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A new look at anti-Helicobacter pylori therapy

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World Journal of Gastroenterology 2011年第35期17卷 3971-3975页

作者： seng-kee chuah Feng-Woei Tsay Ping-I Hsu Deng-Chyang Wu Division of Gastroenterology Kaohsiung Chang Gung Memorial HospitalCollege of MedicineChang Gung University833 KaohsiungTaiwan Division of Gastroenterology Department of Internal MedicineKaohsiung Veterans General HospitalNational Yang-Ming University813 KaohsiungTaiwan Department of General Medicine School of MedicineCollege of MedicineTaipei Medical University110 TaipeiTaiwan Department of Internal Medicine Kaohsiung Medical University Hospital807 KaohsiungTaiwan

With the rising prevalence of antimicrobial resistance,the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e.,80% or less) in most countries.Therefore,several treatment regimens have emerged to cure Helicobacter pylori (H.pylori) infection.Novel first-line anti-H.pylori therapies in 2011 include sequential therapy,concomitant quadruple therapy,hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy.After the failure of standard triple therapy,a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI),bismuth,tetracycline and metronidazole can be employed as rescue treatment.Recently,triple therapy combining a PPI,levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy.This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects.The best second-line therapy for patients who fail to eradicate H.pylori with first-line therapies containing clarithromycin,amoxicillin and metronidazole is unclear.However,a levofloxacin-based triple therapy is an accepted rescue treatment.Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test.Nonetheless,an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H.pylori infection if antimicrobial sensitivity data are unavailable.

关键词：幽门螺杆菌治疗方案抗生素耐药性左氧氟沙星面貌质子泵抑制剂抢救治疗阿莫西林

Endosonographic surveillance of 1-3 cm gastric submucosal tumors originating from muscularis propria

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World Journal of Gastroenterology 2017年第12期23卷 2194-2200页

作者： ming-luen hu keng-liang wu chi-sin changchien seng-kee chuah yi-chun chiu division of hepato-gastroenterology department of internal medicine kaohsiung chang gung memorial hospital and chang gung university college of medicine

AIM To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria(SMTMPs).METHODS By reviewing the computerized medical records over a period of 14 years(2000-2013), patients with 1-3 cm gastric SMTMPs who underwent at least two endoscopic ultrasound(EUS) examinations were enrolled. Tumor progression was defined as a ≥ 1.2 times enlargement in tumor diameter observed during EUS surveillance. All patients were divided into stationary and progressive subgroups and further analyzed. We also reviewed the patients in the progressive subgroup again in 2016.RESULTS A total of 88 patients were studied, including 25 in the progressive subgroup. The mean time of EUS surveillance was 24.6 mo in the stationary subgroup and 30.7 mo in the progressive subgroup. Risk factors for tumor progression included larger tumor size and irregular border. Initial tumor size > 14.0 mm may be considered a cut-off size for predicting tumor progression. Seventeen patients underwent surgery, of whom 13 had gastrointestinal stromal tumors(GISTs) and 4 had leiomyomas. Tumor progression was found only in patients with GISTs. All of the tumors exhibited benign behaviors without metastasis until 2016.CONCLUSION Most 1-3 cm gastric SMTMPs(71.6%) are indolent. Tumor progression was found only in GISTs, and it is a good predictor for differentiating GISTs from leiomyomas. Predictors of tumor progression include larger tumor size(> 14.0 mm) and irregular border.

关键词： Gastrointestinal stromal tumor Submucosal tumors originating from the muscularis propria Stomach Endosonographic surveillance

Understanding pediatric surgical needs in North Korea: a modeling analysis

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World Journal of Pediatric Surgery 2024年第1期7卷 47-53页

作者： Phillip J Hsu Sangchul Yoon kee B Park University of Michigan Ann ArborMichiganUSA Department of Global Health and Social Medicine Harvard Medical SchoolBostonMassachusettsUSA Department of Medical Humanitiesand Social Sciences Yonsei University SeoulSouth Korea

Background Sixty-five percent of children worldwide lack access to surgical care,the majority of whom live in low-income and middle-income countries(LMiCs).Developing surgical infrastructure requires information on surgical need;however,this information is often limited in LMICs.North Korea(Democratic People's Republic of Korea,DPRK)has a low amount of publicly available data.Here,we analyzed available modeled data to understand the causes of pediatric deaths due to conditions treatable with surgery in DPRK.Methods We used World Bank data and models from the Institute for Health Metrics and Evaluation to identify causes of pediatric deaths affecting pediatric patients(age<20 years).We compared mortality of disease between DPRK and countries with similar economic status.Results Between 1990 and 2019,the number of overall pediatric deaths has decreased.In 2019,32.2%of allpediatric deaths in DPRK were caused by surgical conditions.The leading categories of surgical conditions were injuries(53.9%),congenital conditions(34.2%),tumors(8.8%),and abdominal conditions(3.2%).DPRK has a lower relative rate of pediatric deaths compared with other LMICs with similar gross domestic product per capita.However,it has a higher relative rate of pediatric deaths due to conditions requiring treatment with surgery.Transport injuries contribute significantly to the high rate of pediatric deaths in DPRK.Conclusions Although DPRK may be allocating overall resources toward pediatric healthcare more efficiently than economic peers,DPRK may benefit from improvement in pediatric surgical capacity.Improved availability of data and close international collaboration could be potential solutions to bridge this gap.

