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SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance

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World Journal of Gastroenterology 2020年第26期26卷 3767-3779页

作者： Tao-Chieh Liu Chen-Ling Peng Hsiu-Po Wang Hsin-Hung Huang Wei-kuo chang Division of Gastroenterology Department of Internal MedicineTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Integrated Diagnostics&Therapeutics National Taiwan University HospitalNational Taiwan University College of MedicineTaipei 10002Taiwan Division of Gastroenterology and Hepatology Department of Internal MedicineNational Taiwan University HospitalNational Taiwan University College of MedicineTaipei 114Taiwan Division of Gastroenterology Cheng Hsin General HospitalNational Defense Medical CenterTaipei 114Taiwan

BACKGROUND Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%;however,it has been reported that 5.4%of clinically used duodenoscopes remain contaminated with viable high-concern organisms despite following the manufacturer’s *** inspection of working channels has been proposed as a quality control measure for endoscope *** are few studies related to this *** To investigate the types,severity rate,and locations of abnormal visual inspection findings inside patient-ready duodenoscopes and their microbiological *** Visual inspections of channels were performed in 19 patient-ready duodenoscopes using the SpyGlass visualization system in two endoscopy units of tertiary care teaching hospitals(Tri-Service General Hospital and National Taiwan University Hospital)in *** were recorded and reviewed to evaluate the presence of channel scratches,buckling,stains,debris,and *** findings were used to analyze the relevance of microbiological *** Seventy-two abnormal visual inspection findings in the 19 duodenoscopes were found,including scratches(n=10,52.6%),buckling(n=15,78.9%),stains(n=14,73.7%),debris(n=14,73.7%),and fluids(n=6,31.6%).Duodenoscopes>12 mo old had a significantly higher number of abnormal visual inspection findings than those≤12 mo old(46 findings vs 26 findings,P<0.001).Multivariable regression analyses demonstrated that the bending section had a significantly higher risk of being scratched,buckled,and stained,and accumulating debris than the insertion *** and fluids showed a significant positive correlation with microbiological contamination(P<0.05).There was no significant positive Spearman’s correlation coefficient between negative bacterial cultures and debris,between that and fluids,and the concomitance of debris and *** result demonstrated that the presence of fluid and debris was associated with positive

关键词： Duodenoscope Working channel Visual inspection Microbiological surveillance Reprocessing Endoscope reprocessing

Eco-Environmental Impact Assessment of Pre-Leisure Beach Nourishment on the Benthic Invertebrate Community at Anping Coast

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China Ocean Engineering 2011年第2期25卷 215-236页

作者： Chun-Han SHIH Yi-Yu kuo Ta-Jen CHU Wen-Chieh CHOU Wei-Tse chang Ying-Chou LEE Institute of Fisheries Science National Taiwan University Taipei 10617 China Department of Civil Engineering National Chiao Tung University Hsinchu 30010 China Department of Leisure and Recreation Management Chung Hua University Hsinchu 30012 China Department of Civil Engineering Chung Hua University Hsinchu 30012 China

In recent years, owing to global warming and the rising sea levels, beach nourishment and groin building have been increasingly employed to protect coastal land from shoreline erosion. These actions may degrade beach habitats and reduce biomass and invertebrate density at sites where they were employed. We conducted an eco-environmental evaluation at the Anping artificial beach-nourishment project area. At this site, sand piles within a semi-enclosed spur groin have been enforced by use of eco-engineering concepts since 2003. Four sampling sites were monitored during the study period from July 2002 to September 2008. The environmental impact assessment and biological investigations that we conducted are presented here. The results from this study indicate that both biotic （number of species, number of individual organisms, and Shannon-Wiener diversity） and abiotic parameters （suspended solids, biological oxygen demand, chemical oxygen demand, dissolved inorganic nitrogen, dissolved inorganic phosphorus, total phosphorus, total organic carbon, median diameter, and water content） showed significant differences before and after beach engineering construction. Biological conditions became worse in the beginning stages of the engineering but improved after the restoration work completion. This study reveals that the composition of benthic invertebrates changed over the study period, and two groups of organisms, Bivalvia and Gastropoda, seemed to be particularly suitable to this habitat after the semi-enclosed artificial structures completion.

