Jang-Jaer Lee

National Taiwan University, T’ai-pei, Taipei, Taiwan

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Publications (48)118.24 Total impact

  • Journal of the Formosan Medical Association 04/2014; · 1.00 Impact Factor
  • Journal of the Formosan Medical Association 03/2014; · 1.00 Impact Factor
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    ABSTRACT: CD8(+) T cells play important roles in anti-tumor immunity but distribution profile or functional characteristics of effector memory subsets during tumor progression are unclear. We found that, in oral squamous carcinoma patients, circulating CD8(+) T cell pools skewed toward effector memory subsets with the distribution frequency of CCR7(-)CD45RA(-)CD8(+) T cells and CCR7(-) CD45RA(+)CD8(+) T cells negatively correlated with each other. A significantly higher frequency of CD127(lo) CCR7(-)CD45RA(-)CD8(+) T cells or CCR7(-)CD45RA(+)CD8(+) T cells among total CD8(+) T cells was found in peripheral blood or tumor infiltrating lymphocytes, but not in regional lymph nodes. The CD127(hi) CCR7(-)CD45RA(-)CD8(+) T cells or CCR7(-)CD45RA(+)CD8(+) T cells maintained significantly higher IFN-γ, IL-2 productivity and ex vivo proliferative capacity, while the CD127(lo) CCR7(-)CD45RA(-)CD8(+) T cells or CCR7(-)CD45RA(+)CD8(+) T cells exhibited higher granzyme B productivity and susceptibility to activation induced cell death. A higher ratio of CCR7(-)CD45RA(+)CD8(+) T cells to CCR7(-)CD45RA(-)CD8(+) T cells was associated with advanced cancer staging and poor differentiation of tumor cells. Therefore, the CD127(lo) CCR7(-)CD45RA(-)CD8(+) T cells and CCR7(-)CD45RA(+)CD8(+) T cells are functionally similar CD8(+) T cell subsets which exhibit late differentiated effector phenotypes and the shift of peripheral CD8(+) effector memory balance toward CCR7(-)CD45RA(+)CD8(+) T cells is associated with OSCC progression.
    PLoS ONE 01/2014; 9(1):e85521. · 3.53 Impact Factor
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    ABSTRACT: Background/Purpose Needlestick/sharps injuries (NSI) are a major occupational hazard among healthcare workers. Since needles and sharps are commonly used during dental procedures, workers in the dental profession are especially prone to sharps-related injuries. In this study, NSI among workers in the dental department of National Taiwan University Hospital (NTUH) were analyzed to find out the risk factors associated with NSI. Methods NSI cases reported by the Department of Dentistry to NTUH from 2009 to 2011 were collected. Correlations between NSI and parameters related to the events were analyzed. Results A total of 56 NSI events including 31 occurring during surgical treatment and 25 occurring during cleanup procedure were reported. The annual incidence of NSI was 8.19% among all dental workers. NSI incidences per person-year were 21.28% for interns, 7.50% for residents, 6.77% for nursing staffs, 3.33% for clerks, and 0.85% for attending doctors (P < 0.001, chi-square test). NSI events occurred more frequently in the 3-month period from July to September (20 cases), on Wednesday (18 cases) or Friday (14 cases), and at the hours from 11:00 to 14:00 and after 16:00 (39 cases). Dental injection needle (19 cases) was the most common instrument involved in NSI and 9 of these 19 needle injuries occurred during need removal. Conclusion NSI events tend to occur in dental personnel (interns) with lesser clinical skill and experience, in the period (from July to September) when new interns and residents join the clinic, on the working days in the middle (Wednesday) and end (Friday) of the week, and at the hours close to lunch break (11:00 to 14:00) and getting off duty (after 16:00). In addition, establishment of standard operating procedure for injection needle removal is necessary, because one-third of NSI are needle-related.
