Objective:Surgery is one of the salvage treatments for recurrent nasopharyngeal carcinoma. The safety and efficacy of Da Vinci's robotic surgery was preliminarily investigated to resect recurrent nasopharyngeal cancer after one-course radiotherapy.Method:Since Oct 2017, Da Vinci surgery system was used to complete the operation of locally recurrent nasopharyngeal carcinoma including two approaches, such as trans oral with soft palate incision and trans oral and nose with soft palate suspended.Result:Ten patients underwent robotic nasopharyngectomy, The median operation time was 90 minutes, median follow-up time was 6 months, and all patients had clear resection margins. There was no residual, recurrent or cancer related death during short-term follow-up.Conclusion:Robotic nasopharyngectomy via combined approach of nose and mouth is safe, effective and has good local control.
This study aimed to explore the role of apoptosis initiators, caspase-9, caspase-10, mitochondrial anti-viral signaling protein (MAVS), and interferon regulatory factor 7 (pIRF7), in patients with systemic lupus erythematosus (SLE).Leukocyte apoptosis was determined by flow cytometry, including annexin V, APO2.7, and 7-amino-actinomycin D (7-AAD) on each subtype of leukocyte in 35 patients with SLE, 15 disease controls, and 17 volunteer normal controls. Levels of caspase-9, caspase-10, MAVS, and pIRF7 in mononuclear cells and the disease activity index (SLEDAI) in the SLE patients were determined. Correlation among intracellular adaptor proteins and caspase levels were calculated.The SLE patients had higher APO2.7 in total leukocyte, lymphocyte, and monocytes, and higher late apoptosis markers in total leukocytes and neutrophils than normal controls (all p < 0.05). Disease activity was positively associated with the APO2.7 of CD19+ cells in SLE, but negatively associated with MAVS and caspase-9 levels (all p < 0.05). Markers of viral infection and anti-virus transcription factors like MDA5, MAVS, and pIRF7 were significantly higher in SLE patients than in disease controls (p < 0.05). Caspase-9 and caspase-10 levels positively correlated with MAVS and pIRF7 in SLE patients (p < 0.05).The disease activity of SLE is positively associated with APO2.7 level of CD19+ cells but negatively associated with MAVS and caspase-9 levels, which all point to a mitochondrial pathway.
Objective: To investigate the impact of antiphospholipid antibodies (aPLA) on renal outcome in lupus nephritis (LN). Materials and Methods: A retrospective chart review study of patients with biopsy-proven LN was conducted between 1986 and 2007 at Chang Gung Memorial Hospital in Kaohsiung. All of the patients fulfilled the systemic lupus erythematosus classification criteria of the American College of Rheumatology and had histopathological findings compatible with LN. Only those patients whose aPLA, including anti-cardiolipin antibody, anti-β2GPI antibody, Venereal Disease Research Laboratory test, and lupus anticoagulant had been checked were recruited. We reviewed the charts and collected the demographics, clinical characteristics, serological parameters, and treatment courses of the patients recruited. The renal outcome end point was either end-stage renal disease or doubling of serum creatinine within 24 months Results: A total of 66 subjects were recruited, including 55 females and 11 males. The mean age was 30.5±11.1 years. aPLA was present in 18 patients (27.3%) (group I), and 48 patients (72.7%) (group II) had negative test results. The seropositive ratios of anti-dsDNA and anti-RNP in group I were significantly higher (p=0.023 and 0.026) than in group II, respectively. There was no statistical difference in other parameters between the groups. The subjects in group I had a more favorable (p=0.038) renal outcome after 2 years of follow-up. Conclusions: Contradictory to previous studies, the presence of aPLA in patients with LN is probably associated with a better renal outcome.
Abstract Introduction Psoriatic arthritis (PSA) is a form of immune-mediated inflammatory arthritis. Studying the gut microbiota of PSA patients may offer new insights into the pathophysiology of this inflammatory joint disease. We designed a prospective study to examine gut microbiome from patients with PSA, primarily with enthesitis and dactylitis, and compared the data with undifferentiated arthritis patients (NO PSA), without enthesitis or dactylitis.Methods We enrolled nine PSA patients and 10 NO PSA patients in this study. The fecal samples were investigated by using 16S rRNA amplicon sequencing, followed by bioinformatics and statistical analyses. Results None of the available objective clinical laboratory data could differentiate PSA from the NO PSA subgroup. The microbiota result shows that Family: XIII_AD3011 is significantly higher in NO PSA patients than PSA patients’ stool samples (p=0.039). Megasphaera elsdenii in the PSA was 10000 times higher than in the NO PSA group.Conclusion Our results demonstrated high intra-group homogeneous and high inter-group heterogeneous microbiota. The clinical symptoms of either enthesitis or dactylitis link to the specific microbiota in the current study. In the future, a larger cohort and thorough biochemical study is needed for confirmation.