关键词： beach nourishment benthic invertebrate eco-engineering ecological restoration spur groin

A diagnostic dilemma:acute abdomen presenting as segmental arterial mediolysis masked by a ruptured hepatocellular carcinoma

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Gastroenterology Report 2017年第3期5卷 244-246,I0003页

作者： Chen-Yi Liao Wu-Hsien kuo En-Hua Huang An-Tie Hsieh Ching-chang Le Chi-chang Tsai Chao-Wen Hsueh Department of Medicine Kaohsiung Armed Forces General HospitalKaohsiungTaiwan

A 65-year-old male was brought to our hospital with right upper abdominal fullness sensation and recent body weight loss of about 3 *** patient had developed episodes of melena following progressive abdominal muscular guarding and drop of haemoglobin level to 6.3 g/*** abdominal computed tomography scan disclosed a ruptured hepatocellular cell carcinoma.A segmental arterial mediolysis was found on the superior mesenteric artery in the process of repairing the ruptured right hepatic artery with the assistance of *** embolization was carried out and permanent haemostasis was achieved.

关键词： segmental arterial mediolysis hepatocellular carcinoma

Performance Study on Priority Strategies for WDM Packet Switches under Long-Range Dependent Traffic

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光学学报 2003年第S1期23卷 745-746页

作者： Chia-Wei Yu Chao-Chih chang Shou-kuo Shao Jingshown Wu Institute of Communication Engineering and Department of Electrical Engineering Taiwan University Taipei TaiwanInstitute of Communication Engineering and Department of Electrical Engineering Taiwan University Taipei TaiwanShou-Kuo Shao is also with Chunghwa Telecom Labs.Institute of Communication Engineering and Department of Electrical EngineeringTaiwan University Taipei. Taiwan.

The impact of long-range dependent (LRD) traffic on the buffer management schemes for WDM packet switches is studied by simulation. The different priority strategies are compared. The principles of efficient strategy ... 详细信息

关键词： WDM with of Performance Study on Priority Strategies for WDM Packet Switches under Long-Range Dependent Traffic PBS PLP PE for on

AS1411 aptamer-conjugated Gd2O3：Eu nanoparticles for target-specific computed tomography/magnetic resonance/fluorescence molecular imaging

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Nano Research 2014年第5期7卷 658-669页

作者： Tsungrong kuo Weiyun Lai Chenghung Li Yanjhan Wun Huancheng chang Jinnshiun Chen Panchyr Yang Chiachun Chen Department of Chemistry 'National Taiwan Normal University' Taipei 116 Taiwan China Institute of Atomic and Molecular Science 'Academia Sinica' Taipei 106 Taiwan China Molecular Medicine Program Taiwan International Graduate Program Institute of Biomedical Sciences 'Academia Sinica' Taipei 115 Taiwan China Institute of Biochemistry and Molecular Biology School of Life Sciences 'National Yang-Ming University' Taipei 112 Taiwan China Division of Colorectal Surgery Chang Gung Memorial Hospital Chang Gung University Taoyuan 333 Taiwan China College of Medicine 'National Taiwan University' Taipei 106 Taiwan China

Europium-doped gadolinium oxide （Gd2O3：Eu） nanoparticles have been synthesized, and then their surfaces have been conjugated with nucleolin- targeted AS1411 aptamer to form functionalized target-specific Gd2OB：EU nanoparticles （A-GdO：Eu nanoparticles）. The A-GdO：Eu nanoparticles present strong fluorescence in the visible range, high magnetic susceptibility, X-ray attenuation and good biocompatibility. The A-GdO：Eu nanoparticles have been applied to test molecular expression of nucleolin highly expressed CL1-5 lung cancer cells under a confocal microscope. Fluorescence imaging clearly reveals that the nanoparticles can be applied as fluorescent tags for cancer-targeting molecular imaging. Furthermore, taking together their excellent T1 contrast and strong computed tomography （CT） signal, the A-GdO：Eu nanoparticles demonstrate a great capability for use as a dual modality contrast agent for CT and magnetic resonance （MR） molecular imaging. Animal experiments also show that the A-GdO：Eu nanoparticles are able to contrast the tissues of BALB/c mice using CT modality. Moreover, the obvious red fluorescence of A-GdO：Eu nanoparticles can be visualized in a tumor by the naked eye. Overall, our results demonstrate that the A-GdO：Eu nanoparticles can not only serve as new medical contrast agents but also as intraoperative fluorescence imaging probes for guided surgery in the near future.

