC. Methods: This study retrospectively reviewed data for patients who received SSRC or SILC from February 2014 to September 2015. The following variables were analyzed: age, sex, body mass index, indications, pain scale, length of stay, and complications. The data were analyzed with Student t test or by Fisher exact test. Results: The analysis included 51 SSRC (33 women, 18 men) and 63 SILC patients (40 women, 23 men). Patients in both groups had similar demographic features and indications for surgery. The SSRC group required no conversions to conventional laparoscopy and no additional trocars, whereas the SILC group had two (3.17%) cases. Length of stay did not significantly differ between the SSRC and SILC groups (4.29 ± 0.72 vs. 4.13 ± 0.93 days, respectively; p = 0.823). However, the SSRC group had shorter operative time (71.30 ± 48.88 vs. 74.70 ± 30.16 minutes; p = 0.772), less perioperative bile spillage (9.81% vs. 19.05%; p = 0.189), and less postoperative bile leakage (0% vs. 3.17%; p = 0.501). However, the parameters mentioned above were not statistically significant, whereas pain scale scores were significantly lower in the SSRC group (2.11 ± 0.76 vs. 3.98 ± 0.84; p

Conventional laparoscopic cholecystectomy (CLC) is currently the standard of surgical procedure for gallstone disease. Robotic cholecystectomy (RC) has revolutionized the field of minimally invasive surgery; it is safe and ergonomic, but expensive. The aim of this study is to compare the medical resource utilization and clinical outcomes between the two procedures. This study was conducted retrospectively by assessing data of the clinical outcomes and medical resource of 78 patients receiving RC and 367 patients receiving CLC. We reviewed the data of operation times, length of hospital stay, hospital charges, outpatient department visits, outpatient department service charges, and postoperative complications, which were retrieved from the health information system (HIS) database in this hospital. Patients in both groups had similar demographic and clinical features. The RC group had longer length of hospital stay (p=0.056), significantly longer operation time (p=0.035), and much more hospital charges (p=0.001). The RC group, however, experienced less postoperative complication rates (average 3.8% vs. 20.4%, p=0.001). Conversion rate was 1.9% in the CLC group versus 0% in the RC group (p=0.611). Most complications were mild, and following the Clavien-Dindo classification, there were two cases (2.5%) Grade I for the RC group; 50 cases (13.6%) Grade I and 14 cases (3.81%) Grade II for the CLC group (p

The development of automated approaches employing computational methods using data from publicly available drugs datasets for the prediction of drug side effects has been proposed. This paper presents the use of a hybrid machine learning approach to construct side effect classifiers using an appropriate set of data features. The presented approach utilizes the perspective of data analytics to investigate the effect of drug distribution in the feature space, categorize side effects into several intervals, adopt suitable strategies for each interval, and construct data models accordingly. To verify the applicability of the presented method in side effect prediction, a series of experiments were conducted. The results showed that this approach was able to take into account the characteristics of different types of side effects, thereby achieve better predictive performance. Moreover, different feature selection schemes were coupled with the modeling methods to examine the corresponding effects. In addition, analyses were performed to investigate the task difficulty in terms of data distance and similarity. Examples of visualized networks of associations between drugs and side effects are also discussed to further evaluate the results.

Hepatocellular carcinoma (HCC) has been ranked as the third leading cause of cancer-related mortality worldwide. Typically, patients are already in advanced stages of liver cirrhosis at the time of HCC diagnosis. Because HCC is often detected at a late stage and is highly aggressive, noninvasive biomarkers are urgently needed for early diagnosis. Recent advances in gene-expression profiling technologies have enabled molecular classification of HCC into defined subclasses that provide a firm basis for further study of potential mechanisms and biomarkers underlying the development of HCC. This study applied an integrated onco-proteogenomics approach to identify and characterize HCC biomarkers. Specifically, this study integrated proteomic, genomic, and transcriptomic methods to obtain protein expression profiles of urine and tissue samples from HCC patients and from normal controls. Two mediators of inflammation were positively identified: S100A9 and granulin protein markers, which belong to the cytoplasmic alarmin family of the host innate immune system. These HCC-associated cancer-specific biomarkers may have contributing roles not only in the dysregulated processes associated with various inflammatory and autoimmune conditions, but also in tumorigenesis and cancer metastasis.

