Eosinophilia in Pleural Effusions: a Speculative Negative Predictor for Malignancy

Chu, Fang-Yeh,Liou, Ching-Biau,Sun, Jen-Tang,Bei, Chia-Hao,Liou, Tse-Hsuan,Tan, N-Chi,Yu, Yun-Chieh,Chang, Chih-Chun,Yen, Tzung-Hai,Su, Ming-Jang Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.3

Background: Eosinophilic pleural effusion (EPE) is an eosinophil count more than 10% on cytology of pleural samples. Recently, it was reported that malignancy had been the most prevalent cause inducing EPE. Therefore, we conducted an analysis on the prevalence and etiology of EPE and investigated the relationship between EPE and malignancy. Materials and Methods: Data for pleural cell differential count from patients receiving thoracentesis during the period from January 2008 to December 2013 were compared with clinical data and established diagnosis of patients obtained via electronic chart review. Results: A total of 6,801 requests of pleural cytology from 3,942 patients with pleural effusion who had received thoracentesis were available at Far Eastern Memorial Hospital from 2008 to 2013, and of these subjects, 115 (2.9%) were found to have EPE. The most frequent cause of EPE was malignancy (33.0%, n=38), followed by parapneumonic effusions (27.8%, n=32), tuberculosis pleuritis (13.9%, n=16), transudate effusions (12.2%, n=14) and the presence of blood or air in pleural space (10.4%, n=12). Additionally, an inverse relationship of eosinophilia in pleural fluid was identified in patients with malignancy and EPE. The cut-off eosinophil count in pleural fluid was 15% for the most accurate discrimination between malignancy and benign disorders in patients with EPE. At the cut-off level, the sensitivity and specificity were 65.8% and 67.5%, respectively. Conclusions: Pleural fluid eosinophilia was a speculative negative predictor for malignancy, despite the fact that cancers, including lung cancers and metastatic cancers to lung, were the most leading cause of pleural fluid eosinophilia. An inverse correlation was observed between the pleural eosinophil percentage and the likelihood of malignancy in patients with EPE.

Traditional Chinese medicine attenuates hospitalization and mortality risks in diabetic patients with carcinoma in situ in Taiwan

Tsai Li-Jen,Chung Chi-Hsiang,Lin Chien-Jung,Su Sheng-Chiang,Kuo Feng-Chih,Liu Jhih-Syuan,Chen Kuan-Chan,Ho Li-Ju,Kuo Chih-Chun,Chang Chun-Yung,Lin Ming-Hsun,Chu Nain-Feng,Lee Chien-Hsing,Hsieh Chang-H 한국한의학연구원 2022 Integrative Medicine Research Vol.11 No.2

Background: Diabetic patients are at high risk of developing cancer. Traditional Chinese medicine (TCM) has become increasingly popular as an adjuvant treatment for patients with chronic diseases, and some studies have identified its beneficial effect in diabetic patients with cancer. The purpoes of this study was to outline the potential of TCM to attenuate hospitalization and mortality rates in diabetic patients with carcinoma in situ (CIS). Methods: A total of 6,987 diabetic subjects with CIS under TCM therapy were selected from the National Health Insurance Research Database of Taiwan, along with 38,800 of 1:1 sex-, age-, and index year-matched controls without TCM therapy. Cox proportional hazard analysis was conducted to compare hospitalization and mortality rates during an average of 15 years of follow-up. Results: A total of 3,999/1,393 enrolled-subjects (28.62%/9.97%) had hospitalization/mortality, including 1,777/661 in the TCM group (25.43%/9.46%) and 2,222/732 in the control group (31.80%/10.48%). Cox proportional hazard regression analysis showed a lower rate of hospitalization and mortality for subjects in the TCM group (adjusted HR=0.536; 95% CI=0.367–0.780, P<0.001; adjusted HR=0.783; 95% CI=0.574– 0.974, P = 0.022). Kaplan-Meier analysis showed that the cumulative risk of hospitalization and mortality in the case and control groups was significantly different (log rank, P<0.001 and P = 0.011, respectively). Conclusions: Diabetic patients with CIS under TCM therapy were associated with lower hospitalization and mortality rates compared to those without TCM therapy. Thus, TCM application may reduce the burden of national medical resources.