关键词： pediatric surgical injuries

2011 update on esophageal achalasia

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World Journal of Gastroenterology 2012年第14期18卷 1573-1578页

作者： seng-kee chuah Pin-I Hsu Keng-Liang Wu Deng-Chyang Wu Wei-Chen Tai Chi-Sin Changchien Division of Gastroenterology Kaohsiung ChangGung Memorial Hospital College of Medicine Chang GungUniversity Kaohsiung 833 Taiwan Division of Gastroenterology Department of Inter-nal Medicine Kaohsiung Veterans General Hospital NationalYang-Ming University Kaohsiung 813 Taiwan Cancer Center Division of Gastroenterol-ogy Department of Internal Medicine Kaohsiung MedicalUniversity Hospital Kaohsiung Medical University Kaohsiung807 Taiwan

There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years.First,the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtypes.The most favorable outcome is predicted for patients receiving treatment for type Ⅱ achalasia (achalasia with compression).Patients with typeⅠ(classic achalasia) and type Ⅲ achalasia (spastic achalasia) experience a less favorable outcome.Second,the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD).Although the follow-up period was not long enough to reach a convincing conclusion,it merits the continued use of PD as a generally available technique in gastroenterology.Third,the novelendoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia,but it requires increased experience and cautious evaluation.Despite all this good news,the bottom line is a real break-through from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated.

关键词：弛缓随机对照试验诊断工具 ic技术 Ⅱ型糖尿病高分辨率胃肠病学基础研究

Recent Advances in Patterning Strategies for Full‑Color Perovskite Light‑Emitting Diodes

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Nano-Micro Letters 2024年第3期16卷 99-137页

作者： Gwang Heon Lee Kiwook Kim Yunho Kim Jiwoong Yang Moon kee Choi Graduate School of Semiconductor Materials and Devices Engineering Center for Future Semiconductor Technology(FUST)Ulsan National Institute of Science and Technology(UNIST)Ulsan 44919Republic of Korea Department of Energy Science and Engineering Daegu Gyeongbuk Institute of Science and Technology(DGIST)Daegu 42988Republic of Korea Energy Science and Engineering Research Center Daegu Gyeongbuk Institute of Science and Technology(DGIST)Daegu 42988Republic of Korea Department of Materials Science and Engineering Ulsan National Institute of Science and Technology(UNIST)Ulsan 44919Republic of Korea Center for Nanoparticle Research Institute for Basic Science(IBS)Seoul 08826Republic of Korea

Metal halide perovskites have emerged as promising light-emitting materials for next-generation displays owing to their remarkable material characteristics including broad color tunability,pure color emission with remarkably narrow bandwidths,high quantum yield,and solution processability.Despite recent advances have pushed the luminance efficiency of monochromic perovskite light-emitting diodes(PeLEDs)to their theoretical limits,their current fabrication using the spincoating process poses limitations for fabrication of full-color displays.To integrate PeLEDs into full-color display panels,it is crucial to pattern red–green–blue(RGB)perovskite pixels,while mitigating issues such as cross-contamination and reductions in luminous efficiency.Herein,we present state-of-the-art patterning technologies for the development of full-color PeLEDs.First,we highlight recent advances in the development of efficient PeLEDs.Second,we discuss various patterning techniques of MPHs(i.e.,photolithography,inkjet printing,electron beam lithography and laserassisted lithography,electrohydrodynamic jet printing,thermal evaporation,and transfer printing)for fabrication of RGB pixelated displays.These patterning techniques can be classified into two distinct approaches:in situ crystallization patterning using perovskite precursors and patterning of colloidal perovskite nanocrystals.This review highlights advancements and limitations in patterning techniques for PeLEDs,paving the way for integrating PeLEDs into full-color panels.