    Journal of the Formosan Medical Association 01/2014; 113(4):227–233. · 1.00 Impact Factor
  • Journal of the Formosan Medical Association. 01/2014;
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    ABSTRACT: Background/purpose Volatile anesthetics can produce toxic metabolites and lead to postoperative renal or hepatic dysfunction. The aim of this retrospective study is to compare the changes in renal and hepatic function after general anesthesia using two different volatile anesthetics in prolonged surgery for oral malignancy. Materials and methods Patients anesthetized by desflurane or sevoflurane in prolonged surgery (>10 hours) for oral malignancy during past 18 months were included. Common biomarkers such as blood urea nitrogen, serum creatinine, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) in postoperative week (POW) 1, 2, and 3 were the primary outcomes. The mean values and the incidence of abnormality of these biochemical markers were also compared. Results In this study, 21 and 26 patients receiving desflurane and sevoflurane anesthesia, respectively, were included. Blood urea nitrogen and creatinine levels were not significantly different between the two groups. There was a 2.1-fold and a 3-fold increase in AST in POW1 in the desflurane and sevoflurane groups, respectively. The incidence of marked elevation in AST (greater than 100 IU/L) was significantly higher in the sevoflurane group in POW1. There was a 1.9-fold and a 3.2-fold increase in ALT in POW2 in the desflurane and sevoflurane groups, respectively. The incidence of marked elevation in ALT was significantly higher in the sevoflurane group in POW2. Conclusion Both desflurane and sevoflurane did not cause clinically significant nephrotoxicity but produced a transient deterioration in liver function after prolonged anesthesia for oral cancer surgery. Sevoflurane was associated with a more severe degree of liver damage than desflurane in this study.
    Journal of dental sciences 12/2013; 8(4):385–391. · 0.35 Impact Factor
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    Journal of the Formosan Medical Association 10/2013; · 1.00 Impact Factor
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    ABSTRACT: This study aimed at comparing the transverse and sagittal angulations of proximal segment after sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO), and examining their influences on the stability of distal segment. Patients who received SSRO (n = 21) or IVRO (n = 11) for mandibular setback were included. Lateral and posteroanterior cephalograms taken within 1 month before surgery (T1), within 1 week after surgery (T2), and at least 6 months after surgery (T3) were analyzed. The angulation of each proximal segment relative to the upper orbital margin line was measured on posteroanterior cephalogram and the sum of both angles (total ramus angle, TRA) was obtained. On lateral radiograph, ramus inclination angle (RIA) relative to a horizontal reference line 7° to the sella-nasion was assessed and B-point position was measured. From T1 to T2, more increases in TRA and RIA were noted after IVRO than after SSRO. From T2 to T3, TRA and RIA significantly decreased in IVRO group but remained relatively stable in SSRO group. ΔTRAT1-T2 positively related to upward rotation of distal segment for SSRO and downward rotation for IVRO from T2 to T3. For SSRO only, ΔRIAT1-T2 significantly related to forward movement of distal segment during remodeling. TRA and RIA increase significantly after IVRO and then regress, whereas they increase mildly after SSRO and remain stable. Increase in TRA significantly relates to distal segment rotation during remodeling for both surgeries, but increase in RIA relates to forward relapse of the distal segment only for SSRO. The reasons underlying the correlations are not certain and deserve future investigations.
    Journal of the Formosan Medical Association 05/2013; 112(5):244-52. · 1.00 Impact Factor
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    ABSTRACT: Expression of placenta growth factor (PlGF) mRNA is shown to correlate with the progression and prognosis of several human cancers. In this study, we assessed whether the PlGF mRNA level in oral squamous cell carcinoma (OSCC) tissue could be used to predict the progression and prognosis of OSCCs in Taiwan. This study used quantitative real-time reverse transcription-polymerase chain reaction (quantitative RT-PCR) to detect the PlGF mRNA levels in 63 paired OSCC and adjacent normal-looking oral mucosa (non-OSCC) tissues. Threshold cycle (CT) was defined as the PCR cycle number needed to generate a pre-determined amount of DNA (threshold). For a chosen threshold, a smaller starting copy number of mRNA results in a higher CT value. In this study, the relative expression level of tissue PlGF mRNA in each OSCC patients was expressed as -ΔCT = -(OSCC CT - non-OSCC CT). Thus, the higher the -ΔCT, the greater the copy number of PlGF mRNA in tissues. We found that the higher mean PlGF mRNA -ΔCT value was significantly associated with OSCCs with larger tumor size (p = 0.03), positive lymph node metastasis (p = 0.003), more advanced clinical stages (p = 0.013) or the presence of loco-regional recurrence (p = 0.039). Positive lymph node metastasis (p = 0.019) and PlGF mRNA -ΔCT value >2 (p = 0.016) were identified as two independent unfavorable prognosis factors by multivariate analyses with Cox regression model. Moreover, Kaplan-Meier curve showed that OSCC patients with a PlGF mRNA -ΔCT value >2 had a significantly poorer recurrence-free survival than those with a PlGF mRNA -ΔCT value ≤2 (log-rank test, p = 0.017). The OSCC tissue PlGF mRNA level can be used to predict the progression and prognosis of OSCCs in Taiwan.