If portal vein stenosis (PVS) occurs within 1 month after liver transplantation (LT), especially within 1 week, it can be catastrophic and result in rapid loss of the grafts and mortality. Although surgical treatments have been considered standard treatment for PVS, patients are usually unable to receive operations or re-transplantations, because of their critical conditions and a shortage of grafts. Recently, primary percutaneous transhepatic portal vein stents (PTPS) were suggested as alternative and less-invasive treatments of PVS. However, because lethal complications may follow these primary stent placements for patients in early stages after LT, primary PTPS placements for patients suffering PVS 1 month after LT has been suggested. From November 2009 to July 2015, 38 consecutive adult patients underwent LT at our institution. Among them, six recipients suffered PVS within 1 month after LT. Technical success was achieved in all six patients. Clinical success was obtained in two of the four patients suffering PVS within 1 week after LT, and in the other two patients suffering PVS>1 week after LT. All surviving patients and their grafts were in good condition, and their stents remained patent. Our experience showed that primary PTPS placements can be used to effectively treat patients with PVS encountered within 1 month, and even within 1 week, after LT with acceptable short-term results. However, possible fatal complications should be kept in mind. Long-term results of these procedures need further follow-up.

Whether low-concentration desflurane reinforces propofol-based intravenous anesthesia on maintenance of anesthesia for patients undergoing laparoscopic cholecystectomy is to be determined. The aim of this study was to investigate whether propofol-based anesthesia adding low-concentration desflurane is feasible for laparoscopic cholecystectomy. Fifty-two patients undergoing laparoscopic cholecystectomy were enrolled in the prospective, randomized, clinical trial. Induction of anesthesia was achieved in all patients with fentanyl 2 μg/kg, lidocaine 1 mg/kg, propofol 2 mg/kg, and rocuronium 0.8 mg/kg to facilitate tracheal intubation and to initiate propofol target-controlled infusion (TCI) to effect site concentration (Ce: 4 μg/mL with infusion rate 400 mL/h). The patients were then allocated into either propofol TCI based (group P) or propofol TCI adding low-concentration desflurane (group PD) for maintenance of anesthesia. The peri-anesthesia hemodynamic responses to stimuli were measured. The perioperative psychomotor test included p-deletion test, minus calculation, orientation, and alert/sedation scales. Group PD showed stable hemodynamic responses at CO2 inflation, initial 15 minutes of operation, and recovery from general anesthesia as compared with group P. There is no significant difference between the groups in operation time and anesthesia time, perioperative psychomotor functional tests, postoperative vomiting, and pain score. Based on our findings, the anesthetic technique combination propofol and desflurane for the maintenance of general anesthesia for laparoscopic cholecystectomy provided more stable hemodynamic responses than propofol alone. The combined regimen is recommended for patients undergoing laparoscopic cholecystectomy.

OBJECTIVE:The impact of preoperative depressive symptoms on quality of life (QOL) after laparoscopic cholecystectomy (LC) remains unclear. The purpose of this study was to develop a benchmark for capturing the burden of depressive symptoms on QOL after LC and for supporting evidence-based clinical interventions for remediating these effects. METHODS:Patients diagnosed with depressive symptoms (Beck Depression Inventory score > 13) after LC (n = 336) were classified into a depressive symptoms group. Propensity score matching was then used to match them with 336 patients in a non-depressive symptoms group for all potential confounding factors. All patients completed the 36-item Short Form Health Survey (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI) at baseline and at 2 years postoperatively. The 95% confidence intervals (CIs) for differences in responsiveness estimates were derived by bootstrap estimation. RESULTS:The GIQLI results revealed that the non-depressive symptoms group had relatively stronger responses for emotional impairment (4.10, 95% CI 2.81 to 5.39) and social impairment (4.06, 95% CI 2.65 to 5.46) in comparison with the depressive symptoms group. In the SF-36, the non-depressive symptoms group also had stronger responses for role emotional (12.63, 95% CI 10.73 to 14.54), social functioning (11.25, 95% CI 9.85 to 12.65), vitality (3.81, 95% CI 2.82 to 4.81), mental health (11.97, 95% CI 10.36 to 13.56) and general health (3.84, 95% CI 2.95 to 4.75). CONCLUSIONS:Depressive symptoms complicate the management of LC patients and are associated with poorer outcomes. Because depressive symptoms are very common, further studies are needed to evaluate integrated and comprehensive approaches for assessing and treating these symptoms.

