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Application of artificial intelligence-driven endoscopic screening and diagnosis of gastric cancer

World Journal of Gastroenterology 2021年第22期27卷 2979-2993页

作者： Yu-Jer Hsiao Yuan-Chih Wen Wei-Yi Lai Yi-Ying Lin Yi-Ping Yang yueh chien Aliaksandr A Yarmishyn De-Kuang Hwang Tai-Chi Lin Yun-Chia Chang Ting-Yi Lin Kao-Jung Chang Shih-Hwa Chiou Ying-Chun Jheng Department of Medical Research Taipei Veterans General HospitalTaipei 112201Taiwan School of Medicine National Yang-Ming Chiao Tung UniversityTaipei 112304Taiwan Department of Medical Education Taipei Veterans General HospitalTaipei 112201Taiwan Institute of Pharmacology National Yang-Ming Chiao Tung UniversityTaipei 112304Taiwan Department of Internal Medicine Taipei Veterans General HospitalTaipei 112201Taiwan Critical Center Taipei Veterans General HospitalTaipei 112201Taiwan Department of Ophthalmology Taipei Veterans General HospitalTaipei 112201Taiwan Institute of Clinical Medicine National Yang-Ming Chiao Tung UniversityTaipei 112201Taiwan Department of Medicine Kaohsiung Medical UniversityKaohsiung 80708Taiwan Institute of Clinical Medicine National Yang-Ming Chiao Tung UniversityTaipei 112304Taiwan Big Data Center Taipei Veterans General HospitalTaipei 112201Taiwan

The landscape of gastrointestinal endoscopy continues to evolve as new technologies and techniques become *** advent of image-enhanced and magnifying endoscopies has highlighted the step toward perfecting endoscopic screening and diagnosis of gastric ***,with the development of convolutional neural network,artificial intelligence(AI)has made unprecedented breakthroughs in medical imaging,including the ongoing trials of computer-aided detection of colorectal polyps and gastrointestinal *** the past demi-decade,applications of AI systems in gastric cancer have also *** AI’s efficient computational power and learning capacities,endoscopists can improve their diagnostic accuracies and avoid the missing or mischaracterization of gastric neoplastic *** far,several AI systems that incorporated both traditional and novel endoscopy technologies have been developed for various purposes,with most systems achieving an accuracy of more than 80%.However,their feasibility,effectiveness,and safety in clinical practice remain to be seen as there have been no clinical trials ***,AI-assisted endoscopies shed light on more accurate and sensitive ways for early detection,treatment guidance and prognosis prediction of gastric *** review summarizes the current status of various AI applications in gastric cancer and pinpoints directions for future research and clinical practice implementation from a clinical perspective.

关键词： Artificial intelligence Diagnostic Therapeutic Endoscopy Gastric cancer Gastritis

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γδ T cell activation:antigen recognition *** cues

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第八届全国免疫学学术大会

作者： Xun Zeng Yu-ling Wei Jun Hwang Evan W.Newell Brian A.Kidd Casey T.Weaver Mark M.Davis yueh-hsiu chien Department of Microbiology and Immunology Stanford University Program in Immunology Stanford University Program in Immunology Stanford University Department of Pathology University of Alabama at Birmingham Howard Hughes Medical Institute

γδT cells are the major initial IL-17 producers in ***-17 regulates the expansion and recruitment of neutrophils and monocytes to initiate the inflammatory *** acute infection,a swift IL-17 response must be elicited without prior antigen ***,what inducesγδT cells to mount an IL-17 response is *** has been argued that these responses are too rapid and robust to be antigen-specific,and thatγδT cells provide an"innate"source of IL-17.I will discuss experiments indicating that antigen recognition is necessary to activateγδT cells and to initiate

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Robotic-assisted laparoscopic resection of ectopic pancreas in the posterior wall of gastric high body: Case report and review of the literature

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World Journal of Gastroenterology 2005年第48期11卷 7694-7696页

作者： Sheng-Der Hsu Hurng-Sheng Wu chien-Long Kuo yueh-Tsung Lee Division of General Surgery Division of General Surgery Department of SurgeryShow-Chwan Memorial HospitalChanghuaTaiwanChina Department of Pathology

