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Vitamin D for the prevention and treatment of pancreatic cancer

World Journal of Gastroenterology 2009年第27期15卷 3349-3354页

作者： kun-chun chiang Tai C Chen Department of Surgery Chang Gung Memorial Hospital Chang Gung University Taoyuan 333Taiwan China Boston University School of Medicine 715 Albany Street Boston MA 02118 United States

Pancreatic cancer is ranked fi fth among cancer-related deaths worldwide with a 5-year survival rate of less than 5%. Currently, surgery is the only effective therapy. However, most patients are diagnosed in the late stage and are not suitable for receiving curative surgery. Moreover, pancreatic cancer doesn't respond well to traditional chemotherapy and radiotherapy, leaving little effective treatment for advanced pancreatic cancer cases. 1α,25-dihydroxyvitamin D3 [1α,25(OH)2D3], the biologically active form of vitamin D3, was originally identifi ed during studies of calcium and bone metabolism, though it is now recognized that it exerts biological effects in almost every tissue in the body. Abundant evidence has shown that 1α,25(OH)2D3 has antiproliferative, apoptotic, pro-differentiation and antiangiogensis effects in many types of cancer cells in vivo and in vitro, including breast, prostate, and colon. Similarly, the antitumor growth effect of 1α,25(OH)2D3 on pancreatic cells has been demonstrated. The clinical use of 1α,25(OH)2D3 is impeded by the lethal side effects of hypercalcemia and hypercalciuria. Therefore, 1α,25(OH)2D3 analogs, which are either equipotent or more potent than 1α,25(OH)2D3 in inhibiting tumor cell growth but with fewer hypercalcemic and hypercalciuric side effects, have been developed for the treatment of different cancers. Recently, a pre-clinical study demonstrated that a less calcemic analog of 1α,25(OH)2D3, 19-nor-1α,25(OH)2D2 (Paricalcitol), is effective in inhibiting tumor growth in vitro and in vivo , via upregulation of p21 and p27 tumor suppressor genes. Studies on the anti-tumor effects of a more potent analog of Paricalcitol are underway.1α,25(OH)2D3 and its analogs are potentially attractive novel therapies for pancreatic cancer.

关键词： Vitamin D Pancreatic cancer Calcitriol Paricalcitol Chemoprevention Adenocarcinoma CYP27b1

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Advanced gastrointestinal stromal tumor patients with complete response after treatment with imatinib mesylate

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World Journal of Gastroenterology 2006年第13期12卷 2060-2064页

作者： kun-chun chiang Tsung-Wen Chen chun-Nan Yeh Hsiang-Lin Lee Department of Surgery and Nuclear Medicine Chang Gung Memorial Hospital Chang Gung UniversityTaoyuanTaiwanChina

AIM： Most gastrointestinal stromal tumors （GISTs） express constitutively activated mutant isoforms of kit kinase or platelet-derived growth factor receptor alpha （PDGFRA）, which are potential therapeutic targets for imatinib mesylate （Glivec）. Partial response occurred in almost two thirds of GIST patients treated with Glivec. However, complete response （CR） after Glivec therapy was sporadically reported. Here we illustrated advanced GIST patients with CR after Glivec treatment. METHODS： Between January 2001 and June 2005, 42 advanced GIST patients were treated with Glivec. Patients were administered 400 mg of Glivec in 100-mg capsules, taken orally daily with food. The response of the tumor to Glivec was evaluated after one month, three months, and every three months thereafter or whenever medical need was indicated. Each tumor of patients was investigated for mutations of kit or PDGFRA. RESULTS： The median follow-up time of the 42 ad-vanced GIST patients treated with Glivec was 16.9 months （range, 1.0- 47.0 months）. Overall, 3 patients had complete response CR （7.1%）, 26 partial response （67.8%）, 5 stationary disease （11.9%）, and 3 progressive disease （11.9%）. The median duration of Glivec administration for the three patients was 36 months （range, 23-36 months）. The median time to CR after Glivec treatment was 20 months （range, 9-26 months）. Deletion and insertion mutations of c-kit exon 11 and insertion mutation of c-kit exon 9 were found in two cases and one case, respectively. CONCLUSION： Complete response （CR） can be achieved in selected advanced GIST patients treated with Glivec. The median time to CR after Glivec treatment was 20 months. Deletion and insertion mutations of kit exon 11 and insertion mutation of kit exon 9 contribute to the genetic features in these selected cases.