Few studies have compared percutaneous biliary stenting (PBS) and endoscopic biliary stenting (EBS) in terms of long-term effects on cholangiocarcinoma (CC), and few have systematically evaluated outcome associations in Taiwan. This study aimed to compare long-term outcomes between two treatments for unresectable CC: PBS and EBS. After propensity score matching (PSM) to reduce the effect of selection bias, 1002 CC patients were included in this analysis: 501 in the PBS group and 501 in the EBS group. The Kaplan-Meier method was used to construct the survival curve for all CC patients, and the Cox proportional hazards model was used for multivariate assessment of outcome predictors. After PSM, group comparisons revealed a significantly longer length of stay in the PBS group compared to the EBS group (25 days vs. 19 days, respectively; p

The target controlled infusion (TCI) of propofol with fentanyl facilitates easy titration of the depth of anesthesia, and thereby may improve the quality of anesthesia. The aim of this study is to investigate if propofol TCI-based anesthesia is practical for anterior cervical discectomy and fusion (ACDF), one of the most common surgical interventions in spine procedures, when compared with sevoflurane-based anesthesia with respect to the quality of anesthesia. Patients were classified into two groups according to the anesthesia regimen of maintenance of anesthesia with fentanyl and either propofol TCI (group FP) or inhalational sevoflurane (group FS), respectively. The primary endpoint was to evaluate quality of anesthesia and extubation time. Secondary endpoints were hemodynamic stability during the operation, operative fentanyl consumption, and postoperative complications. The study results revealed there were comparable results on time to extubation, changes in intraoperative hemodynamic parameters, and the occurrence of postoperative complications between the groups. No differences in average length of intensive care unit (ICU) stay and hospital stay were noticed. However, opioid consumption and blood loss during the operation for patients in group FP were significantly higher than those of patients in group FS (551.28 ± 193.98 vs. 446.86 ± 177.15 μg, p = 0.005; 52.06 ± 58.25 vs. 28.33 ± 40.74 mL, p = 0.019, respectively). In these adult patients undergoing ACDF, propofol TCI-based anesthesia appears to be as efficacious as sevoflurane-based anesthesia but consumed more fentanyl and experienced higher blood loss.

Through a review of the literature, a splenic artery aneurysm (SAA) with associated spontaneous splenorenal shunt (SSRS) was only reported in patients with liver cirrhosis and portal hypertension. However, a natural course of a SAA with associated SSRS was found in a non-cirrhotic male patient during an 8-year observational follow-up, and thus reported. Initially, splenomegaly and thrombocytopenia were noted; SSRS was observed later with a tortuous dilated splenic artery, and a SAA was then progressively formed and found. The patient received splenectomy with aneurysm resection and SSRS was preserved. Post-operative follow-up revealed that the size of the SSRS was reduced. Through the course, no abnormalities of liver enzymes, portal hypertension, or esophageal-gastric varicose were found in the patient. No positive association was demonstrated between the formation of SSRS and the severity of liver cirrhosis in patients, implying some other factors, e.g., vascular endothelial growth factor (VEGF) mentioned in the literature, might be involved.

