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Current status in the treatment options for esophageal achalasia

World Journal of Gastroenterology 2013年第33期19卷 5421-5429页

作者： Seng-Kee Chuah chien-hua chiu Wei-Chen Tai Jyong-Hong Lee Hung-I Lu Chi-Sin Changchien Ping-Huei Tseng Keng-Liang Wu Gastrointestinal Motility Unit Division of HepatogastroenterologyKaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine Division of General Medicine Department of MedicineKaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine Digestive Disease Center Department of Medical ResearchShow-Chwan Memorial Hospital Division of Thoracic and Cardiovascular Surgery Kaohsiung Chang Gung Memorial Hospital Department of Internal Medicine Graduate Institute of Clinical MedicineNational Taiwan University Hospital and College of MedicineNational Taiwan University

Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy(POEM).The first multicenter randomized,controlled,2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy(LHM)was not superior to pneumatic dilations(PD).Publications on the long-term success of laparoscopic surgery continue to *** addition,laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior *** optimal treatment option is an ongoing matter of *** this review,we provide an update of the current progress in the treatment of esophageal *** new conclusive data prove otherwise,LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated ***,PD is the first choice for non-surgical treatment and is more *** PD according to an"on-demand"strategy based on symptom recurrence can achieve long-term *** making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment *** has shown promise but its long-term efficacy and safety need to be assessed further.

关键词： Esophageal achalasia Endoscopic pneumatic dilations Botulinum injection Peroral endoscopic myotomy Minimally invasive Heller myotomy

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Three New Cucurbitacins from Hemsleya lijiangensis

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Chinese Chemical Letters 2003年第4期14卷 389-392页

作者： Ming hua chiu Juan GAO State Key Laboratory of Phytochemistry and Plant Resource in West China Kunming Institute of BotanyChinese Academy of SciencesKunming 650204

Three new cucurbitacins were isolated from the BuOH extract of the rhizomes of Hemsleya lijiangensis. Their structures were elucidated as 23, 24 -dihydro cucurbitacin F-16, 25-diacetate(1), 23, 24-dihydro cucurbitacin F-16, 25-diacetate-2-O-β-D glucopyranoside (2), 23, 24-dihydro-cucurbitacin F-16-acetate(3), respectively; by spectral analyses.

关键词： Hemsleya lijiangensis Cucurbitaceae Hemslecins D, E, F.

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SPIN WAVES IN MAGNETIC SUPERLATTICES

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Chinese Physics Letters 1984年第2期1卷 92-94页

作者： MA Hong-ru TSAI chien-hua Institute of Solid State Physics Nanjing UniversityNanjing Institute of Solid State Physics Nanjing UniversityNanjingand Department of PhysicsChiao-tung UniversityShanghai

We discuss,in terms of a simple model,the spin wave excitations,spontaneous magnetization and response to alternating fields of magnetic superlattices.

关键词： excitation magnetization alternating

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Neuroprotective effects of statins against amyloid β-induced neurotoxicity

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Neural Regeneration Research 2018年第2期13卷 198-206页

作者： Hsin-hua Li Chih-Li Lin chien-Ning huang Institute of Medicine Chung Shan Medical University Department of Medical Research Chung Shan Medical University Hospital Department of Internal Medicine Chung Shan Medical University Hospital

A growing body of evidence suggests that disruption of the homeostasis of lipid metabolism affects the pathogenesis of Alzheimer＇s disease （AD）. In particular, dysregulation of cholesterol homeostasis in the brain has been reported to considerably increase the risk of developing AD. Thus, dysregulation of lipid homeostasis may increase the amyloid β （Aβ） levels by affecting amyloid precursor protein （APP） cleavage, which is the most important risk factor involved in the pathogenesis of AD. Previous research demonstrated that Aβ can trigger neuronal insulin resistance, which plays an important role in response to Aβ-induced neurotoxicity in AD. Epidemiological studies also suggested that statin use is associated with a decreased incidence of AD. Therefore, statins are believed to be a good candidate for conferring neuropro- tective effects against AD. Statins may play a beneficial role in reducing A^-induced neurotoxicity. Their effect involves a putative mechanism beyond its cholesterol-lowering effects in preventing A[3-induced neurotoxicity. However, the underlying molecular mechanisms of the protective effect of statins have not been clearly determined in Aβ-induced neurotoxicity. Given that statins may provide benefits beyond the inhibition of 3-hydroxy-3-methylglutaryl coenzyme A （HMG-CoA） reductase, these drugs may also improve the brain. Thus, statins may have beneficial effects on impaired insulin signaling by activating AMP-activated protein kinase （AMPK） in neuronal cells. They play a potential therapeutic role in targeting Aβ-mediated neurotoxicity.