    Journal of the Formosan Medical Association 05/2013; 112(5):253-8. · 1.00 Impact Factor
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    ABSTRACT: BACKGROUND: Studies concerning prognostic factors specific for alendronate-related osteonecrosis of the jaws (ONJ) are rare. METHODS: We surveyed a cohort of 100 osteoporotic patients with 111 alendronate-related ONJ lesions treated during a 4-year period. Prognostic values of clinical variables and serum markers of bone turnover were assessed by univariate and multivariate analyses. RESULTS: The cumulative complete response rate at 6 months was 48.65%. Serum bone-specific alkaline phosphatase (BSAP) level >10 μg/L, lesion depth ≦ 10 mm, and lesions in anterior regions denoted a better chance of healing within 6 months and the adjusted hazard ratios were 2.48 (95% confidence interval [CI], 1.41-4.37), 2.71 (95% CI, 1.57-4.70), and 3.94 (95% CI, 1.87-8.30), respectively. CONCLUSIONS: Early discovery of lesions and prevention of their deeper extension are crucial for improving the prognosis of alendronate-related ONJ. A higher pretreatment level of BSAP indicates a better prognosis. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
    Head & Neck 03/2013; · 2.83 Impact Factor
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    ABSTRACT: BACKGROUND: Expression of Gα12 is found to be associated with cancer cell proliferation, migration, invasion, and metastasis. METHODS: This study used immunohistochemistry to examine the expression of Gα12 protein in 100 specimens of oral squamous cell carcinoma (OSCC), 45 specimens of oral epithelial dysplasia (OED), and 36 specimens of normal oral mucosa (NOM). RESULTS: The mean Gα12 labeling indices (LIs, defined as the percentage of positive cells in total cells) increased significantly from NOM (7 ± 11%) through OED (21 ± 20%) to OSCC samples (53 ± 33%, P < 0.001). The higher mean Gα12 LI was significantly associated with OSCCs with larger tumor size (P = 0.003), positive lymph node metastasis (P = 0.002), or more advanced clinical stages (P = 0.003). Positive lymph node metastasis (P = 0.039) and Gα12 LI > 50% (P = 0.009) were identified as independent unfavorable prognosis factors by multivariate analyses with Cox regression model. Moreover, Kaplan-Meier curve showed that OSCC patients with a Gα12 LI > 50% had a significantly poorer cumulative survival than those with a Gα12 LI ≤ 50% (log-rank test, P = 0.009). CONCLUSIONS: Our results showed a stepwise and significant elevation in Gα12 protein expression from NOM through OED to OSCCs, suggesting that overexpression of Gα12 protein may be an early event in oral carcinogenesis and may play a pivotal role in oral cancer development. Moreover, the Gα12 protein can be a biomarker for prediction of the progression of OSCCs and the prognosis of patients with OSCC in Taiwan.