关键词： GIST Complete response Imatinib mesylate

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Management of chronic pancreatitis complicated with a bleeding pseudoaneurysm

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World Journal of Gastroenterology 2014年第43期20卷 16132-16137页

作者： kun-chun chiang Tsung-Hsing Chen Jun-Te Hsu Department of Surgery Chang Gung Memorial Hospital at KeelungChang Gung University College of Medicine Department of Gastroenterology Chang Gung Memorial Hospital at LinkouChang Gung University College of Medicine Department of Surgery Chang Gung Memorial Hospital at LinkouChang Gung University College of Medicine

Chronic pancreatitis is an ongoing disease characterized by persistent inflammation of pancreatic tissues. With disease progression, patients with chronic pancreatitis may develop troublesome complications in addition to exocrine and endocrine pancreatic functional loss. Among them, a pseudoaneurysm, mainly induced by digestive enzyme erosion of vessels in proximity to the pancreas, is a rare and life-threatening complication if bleeding of the pseudoaneurysm occurs. At present, no prospective randomized trials have investigated the therapeutic strategy for this rare but critical situation. The role of arterial embolization, the timing of surgical intervention and even surgical procedures are still controversial. In this review, we suggest that dynamic abdominal computed tomography and angiography should be performed first to localize the bleeders and to evaluate the associated complications such as pseudocyst formation, followed by arterial embolization to stop the bleeding and to achieve early stabilization of the patient’s condition. With advances and improvements in endoscopic devices and techniques, therapeutic endoscopy for pancreatic pseudocysts is technically feasible, safe and effective. Surgical intervention is recommended for a bleeding pseudoaneurysm in patients with chronic pancreatitis who are in an unstable condition, for those in whom arterial embolization of the bleeding pseudoaneurysm fails, and when endoscopic management of the pseudocyst is unsuccessful. If a bleeding pseudoaneurysm is located over the tail of the pancreas, resection is a preferential procedure, whereas if the lesion is situated over the head or body of the pancreas, relatively conservative surgical procedures are recommended.

关键词： Chronic pancreatitis Pseudocyst Pseudoaneurysm bleeding Arterial embolization Endoscopy Surgery

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Prognostic analysis of patients with pancreatic head adenocarcinoma less than 2cm undergoing resection

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World Journal of Gastroenterology 2009年第34期15卷 4305-4310页

作者： kun-chun chiang chun-Nan Yeh Wei-Chen Lee Yi-Yin Jan Tsann-Long Hwang Pancreatic Cancer Team Department of SurgeryChang Gung Memorial Hospital Chang Gung University

AIM:To investigate the differences in clinicopathological features between patients with pancreatic cancer greater or less than 2 cm situated over the pancreatic head and the prognostic factors for survival of patients with pancreatic cancer2 cm)and 36 cases of small(S)-PAC(tumor≤2 cm).We compared the clinicopathological characteristics and prognosis of L-PAC and S-PAC *** clinicopathological characteristics of S-PAC were investigated to clarify the prognosis predictive factors of S-PAC. RESULTS:One hundred and fifty-nine PAC patients, aged 16-93 years(median,59.0 years)with a tumor at the pancreatic head undergoing intentional curative resection were *** S-PAC and L-PAC patients had similar demographic data,clinical features,and tumor markers(a similar positive rate of carcinoembryonic antigen and carbohy- drate antigen 19-9).There were also similar rates of lymph node metastasis,portal vein invasion,stage distribution,tumor differentiation,positive resection margin,surgical morbidity and mortality observedbetween the two *** a follow-up period ranging from 1.0 to 122.7 mo(median,10.9 mo), S-PAC and L-PAC patients had a similar prognosis after resection(P=0.4805).Among the S-PAC patients group,patients with higher albumin level(>3.5 g/dL) had more favorable survival than those with lower albumin levels,which was the only favorable predictive prognostic ***,early-staged(stageⅠ,Ⅱ) S-PAC patients tended to have a more favorable outcome than late-stage(stageⅢ,Ⅳ)S-PAC patients, but this was not statistically significant. CONCLUSION:S-PAC patients should not be regarded as early *** higher albumin level(>3.5 g/dL) an

关键词： Prognostic factor Pancreas Pancreatic head area Pancreatic cancer

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Primary squamous cell carcinoma of the liver:A successful surgically treated case

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World Journal of Gastroenterology 2006年第33期12卷 5419-5421页

