Y L Lai

Mackay Memorial Hospital, T’ai-pei, Taipei, Taiwan

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Publications (9)15.4 Total impact

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    ABSTRACT: Radiation injury to the skin is one of the major limiting factors in radiotherapy. We designed this study using Sprague-Dawley rats to evaluate the reduction in skin injury achieved using natural products from plant extracts as protection. The acute skin reaction in tetrandrine- and Madecassol-treated animals appeared earlier, but was significantly less severe, than in the control group. The peak skin reactions in the tetrandrine group were less serious than those of the control group at three different radiation doses. At a high dose irradiation, the healing effect of tetrandrine is better than Madecassol and vaseline. The histologic findings indicate that tetrandrine and Madecassol are able to reduce acute radiation reactions by their anti-inflammatory activity.
    Biological & Pharmaceutical Bulletin 08/1999; 22(7):703-6. · 1.85 Impact Factor
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    ABSTRACT: Tetrandrine, a calcium channel antagonist, is a plant alkaloid possessing various pharmacological activities including anti-tumor activity. We studied tetrandrine to determine whether or not this anti-tumor effect occurs through induction of apoptosis. Tetrandrine inhibited both proliferation and clonogenicity of human leukemic U937 cells at an optimal concentration of 2.5 microg/ml. This growth inhibition was dose and time dependent, and accompanied with evidence of apoptotic changes. The characteristic morphological changes of apoptosis were observed in U937 cells under light microscopy and DNA fragmentation was noted by gel electrophoresis. Moreover, flow cytometric detection of surface phosphatidyl serine expression of U937 cells after treatment with tetrandrine confirmed the induction of apoptosis in these cells. The induction of apoptosis by tetrandrine would appear to proceed via non-Ca2+-dependent pathways.
    Anti-Cancer Drugs 02/1998; 9(1):77-81. · 2.23 Impact Factor
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    ABSTRACT: Tetrandrine, an alkaloid isolated from the plant Stephania tetrandra, at low concentration (2 micrograms/ml) was shown to protect normal human mononuclear cells in vitro against damage due to a single high-dose of ionizing irradiation (10 Gy). The cell survival rate increased from 58.3 +/- 2.2% in the irradiated group to 78.0 +/- 2.6% in the tetrandrine-pretreated group, and similarly, the percentage of necrotic cells declined from 20.7 +/- 2.5% to 10.7 +/- 1.9%, respectively. This protective effect of tetrandrine for cell surviving fraction increased in a dose-dependent manner. Tetrandrine was also found to inhibit inflammatory responses induced by irradiation including the release of superoxide (NBT [nitroblue tetrazolium] reduction decreased from 21.3 +/- 2.3% to 10.2 +/- 2.5%) and phagocytic activity (decreased from 80.7 +/- 3.8% to 50.7 +/- 2.3%, the same range level as that of the control group). However, the alkaloid demonstrated no effect on the production of nitric oxide. In terms of cell morphology, only two types were observed-normal or necrotic cells, and there were no characteristics of programmed cell death. These results indicate that tetrandrine possesses radioprotective activity against 10 Gy of ionizing irradiation and could suppress irradiation-induced inflammatory processes.
    Biological & Pharmaceutical Bulletin 12/1997; 20(11):1160-4. · 1.85 Impact Factor
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    ABSTRACT: The hospice at Mackay Memorial Hospital was established in February 1990. A group of team workers including physicians, nurses, social workers and the clergy were involved in this holistic care program for terminal cancer patients. Four hundred and seventy-nine patients were eligible for the program up to February 1993. Regarding duration of stay, 62.5% of patients resided for 14 days. Those surviving under 90 days constituted 75.5% of patients. Fifty-one point eight percent of patients died in the hospice and 18.2% died at home soon after being discharged from the hospice. Pain is the most common symptom among the patients. Treatment strategies vary according to the three-step-ladder protocol designed by WHO. Total pain relief was achieved in 80% of patients. Opportune private talking and family conferences formed the basis of the "peer model". Through this model, treatment decisions including physical, psychosocial and spiritual issues were made. Before the peer model, only 36 (10.3%) patients agreed with the idea of hospice care, while 257 (73.6%) patients agreed after the model was established. Awareness of dying was evident in 412 (86%) patients. Two hundred and eighty (68%) patients became aware of the prospect of death through guessing, while the other 132 (32%) patients were informed by medical staff. Problems encountered by the team workers included 1) needs in education and training, 2) psychological pressure, 3) management of loss and grief, 4) needs in supportive system and 5) troubles caused by families' lying to patients. The team workers were satisfied with the quality of care in 38.4% of patients and fairly satisfied with 30.7% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
    Journal of the Formosan Medical Association 10/1994; 93 Suppl 2:S98-102. · 1.00 Impact Factor
  • Y L Lai, F M Fang, C Y Yeh
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    ABSTRACT: Megestrol acetate and corticosteroid have been demonstrated to be effective in the treatment of anorexia in patients with advanced cancer. The purpose of this preliminary study is to evaluate the role of megestrol acetate and prednisolone in the treatment of anorexia induced during whole pelvis external irradiation. Fifty-two patients were randomized in this prospective study to either receive megestrol acetate (40 mg orally four times a day), prednisolone (10 mg orally three times a day), or placebo (1 tablet orally three times a day) for 21 consecutive days. Body weight, appetite, performance status, sense of well-being, and complications were assessed every 3 days. Both the megestrol acetate group and the prednisolone group showed improvement in body weight gain, appetite, performance status, and sense of well-being. Appetite improvement was statistically significant in the megestrol acetate group (P = 0.024) when compared with the placebo group. There were no complications during the 21-day trial.