关键词： aptamer contrast agent Gd2O3 nanoparticles molecular imaging nanoparticles synthesis

Analysis and design of a smart card based authentication protocol

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Journal of Zhejiang University-Science C(Computers and Electronics) 2013年第12期14卷 909-917页

作者： kuo-Hui YEH kuo-Yu TSAI Jia-Li HOU Department of Information Management National Dong Hwa University Department of Management Information Systems Hwa Hsia Institute of Technology

Numerous smart card based authentication protocols have been proposed to provide strong system security and robust individual privacy for communication between parties these days. Nevertheless, most of them do not provide formal analysis proof, and the security robustness is doubtful. chang and Cheng(2011) proposed an efficient remote authentication protocol with smart cards and claimed that their proposed protocol could support secure communication in a multi-server environment. Unfortunately, there are opportunities for security enhancement in current schemes. In this paper, we identify the major weakness, i.e., session key disclosure, of a recently published protocol. We consequently propose a novel authentication scheme for a multi-server environment and give formal analysis proofs for security guarantees.

关键词： Authentication Privacy Security Smart card

A cohort study of hospitalized adult dengue patients with fatality in Taiwan: The elderly and febrile characteristics matter for prognosis

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Asian Pacific Journal of Tropical Medicine 2020年第7期13卷 301-307页

作者： Tsung-Hang kuo Chia-chang Chuang Chin-Chung Tseng Ming-Yuan Hong Sheng-Hsiang Lin Institute of Clinical Medicine College of MedicineNational Cheng Kung UniversityTainan 70403 Department of emergency National Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainan 70403 Department of Internal Medicine National Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainan 70403 Biostatistics Consulting Center National Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainan 70403 Department of Public Health College of MedicineNational Cheng Kung UniversityTainan 70403

Objective:To identify the febrile characteristics and clinical presentations associated with fatality in hospitalized adult patients with dengue virus(DENV)***:A total of 289 adult hospitalized patients with laboratoryconfirmed DENV infections were examined,of which 22 were fatal and 267 were non-fatal.A comparison of the clinical and laboratory characteristics was retrospectively conducted of the deceased and surviving *** logistic regression and receiver operating characteristic curve analysis were performed to identify predictors of ***:Fatal patients exhibited significantly more comorbidities,particularly renal and cardiac comorbidities,and they were,in general,older than control individuals(P<0.0001).The results of logistic regression analysis showed that febrile duration of less than four days before arriving in the Emergency Department(OR=5.34;95%CI:1.39–20.6),episode of hypotension in the Emergency Department(OR=6.95;95%CI:2.40–20.1),and comorbidity with congestive heart failure(OR=11.26;95%CI:2.31–54.79)were all significantly associated with inpatient fatality due to DENV *** ROC curve analysis indicated that the final prognostic model yielded an area under the curve of 0.87(95%CI:0.79–0.97)for ***:The aforementioned clinical findings may help clinicians predict fatality among adult inpatients with DENV infection.