作者： Hsiang-Lin Lee Yu-Yin Liu chun-Nan Yeh kun-chun chiang Tse-Ching Chen Yi-Yin Jan Department of Surgery Chang Gung Memorial Hospital Chang Gung University Taiwan China Department of Pathology Chang Gung Memorial Hospital Chang Gung University Taiwan China

Primary squamous cell carcinoma (SCC) of the liveris rare. Totally nine such cases have been reportedin the literature. Primary SCC of the liver has beenreported to be associated with hepatic teratoma,hepatic cyst, or hepatolithiasis. Complete remission ofpoorly differentiated SCC of the liver could be achievedby systemic chemotherapy followed by surgery orremarkably respond to hepatic arterial injection of lowdose chemotherapeutic drugs. Here we report the fi rstcase of primary SCC of the liver presenting as a solidtumor and receiving successful hepatic resection with9-mo disease free survival.

关键词： Squamous cell carcinoma Liver Surgery

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Multifocal intraductal papillary mucinous neoplasm of the pancreas-A case report

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World Journal of Gastroenterology 2009年第5期15卷 628-632页

作者： kun-chun chiang Jun Te Hsu Shyh Chuan Jwo Tsann-Long Hwang Yi-Yin Jan chun-Nan Yeh Department of Surgery Chang Gung Memorial Hospital Chang Gung University 5 Fu-Hsing Street Kwei-Shan Taoyuan Taiwan 333 China

Cystic neoplasms of the pancreas are relatively rare, comprising 10 percent of pancreatic cysts and only 1 percent of pancreatic cancers. Cystic neoplasms include mucinous cystic neoplasms, serous cystadenomas, papillary cystic tumors, cystic islet cell tumors and intraductal papillary mucinous neoplasms of the pancreas (IPMNs). IPMN was first described in 1982. It has been most commonly described in 60 to 70 years old males, and represents a relatively ''new'' but increasingly recognized disease. The improvement and widespread use of modern imaging equipments and heightened awareness of physicians contribute to the increasing incidence of IPMN. The majority of IPMNs are located in the pancreatic head (75%) while the rest involves the body/tail regions. Multifocal IPMNs have been hypothesized, but the true presence of multifocality is unknown. Here we present a 72-yearold male diagnosed with IPMN (carcinoma in situ ) in the pancreatic head and a branch duct type IPMN (duct atypia) in the pancreatic body and tail. The patient underwent a Whipple intervention and a distal pancreatectomy. A three-year disease-free survival has been observed so far.

关键词： Intraductal papillary mucinous neoplasm Pancreas Multifocal Pancreatectomy Intraductalpapillary mucinous neoplasms

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Peliosis hepatis complicated by portal hypertension following renal transplantation

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World Journal of Gastroenterology 2014年第9期20卷 2420-2425页

作者： Chia-Ying Yu Liang-Che Chang Li-Wei Chen Tsung-Shih Lee Rong-Nan Chien Ming-Fang Hsieh kun-chun chiang Department of Gastroenterology Chang Gung Memorial Hospital and University at Keelung Department of Pathology Chang Gung Memorial Hospital and University at Keelung Division of Nephrology Department of Gastroenterology Chang Gung Memorial Hospital and University at Keelung Department of General Surgery Chang Gung Memorial Hospital and University at Keelung

Peliosis hepatis(PH)is a vascular lesion of the liver that mimics a hepatic *** is often associated with underlying conditions,such as chronic infection and tumor malignancies,or with the use of anabolic steroids,immunosuppressive drugs,and oral *** patients with PH are asymptomatic,but some present with abdominal distension and *** some cases,PH may induce intraperitoneal hemorrhage and portal *** study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal *** patient experienced progressive abdominal distention and pain in the six months prior to this ***,imaging studies revealed multiple liver tumor-like abnormalities,which were determined to be PH by pathological *** the hepatic lesions were progressively enlarged,the patient suffered from complications related to portal hypertension,such as intense ascites and esophageal varices *** the patient was scheduled to undergo liver transplantation,he suffered hepatic failure and died prior to availability of a donor organ.

