1.Clinics in diagnostic imaging (143). Perianal mucinous adenocarcinoma arising from chronic fistula-in-ano.
Chia Ming HO ; Cher Heng TAN ; Bernard Chi-Shern HO
Singapore medical journal 2012;53(12):843-quiz p. 849
We report a case of mucinous adenocarcinoma arising in the perianal soft tissue in association with chronic fistula-in-ano in a 43-year-old man who had a relapse of perianal pain and bloody discharge after six years of defaulted follow-up. He underwent magnetic resonance (MR) and computed tomography imaging with correct identification of the disease entity on imaging. Mesh-like septations and an enhancing solid component with high diffusion-weighted imaging (DWI) and intermediate apparent diffusion coefficient signals were observed. He underwent abdominoperineal resection of the tumour but succumbed due to postoperative complications. Literature on the MR imaging features of this tumour remains scarce. We highlight the MR imaging features, including those seen on DWI, which were useful in making the correct diagnosis. Though uncommon, this would be an important condition to recognise since assessment of fistula-in-ano by MR imaging is considered to be the standard of care in current clinical practice. The clinical features of this entity are also briefly discussed.
Adenocarcinoma, Mucinous
;
complications
;
diagnosis
;
Adult
;
Anus Neoplasms
;
complications
;
diagnosis
;
Chronic Disease
;
Diagnosis, Differential
;
Diffusion Magnetic Resonance Imaging
;
Humans
;
Male
;
Rectal Fistula
;
complications
;
diagnosis
;
Tomography, X-Ray Computed
2.Traditional and Complementary Medicine (TCM) among Study Population with Cardiovascular Risk; use and Substitution for Conventional Medicine in Pahang, Malaysia
Yueting Kew ; Yuik Ling Chia ; Su Meng Lai ; Kim Yeong Chong ; Xin Lun Ho ; Da Wei Liew ; Foong Ming Moy ; Sharmini Selvarajah
The Medical Journal of Malaysia 2015;70(2):86-92
Introduction: Cardiovascular diseases are the main cause of
morbidity and mortality in Malaysia. There is evidence of
high traditional and complementary medicine (TCM) use
among population with cardiovascular risk and there have
been anecdotal reports about substitution of conventional
medicines with TCM. We investigated the prevalence of TCM
use, treatment preference and substitution of conventional
medicines in study population with cardiovascular risk
factors in Pahang, Malaysia.
Methods: A cross-sectional survey was conducted using an
interviewer-administered questionnaire in five districts of
Pahang. A total of 1250 households were chosen through
proportionate and systematic sampling. Respondents aged
18 years and above were selected.
Results: The study population with cardiovascular risk
factors who used TCM was higher than the general
population (31.7% versus 25.9%). There were no clear
preferences in using TCM by gender, age groups,
educational level and income even though other
bumiputeras showed a slight inclination towards TCM use.
Among the study population with cardiovascular risk
factors who consumed TCM, 20-30% of them were using
TCM as a substitute for their conventional medications.
Respondents from the younger age group (18-40 years)
(57.1%), highest educational level (43.2%), other
bumiputeras (38.4%) and highest income group (31.4%)
preferred the combination of both conventional and
traditional medicine.
Conclusion: TCM use among population with cardiovascular
risk factors is high. The high preference for combination
therapy of TCM and conventional medications among young
adults and the use of TCM to substitute conventional
medications show that much research is needed to provide
proven TCM therapies to avoid self-mismanagement of
cardiovascular risk in Malaysia.
Complementary Therapies
;
Medicine, Traditional
3.Conventional and machine learning-based risk scores for patients with early-stage hepatocellular carcinoma
Chun-Ting HO ; Elise Chia-Hui TAN ; Pei-Chang LEE ; Chi-Jen CHU ; Yi-Hsiang HUANG ; Teh-Ia HUO ; Yu-Hui SU ; Ming-Chih HOU ; Jaw-Ching WU ; Chien-Wei SU
Clinical and Molecular Hepatology 2024;30(3):406-420
Background/Aims:
The performance of machine learning (ML) in predicting the outcomes of patients with hepatocellular carcinoma (HCC) remains uncertain. We aimed to develop risk scores using conventional methods and ML to categorize early-stage HCC patients into distinct prognostic groups.