Minimally invasive surgery has revolutionized the treatment of gastrointestinal tumors. Submucosal tumors of the stomach can be resected using laparoscopic techniques. We report here a case of ectopic pancreas tissue in the gastric wall that was removed using robotic-assisted laparoscopic resection. The patient was a 15-year-old female who presented with abdominal discomfort and tarry stools. Laboratory analysis showed iron deficiency anemia. Preoperative endoscopy revealed a submucosal lesion in the posterior wall of the gastric high body. Intraoperative upper endoscopy clearly located the lesion. A robotic-assisted laparoscopic wedge resection of the putative gastric submucosal tumor was performed. The pathology results showed an ectopic pancreas. The patient had an uneventful recovery and we believe that this is a valid treatment option for this benign condition.

关键词： Robotic surgery Ectopic pancreas

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Primary retroperitoneal mucinous cystadenoma:Report of a case and review of the literature

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World Journal of Gastroenterology 2008年第37期14卷 5769-5772页

作者： Sheng-Lei Yan Ho Lin chien-Long Kuo Hurng-Sheng Wu Ming-Ho Huang yueh-Tsung Lee Division of Gastroenterology Departmentof Internal Medicine Chang Bing Show Chwan MemorialHospital Changhua County 505 Taiwan China Department of Life Sciences NationalChun~ Hsing University. Taichung City 402. Taiwan. China Department of Pathology Show ChwanMemorial Hospital Changhua City 500 Taiwan China Division of GeneralSurgery Department of Surgery Show Chwan MemorialHospital Changhua City500 Taiwan China Division of General Surgery Departmentof Surgery Chang Bing Show Chwan Memorial HospitalChanghua County 505 Taiwan China

Primary retroperitoneal mucinous cystadenomas (RMCs) are very rare and their biological behavior and histogenesis remain speculative. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. We describe a 29-year-old woman with abdominal pain and a palpable mass. Computed tomography (CT) of the abdomen revealed a retroperi-toneal cystic mass which was resected successfully at laparotomy. Histopathological examination of the resected mass confirmed the diagnosis of RMC. There was no evidence of disease 2 years after surgery.

关键词： Retroperitoneal Mucinous cystadenoma Cystic mass Clinical features

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Squamous cell carcinoma arising from longstanding colocutaneous fistula: A case report

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World Journal of Gastroenterology 2005年第33期11卷 5251-5253页

作者： yueh-Tsung Lee Sheng-Der Hsu chien-Long Kuo Dev-Aur Chou Mao-Sheng Lin Min-Ho Huang Hurng-Sheng Wu Division of General Surgery Department of Surgery Show-Chwan Memorial Hospital Changhua Taiwan China Department of Pathology Show-Chwan Memorial Hospital Changhua Taiwan China Division of General Surgery Department of SurgeryTri-Service General Hospital Taipei Taiwan China Division of Urology Department of Surgery Show-Chwan Memorial Hospital Changhua Talwan China

A 60-year-old female patient suffered unhealed wounds over left flank for around 30 years after surgical removal of left renal stones. Fecal material spilled from the two small openings of the scar, bothered her all day long. During the course of the 30 years, she suffered from intermittent fever, diarrhea and wound pain and presented with malnourished condition. After serial examinations, tumor associated with iatrogenic colo-cutaneous fistula was impressed and she received en bloc resection. Pathology revealed squamous cell carcinoma arising from the fistula with colon and spleen invasion. To the best of our knowledge,no such case has been reported, as yet.

关键词： Squamous cell carcinoma Colo-cutaneous fistula

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Aberrant activation of nuclear factor of activated T cell 2 in lamina propria mononuclear cells in ulcerative colitis

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World Journal of Gastroenterology 2008年第11期14卷 1759-1767页

作者： Tsung-Chieh Shih Sen-Yung Hsieh Yi-yueh Hsieh Tse-Chin Chen chien-Yu Yeh Chun-Jung Lin Deng-Yn Lin Cheng-Tang Chiu Clinical Proteomics Center Chang Gung Memorial HospitalTaoyuan 333Taiwan Clinical Proteomics Center Chang Gung Memorial HospitalTaoyuan 333Taiwan Department of Hepato-GastroenterologyChang Gung Memorial HospitalChang Gung University School of Medicine Taoyuan 333Taiwan Department of Anatomic Pathology Chang Gung Memorial HospitalTaoyuan 333Taiwan Department of Colorecto-Surgery Chang Gung Memorial HospitalTaoyuan 333Taiwan Department of Hepato-Gastroenterology Chang Gung Memorial HospitalChang Gung University School of Medicine Taoyuan 333Taiwan

