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Pancreatic stent improves the success rate of needle-knife papillotomy in patients with difficult biliary cannulation

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World Journal of Gastroenterology 2025年第1期31卷 58-67页

作者： Mu-Hsien Lee Cheng-Hui Lin Chi-Huan Wu Yung-Kuan Tsou Kai-Feng Sung Sheng-Fu Wang Nai-Jen Liu Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital and Chang Gung University College of MedicineTaoyuan 33305Taiwan School of Medicine Chang Gung UniversityTaoyuan 33305Taiwan

BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed ***,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of *** To explore whether PS placement improves the success rate of NKP in patients with difficult biliary *** This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary *** cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's *** primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event *** Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP *** the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.

关键词： Difficult biliary cannulation Endoscopic retrograde cholangiopancreatography Needle-knife papillotomy Pancreatic stent Selective biliary cannulation

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Mesenteric ischemia with intrasplenic gas:A case report

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World Journal of Clinical Cases 2025年第7期13卷 52-56页

作者： Hsiang-Yu Tsang Chee-Chien Yong Hao-Ping Wang Department of Surgery Kaohsiung Chang Gung Memorial HospitalKaohsiung 833401Taiwan

BACKGROUND Acute mesenteric ischemia is a life-threatening *** gas is an extremely rare finding in such *** SUMMARY We report a case of a 79-year-old woman with a history of end-stage renal disease on hemodialysis for approximately 20 years,type 2 diabetes mellitus,and atrial fibrillation who presented with two days of epigastric pain.A computed tomography scan of the abdomen revealed intraperitoneal free air and significant intrasplenic *** revealed diffuse intestinal gangrene,and acute superior mesenteric ischemia was *** patient died within 24 hours owing to profound *** Intrasplenic gas is an extremely rare finding on computed tomography imaging in cases of acute mesenteric ischemia.

关键词： Acute mesenteric ischemia Spleen Hepatic portal venous gas Pneumatosis cystoides intestinalis Prognosis Case report

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Microplastic and nanoplastic exposure and risk of diabetes mellitus

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World Journal of Clinical Cases 2025年第3期13卷 24-29页

作者： Hui-Yi Hsiao Chung-Yi Nien Ruei-Feng Shiu Wei-Chun Chin Tzung-Hai Yen Department of Biomedical Sciences College of MedicineChang Gung UniversityTaoyuan 33302TaiwanChina Center for Tissue Engineering Chang Gung Memorial HospitalLinkouTaoyuan 33305TaiwanChina Department of Life Sciences National Central UniversityZhongli 320317TaoyuanTaiwanChina Center of Excellence for The Oceans Taiwan Ocean UniversityKeelung 20224TaiwanChina Institute of Marine Environment and Ecology Taiwan Ocean UniversityKeelung 20224TaiwanChina Department of Chemical and Materials Engineering University of California MercedMercedCA 95343United States Department of Nephrology Clinical Poison CenterChang Gung Memorial HospitalLinkou 33305TaoyuanTaiwanChina School of Traditional Chinese Medicine College of MedicineChang Gung UniversityTaoyuan 33302TaiwanChina

The issue of plastic pollutants has become a growing *** microplastics(MPs)(particle size<5 mm)and nanoplastics(NPs)(particle size<1μm)can cause DNA damage,cytotoxicity,and oxidative stress in various *** primary known impacts of microplastic/nanoplastic are observed in the liver and respiratory system,leading to hepatotoxicity and chronic obstructive pulmonary *** research on the effects of MPs and NPs on diabetes is still in its early stages,there are potential *** editorial highlights the risk to diabetics from co-exposure to contaminants and MPs/NPs,supported by evidence from animal studies and the various chemical compositions of MPs/NPs.