    Journal of Pain and Symptom Management 06/1994; 9(4):265-8. · 2.60 Impact Factor
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    ABSTRACT: From January 1980 to December 1988, a total of 73 cases of invasive cervical cancer after simple hysterectomy were treated with radiotherapy. Seven patients were excluded due to incomplete treatment or loss of follow-up. Among the 66 patients, 52 had squamous cell carcinoma and 14 had adenocarcinoma or adenosquamous cell carcinoma. The patients were grouped as follows: group A, patients without gross residual tumor (n = 32); group B, patients with gross residual tumor (n = 23); and group C, patients with gross recurrent tumor (n = 11). All patients in groups A and B received radiotherapy immediately (within 4 months) following their simple hysterectomy. Patients in group C were treated six months to five years later. Different methods of radiotherapy were delivered during the two consecutive time periods. Before 1985, patients (n = 30) were irradiated with a dose of 45-50 Gy in the midpelvic plane, followed by a transvaginal boost of 30 Gy. After 1985, patients (n = 36) were treated with the same midpelvic dose, and boosted with 30 Gy by high-dose-rate brachytherapy. The overall five-year survival rate was 67%. The five-year survival rates were 81% in group A, 56% in group B, and 45% in group C. A low complication rate (10%) was obtained in our series.(ABSTRACT TRUNCATED AT 250 WORDS)
    Journal of the Formosan Medical Association 06/1993; 92(5):420-5. · 1.00 Impact Factor
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    ABSTRACT: High-dose-rate (HDR) afterloading brachytherapy has been used at Mackay Memorial Hospital since 1984 for the treatment of gynecological malignancies. From October 1984 to October 1990, a total of 321 previously untreated patients with biopsy proven uterine cervical cancer were treated with radiation therapy with curative intent. According to FIGO staging, the patients were grouped into stage I (19 patients), stage IIA (13 patients), stage IIB (96 patients), stage III (158 patients) and stage IVA (35 patients). All patients received a combination of external beam irradiation plus intracavitary brachytherapy using the Buchler Remote Afterloading (RAL) system. For most cases, external beam irradiation using a Co-60 or Clinac 1800 photon beam (6 MV or 15 MV) of 3,060 cGy to 3,960 cGy was given to the whole pelvis (180 cGy/day, five days/week), followed by a midline shield after RAL. The total dose to the pelvic sidewall was 5,040 cGy to 5,400 cGy. The overall actuarial five-year survival rate was 55%. The total complication rate in a follow-up of two to eight years was 1% to 4%, and a good correlation existed between rectal complications and the calculated rectal dose. We conclude that fractionated HDR intracavitary therapy concurrent with teletherapy can achieve a high regional control rate with few complications, and can reduce the cost of hospitalization and the risk of anesthesia.
    Journal of the Formosan Medical Association 03/1993; 92(2):165-73. · 1.00 Impact Factor
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    ABSTRACT: From January 1979 to September 1985, a total of 125 patients preoperatively staged as International Federation of Gynecology and Obstetrics (FIGO) Ib uterine cervical carcinoma were proven to have either microscopic involvement of the surgical margin, parametrium and/or regional lymph node metastasis histopathologically after radical hysterectomy and pelvic lymphadenectomy. All of these patients were treated postoperatively with radiotherapy because of the above indications. Based on indications of postoperative radiotherapy, patients were divided into 3 major subgroups according to the microscopic involvement: group A patients (50) with microscopic evidence of regional lymph node metastasis only; group B patients (59) with microscopic evidence of parametrial involvement; and group C patients (16) with microscopic infiltration of the surgical margin involving the vaginal cuff. All patients were treated with external irradiation using a Cobalt-60 teletherapy machine. The overall actuarial 5-year survival rate was 62% with a 77% 5-year survival rate for group A, a 50% rate for group B and a 75% rate for group C. Further analysis of the prognostic factors revealed that those with regional lymph node involvement of 4 or less had a better chance of survival than those with lymph node involvement of more than 4. Also those with poorly differentiated squamous cell carcinoma had a lower 5-year survival rate than those with moderately or well-differentiated squamous cell carcinoma. Univariate analysis revealed that hemoglobin values, age, and the time interval from surgery to radiotherapy were not significant prognostic factors.
    Journal of the Formosan Medical Association 10/1991; 90(9):836-9. · 1.00 Impact Factor
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    ABSTRACT: From January 1980 to December 1985, a total of 110 patients with postoperative recurrent uterine cervical carcinoma were treated with radiotherapy. The mean age was 53 years. Ten patients were excluded due to incomplete treatment. The population was grouped according to the classification by Ciatto et al. into patients with central recurrence (n = 48), with peripheral limited recurrence (n = 43), and with peripheral massive recurrence (n = 9). The midpelvic dose given to patients with central recurrence was 40 to 45 Gy, followed by a boost given either by perineal teletherapy with 30 Gy or brachytherapy with 30 Gy at 0.5 cm. beneath the vaginal mucosa. For the peripheral group, the midpelvic dose was 50 Gy followed by a boost of 10 Gy through reduced portals. Further boost to the vaginal mucosa was given by either of the two methods mentioned above. The overall 5-year survival rate was 28%. In the group with central recurrence, it was 42% and in the group with peripheral recurrence 15%. Sixteen patients had persistent local tumor and 15 patients developed distant metastasis. Complications noted were proctitis (5%), cystitis (2%), vesicovaginal fistula (2%) and rectovaginal fistula (2%). Our data clearly indicate that radiotherapy was effective in controlling central recurrence, but for peripheral recurrence, control rate and prognosis were less favorable.
    Acta Oncologica 02/1991; 30(3):353-6. · 2.87 Impact Factor