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Tracheostomy and venovenous extracorporeal membrane oxygenation for difficult airway patient with carinal melanoma:A case report and literature review

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World Journal of Clinical Cases 2022年第35期10卷 13088-13098页

作者： I-Liang Liu An-Hsun Chou chien-hung chiu Yu-Ting Cheng Huan-Tang Lin Department of Anesthesiology Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan College of Medicine Chang Gung UniversityTaoyuan 333Taiwan Division of Thoracic and Cardiovascular Surgery Department of SurgeryChang Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan Graduate Institute of Clinical Medical Sciences Chang Gung UniversityTaoyuan 333Taiwan

BACKGROUND Anesthesia for tracheal tumor resection is challenging,particularly in patients with a difficult upper *** report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total left bronchial obstruction and requiring emergency tracheostomy and venovenous extracorporeal membrane oxygenation(VV-ECMO)support for rigid bronchoscopy-assisted tumor *** SUMMARY A 41-year-old man with a history of right retromolar melanoma treated by tumor excision and myocutaneous flap reconstruction developed progressive dyspnea on exertion and syncope *** computed tomography revealed a 3.0-cm tracheal mass at the carinal level,causing 90%tracheal lumen *** bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal *** of aggravated symptoms,emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby *** to limited mouth opening,tracheostomy was necessary for rigid bronchoscopy *** transferring the patient to the operating table,sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation *** and internal jugular vein were catheterized to facilitate possible VV-ECMO *** tracheostomy,progressive desaturation developed and VV-ECMO was instituted *** tumor resection and tracheal stenting,VV-ECMO was weaned smoothly,and the patient was sent for intensive postoperative *** days later,he was transferred to the ward for palliative immunotherapy and subsequently discharged *** In a difficult airway patient with severe airway obstruction,emergency tracheostomy for rigid bronchoscopy access and standby VV-ECMO can be life-saving,and ECMO can be weaned smoothly after tumor *** anesthesia for patients with tracheal tumors causing critical airway obstruction,spontaneous ventilation should be maintaine

关键词： Tracheostomy Extracorporeal membrane oxygenation Tracheal tumor Melanoma Case report

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Serum hepatitis B surface antigen levels predict treatment response to nucleos(t)ide analogues

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World Journal of Gastroenterology 2014年第24期20卷 7686-7695页

作者： chien-hung Chen Yi-Chun chiu Sheng-Nan Lu Chuan-Mo Lee Jing-Houng Wang Tsung-Hui Hu Chao-hung hung Division of Hepato-Gastroenterology Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine

Quantification of hepatitis B surface antigen(HBsAg)has been suggested to be helpful in the management of chronic hepatitis B(CHB)***(t)ide analogs(NAs)are the therapy of choice for CHB and are used in the majority of CHB *** are able to induce hepatitis B virus(HBV)viral suppression,normalization of alanine aminotransferase(ALT)levels,and improvement in liver *** quantitative assays for serum HBsAg have recently become available,facilitating standardized quantification of serum *** has led to increased interest in the clinical application of quantitative serum HBsAg for predicting therapeutic response to *** studies have shown that a decline in serum HBsAg levels in patients receiving peginterferon may signal successful induction of immune control over HBV,and can therefore be used to predict therapeutic *** treatment typically induces a less rapid decline in HBsAg than interferon treatment;it has been estimated that full HBsAg clearance can require decades of NA ***,a rapid HBsAg decline during NA therapy may identify patients who will show clearance of ***,there is no consensus on the clinical utility of serum HBsAg monitoring for evaluating patient responses to NA *** review focuses on recent findings regarding the potential application of HBsAg quantification in the management of CHB patients receiving NA therapy.