Degenerative cervical spondylosis (DCS) is part of the aging process and is the most common reason for degenerative changes with the spinal column. Anterior cervical discectomy and fusion (ACDF) is a major option for operative management of DCS in our institution. This retrospective study investigated the frequency of postoperative complications and resource utilization in 145 patients who underwent ACDF procedures from January 2009 to December 2011. Patients with degenerative changes that involved cervical intervertebral levels C1–C2, spinal injury of traumatic origin, spinal tumors, or previous cervical fusion were excluded. Patients were then further classified into two groups: (1) level 1 or 2 disease (Group M) and (2) level 3 or 4 disease (Group S). Measures of mortality, complications after surgery as well as immediate reoperation for any reason were evaluated. Operation time, length of hospital stay, and hospitalization cost were defined as resource utilization. Ninety seven patients met the inclusion criteria and were further reviewed to characterize the sample better. There were no hematomas, airway complications or deaths, except in one patient who developed postoperative hemorrhage that required immediate surgical intervention, and resolved without any neurological deficit or casualty. Resource utilization indicated that the average operation time for Group S was significantly higher than for Group M (4.31±1.25 vs. 2.88±0.90 hours, p

Surgical resection for hepatocellular carcinoma (HCC) is regarded as a curable treatment; however, the postoperative recurrence still poses a challenge to surgeons. The effect of surgical margin on long-term outcome is still controversial, although it has been considered as the treatment-related risk factor for recurrence. A precise assessment of the effects of surgical margin on clinical outcome is required to clarify the issue. Methods: A retrospective study was conducted on 407 patients with microscopically complete resection of HCC; they were divided into three groups with surgical margin negative by 1–5 mm (Group A, n = 156), 6–10 mm (Group B, n = 109), and wider than 10 mm (Group C, n = 142). The groups were compared for clinicopathologic characteristics, perioperative features, postoperative recurrence, and long-term outcome. Results: The median follow-up time for all patients was 72.97 months. Recurrence rates were similar among these groups. There was no significant difference in the overall 1-, 3-, and 5-year actual survival rates for the groups on the log-rank test (p = 0.073). After controlling the independent risks for disease-free survival, there was also no significant difference in the 1-, 3-, and 5-year disease-free survival rates for the groups (p = 0.354). The patients with wider surgical margin had worse perioperative outcomes; more patients in this group needed blood transfusion (p

This large-scale prospective cohort study of a Taiwan population applied generalized estimating equations to evaluate predictors of health-related quality of life (HRQOL) after open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) procedures performed between February 2007 and November 2008. The Gastrointestinal Quality of Life Index and Short Form-36 were used in a preoperative assessment and in 3rd month and 6th month postoperative assessments of 38 OC and 259 LC patients. The HRQOL of the cholecystectomy patients were significantly improved at 3 months and 6 months postsurgery (p

In this report, we describe a 31-year-old man in whom acute pancreatitis was the initial feature of a subsequently diagnosed pancreatic adenocarcinoma with multiple metastases. He initially presented at our hospital with acute pancreatitis. Abdominal ultrasonography revealed a mildly dilated pancreatic duct and an enlarged pancreatic head. Although a follow-up abdominal ultrasonography revealed a progressively dilated pancreatic duct and a progressively enlarged pancreatic head, he refused further investigation and was lost to follow-up. Four months later, he returned to our hospital with relapsed acute pancreatitis. Obstructive jaundice was noted and drainage was performed. Because choledochoplasty with multiple balloon catheters was not fully effective, biliary tract bypass surgery was carried out. Intraoperative biopsy confirmed pancreatic adenocarcinoma with multiple metastases. The patient died of massive gastrointestinal bleeding a few weeks later. To our knowledge, this is the youngest case of pancreatic cancer with the uncommon initial presentation of acute pancreatitis reported in the literature. For a patient with acute pancreatitis, particularly recurrent episodes, but with no known risk factors for pancreatitis, a pancreatic neoplasm should be considered as a potential underlying cause, even in a young man.