Methods:
The study retrospectively enrolled 1,411 consecutive treatment-naïve patients with the Barcelona Clinic Liver Cancer (BCLC) stage 0 to A HCC from 2012 to 2021. The patients were randomly divided into a training cohort (n=988) and validation cohort (n=423). Two risk scores (CATS-IF and CATS-INF) were developed to predict overall survival (OS) in the training cohort using the conventional methods (Cox proportional hazards model) and ML-based methods (LASSO Cox regression), respectively. They were then validated and compared in the validation cohort.
Results:
In the training cohort, factors for the CATS-IF score were selected by the conventional method, including age, curative treatment, single large HCC, serum creatinine and alpha-fetoprotein levels, fibrosis-4 score, lymphocyte-tomonocyte ratio, and albumin-bilirubin grade. The CATS-INF score, determined by ML-based methods, included the above factors and two additional ones (aspartate aminotransferase and prognostic nutritional index). In the validation cohort, both CATS-IF score and CATS-INF score outperformed other modern prognostic scores in predicting OS, with the CATSINF score having the lowest Akaike information criterion value. A calibration plot exhibited good correlation between predicted and observed outcomes for both scores.
Conclusions
Both the conventional Cox-based CATS-IF score and ML-based CATS-INF score effectively stratified patients with early-stage HCC into distinct prognostic groups, with the CATS-INF score showing slightly superior performance.
4.Metformin and statins reduce hepatocellular carcinoma risk in chronic hepatitis C patients with failed antiviral therapy
Pei-Chien TSAI ; Chung-Feng HUANG ; Ming-Lun YEH ; Meng-Hsuan HSIEH ; Hsing-Tao KUO ; Chao-Hung HUNG ; Kuo-Chih TSENG ; Hsueh-Chou LAI ; Cheng-Yuan PENG ; Jing-Houng WANG ; Jyh-Jou CHEN ; Pei-Lun LEE ; Rong-Nan CHIEN ; Chi-Chieh YANG ; Gin-Ho LO ; Jia-Horng KAO ; Chun-Jen LIU ; Chen-Hua LIU ; Sheng-Lei YAN ; Chun-Yen LIN ; Wei-Wen SU ; Cheng-Hsin CHU ; Chih-Jen CHEN ; Shui-Yi TUNG ; Chi‐Ming TAI ; Chih-Wen LIN ; Ching-Chu LO ; Pin-Nan CHENG ; Yen-Cheng CHIU ; Chia-Chi WANG ; Jin-Shiung CHENG ; Wei-Lun TSAI ; Han-Chieh LIN ; Yi-Hsiang HUANG ; Chi-Yi CHEN ; Jee-Fu HUANG ; Chia-Yen DAI ; Wan-Long CHUNG ; Ming-Jong BAIR ; Ming-Lung YU ;
Clinical and Molecular Hepatology 2024;30(3):468-486
Background/Aims:
Chronic hepatitis C (CHC) patients who failed antiviral therapy are at increased risk for hepatocellular carcinoma (HCC). This study assessed the potential role of metformin and statins, medications for diabetes mellitus (DM) and hyperlipidemia (HLP), in reducing HCC risk among these patients.
Methods:
We included CHC patients from the T-COACH study who failed antiviral therapy. We tracked the onset of HCC 1.5 years post-therapy by linking to Taiwan’s cancer registry data from 2003 to 2019. We accounted for death and liver transplantation as competing risks and employed Gray’s cumulative incidence and Cox subdistribution hazards models to analyze HCC development.
Results:
Out of 2,779 patients, 480 (17.3%) developed HCC post-therapy. DM patients not using metformin had a 51% increased risk of HCC compared to non-DM patients, while HLP patients on statins had a 50% reduced risk compared to those without HLP. The 5-year HCC incidence was significantly higher for metformin non-users (16.5%) versus non-DM patients (11.3%; adjusted sub-distribution hazard ratio [aSHR]=1.51; P=0.007) and metformin users (3.1%; aSHR=1.59; P=0.022). Statin use in HLP patients correlated with a lower HCC risk (3.8%) compared to non-HLP patients (12.5%; aSHR=0.50; P<0.001). Notably, the increased HCC risk associated with non-use of metformin was primarily seen in non-cirrhotic patients, whereas statins decreased HCC risk in both cirrhotic and non-cirrhotic patients.
Conclusions
Metformin and statins may have a chemopreventive effect against HCC in CHC patients who failed antiviral therapy. These results support the need for personalized preventive strategies in managing HCC risk.