Abstract Introduction. Several forms of allergy have been clinically presented, including, among others, atopic dermatitis (eczema), urticaria (hives), and allergic rhinitis (rhinitis). As their detailed pathogenesis continues to be researched, we aimed in the current study to compare gut microbiota differences between eczema, hives, and rhinitis patients. Methods. We enrolled 19 eczemas, nine hives, and 11 allergic rhinitis patients in this study. Fecal samples were examined using 16S ribosomal ribonucleic acid amplicon sequencing, followed by bioinformatics and statistical analyses. We compared microbiota in dermatitis (eczema), chronic urticaria (hives), and allergic rhinitis (rhinitis). Results. All clinical data were similar between the subgroups. The microbiota results indicated that Bacteroidales species were found in skin allergies, both urticaria and eczema, when compared to rhinitis. The microbiota differs substantially between those patients with atopic dermatitis (eczema), chronic urticaria (hives), and allergic rhinitis (rhinitis), thus indicating that the gut-skin and gut-nose axes exist. Gut flora colonies differ significantly between skin allergy and nose allergy. Bacteroidales species could be a clinical link between gut flora and skin allergy; of those, Bacteroids Plebeius DSM 17135 is significantly associated with the urticaria (hives) subgroup.Conclusion. Our results demonstrated high intra-group homogeneous and high inter-group heterogeneous microbiota. The clinical symptoms of eczema, hives, and rhinitis can all be linked to specific microbiota in the current study. In this pilot study, the Ruminococcaceae and Bacteroidales species are associated with allergic disease, in line with several previous published articles, and the abundance of Firmicutes Phylum is representative of intestinal dysbiosis. In the future, a larger cohort and thorough biochemical studies are needed for confirmation.
Objective. Biologics have been linked to both anti-autoimmune and anti-inflammatory mechanisms. We examine the long-term effects of biologics on rheumatoid arthritis (RA) patients in a real-world analytic cohort study using a nationwide database. Design. We designed a cohort study using the National Health Insurance Research Database in Taiwan between 1997 and 2010. Methods. Based on biologics and other anti-rheumatic agent prescriptions, we divided all patients into either the biologics group or the non-biologics group. The outcomes were the incidence rate of each comorbidity and the hazard ratio of each comorbidity between those using biologics and those not. We followed patients from the index date to the date on which the database ended. Results. In total, 19,681 patients were eligible for analysis in this study. During an average follow-up of 15 years, the event rates of each comorbidity differed significantly between the users and non-users of biologics with regard to cardiovascular comorbidity, metabolic comorbidity, rheumatologic comorbidity, and the miscellaneous comorbidity (all p<0.05). The usage of biologic agents in RA patients reduced the HR of cardiovascular comorbidities by 18%, metabolic comorbidities by 17%, rheumatology comorbidities by 36%, and miscellaneous comorbidities by 15% compared to those patients who did not use biologics. Oncology comorbidities and infection comorbidities were not affected by treatment with biologics (p>0.05). Conclusions. Biologics may have benefits beyond arthritis control with regard to reducing real-world comorbidities.
Silent brain infarctions (SBI) commonly go unnoticed due to the subtlety of their neurological signs. However, there is the risk of subsequent symptomatic stroke and dementia. A better understanding of the risk factors of SBI may help accurately predict those who will require treatment.This one-year retrospective study enrolled 199 adult healthy Taiwanese. Multiple logistic regression analysis was used to evaluate the relationships between baseline clinical factors and the presence of SBI during the study period.Fifteen (7.5%) healthy subjects had SBI, including 4.9% (5/103) males and 10.4% (10/96) females. Multiple logistic regression analysis revealed that both mean age and hypertension were independently associated with SBI, such that any increase of one year in mean age increased the SBI rate by 7.3%.In the present study, there is a close relationship between elderly patients and SBI and any increase of one year in mean age increases the SBI rate by 7.3%. Aside from age, hypertension is by far the strongest modifiable risk factor identified to date. Prospective, longitudinal observational studies are warranted to evaluate the relationship between control of hypertension and SBI in this specific population to determine how to prevent subsequent symptomatic stroke.
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