Circulating retinol binding protein 4 (RBP4) is associated with a variety of obesity-related diseases. This study investigated whether there were aberrant concentrations of RBP4 in cholesterol gallstone disease. Methods: Serum RBP4 levels of 100 cholesterol gallstone patients and 147 healthy controls were measured by enzyme-linked immunosorbent assay and further correlated with clinical and biochemical characteristics, including insulin resistance and renal function. Gallstone specimens were obtained during laparoscopic cholecystectomy and analyzed for their chemical composition using Fourier transform infrared spectroscopy Results: Significantly lower serum RBP4 levels were found in patients with cholesterol gallstones in comparison with controls (30.57 ± 13.64 mg/L vs. 41.52 ± 20.25 mg/L, p

This cross-sectional study analyzed the effects of two single nucleotide polymorphisms (SNP) of the adiponectin gene, SNP45 and SNP276, on hyperglycemia in indigenous Taiwanese, and whether central obesity modulates the effects of these SNPs. Overall, 550 indigenous Taiwanese were recruited for this cross-sectional study. The subjects were categorized into a hyperglycemic group if fasting plasma glucose was > 126 mg/dL (n = 88) or the control group if fasting plasma glucose was < 100 mg/dL (n = 462). The SNP276 TT homozygote carried greater hyperglycemia risk than SNP276 GG [odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.05–6.78], but not heterozygote (OR = 1.54, 95% CI = 0.95–2.50). SNP45 T > G was not associated with hyperglycemia risk. In multivariate-adjusted modeling, we found a significant relationship between SNP276 T carriers (GT + TT) (OR = 2.06, 95% CI = 1.10–3.88) and central obesity (OR = 4.50, 95% CI = 1.91–10.61) with hyperglycemia. Compared with non-central-obese carriers of SNP276 GG, non-central-obese SNP276 T carriers, and central obese subjects with SNP276 GG and SNP276 T carriers had 5.50, 8.31 and 13.76-fold, respectively, higher risks for hyperglycemia; obese carriers of the T-containing variants experienced a combined risk for hyperglycemia. Furthermore, the hyperglycemic risks were more pronounced in leaner (non-central-obese) individuals carrying the T variant than the central-obese individuals. The adiponectin SNP276 T variant and central obesity had independent and additive effects on hyperglycemia risks. These findings may provide valuable information regarding preventive strategies that might be useful to prevent or treat diabetes and its related complications.

To investigate the relationship between changes in patient attributes and hospital attributes over time and to explore predictors of medical utilization and mortality rates in mechanical ventilation (MV) patients in Taiwan.Providing effective medical care for MV patients is challenging and requires good planning and effective clinical decision making policies. Most studies of MV, however, have only analyzed a single regional ventilator weaning center or respiratory care unit, high-quality population-based studies of MV trends and outcomes are scarce.This population-based cohort study retrospectively analyzed 213,945 MV patients treated during 2004-2009.During the study period, the percentages of MV patients with the following characteristics significantly increased: age ≦ 65 years, treatment at a medical center, and treatment by a high-volume physician. In contrast, the percentages of MV patients treated at local hospitals and by low-volume physicians significantly decreased (P

Gallbladder carcinoma (GBC) is a highly lethal but relatively rare neoplasm of the digestive tract. The progression from gallbladder adenoma to carcinoma remains unclear. The p53 gene is the most frequently mutated tumor suppressor in human cancers. In this study, we analyzed the expression patterns of the p53 protein in 22 cases of GBC, 17 cases of precursor lesions (16 gallbladder adenomas and 1 cystadenoma), and 15 cases of normal epithelia using immunohistochemical analysis. The results were correlated with clinicopathologic characteristics. We found that p53 expression was significantly increased in 59.1% (13/22) of GBC cases and in 17.6% (3/17) of gallbladder adenoma cases (p = 0.009). There was no p53 expression in the 15 cases of normal epithelia, and a significant difference was shown between normal epithelium and GBC cases (p < 0.001). In addition, the expression pattern of p53 protein did not show any significant correlation with the histologic type and the differentiation grade of GBC. In conclusion, we suggest that the aberrant p53 expression may play a role in the occurrence of GBC.