Multimorbidity Pattern and Risk for Mortality Among Patients With Dementia: A Nationwide Cohort Study Using Latent Class Analysis

Che-Sheng Chu,Shu-Li Cheng,Ya-Mei Bai,Tung-Ping Su,Shih-Jen Tsai,Tzeng-Ji Chen,Fu-Chi Yang,Mu-Hong Chen,Chih-Sung Liang 대한신경정신의학회 2023 PSYCHIATRY INVESTIGATION Vol.20 No.9

Objective Individuals with dementia are at a substantially elevated risk for mortality; however, few studies have examined multimorbidity patterns and determined the inter-relationship between these comorbidities in predicting mortality risk.Methods This is a prospective cohort study. Data from 6,556 patients who were diagnosed with dementia between 1997 and 2012 using the Taiwan National Health Insurance Research Database were analyzed. Latent class analysis was performed using 16 common chronic conditions to identify mortality risk among potentially different latent classes. Logistic regression was performed to determine the adjusted association of the determined latent classes with the 5-year mortality rate.Results With adjustment for age, a three-class model was identified, with 42.7% of participants classified as “low comorbidity class (cluster 1)”, 44.2% as “cardiometabolic multimorbidity class (cluster 2)”, and 13.1% as “FRINGED class (cluster 3, characterized by FRacture, Infection, NasoGastric feeding, and bleEDing over upper gastrointestinal tract).” The incidence of 5-year mortality was 17.6% in cluster 1, 26.7% in cluster 2, and 59.6% in cluster 3. Compared with cluster 1, the odds ratio for mortality was 9.828 (95% confidence interval [CI]=6.708–14.401; p<0.001) in cluster 2 and 1.582 (95% CI=1.281–1.953; p<0.001) in cluster 3.Conclusion Among patients with dementia, the risk for 5-year mortality was highest in the subpopulation characterized by fracture, urinary and pulmonary infection, upper gastrointestinal bleeding, and nasogastric intubation, rather than cancer or cardiometabolic comorbidities. These findings may improve decision-making and advance care planning for patients with dementia.

ONYX-II: Efficacy of Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir + Ribavirin in HCV Genotype 1b-Infected Patients with Compensated Cirrhosis from South Korea and Taiwan

( Seung Woon Paik ),( Chi-jen Chu ),( Yan Luo ),( Kwang-hyub Han ),( Jia-horng Kao ),( Jeong Heo ),( Cheng-yuan Peng ),( Yoon Jun Kim ),( Ting-tsung Chang ),( Young-suk Lim ),( Ming Lung Yu ),( Linda 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Background: Chronic hepatitis C virus (HCV) infection is associated with development of complications including hepatocellular carcinoma, liver failure and cirrhosis. Patients with cirrhosis are historically more difficult to cure. In southeastern Asia, the most prevalent HCV genotype (GT) is GT1b. In western populations, the 3 direct-acting antiviral (3-DAA) regimen of ombitasvir (OBV), ritonavir-boosted paritaprevir (PTV/r; identified by AbbVie and Enanta) and dasabuvir (DSV) ± ribavirin (RBV) demonstrated sustained virologic response (SVR) at post-treatment week 12 (SVR12) rates of 99% in patients with GT1b infection and compensated cirrhosis regardless of prior treatment experience. The regimen, however, has not been investigated in southeastern Asian populations. The ONYX-II study is evaluating the efficacy and safety of this regimen in Asian patients with HCV GT1b infection and compensated cirrhosis. Methods: Treatment-naive and interferon-based therapy-experienced patients with HCV GT1b-infection and compensated cirrhosis were enrolled in South Korea, Taiwan, and China, and received 12 weeks of OBV/PTV/r (25 mg/150 mg/100 mg once daily) and DSV (250 mg twice daily) with RBV (weight-based). Patients will be followed for 48 weeks after the last dose of study drugs. The primary objectives are to compare the SVR12 rate to the known SVR rate of telaprevir + peg-interferon (IFN) + RBV therapy, and to assess the safety of OBV/PTV/r + DSV + RBV. Results: Twenty-one and 20 subjects were enrolled in South Korea and Taiwan, respectively. Of South Korean patients, 52% were male and 71% were treatment-experienced; of Taiwanese patients, 45% were male and 65% were treatment-experienced. Safety data and SVR at post-treatment week 4 (SVR4) will be available for presentation. Conclusions: The ONYX-II study evaluates the 3-DAA regimen of OBV/PTV/r + DSV with RBV for Asian patients with compensated cirrhosis and HCV GT1b infection. Resultant data may provide evidence for treatment guidelines for HCV GT1b in this population.