    Journal of Oral Pathology and Medicine 02/2013; · 2.06 Impact Factor
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    ABSTRACT: BACKGROUND: There are 600 million betel quid chewers around the world. betel quid chewing is a major risk factor of oral cancer. Why betel quid components induce oral cancer is not clear. METHODS: Cytotoxicity of areca nut extract and arecoline (an areca nut alkaloid) to SAS oral epithelial cell line was evaluated by trypan blue dye exclusion and MTT assays. Cell cycle distribution and apoptosis was analyzed by propidium iodide staining flow cytometry. Chk1 and chk2 activation was analyzed by Pathscan phospho-enzyme-linked immunosorbent assay. Metalloproteinase-9 (MMP-9), tissue inhibitors of metalloproteinase (TIMPs) production was measured by enzyme-linked immunosorbent assay. RESULTS: Areca nut extract (800 μg/mL) and arecoline (>0.4 mmol/L) caused cell death, apoptosis, and cell cycle arrest of SAS cells. Areca nut extract and arecoline stimulated Chk1 and Chk2 phosphorylation in SAS cells. Areca nut extract stimulated cellular MMP-9 but suppressed TIMP-1 and TIMP-2 production. CONCLUSIONS: Areca nut components activate Chk1/Chk2, alter cell cycle regulation/apoptosis, MMP-9, and TIMPs production, contributing to the pathogenesis of oral carcinogenesis. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 08/2012; · 2.83 Impact Factor
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    ABSTRACT: Vascular cell adhesion molecule (VCAM-1) plays a critical role in the inflammatory processes by stimulating the recruitment, extravasation, and migration of leukocytes. Its expression and regulation in the dental pulp is not well elucidated. Primary dental pulp cells were exposed to prostaglandin E(2) (PGE(2)), prostaglandin F(2α) (PGF(2α)), or interleukin 1β (IL-1β) with/without aspirin. VCAM-1 messenger RNA expression was analyzed by reverse transcriptase-polymerase chain reaction. Soluble VCAM-1 (sVCAM-1) in the culture medium was determined by enzyme-linked immunosorbent assay, and the number of viable cells was estimated by (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay. IL-1β induced VCAM-1 gene expression of pulp cells. IL-1β also stimulated sVCAM-1 production. The IL-1β-induced sVCAM-1 production was not inhibited but rather enhanced by aspirin, a cyclooxygenase (COX) inhibitor. PGE(2) and PGF(2α) decreased the VCAM-1 expression and sVCAM-1 production of pulp cells. U0126 (1,4-diamino-2,3-dicyano-1,4-bis[2-aminophenylthio]butadiene), a mitogen-activated protein kinase kinase (MEK) inhibitor, attenuated IL-1β-induced sVCAM-1 production. However, no marked cytotoxicity was noted in these experimental conditions as analyzed by MTT assay. IL-1β may be involved in the pulpal inflammatory processes via stimulation of VCAM-1 expression and sVCAM-1 production. This event is not mediated by COX activation and prostanoid production but is associated with MEK signaling. PGE(2) and PGF(2α) may potentially regulate inflammatory processes by the inhibition of VCAM-1.
    Journal of endodontics 06/2012; 38(6):774-9. · 2.95 Impact Factor
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    ABSTRACT: We recently found that the expression of placenta growth factor (PlGF) in oral squamous cell carcinoma (OSCC) specimens is correlated with the progression and prognosis of OSCC. In this study, serum samples were obtained from 72 OSCC patients before and 3 months after surgical cancer excision and from 30 normal controls. Serum PlGF levels were determined by enzyme-linked immunosorbent assay (ELISA). The mean serum PlGF levels were significantly higher in pre-surgery OSCC patients than in normal controls (19.1±10.7 vs. 10.1±4.5, P<0.001). Serum PlGF levels dropped to near the normal control levels after surgical cancer removal. Higher pre-surgery serum PlGF levels were significantly associated with larger tumor size (P=0.015), positive lymph node metastasis (P=0.001), more advanced clinical stages (P=0.002), and loco-regional recurrence (P=0.037). The serum PlGF level was identified as an independent unfavorable prognosis factor by multivariate Cox regression analyses (P=0.014). Kaplan-Meier curve showed that OSCC patients with a higher serum PlGF level had a significantly poorer cumulative recurrence-free survival than those with a lower serum PlGF level (log-rank test, P=0.009). When we used the serum PlGF level of 19.1 pg/ml (mean normal control value plus 2 standard deviations) as a cutoff point, the sensitivity, specificity, and positive predictive value for tumor recurrence was 80%, 56% and 78%, respectively. We conclude that the serum PlGF level may be a valuable biomarker for prediction of therapeutic effect, progression, recurrence and prognosis of OSCC.