AIM:To investigate the role of nuclear factor of activated T cell 2(NFAT2),the major NFAT protein in peripheral T cells,in sustained T cell activation and intractable inflammation in human ulcerative colitis(UC). METHODS:We used two-dimensional gel-electrophoresis, immunohistochemistry,double immunohistochemical staining,and confocal microscopy to inspect the expression of NFAT2 in 107,15,48 and 5 cases of UC, Crohn's disease(CD),non-specific colitis,and 5 healthy individuals,respectively. RESULTS:Up-regulation with profound nucleo- translocation/activation of NFAT2 of lamina propria mononuclear cells(LPMC)of colonic mucosa was found specifically in the affected colonic mucosa from patients with UC,as compared to CD or NC(P<0.001,Kruskal- Wallis test).Nucleo-translocation/activation of NFAT2 primarily occurred in CD8+T,but was less prominent in CD4+T cells or CD20+B *** was strongly associated with the disease activity,including endoscopic stage (τ=0.2145,P=0.0281)and histologic grade(τ=0.4167, P<0.001). CONCLUSION:We disclose for the first time the nucleo-translocation/activatin of NFAT2 in lamina propria mononuclear cells in ulcerative *** of NFAT2 was specific for ulcerative colitis and highly associated with disease *** activation of NFAT2is implicated in an auto-regulatory positive feedback loop of sustained T-cell activation and NFAT proteins play key roles in the calcium/calcineurin signaling pathways,our results not only provide new insights into the mechanism for sustained intractable inflammation,but also suggest the calcium-calcineurin/NFAT pathway as a new therapeutic target for ulcerative colitis.

关键词： Nuclear factor of activated T cells Ulcerative colitis Inflammatory bowel disease Nuclear factor of activated T cells cl Nuclear factor of activated T cells 2

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Laparoscopic Sleeve Gastrectomy following Pylorus-Preserving Pancreaticoduodenectomy

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Surgical Science 2023年第5期14卷 355-359页

作者： chien-Hua Lin Jing-Jim Ou yueh-Tsung Lee Hurng-Sheng Wu Department of Surgery Chang Bing Show Chwan Memorial Hospital Taiwan IRCAD Taiwan

Background: A 35-year-old married female (68 kg, 150 cm, BMI: 30.2) with pancreatic divisum complicated chronic pancreatitis and underwent pylorus-preserving pancreaticoduodenectomy in 2010. After that, her condition was well. However, body weight gained progressively to 76 kg (BMI: 33.7) and hypertension developed. During these two years, tried exercise and medication control for hypertension, but in vain. She received a laparoscopic sleeve gastrectomy in October 2013. The post-operative course was uneventful. Methods: We applied three ports for laparoscopic operation, including two 12 mm and one 5 mm trocars. The liver was not needed to be elevated due to adhesion. The operative time was 75 minutes. Results: The patient’s body weight was 10 kg reduced in the first two months and reduced to 59 kg 6 months later. Conclusions: We report a case that received laparoscopic sleeve gastrectomy following pylorus-preserving pancreaticoduodenectomy due to pancreatic divisum. This case encourages us to extend the indication of laparoscopic sleeve gastrectomy.

关键词： Sleeve Gastrectomy Morbid Obesity Obesity Pancreatectomy

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An Easy Way to Close the Trocar Hole in Obese Patients

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Surgical Science 2015年第10期6卷 459-463页

作者： chien-Hua Lin Hurng-Sheng Wu Jing-Jim Ou yueh-Tsung Lee IRCAD Taiwan Department of Surgery Chang-Bing Show Chwan Memorial Hospital Taiwan Department of Surgery Tri-Service General Hospital Taiwan