关键词： Alanine aminotransferase Hepatitis B virus Hepatitis B surface antigen Nucleos(t)ide analogs Virological response

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Numerical Implementation of a Unified Viscoplastic Model for Considering Solder Joint Response under Board-Level Temperature Cycling

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Computer Modeling in Engineering & Sciences 2021年第8期128卷 639-668页

作者： hung-Chun Yang Tz-Cheng chiu Department of Mechanical Engineering National Cheng Kung UniversityTainan701Taiwan

An implicit integration scheme was developed for simulating the viscoplastic constitutive behavior ofSn3.0Ag0.5Cu solder and programmed into a user material subroutine of the finite element software ANSYS. Thenumerical procedure first solves the essential state variables by using a three-level iterative procedure, and updatesthe remaining stress and state variables accordingly. The numerical implementation was applied to consider theresponses of solder joints in an electronic assembly under temperature cycling condition. The viscoplastic strainenergy density accumulation over one temperature cycle was identified as a feasible parameter for evaluating thethermomechanical reliability of the solder joints.

关键词： Pb-free hysteresis ratcheting fatigue tangent modulus

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Injury-induced rapid activation of MAPK signaling in dechorionated eggs and larvae of the silkworm Bombyx mori

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Insect Science 2017年第2期24卷 248-258页

作者： Shi-Hong Gu chien-hung Chen Department of Biology National Museum of Natural Science Taichung Taiwan China Chung Hwa University of Medical Technol-ogy Tainan County Taiwan China

Previous study showed that diapause in Bombyx mori eggs can be ter- minated by dechorionation and that activation in the mitogen-activated protein kinase （MAPK）/extracellular signal-regulated kinase （ERK） in dechorionated cultured eggs is involved in diapause termination. In the present study, the possible mechanism underlying activation of ERK upon dechorionation was further investigated. Results showed that me- chanical injury of diapause eggs without medium incubation also resulted in rapid increase in the phospho-ERK levels and that injury increased the phospho-ERK levels at different stages of both diapause eggs and eggs in which diapause initiation was prevented by HC1. Effects of anaerobiosis on dechorionation-stimulated phospho-ERK levels showed that the mechanical injury itself but not the dramatic increase in oxygen uptake upon injury is in- volved in a rapid activation of ERK. Chemical anaerobiosis on dechorionation-stimulated phospho-ERK levels and the in vivo effect of anaerobiosis showed that the supply of oxygen also plays a role in ERK signaling. In addition, injury induced the phosphory- lation of c-jun N-terminal kinases （JNKs） and p38 kinase, components of two parallel MAPK pathways. A kinase assay showed a dramatic increase in .INK kinase activity in egg lysates upon injury. When newly hatched first instar larvae were injured, an increase in the phospho-ERK levels similar to that in dechorionated eggs was observed. From the results, we hypothesize that the injury-induced rapid activation of MAPK signaling, which serves as a natural signal for embryonic development, is related to diapause termination in dechorionated eggs.

关键词： Bombyx mori dechorionation embryonic diapause ERK phosphorylation injury MAPK

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Numerical Simulation of the Motion of A Floating Body with Partially Filled Tanks by A Pressure-Convection Particle Method

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China Ocean Engineering 2010年第3期24卷 401-416页

作者： hung-Pin chien Jen-Shiang KOUH Yen-Jen CHEN Institute of Engineering Science and Ocean Engineering National Taiwan University Department of Multimedia and Game Science Lunghwa University of Science Technology

The moving particle semi-implicit（MPS）method has demonstrated its usefulness in practical engineering *** it has wide applicability,it is still hard to predict the pressure precisely using the MPS method.A pressure-convection particle method based on the MPS method is proposed to overcome this *** improved performance of this new method is validated with computational and measured *** approach is also applied to compute the problem of sloshing associated with floating body motion in *** pressure-convection MPS method demonstrated its capability to improve the prediction of pressure.