关键词： Peliosis hepatis Liver neoplasm Portal hypertension Renal failure Renal transplantation

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Coupling Analysis of Multiple Machine Learning Models for Human Activity Recognition

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Computers, Materials & Continua 2024年第6期79卷 3783-3803页

作者： Yi-chun Lai Shu-Yin chiang Yao-chiang Kan Hsueh-chun Lin Department of Public Health China Medical UniversityTaichung406040Taiwan Department of Information and Telecommunications Engineering Ming Chuan UniversityGui-ShanTaoyuan333Taiwan Department of Electrical Engineering Yuan Ze UniversityChung-Li32003Taiwan Department and Institute of Health Service Administrations China Medical UniversityTaichung406040Taiwan

Artificial intelligence(AI)technology has become integral in the realm of medicine and healthcare,particularly in human activity recognition(HAR)applications such as fitness and rehabilitation *** study introduces a robust coupling analysis framework that integrates four AI-enabled models,combining both machine learning(ML)and deep learning(DL)approaches to evaluate their effectiveness in *** analytical dataset comprises 561 features sourced from the UCI-HAR database,forming the foundation for training the ***,the MHEALTH database is employed to replicate the modeling process for comparative purposes,while inclusion of the WISDM database,renowned for its challenging features,supports the framework’s resilience and *** ML-based models employ the methodologies including adaptive neuro-fuzzy inference system(ANFIS),support vector machine(SVM),and random forest(RF),for data *** contrast,a DL-based model utilizes one-dimensional convolution neural network(1dCNN)to automate feature ***,the recursive feature elimination(RFE)algorithm,which drives an ML-based estimator to eliminate low-participation features,helps identify the optimal features for enhancing model *** best accuracies of the ANFIS,SVM,RF,and 1dCNN models with meticulous featuring process achieve around 90%,96%,91%,and 93%,*** analysis using the MHEALTH dataset showcases the 1dCNN model’s remarkable perfect accuracy(100%),while the RF,SVM,and ANFIS models equipped with selected features achieve accuracies of 99.8%,99.7%,and 96.5%,***,when applied to the WISDM dataset,the DL-based and ML-based models attain accuracies of 91.4%and 87.3%,respectively,aligning with prior research *** conclusion,the proposed framework yields HAR models with commendable performance metrics,exhibiting its suitability for integration into the healthcare services system through AI-driven applications.

关键词： Human activity recognition artificial intelligence support vector machine random forest adaptive neuro-fuzzy inference system convolution neural network recursive feature elimination

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Energy-Based Collaborative Spectrum Sensing for Cognitive UWB Impulse Radio

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Journal of Electronic Science and Technology 2015年第2期13卷 174-180页

作者： Wei-chiang Wu chun-Te Wu Department of Electrical Engineering Da-Yeh University

This paper focuses on the issue of collaborative spectrum sensing in cognitive ultra wideband（CUWB） impulse radio. We employ energy-based signal detection method and apply the Neyman-Pearson（NP） decision rule to determine the optimum threshold. Two cooperative spectrum sensing schemes are developed in this paper. The decision fusion scheme is based on hard decision, in which each cooperating cognitive user（CU） sends its own local decision to the fusion center（FC）. The FC then makes a final decision according to the majority voting rule. Alternatively, the data fusion scheme is based on soft decision, in which each local CU sends its observed value directly to the FC. The FC combines these values, compares to a threshold and then makes the final decision. The performances of both schemes are studied by using analytical tools and computer simulations. The receiver operating characteristics（ROC）, which reveal the probability of detection versus false-alarm curve, are employed to evaluate the system performance under different scenarios. Simulation results demonstrate that the data fusion scheme outperforms the decision fusion scheme and verify that the collaborative spectrum sensing has practical importance in CUWB networks.

关键词： Impulse collaborative false Spectrum wideband alarm apply receiver verify scenarios

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Inter-granular liquid phase aiding grain boundary sliding in superplastic deformation of fine-grained ZK60 Mg alloy

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Transactions of Nonferrous Metals Society of China 2010年第B7期20卷 576-579页

作者： LEE Shyong chiang Chih-te CHU chun-lin HSU Chang-chuan Department of Mechanical Engineering National Central University Jhong-li Taiwan China chun-Shan Institute of Science Lung-tan Taiwan China

For 7475 Al alloy,there were micrographs showing filaments or whiskers formation during the separation stage of superplastic *** indicates the presence of liquid phase which accommodates grain boundary sliding to reach *** the other hand,there is no such phenomenon reported regarding Mg alloy in *** electron microscopic(SEM)fractography exceptionally exhibits a mark of grain boundary sliding and its accommodating mechanism of inter-granular liquid *** the testing conditions of 350℃ and 1×10- 4s -1,the initially fine-grained structure(3.7μm)yields 642%superplastic elongation and exhibits fluffy appearance on the fractured *** other specimens showing less superplasticity,their fractured surfaces exhibit partial fluffy appearance.

关键词： Mg alloy inter-granular phase grain boundary sliding superplastic deformation

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