Sofosbuvir/velpatasvir plus ribavirin for Child-Pugh B and Child-Pugh C hepatitis C virus-related cirrhosis

( Chen-hua Liu ),( Chi-yi Chen ),( Wei-wen Su ),( Chun-jen Liu ),( Ching-chu Lo ),( Ke-jhang Huang ),( Jyh-jou Chen ),( Kuo-chih Tseng ),( Chi-yang Chang ),( Cheng-yuan Peng ),( Yu-lueng Shih ),( Chia 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.4

Background/Aims: Real-world studies assessing the effectiveness and safety of sofosbuvir/velpatasvir (SOF/VEL) plus ribavirin (RBV) for Child-Pugh B/C hepatitis C virus (HCV)-related cirrhosis are limited. Methods: We included 107 patients with Child-Pugh B/C HCV-related cirrhosis receiving SOF/VEL plus RBV for 12 weeks in Taiwan. The sustained virologic response rates at off-treatment week 12 (SVR₁₂) for the evaluable population (EP), modified EP, and per-protocol population (PP) were assessed. The safety profiles were reported. Results: The SVR₁₂ rates in the EP, modified EP and PP were 89.7% (95% confidence interval [CI], 82.5-94.2%), 94.1% (95% CI, 87.8-97.3%), and 100% (95% CI, 96.2-100%). Number of patients who failed to achieve SVR₁₂ were attributed to virologic failures. The SVR₁₂ rates were comparable regardless of patient characteristics. One patient discontinued treatment because of adverse events (AEs). Twenty-four patients had serious AEs and six died, but none were related to SOF/VEL or RBV. Among the 96 patients achieving SVR₁₂, 84.4% and 64.6% had improved Child-Pugh and model for endstage liver disease (MELD) scores. Multivariate analysis revealed that a baseline MELD score ≥15 was associated with an improved MELD score of ≥3 (odds ratio, 4.13; 95% CI, 1.16-14.71; P=0.02). Patients with chronic kidney disease (CKD) stage 1 had more significant estimated glomerular filtration rate declines than patients with CKD stage 2 (-0.42 mL/min/1.73 ㎡/month; P=0.01) or stage 3 (-0.56 mL/min/1.73 ㎡/month; P<0.001). Conclusions: SOF/VEL plus RBV for 12 weeks is efficacious and well-tolerated for Child-Pugh B/C HCV-related cirrhosis. (Clin Mol Hepatol 2021;27:575-588)

Clinical Significance of Smudge Cells in Peripheral Blood Smears in Hematological Malignancies and Other Diseases

Chang, Chih-Chun,Sun, Jen-Tang,Liou, Tse-Hsuan,Kuo, Chin-Fu,Bei, Chia-Hao,Lin, Sheng-Jun,Tsai, Wei-Ting,Tan, N-Chi,Liou, Ching-Biau,Su, Ming-Jang,Yen, Tzung-Hai,Chu, Fang-Yeh Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.4

Background: It is reported that the percentage of smudge cells in the blood smear could be a prognostic indicator in chronic lymphocytic leukemia. However, the clinical significance of smudge cells in other hematological malignancies, solid tumors or non-malignant diseases is less clear. Hence, this study was conducted to survey the clinical significance of smudge cells in hematological cancers and other disorders. Materials and Methods: From January to November, 2015, the clinical data of patients who received blood examination with differential counts for clinical purpose and were found to have smudge cells in the peripheral blood film in Far Eastern Memorial Hospital were selected. The percentage of smudge cells and patient outcomes were evaluated for further univariate and survival analyses. Results: A total of 102 patients with smudge cells in their blood smears were included. Smudge cells were frequently presented in out-of-hospital cardiac arrest (OHCA; n=30), infections (n=23), hematological cancers (n=23) and solid cancers (n=10). There was no relationship between the percentage of smudge cells and the patient mortality in all diseases (OR: 1.08, 95% CI: 0.47-2.48, P=1.000) as well as the OHCA group (OR: 1.91, 95% CI: 0.38-9.60, P=0.694). It was observed that in patients with all cancers with the percentage of smudge cells less than 50% had a lower mortality rate in comparison with those who had the percentage of smudge cells of 50% or more (OR: 22.29, 95% CI: 2.38-208.80, P<0.001). Additionally, it was seemingly that patients with smudge cells of 50% or more had a lower survival rate than those with smudge cells less than 50% in all cancers with follow-up at 2-month intervals, but without statistical significance (P=0.064). Conclusions: Our survey indicated that in all cancers, those who had higher percentage of smudge cells were prone to have poor outcomes when compared with the subjects with lower percentage of smudge cells. This finding was quite different from the results of previous studies in which the race-ethnicity of most study populations was non-Asian; hence, further investigations are required. Besides, there was no apparent association of the percentage of smudge cells with patient outcomes in all diseases, including OHCA.