Background: Ten-millimeter ports are often used in laparoscopic surgery. It could be difficult to close the ports sites, especially in obese patients. We described a new method to close ten-millimeter port-site wounds, effective and easily to perform. Methods: Forty cases of laparoscopic bariatric surgery were performed from April 2010 to September 2011 at IRCAD Taiwan. Among them, 30 patients received trocar hole closed with SURGICEL® Original Hemostat and the other 10 patients received trocar hole closed with autologous fat. The results were recorded. Results: In group of SURGICEL® Original Hemostat, includes 21 female and 9 male, age range from 18 to 54 with average 39.5 years. Average BMI is 42.4 (range from 32.6 to 55). The operations include 27 cases of laparoscopic sleeve gastrectomy, 2 cases of laparoscopic gastric bypass, and 1 case of laparoscopic mini-bypass. Group of autologous fat includes 3 female and 7 male, age range from 20 to 49 with average 38.6 years. Average BMI is 39 (range from 32.8 to 64.5). The operations include 9 cases of laparoscopic sleeve gastrectomy, and 1 case of laparoscopic mini-bypass. No complications of trocar wound including infection, hematoma, and hernia were found for a mean follow-up of 6 months. Conclusions: For obese patients, closure of port sites can be difficult. We described a method of closing 10-mm port-sites wounds, which are easy, effective, and not required any special instruments.

关键词： Bariatric Surgery Autologous Fat Troca Port Site Hernia

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The Causes of Conversion from Laparoscopy to Laparotomy in Patients with Laparoscopic Repair of Perforated Peptic Ulcer

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Surgical Science 2015年第2期6卷 75-79页

作者： chien-Hua Lin Der-Ao Chou yueh-Tsung Lee Hurng-Sheng Wu Department of Surgery Chang-Bing Show Chwan Memorial Hospital Changhua Chinese Taipei IRCAD Changhua Chinese Taipei

Purpose: Perforated peptic ulcer is an emergency condition. Laparoscopic ulcer repair is a feasible and safe procedure. The aim of this study was to research the efficacy of laparoscopic repair of peptic ulcer and to discuss the causes of conversion from laparoscopy to laparotomy. Methods: We collected 34 patients with perforated peptic ulcer underwent laparoscopic surgery from October 2003 to October 2008. Thirty four patients with perforated peptic ulcer underwent laparoscopic intervention and 6 cases were converted to laparotomy. The demographics, laboratory data, perioperative data, morbidity and mortality were compared. Results: In demographics of two groups, there were no significant differences in sex, age, location, and mean duration of symptoms of acute abdominal pain. However, there were significant differences in median size of perforation, mean duration of history of peptic ulcer related pain, and the experiences of surgeon. There were no significant differences in the laboratory data and perioperative data of two groups. In morbidity?and mortality of two groups, there were no significant differences in leakage, wound infection, intra-abdominal abscess, ileus, urinary tract infection, pneumonia, and mortality, but there was significant difference in overall morbidity in two groups. Conclusions: Laparoscopic repair of perforated peptic ulcer is safe and could be used in routine clinical practice. However, patients with larger perforations (>10 mm), longer duration of history peptic ulcer related pain (>2 years), and learning curve of surgeon could be associated with conversion rate. It is associated with higher morbidity in patients with conversion from laparoscopy to laparotomy.

关键词： Laparoscopy Perforated Peptic Ulcer Repair Conversion Rate

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Continuously Injection with Diluted Heparin Solution via Catheter for Implantation of Totally Implantable Access Ports (TIAP)

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Surgical Science 2012年第7期3卷 371-372页

作者： chien-Hua Lin Jing-Jim Ou yueh-Tsung Lee Hurng-Sheng Wu Department of Surgery Chang-Bing Show Chwan Memorial Hospital Changhua Chinese Taipei

Background: Totally implantable access ports (TIAP) could be done in two methods: puncture of subclavian vein and cephalic vein cutdown. Cephalic vein cutdown method has fewer complications but has higher failure rates. We present a method to decrease the failure rates. Methods: We use the continuously injection with diluted heparin solution via catheter while introducing the TIAP catheter into the cephalic vein. Results: From January 2005 to January 2009, 20 patients were performed. This method was successfully applied in 11 patients with no complications. The other 9 patients was unsuccessfully and further underwent guidewire assisted. Conclusions: Continuously injection with diluted heparin solution via catheter while inserting TIAP catheter into the cephalic vein is safe and simple. It could be used for difficulties of insertion of TIAP and increased the successful rates of cephalic vein cut-down method.

关键词： Totally Implantable Access Ports (TIAP) Arrhythmia Port-A

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