关键词： Perovskite Light-emitting diode Full-color display High-resolution patterning Electroluminescence

Gastric juice acidity in upper gastrointestinal diseases

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World Journal of Gastroenterology 2010年第43期16卷 5496-5501页

作者： Pei-Jung Lu Ping-I Hsu Chung-Hsuan Chen Michael Hsiao Hui-Hwa Tseng Kung-Hung Lin seng-kee chuah Institute of Clinical Medicine National Cheng Kung University Division of Gastroenterology Department of Internal Medicine Kaohsiung Veterans General Hospital National Yang-Ming University Genomics Research Center Academic Sinica Department of Pathology Kaohsiung Veterans General Hospital and National Yang-Ming University Division of Gastroenterology Chang Gung Memorial Hospital Kaohsiung Medical Center College of Medicine Chang Gung University

AIM: To search the independent factors determining gastric juice acidity and to investigate the acidity of gastric juices in various benign and malignant upper gastrointestinal diseases. METHODS: Fasting gastric juice acidity of 165 healthysubjects and 346 patients with esophageal ulcer (n = 21), gastric ulcer (n = 136), duodenal ulcer (n = 100) or gastric cancer (n = 89) were measured and compared. Additionally, gastric specimens were taken from the antrum and body for rapid urease test and histological examination. RESULTS: Multivariate analysis revealed that bile stain of gastric juice, high acute inflammatory score of the corpus, and atrophy of the corpus were independent risk factors for the development of gastric hypoacidity with odds ratios of 3.1 (95% CI: 1.3-7.3), 3.1 (95% CI: 1.2-7.9) and 3.5 (95% CI: 1.3-9.2). Esophageal ulcer and duodenal ulcer patients had a lower pH level (1.9 and 2.1 vs 2.9, both P < 0.05) of gastric juices than healthy subjects. In contrast, gastric ulcer and gastric cancer patients had a higher pH level (3.4 and 6.6 vs 2.9, both P < 0.001) than healthy controls. Hypoacidity existed in 22%, 5%, 29%, 5% and 88% of healthy subjects, esophageal ulcer, gastric ulcer, duodenal ulcer and gastric cancer patients, respectively. CONCLUSION: Bile reflux, atrophy and dense neutrophil infiltrate of the corpus are three independent factors determining the acidity of gastric juice.

关键词： Acidity Gastric juice Gastric cancer Peptic ulcer Esophageal ulcer

Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers

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World Journal of Gastroenterology 2010年第43期16卷 5490-5495页

作者： Ming-Luen Hu King-Wah Chiu Yi-Chun Chiu Yeh-Pin Chou Tsung-Hui Hu Shue-Shian Chiou seng-kee chuah Division of Hepatogastroenterology Department of Internal Medicine Chang Gung Memorial Hospital-Kaohsiung Medical Center Chang Gung University College of Medicine

AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.

关键词： Epinephrine injection High-risk ulcers Initial hemostasis Predictors Rebleeding

The Cause of Institutionalized Private Tutoring in Korea:Defective Public Schooling or a Universal Desire for Family Reproduction?

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ECNU Review of Education 2024年第1期7卷 12-41页

作者： Sang Hoon Bae kee Ho Choi Sungkyunkwan University Seoul National University

Purpose:In Korea,private tutoring is considered a social evil that damages the capacity of public schooling and undermines social justice.Although the government has implemented various policies to reduce private tutoring,ranging from improving the quality of education to providing"quasi-private tutoring"programs and regulating the shadow education market,total spending on private tutoring has continued to increase.This study examines a little noticed but important cause of institutionalized private tutoring in Korea.Design/Approach/Methods:The study employed a socio-ecological perspective to analyze both education and socio-structural factors.An extensive review of the government's private tutoring reduction policies and related literature was conducted.Findings:Private tutoring functions as a means by which parents can help their children compete for admission to prestigious universities and pass on wealth and social status to their children.Participation in private tutoring has become a social norm that is taken for granted.The root causes of institutionalized private tutoring lie in both educational and socio-structural factors.Originality/Nalue:The study suggests that government policies,when ignoring the long-established"grammar"of parents about children's education,may either end in failure or produce unintended consequences.

关键词： Private tutoring social reproduction unintended consequences upward mobility

Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia

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World Journal of Gastroenterology 2009年第35期15卷 4461-4463页

作者： Ming-Tzung Lin King-Wah Chiu Yeh-Pin Chou Ming-Chao Tsai Tsung-Hui Hu Chuan-Mo Lee Chi-Sin Changchien seng-kee chuah Division of Hepatogastroenterology Chang Gang Memorial Hospital Kaohsiung 123Ta-Pei RoadNiaosung HsiangKaohsiung Country 833TaiwanChina Chang Gung University College of MedicineKaohsiung 833TaiwanChina

Pneumatic dilation(PD)is considered to be a safe and effective first line therapy for achalasia.The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation.It has been reported that delayed management of perforation for more than 24 h is associated with high mortality.Surgery is the treatment of choice within 24 h,but the management of delayed perforation remains controversial.Hereby,we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia.She completely recovered after intensive medical care.A review of the literature is also discussed.

关键词：穿孔弛缓食管延迟气囊局部放电死亡率治疗