关键词： statins neuroprotective effects amyloid E-induced neurotoxicity insulin signaling AMP-activated protein kinase

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Cystic lymphangioma of the jejunal mesentery in an adult: A case report

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World Journal of Gastroenterology 2005年第32期11卷 5084-5086页

作者： Sheng-Der Hsu chien-hua Lin Jyh-Cherng Yu Division of General SurgeryDepartment of Surgery Department of PathologyTri-Service General HospitalTaipeiTaiwanChina

We herein describe the case of a 27-year-old female, who presented with a large mass of the upper left abdominal cavity discovered incidentally, through an annual health examination. Preoperative studies including abdominal ultrasonography and magnetic resonance imaging were performed, but they could not accurately determine the nature of the tumor. At laparotomy, a large cystic tumor of the small bowel mesentery was found. Histopathologic examination diagnosed the tumor as a cystic *** lymphangiomas are rare, especially in the abdomen of adults, they may sometimes present as acute abdomen,causing complications that require emergent surgery.

关键词： Jejunum Lymphangioma Small bowel mesentery

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Two New Compounds from Hemsleya penxianensis var. gulinensis

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Chinese Chemical Letters 2003年第2期14卷 169-172页

作者： Yu Ping LIN Ming hua chiu 等 StateKeyLaboratoryofPhytochemistryandPlantResourcesinWestChina.KunmingInstituteofBotany TheChineseAcademyofSciencesKunming650204 StateKeyLaboratoryofPhytochemistryandPlantRe

Two new compounds, oleanolic acid 28-O--D-glucopyranosyl-3-O--L-arabinopyrano- syl-(13)-(6-butyl ester)--D-glucuropyranoside 1, oleanolic acid 28-O--D-glucopyranosyl- (16)--D-glucopyranoside 2 have been isolated from the roots of Hemsleya penxianensis var. gulinensis. Their structures were determined on the bases of the spectral and chemical evidences.

关键词： Hemsleya penxianensis var. gulinensis cucurbitaceae oleanolic acid 28-O--D-glucop -yranosyl-3-O--L-arabinopyranosyl-(13)-(6-butyl ester)--D-glucuropyranoside oleanolic acid 28-O--D-glucopyranosyl-(16)--D-glucopyranoside.

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An Experi mental Study on Wave-Induced Dynamic Stresses in Seabed

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China Ocean Engineering 2006年第1期20卷 27-44页

作者： S.C.Chang L.K.chien J .G.Lin Y.F.chiu Department of Harbor and River Engineering National Taiwan Ocean University Taiwan China Harbor and Marine Technology Center Taiwan China

A series of hydraulic model tests with horizontal movable seabed under regular wave actions have been carried out to investigate the dynamic interactions between water waves and seabed soil. Seabed dynamic stresses from experiments are, tound to differ from theoretical resuhs. The response of p0 in permeable seabed has a small decay and phase shift to the nonlinear wave actions, and the dynamic stresses, σs/p0, σh/p0 and u/p0, contain different phase shift characteristics. Such phenomena will strongly affect the dynamic stress path in seabed. If the phase shifts of σs. and σh are neglected, the stress path will become a straight line; otherwise, it will become an elliptical curve. In phase shift cases, the long axis of the p - q diagram will be shortened when the depth increases, and the short axis will become longer when the phase shift increases. For the p＇ - q＇ diagram, the larger the phase lag of u, the longer the short axis. Relative results offer useful information for the analysis of seabed stability.