    Oral Oncology 01/2012; 48(5):424-8. · 2.70 Impact Factor
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    ABSTRACT: Src protein overexpression correlates with progression and prognosis of a variety of human cancers. This study used immunohistochemistry to examine the expression of Src protein in 93 specimens of oral squamous cell carcinoma (OSCC). We found a significant association of high expression of Src protein (labeling indices >50%) with larger tumor size (p = .017), positive lymph node metastasis (p = .030), more advanced clinical stages (p = .007), and recurrence (p < .001) of OSCC. High expression of Src protein was identified as an independent unfavorable prognosis factor by multivariate Cox regression analysis. The Kaplan-Meier curve showed that patients with OSCC with high expression of Src protein had a significantly poorer cumulative survival than those with low expression of Src protein (log-rank test, p = .00267). The expression of Src protein is significantly associated with the progression, recurrence, and prognosis of OSCCs in Taiwan.
    Head & Neck 11/2011; 34(9):1340-5. · 2.83 Impact Factor
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    ABSTRACT: T helper 17 (Th17) and regulatory T cells share plasticity in the expression of interleukin (IL)-17 and forkhead box P3 (FOXP3), but their mutual presence in human diseases is unclear. IL-17 and FOXP3 were analyzed by immunohistostaining and flow cytometry. The cytokine milieu was analyzed by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). Oral squamous cell carcinoma expresses high levels of IL-1β, IL-6, and transforming growth factor (TGF)-β. A unique subset of FOXP3(+) IL-17-producing CD4(+) T cells was consistently identified in tumor-infiltrating lymphocytes from advanced stages of cancer, but not in the circulation, at a frequency of 0.5% to 5.5 % of total CD4(+) T and positively correlated with the frequency of IL-17(+)FOXP3(-) T cells. The IL-17(+)FOXP3(+) T cells express CCR6 and suppress the proliferation of autologous CD4(+) CD25(-) responder T-cells in vitro. The prevalence of IL-17-producing FOXP3(+) CD4(+) tumor infiltrating lymphocytes is increased in oral squamous cell carcinoma.
    Head & Neck 09/2011; 33(9):1301-8. · 2.83 Impact Factor
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    ABSTRACT: BACKGROUND: Once-yearly zoledronic acid has been proven effective in the management of osteoporosis. Osteonecrosis of the jaws (ONJ) related to its use has not been reported since its approval in 2007. METHODS: Two women with osteoporosis/osteopenia developed ONJ after the second infusion of yearly zoledronic acid. They had no other systemic diseases and ONJ occurred after oral surgeries, which were performed about 2 months following drug administration. RESULTS: In 1 case osteonecrosis of the maxilla resolved after conservative therapy and sequestrectomy. In the other case bone necrosis developed on both sides of mandible, and the symptoms/signs of ONJ were partially responsive to conservative treatment. CONCLUSIONS: ONJ related to yearly zoledronic acid is a severe complication that should not be ignored. To minimize the risk, we recommend preventive oral care before the start of therapy and avoiding dental invasive procedures within 3 months after drug administration. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.
    Head & Neck 04/2011; · 2.83 Impact Factor
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    ABSTRACT: Transforming growth factor β1 (TGF-β1) plays a role in repair and dentinogenesis in dental pulp. The purpose of this study was to study how TGF-β1 affects 2 differentiation markers, Runt-related transcription factor 2 (Runx-2) and ALP, in dental pulp cells. Primary-cultured human dental pulp cells were treated with TGF-β1 with or without pretreatment and coincubation with 1,4-diamino-2,3-dicyano-1,4-bis(o-aminophenylmercapto)butadiene (U0126, a mitogen-induced extracellular kinase (MEK)/extracellular signal-regulated kinase (ERK) inhibitor), Noggin (a bone morphogenetic protein inhibitor), or 4-(5-benzol[1,3]dioxol-5-yl-4-pyrldin-2-yl-1H-imidazol-2-yl)-benzamide hydrate (SB431542, an activin receptor-like kinase (ALK) 5/Smad2/3 inhibitor). The differentiation status of pulp cells was evaluated by ALP staining and quantitative ALP activity assay. Changes in ALP and Runx-2 mRNA expression were determined by reverse-transcription polymerase chain reaction. Cells under the treatment of TGF-β1 (5 and 10 ng/mL) showed a decrease in ALP activity and gene expression of ALP and Runx-2. Pretreatment by U0126 and Noggin was not effective to prevent the TGF-β1-induced decline of ALP activity. Interestingly, SB431542 prevented the TGF-β1-induced decline of ALP activity and ALP and Runx-2 gene expression. TGF-β1 down-regulates Runx-2 and ALP in human dental pulp cells via ALK5/Smad2/3 signaling. These events may play important roles at specific stages of pulpal repair and dentinogenesis.
    Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 03/2011; 111(3):394-400. · 1.50 Impact Factor
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    ABSTRACT: Mercury is a well-known neurotoxin but the susceptibility of autonomic nerves to mercury poisoning in vivo has seldom been studied. Our previous studies have shown that the hypoglossal nerve in hamsters contains somatic motor and postganglionic sympathetic fibers. The aim of this study was to investigate the ultrastructural changes in the nervous system following intraneural injection of mercuric chloride into the hypoglossal nerve in hamsters. Six adult hamsters were used in this study. After anesthesia, the digastric muscle on the right side was removed and the trunk of the hypoglossal nerve was exposed. Two microliters of mercuric chloride aqueous solution was injected into the main trunk of the hypoglossal nerve at the bifurcation. The contralateral hypoglossal nerve was kept intact and used as the normal control. Animals were allowed to survive for 1 or 3 days and were prepared for ammonium sulfide histochemistry and electron microscopy. Three days after injection of mercuric chloride solution, almost all unmyelinated sympathetic fibers in the hypoglossal nerve trunk were lost, whereas myelinated somatic axons were spared. Although mercury deposition in the myelin sheaths of neuronal processes was observed in the hypoglossal nucleus, the neuronal somas were intact. By contrast, degenerated neuronal processes and mercury deposition in neuronal somas were frequently found in the superior cervical ganglia. This study demonstrated an undue susceptibility of sympathetic fibers to mercury intoxication. The mechanisms that underlie the selective reaction of sympathetic fibers to mercury warrant further investigation.
    Journal of the Formosan Medical Association 02/2011; 110(2):93-9. · 1.00 Impact Factor
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    ABSTRACT: Expression of vascular endothelial growth factor (VEGF) correlates with progression and prognosis of several human cancers. The main purposes of this study were to assess expression of VEGF in specimens of oral squamous cell carcinoma (OSCC) and to evaluate the possible influence of VEGF on the progression and prognosis of OSCC in Taiwan. An immunohistochemical technique was used to examine the expression of VEGF in 100 specimens of OSCC, 66 specimens of oral epithelial dysplasia, and 36 specimens of normal oral mucosa. We found that the mean labeling indices (Lis) of VEGF increased significantly from normal oral mucosa (13 ± 6%), through mild (22 ± 8%), moderate (24 ± 13%), and severe oral epithelial dysplasia (32 ± 14%), to OSCC samples (50 ± 18%, p < 0.001). The higher mean VEGF LI was significantly related to OSCC with positive lymph node metastasis (p = 0.022) and with more advanced clinical stages (p = 0.046). In addition, positive lymph node metastasis (p = 0.008) and VEGF LI > 40% (p = 0.046) were identified as independent unfavorable prognosis factors for OSCC patients by multivariate analysis with the Cox regression model. Moreover, the Kaplan-Meier curve showed that OSCC patients with a VEGF LI > 40% had a significantly poorer cumulative survival than those with a VEGF LI ≤ 40% (log-rank test, p = 0.016). We conclude that VEGF may be a biomarker for prediction of the progression and prognosis of OSCC in Taiwan.
    Journal of the Formosan Medical Association 01/2011; 110(1):50-7. · 1.00 Impact Factor

Publication Stats

659 Citations
118.24 Total Impact Points

Institutions

  • 2002–2014
    • National Taiwan University
      • • Department of Dentistry
      • • Graduate Institute of Clinical Dentistry
      T’ai-pei, Taipei, Taiwan
    • National Taiwan University Hospital
      • School of Dentistry
      T’ai-pei, Taipei, Taiwan
  • 2010–2012
    • Taipei Medical University
      • School of Dentistry
      T’ai-pei, Taipei, Taiwan
  • 2008–2012
    • Chang Gung University of Science and Technology
      Taoyuan City, Taiwan, Taiwan
    • Chang Gung Memorial Hospital
      • Department of Dentistry
      Taipei, Taipei, Taiwan