Numerical Analysis of Dielectrophoresis-Based Microfluidic Chip with a Facing-Electrode Design for Cell Separation

Nguyen Thu Hang,Nguyen Mai Chi,Nguyen Hoang Trung,Thi Y Van Tran,Vu Ngoc Trung,Thu Hang Bui,Duc Trinh Chu,Bui Tung Thanh,Jen Chun-Ping,Quang Loc Do 한국농업기계학회 2024 바이오시스템공학 Vol.49 No.1

Purpose Circulating tumor cell separation and analysis have played a critical role in cancer diagnosis, prognosis, and treatment. In this work, we aim to design and investigate a novel biochip that integrates dielectrophoresis, microfl uidic technology to separate circulating tumor cells from blood cells. To create a dielectrophoresis-induced non-uniform electric fi eld, a facing-electrode design was proposed and utilized, in which a slanted electrode array and a simple rectangular ground electrode are placed parallel on the top and bottom parts of the microfl uidic channel, respectively. This design can reduce the particle position dependence in the microchannel and the complexity of the microfabrication process. Methods The separation process, effi ciency, and optimization of the proposed device were numerically investigated using the fi nite element method. Parametric research was conducted to comprehensively examine the impact of various operating and design factors on the cell movement and trajectories in the microfl uidic device. Results The results indicated the potential of the proposed biochip to ensure cancer cell separation from blood cells with high effi ciency, high purity in a label-free, non-invasive, easy integration, and low-cost manner. Under the optimal conditions, the separation effi ciency reached 92%, 88%, and 96% for human colon cancer cells (HT-29), red blood cells, and white blood cells, respectively. Conclusions In this study, a novel DEP-based microfl uidic chip was proposed to separate HT-29 tumor cells from blood cells and numerically investigated to verify the performance of the biochip design. Our fi ndings could provide a foundation for further theoretical and practical investigations. The proposed system can separate cancer cells from red blood cells and white blood cells as well as off ers numerous advantages, such as compact size, low voltage, high effi ciency, non-invasiveness, and label-free nature. The tumor cell enrichment platform has the potential for application in cancer detection, analysis, and assessment.

Efficacy/Safety of Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir with Ribavirin in Asian Patients with Genotype 1b HCV-Infected, Compensated Cirrhosis: ONYX-II SVR 24 Results

( Lai Wei ),( Gui-qiang Wang ),( Yan Luo ),( Chi-jen Chu ),( Seung Woon Paik ),( Jinlin Hou ),( Jun Cheng ),( Qing Xie ),( Zhongping Duan ),( Jia-horng Kao ),( Linda Fredrick ),( Bo Fu ),( Niloufar Mo 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: ONYX-II is a phase 3, open-label study of 3-DAA regimen of OBV/PTV/r and DSV with RBV in treatment-naive and experienced patients with genotype 1b HCV infection and compensated cirrhosis in China, South Korea and Taiwan. SVR12 rate was 100% and the favourable safety profile was shown. The present analysis reports efficacy( SVR24) and safety results. Methods: Patients with chronic GT1b HCV infection and compensated cirrhosis received OBV/PTV/r + DSV + RBV for 12 weeks and will be followed for 48 weeks post-treatment. Efficacy was assessed by SVR12 and SVR24. Safety was assessed as the percentage of patients wi th treatment-emergent adverse events (TEAEs) and laboratory evaluation. Results: Total of 104 patients with chronic GT1b HCV infection (62% female, 100% Asian, 58% treatment-experienced) were enrolled from China (n=63), South Korea (n=21) and Taiwan (n=20). All patients received at least one dose of study drugs. The SVR24 rate was 100% (concordant with SVR12), with no patient relapsing between post-treatment week 12 and 24. Most TEAEs were mild in severity. The most common TEAEs (≥10%) were increased blood bilirubin levels (25%), pruritus (15%), anaemia (14%), asthenia (12%), bilirubin conjugated increased (12%), blood bilirubin unconjugated increased (12%), dizziness (11%) and fatigue (11%). Four patients had serious AEs and all were assessed as not being related to the 3-DAA regimen (one was assessed as being possibly related to RBV). One patient discontinued treatment due to TEAEs (elevations in alanine aminotransferase [ALT], aspartate aminotransferase [AST] and blood bilirubin) after 3 weeks of dosing but achieved SVR12 and SVR24. Laboratory abnormalities ≥ grade 3 were infrequent (ALT: 3%; AST 2%; total bilirubin: 7%). No grade 3 haemoglobin decrease was reported. Conclusions: SVR24 and SVR12 rates were concordant (100%) in HCV GT1b-infected Asian patients with compensated cirrhosis. The regimen was generally well tolerated with mostly mild TEAEs reported.