关键词： Dengue Hospitalized patient Adult Fatality Febrile duration Hypotension

Fractionated evaluation of immunohistochemical hormone receptor expression enhances prognostic prediction in breast cancer patients treated with tamoxifen as adjuvant therapy

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2010年第1期11卷 1-9页

作者： Ching-hung LIN Huang-chun LIEN Fu-chang HU Yen-shen LU Sung-hsin kuo Ling-chu WE San-lin YOU Ann-lii CHENG King-jen chang Department of Oncology National Taiwan University Hospital Taiwan Taipei 10016 Department of Pathology National Taiwan University Hospital Taiwan Taipei 10016 National Center of Excellence for General Clinical Trial and Research National Taiwan University Hospital Taiwan Taipei 1001 6 Graduate Institute of Epidemiology College of Public Health National Taiwan University Taiwan Taipei 10055 Department of Surgery National Taiwan University Hospital Taiwan Taipei 10016

Objective： To compare the prognostic prediction between dichotomized and fractionated evaluations of hormone receptor expressions. Methods： Patients with stages Ⅰ-Ⅲ breast cancers, who received adjuvant tamoxifen, were enrolled. The expression of estrogen receptor （ER） and progesterone receptor （PR） was evaluated by immu- nohistochemistry （IHC）. A fractionated score （F score）, the percentage of positive-staining nuclei （0=none, 1=1%-10% 2= 11%-30%, 3=31%-50%, 4=51%-70%, and 5=71%-100%）, was assigned to each case. The dichotomized scoring method defines an F score 〉1 as positive. The prognostic values of both scores were compared by multiple Cox＇s proportional hazard models of disease-free survival （DFS） and overall survival （OS）. Results： Four hundred and six- teen patients with a median follow-up of 78.0 months were included. F scores for ER and PR correlated directly with DFS and OS. Although both the dichotomized and fractionated ER and PR scores were significantly associated with DFS and OS in univariate analyses, only fractionated ER and PR scores remained as independent prognostic factors of DFS and OS in the final multiple Cox＇s proportional hazard models. Conclusion： Fractionated IHC hormone receptor expression evaluation enhances the prognostic prediction compared with a dichotomized assessment.

关键词： Breast cancer Fractionated evaluation Estrogen receptor Progesterone receptor

Endometriosis coexisting with dermoid cyst in a single ovary： a case report

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Chinese Medical Journal 2011年第4期124卷 627-630页

作者： CHEN Tsai-chuan kuo Hsu-tung SHYU Shin-kuo CHU Chih-ping chang Tien-chang Department of Obstetrics and Gynecology Lin-Shin Medical Corporation Lin-Shin Hospital Department of Family Medicine Lin-Shin Medical Corporation Lin-Shin Hospital Graduate Institute of Biomedical Engineering National Chung Hsing UniversityTaichung 408 TaiwanChina Department of Anatomical Pathology Lin-Shin Medical Corporation Lin-Shin Hospital chang Tien-chang General Clinic Taichung 408 TaiwanChina

Endometriosis coexisting with a dermoid cyst of the ovary is extraordinarily rare, although these both benign conditions are said to be common in women in the reproductive age group. There are only two previous case reports, which is evident from our literature review from January 1960 through January 2010. Acute abdomen is one of the greatest diagnostic challenges and easily ignored by the clinicians to exclude the possibility of gynecologic illness. A 35-year-old woman was referred by the doctor in Family clinic. She experienced a three-day period of severe right lower abdominal pain and intermittent vomiting. Ultrasonography identified a bilocular, cystic, hypoechoic, and hyperechoic tumor, 7 cm×6 cm×6 cm in the right adnexal region. Laparoscopic cystectomy was performed under the impression of ovarian cyst with torsion or hemorrhage. The frozen section was benign and appendiceal status was adequate. Histopathologic examination described an ovarian cyst composed of endometrial-type lining with stroma cells （endometriosis） and benign terotoma tissue with plenty of skin appendages and sebaceous glands. We report this unusual and interesting ovarian mass to remind physicians that the usage of the Endobag after cystectomy, the benefits on minimizing operative time, spilled opportunity, and postoperative complications. Laparoscopic techniques for large ovarian masses might be considered. The experience of the surgeon is also very important to prevent misdiagnosis or complication. Further follow up is mandatory for this simultaneous finding of ovarian endometriosis with coincidental dermoid cyst as a separate pathology in single ovary of such a nature. It also presents a challenge to the clinicians and to the pathologists.

关键词： endometriosis dermoid cyst cystectomy endobag