关键词： wave-induced dynamic stresses movable seabed hydraulic model test stress path

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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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Lymphoepithelioma-like cholangiocarcinoma:A mimic of hepatocellular carcinoma on imaging features

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World Journal of Gastroenterology 2015年第13期21卷 4089-4095页

作者： Tsan-Chieh Liao chien-An Liu Nai-Chi chiu Yi-Chen Yeh Yi-You Chiou Department of Radiology Taipei Veterans General Hospital National Yang-Ming University School of Medicine Department of Pathology Taipei Veterans General Hospital

Primary lymphoepithelioma-like carcinoma in the liver is extremely rare. A few cases of lymphoepithelioma-like cholangiocarcinoma have been reported, but few radiologic features were described. We reviewed 23 cases of lymphoepithelioma-like cholangiocarcinoma reported between 1996 and 2014 and describe a rare case of a 35-year-old woman in our hospital who was diagnosed with lymphoepithelioma-like cholangiocarcinoma of the liver and was a hepatitis B carrier. The tumor(1.6 cm) in our patient appeared to be hypoechoic in sonographic images and hypodense in computed tomography(CT) images. In addition, it was homogeneous hypointense in T1-weighted magnetic resonance(MR) images(MRI) and hyperintense in T2-weighted MRI. Dynamic gadolinium-enhanced MRI showed typical image pattern of hepatocellular carcinoma(HCC). The patient underwent a laparoscopic left hepatic lobectomy, and the resected tumor consisted of well-differentiated glandular cells with extensive lymphocytic infiltration that were immunoreactive to CK(AE1/AE3), CD3, and CD20. In addition, the tumor was positive for Epstein-Barr virus-encoded RNA in situ hybridization. Finally, lymphoepithelioma-like cholangiocarcinoma was diagnosed. In previous studies, the incidence is highest among middle-aged people. Most tumors appeared to be hypodense with either hypovascular or hypervascular patterns in CT images. This case report is the first study to address sonography, CT, and MRI observations and delineate pathologic correlations. We suggest that the imaging pattern of lymphoepithelioma-like cholangiocarcinoma, either the typical cholangiocarcinoma pattern or a mimic of HCC, should be considered in the differential lists for HCC.

关键词： Epstein-Barr virus Hepatocellular carcinoma Lympho

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Combined immune checkpoint inhibitors of CTLA4 and PD-1 for hepatic melanoma of unknown primary origin: A case report

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World Journal of Clinical Cases 2021年第11期9卷 2641-2648页

作者： An-Che Cheng Yi-Jia Lin Sung-hua chiu Yu-Lueng Shih Department of Internal Medicine Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Radiology Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Department of Internal Medicine Division of GastroenterologyTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan

BACKGROUND Melanoma is uncommonly found in lymph nodes,subcutaneous tissue,or visceral organs without a primary lesion,where it is identified as metastatic melanoma with unknown primary(MUP).Hepatic MUP is extremely rare and has a poor *** is limited information on its pathogenesis,clinical and imaging features,and pathological *** are no guidelines for the use of immune checkpoint inhibitors(ICIs)in hepatic MUP,and the treatment outcome has rarely been *** SUMMARY A 42-year-old woman presented to our hospital with hepatic tumors found incidentally during a routine ***-enhanced abdominal computerized tomography showed multiple mass lesions in the *** results revealed melanoma,which was confirmed by immunohistochemical staining for HMB-45(+),Melan-A(+),S-100(+),and SOX10(+).There was no evidence of primary cutaneous,ocular,gastrointestinal,or anal lesion on a comprehensive *** patient was diagnosed with hepatic *** received combined antibodies against cytotoxic T-lymphocyte-associated antigen 4(CTLA-4,ipilimumab)and programmed death protein-1(PD-1,nivolumab).She died of hepatic failure 9 mo after hepatic MUP was *** the first case of hepatic MUP treated with combined ipilimumab and nivolumab,who showed better outcome than previous *** ICIs of PD-1 and CTLA-4 may be considered as the first-line therapyfor patients with hepatic MUP.

关键词： Metastatic melanoma with unknown primary Liver metastasis Immune checkpoint inhibitor Programmed death protein-1 Cytotoxic T-lymphocyte-associated antigen 4 Case report

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