An Internet Based Embedded Network Monitoring System for Renewable Energy Systems

Po-Yen Chen,Se-Kang Ho,Wei-Jen Lee,Chia-Chi Chu,Ching-Tsa Pan 전력전자학회 2007 ICPE(ISPE)논문집 Vol.- No.-

In this paper, an internet based embedded network monitoring system is proposed for renewable energy systems. By using a low cost network communication module (RCM 3700) as a web server, one can achieve better network security, lower power consumption, compact size, and easier to use as compared with a PC based one. Also, Java language is chosen for designing a dynamic webpage to graphically display various real time waveforms of the controlled system for multi-user at the same time. As an illustrative example, a small scale wind power generation system equipped with an EZDSP 2812 controller is adopted for demonstration. In addition, an FPGA EC10 is implemented as a bidirectional communication interface for coordinating the asynchronous data transmission modes. Experimental results from the constructed prototype verify that the proposed monitoring system can indeed achieve the desired function.

ONYX-I: Efficacy of Ombitasvir/Paritaprevir/Ritonavir + Dasabuvir in South Korean and Taiwanese Patients with HCV Genotype 1b Infection and without Cirrhosis

( Jeong Heo ),( Wan-Long Chuang ),( Yan Luo ),( Mong Cho ),( Chi-Jen Chu ),( Kwang-Hyub Han ),( Jia-Horng Kao ),( Seung Woon Paik ),( Chun-Yen Lin ),( Jin-Woo Lee ),( Cheng-Yuan Peng ),( Young-Suk Lim 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Background: Approximately 45-50% of Hepatitis C virus (HCV) infections in South Korea and Taiwan are genotype (GT) 1b. Previous phase 3 studies demonstrated that the direct-acting antiviral (DAA) regimen of ombitasvir (OBV), ritonavir-boosted paritaprevir (PTV/r; identified by Abbvie and Enanta) and dasabuvir (DSV) was well tolerated and achieved sustained virologic response at post-treatment week 12 (SVR12) in 99% of treatment-naive and 100% of treatment- experienced patients with HCV GT1b. ONYX-I (NCT02517515) was designed to evaluate efficacy and safety in Asian patients with HCV GT1b infection without cirrhosis. Methods: Treatment-naive and IFN-based therapy-experienced patients with HCV GT1b infection in South Korea, Taiwan, and China were randomized 1:1 to receive either OBV/PTV/r (25 mg/150 mg/100 mg once daily) and DSV (250 mg twice daily) or placebo for 12 weeks during the double-blind (DB) period. Patients in the placebo arm subsequently received OBV/PTV/r + DSV for 12 weeks during the open-label period. Patients will be followed for 48 weeks after last dose of study drugs. The primary objectives are to compare the SVR12 rates for the treatment-naive and -experienced patients to corresponding historical SVR rates of telaprevir + peg-interferon and ribavirin therapy, and assess the safety of the OBV/PTV/r + DSV regimen. Presented are results from the South Korean and Taiwanese populations. Results: In both South Korea and Taiwan, 120 patients were randomized and treated. Of South Korean patients, 45% were male, 33% were treatment-experienced and 89% had F0-F1 fibrosis. Of Taiwanese patients, 39% were male, 33% were treatment-experienced, and 87% had F0-F1 fibrosis. Safety data and SVR at post-treatment week 4 will be presented. Conclusions: The ONYX-I study is evaluating the safety and efficacy of DAA regimen, OBV/PTV/r + DSV, in Southeast Asian patients without cirrhosis infected with HCV GT1b. Resultant data may help inform treatment guidelines for HCV GT1b in this population.