关键词： pressure-convection particle method impact pressure heaving motion rolling motion

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On the Current Error Based Sampled-data Iterative Learning Control with Reduced Memory Capacity

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International Journal of Automation and computing 2015年第3期12卷 307-315页

作者： Chiang-Ju chien Yu-Chung hung Rong-Hu Chi Department of Electronic Engineering Huafan University School of Automation and Electrical Engineering Qingdao University of Science and Technology

The design of iterative learning controller(ILC) requires to store the system input, output or control parameters of previous trials for generating the input of the current trial. In order to apply the iterative learning controller for a real application and reduce the memory size for implementation, a current error based sampled-data proportional-derivative(PD) type iterative learning controller is proposed for control systems with initial resetting error, input disturbance and output measurement noise in this *** proposed iterative learning controller is simple and effective. The first contribution in this paper is to prove the learning error convergence via a rigorous technical analysis. It is shown that the learning error will converge to a residual set if a forgetting factor is introduced in the controller. All the theoretical results are also shown by computer simulations. The second main contribution is to realize the iterative learning controller by a digital circuit using a field programmable gate array(FPGA) chip applied to repetitive position tracking control of direct current(DC) motors. The feasibility and effectiveness of the proposed current error based sampleddata iterative learning controller are demonstrated by the experiment results. Finally, the relationship between learning performance and design parameters are also discussed extensively.

关键词： Iterative learning control current error sampled-data system memory capacity field programmable gate array(FPGA) chip.

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Liu-stain quick cytodiagnosis of ultrasound-guided fine needle aspiration in diagnosis of liver tumors

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World Journal of Gastroenterology 2007年第3期13卷 448-451页

作者： Chi-Sin Changchien Jing-Houng Wang Chao-hung hung chien-hung Chen Chuan-Mo Lee Division of Hepato-Gastroenterology Department of Internal Medicine Chang-Gung Memorial Hospital Kaohsiung Medical Center Chang Gung University College of Medicine Taiwan China

AIM： To combine ultrasound-guided fine-needle aspiration （US-FNA） and Liu （Riu） stain to make a quick study on liver tumor lesions. METHODS： Two hundred and twenty-eight aspirations from 232 patients were completely studied. The operator himself made the quick cytodiagnosis of US-FNA smear stained by Liu method within thirty minutes. The US-FNA specimen was also sent to the pathological department for cytological study and cellblock histology. The result of our Uu-stain quick cytodiagnosis in each patient was confirmed by the final cytopathological diagnosis from pathological report. RESULTS： Among 228 samples, the quick cytodiagnosis revealed 146 malignancies, 81 benign lesions and one inadequate specimen. Cytopathological diagnosis from the pathological department revealed 150 malignancies, and 78 benign lesions. Four well-differentiated hepatocellular carcinomas （HCCs） were under-diagnosed by quick cytodiagnosis as benign and 3 benign lesions were over-diagnosed as well-differentiated HCCs. Compared with cytopathological diagnosis, quick cytodiagnosis correctly diagnosed 143 malignancies and 77 benign lesions. Except for the one inadequate specimen in quick cytodiagnosis, the accuracy of quick cytodiagnosis was 96.9% （220/227）, and its sensitivity, specificity and positive and negative predictive values were 97.9%, 95.1%, 97.3% and 96.3%, respectively. CONCLUSION： Liu-stain quick cytodiagnosis is a fast, convenient, safe and effective method for hepatologists in clinic practice to diagnose liver tumor. In few cases of well-differentiated HCC, Liu-stain quick cytodiagnosis has its limitation.

关键词： Liver tumor Cytology Ultrasound guided FNA Liu stain

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Smart partition system - A room level support system for integrating smart technologies into existing buildings

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Frontiers of Architectural Research 2014年第4期3卷 376-385页

作者： Sheng-Fen chien hung-Jen Wang Department of Architecture University of Cheng Kung University 1 University Road Tainan 70101Taiwan China

We proposed a support system caLLed the ＂Smart Partition System＂ for infill elements that integrate smart technologies according to the Open Building principles. The design requirements were collected from design practitioners. These design requirements consisted of both architectural and information subsystems. The Smart Partition System was composed of the foLLowing multiple levels of smartness： the foundation/core Level with an embedded design knowledge in the support system and the utility Level with a modular infill that integrate smart technologies. We constructed functional prototypes to demonstrate the feasibility of our proposed support system and some of the possibilities of the smart infill elements. Furthermore, the prototypes were evaluated by design practitioners. We compared our approach with current practices of smart building developments, and we also discussed some future prospects.