A case of recurrent massive upper gastrointestinal bleeding originating from metastatic renal cell carcinoma is reported. A 63-year-old woman underwent right nephrectomy 9 years previously and experienced no recurrence during follow-up. A gradually enlarging ulcerative tumor over the bulb of the duodenum and four subsequent episodes of massive bleeding from this tumor occurred between June 2001 and March 2002. The patient underwent surgery in April 2002 for intractable bleeding from the tumor. Renal cell carcinoma metastasis to the duodenum was confirmed from the surgical specimen. Upper gastrointestinal bleeding due to malignancy is very rare and the duodenum is the least frequently involved site. Furthermore, a solitary late renal cell carcinoma metastasis 9 years after a nephrectomy is extremely uncommon. This case suggests that life-long follow-up of renal cell carcinoma patients is necessary, owing to unpredictable behavior and the possibility of long disease-free intervals. In nephrectomized patients suffering from gastrointestinal bleeding, complete evaluation, especially endoscopic examination, is indicated. The possibility of late recurrent renal cell carcinoma metastasis to the gastrointestinal tract should be kept in mind, although it is rare. If the patient is fit for surgery, metastatectomy is the first choice of treatment.

BackgroundDespite the high cost of initial cancer care, that is, care in the first year after diagnosis, limited information is available for specific categories of cancer-related costs, especially costs for specific services. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment.Methodology/principal findingsThe analysis of trends in initial treatment costs focused on cancer-related surgery, chemotherapy, radiation therapy, and treatments other than active treatments. For each cancer-specific trend, slopes were calculated for regression models with 95% confidence intervals. Analyses of patients diagnosed in 2007 showed that the National Health Insurance (NHI) system paid, on average, $10,780 for initial care of a gastric cancer patient and $10,681 for initial care of a lung cancer patient, which were inflation-adjusted increases of $6,234 and $5,522, respectively, over the 1996 care costs. During the same interval, the mean NHI payment for initial care for the five specific cancers increased significantly (pConclusions/significanceIn addition to the growing number of NHI beneficiaries with cancer, treatment costs and the percentage of patients who undergo treatment are growing. Therefore, the NHI must accurately predict the economic burden of new chemotherapy agents and radiation therapies and may need to develop programs for stratifying patients according to their potential benefit from these expensive treatments.

Hepatocellular carcinoma (HCC) is the leading cause of cancer-related deaths worldwide. Epirubicin can induce intracellular reactive oxygen species and is widely used to treat unresectable HCC. Progesterone has been found to inhibit the proliferation of hepatoma cells. This study was designed to test the combined effects of epirubicin and progesterone on human hepatoma cell line, HA22T/VGH. These cells were treated with different concentrations of epirubicin with or without the coaddition of 30 μM progesterone and then analyzed for apoptosis, autophagy, and expressions of apoptotic-related proteins and multidrug-resistant gene. Epirubicin treatment dose-dependently inhibited the growth of HA22T/VGH cells. Addition of 30 μM progesterone, which was inactive alone, augmented the effect of epirubicin on the inhibition of growth of HA22T/VGH cells. Cotreatment with progesterone enhanced epirubicin-induced apoptosis, as evidenced by greater increase in caspase-3 activity and in the ratio of the apoptosis-regulating protein, Bax/Bcl-XL. The combination also caused a decrease in autophagy and in the expression of multidrug resistance-related protein 1 mRNA compared to epirubicin alone. This study shows the epirubicin/progesterone combination was more effective in increasing apoptosis and inversely decreasing autophagy on HA22T/VGH cells treated with epirubicin alone, suggesting that this combination can potentially be used to treat HCC.

The aim of this present study is firstly to compare significant predictors of mortality for hepatocellular carcinoma (HCC) patients undergoing resection between artificial neural network (ANN) and logistic regression (LR) models and secondly to evaluate the predictive accuracy of ANN and LR in different survival year estimation models. We constructed a prognostic model for 434 patients with 21 potential input variables by Cox regression model. Model performance was measured by numbers of significant predictors and predictive accuracy. The results indicated that ANN had double to triple numbers of significant predictors at 1-, 3-, and 5-year survival models as compared with LR models. Scores of accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of 1-, 3-, and 5-year survival estimation models using ANN were superior to those of LR in all the training sets and most of the validation sets. The study demonstrated that ANN not only had a great number of predictors of mortality variables but also provided accurate prediction, as compared with conventional methods. It is suggested that physicians consider using data mining methods as supplemental tools for clinical decision-making and prognostic evaluation.