关键词： Support system Smart house Open buildins Building renovationmodule Technotogy intesration

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Strengthening reinforced concrete beams using prestressed glass fiber-reinforced polymer-Part I: Experimental study

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Journal of Zhejiang University-Science A(Applied Physics & Engineering) 2005年第8期6卷 166-174页

作者： WU Jong-hwei YEN Tsong hung chien-hsing LIN Yiching Department of Civil Engineering National Chung-Hsing University 40227 Taiwan ChinaDepartment of Civil Engineering National Chung-Hsing University 40227 Taiwan ChinaDepartment of Civil Engineering National Chung-Hsing University 40227 Taiwan ChinaDepartment of Civil Engineering National Chung-Hsing University 40227 Taiwan China

This work is aimed at studying the strengthening of reinforced concrete (R. C.) beams using prestressed glass fi- ber-reinforced polymer (PGFRP). Carbon fiber-reinforced polymer (CFRP) has recently become popular for use as repair or rehabilitation material for deteriorated R. C. structures, but because CFRP material is very stiff, the difference in CFRP sheet and concrete material properties is not favorable for transferring the prestress from CFRP sheets to R. C. members. Glass fi- ber-reinforced polymer (GFRP) sheets with Modulus of Elasticity quite close to that of concrete was chosen in this study. The load-carrying capacities (ultimate loads) and the deflections of strengthened R. C. beams using GFRP and PGFRP sheets were tested and compared. T- and ⊥-shaped beams were used as the under-strengthened and over-strengthened beams. The GFRP sheets were prestressed to one-half their tensile capacities before being bonded to the T- and ⊥-shaped R. C. beams. The prestressed tension in the PGFRP sheets caused cambers in the R. C. beams without cracks on the tensile faces. The PGFRP sheets also enhanced the load-carrying capacity. The test results indicated that T-shaped beams with GFRP sheets increased in load-carrying capacity by 55% while the same beams with PGFRP sheets could increase load-carrying capacity by 100%. The ⊥-shaped beams with GFRP sheets could increase load-carrying capacity by 97% while the same beams with PGFRP sheets could increase the loading-carrying capacity by 117%. Under the same external loads, beams with GFRP sheets underwent larger deflections than beams with PGFRP sheets. While GFRP sheets strengthen R. C. beams, PGFRP sheets decrease the beams’ ductility, especially for the over-strengthened beams (⊥-shaped beams).

关键词： Strengthening Prestressed glass fiber reinforcement polymer Modulus of Elasticity R. C. beams

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Terminal ileum gangrene secondary to a type Ⅳ paraesophageal hernia

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World Journal of Gastroenterology 2016年第8期22卷 2642-2646页

作者： Ching Tsai Hsu Po Jen Hsiao Chih chien chiu Jenq Shyong Chan Yee Fung Lin Yuan hung Lo Chia Jen Hsiao Department of Internal Medicine Taoyuan Armed Forces General Hospital Tri-Service General Hospital National Defense Medical Center Division of Nephrology Department of Internal Medicine Taoyuan Armed Forces General Hospital Division of General Surgery Department of Surgery Taoyuan Armed Forces General Hospital Division of Gastroenterology Department of Internal Medicine Taoyuan Armed Forces General Hospital

Type Ⅳ paraesophageal hernia(PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type Ⅳ PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in Pub Med. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type Ⅳ PEH with incarceration of only the terminal ileum.

关键词： Gangrene Hiatal Ileum Paraesophageal hernia Thoracic cavity

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