BACKGROUND: Since most published articles comparing the performance of artificial neural network (ANN) models and logistic regression (LR) models for predicting hepatocellular carcinoma (HCC) outcomes used only a single dataset, the essential issue of internal validity (reproducibility) of the models has not been addressed. The study purposes to validate the use of ANN model for predicting in-hospital mortality in HCC surgery patients in Taiwan and to compare the predictive accuracy of ANN with that of LR model. METHODOLOGY/PRINCIPAL FINDINGS: Patients who underwent a HCC surgery during the period from 1998 to 2009 were included in the study. This study retrospectively compared 1,000 pairs of LR and ANN models based on initial clinical data for 22,926 HCC surgery patients. For each pair of ANN and LR models, the area under the receiver operating characteristic (AUROC) curves, Hosmer-Lemeshow (H-L) statistics and accuracy rate were calculated and compared using paired T-tests. A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and the relative importance of variables. Compared to the LR models, the ANN models had a better accuracy rate in 97.28% of cases, a better H-L statistic in 41.18% of cases, and a better AUROC curve in 84.67% of cases. Surgeon volume was the most influential (sensitive) parameter affecting in-hospital mortality followed by age and lengths of stay. CONCLUSIONS/SIGNIFICANCE: In comparison with the conventional LR model, the ANN model in the study was more accurate in predicting in-hospital mortality and had higher overall performance indices. Further studies of this model may consider the effect of a more detailed database that includes complications and clinical examination findings as well as more detailed outcome data.

BACKGROUND: A database for hepatocellular carcinoma (HCC) patients who had received hepatic resection was used to develop prediction models for 1-, 3- and 5-year disease-free survival based on a set of clinical parameters for this patient group. METHODS: The three prediction models included an artificial neural network (ANN) model, a logistic regression (LR) model, and a decision tree (DT) model. Data for 427, 354 and 297 HCC patients with histories of 1-, 3- and 5-year disease-free survival after hepatic resection, respectively, were extracted from the HCC patient database. From each of the three groups, 80% of the cases (342, 283 and 238 cases of 1-, 3- and 5-year disease-free survival, respectively) were selected to provide training data for the prediction models. The remaining 20% of cases in each group (85, 71 and 59 cases in the three respective groups) were assigned to validation groups for performance comparisons of the three models. Area under receiver operating characteristics curve (AUROC) was used as the performance index for evaluating the three models. CONCLUSIONS: The ANN model outperformed the LR and DT models in terms of prediction accuracy. This study demonstrated the feasibility of using ANNs in medical decision support systems for predicting disease-free survival based on clinical databases in HCC patients who have received hepatic resection.

BACKGROUND: Few studies of laparoscopic cholecystectomy (LC) outcome have used longitudinal data for more than two years. Moreover, no studies have considered group differences in factors other than outcome such as age and nonsurgical treatment. Additionally, almost all published articles agree that the essential issue of the internal validity (reproducibility) of the artificial neural network (ANN), support vector machine (SVM), Gaussian process regression (GPR) and multiple linear regression (MLR) models has not been adequately addressed. This study proposed to validate the use of these models for predicting quality of life (QOL) after LC and to compare the predictive capability of ANNs with that of SVM, GPR and MLR. METHODOLOGY/PRINCIPAL FINDINGS: A total of 400 LC patients completed the SF-36 and the Gastrointestinal Quality of Life Index at baseline and at 2 years postoperatively. The criteria for evaluating the accuracy of the system models were mean square error (MSE) and mean absolute percentage error (MAPE). A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and to rank the variables in order of importance. Compared to SVM, GPR and MLR models, the ANN model generally had smaller MSE and MAPE values in the training data set and test data set. Most ANN models had MAPE values ranging from 4.20% to 8.60%, and most had high prediction accuracy. The global sensitivity analysis also showed that preoperative functional status was the best parameter for predicting QOL after LC. CONCLUSIONS/SIGNIFICANCE: Compared with SVM, GPR and MLR models, the ANN model in this study was more accurate in predicting patient-reported QOL and had higher overall performance indices. Further studies of this model may consider the effect of a more detailed database that includes complications and clinical examination findings as well as more detailed outcome data.