关键词： Microplastics Nanoplastics Plastic pollution,Diabetes mellitus Insulin resistance

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Coexistence of hepatoma with mantle cell lymphoma in a hepatitis B carrier

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World Journal of Gastroenterology 2015年第45期21卷 12981-12986页

作者： Mu-Hsien Lee Yu-Ching Lin Hao-Tsai Cheng Wen-Yu Chuang Hsin-Chih Huang Hsiao-Wen Kao Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Intervention and Imaging Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Pathology Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Hematology-Oncology Chang Gung Memorial Hospital and Chang Gung University College of Medicine

The coexistence of hepatocellular carcinoma(HCC) and non-Hodgkin's lymphoma(NHL) in the liver is rare. Reports show that these patients have cirrhotic livers or hepatitis virus infections before they develop HCC and NHL. We present a patient with hepatitis B virus infection who was transferred to our hospital with a newly detected liver mass; abdominal computed tomography examination showed one hypodense mass of 7 cm in diameter and multiple mesenteric and mediastinal lymph nodes. A liver tumor biopsy showed a hepatoma, and the pathologic findings from an inguinal lymph node excision showed mantle cell lymphoma. An immunohistochemical stain confirmed that the atypical lymphoid cells within the HCC were positive for the CD20, CD5 and cyclin D1 antigens. Taking these findings into account, the hepatic tumor was determined to be a HCC infiltrated by mantle cell lymphoma.

关键词： Hepatocellular carcinoma Mantle cell lymphoma Hepa

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Coagulation factor Ⅶ gene polymorphisms are not associated with the occurrence or the survival of hepatocellular carcinoma:a report of 37 cases

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Cancer Biology & Medicine 2018年第3期15卷 275-281页

作者： Chih-Che Lin Chun-Hsien Wu Li-Yu Chen Ming-Chao Tsai Ahmed M.Elsarawy Kuang-Tzu Huang Liver Transplantation Center Department of Surgery Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Institute for Translational Research in Biomedicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Division of Hepato-Gastroenterology Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine

Objective: Coagulation factor VII(FVII) triggers the extrinsic pathway of blood coagulation. In our previous study, we showed that FVII plays an important role in tumorigenesis of hepatocellular carcinoma(HCC). However, the role of FVII polymorphism in HCC is still unknown. The present study aimed to investigate the relationship between HCC carcinogenesis and single nucleotide polymorphism of ***: Thirty-seven HCC patients and 30 healthy donors were recruited in this study. Four common FVII gene polymorphisms– a decanucleotide insertion at position –323(–323 ins10-bp), a G to T substitution at position –401(–401 G/T), a G to A substitution at position –402(–402 G/A), and a T to C substitution at position –122(–122 T/C) – were analyzed by sequencing or commercialized assays using genomic DNA isolated from blood samples. Clinicopathological parameters between control and HCC subjects were compared according to the specific ***: The most common nucleotide variation was –402 G/A. However, no statistically significant difference was observed between healthy controls and HCC subjects for all four polymorphisms in terms of genotype distribution and allele frequencies,indicating that these polymorphisms may not affect HCC tumorigenesis. Furthermore, no association was found between–402 G/A polymorphisms and tumor stage, recurrence, and overall ***: Our results indicate that FVII polymorphisms may not be a key factor that clinically impact tumorigenesis and outcomes of HCC, although further investigations should be conducted to confirm our findings.

关键词： Factor Ⅶ gene polymorphism liver hepatocellular cancer survival

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Glycerophospholipids pathways and chromosomal instability in gastric cancer: Global lipidomics analysis

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World Journal of Gastrointestinal Oncology 2019年第3期11卷 181-194页

作者： Cheng-Yu Hung Ta-Sen Yeh Cheng-Kun Tsai Ren-Chin Wu Ying-Chieh Lai Meng-Han Chiang Kuan-Ying Lu Chia-Ni Lin Mei-Ling Cheng Gigin Lin Molecular Medicine Research Center Chang Gung University Clinical Metabolomics Core Lab Chang Gung Memorial Hospital at Linkou and Chang Gung University Department of Medical Imaging and Intervention Imaging Core Lab Institute for Radiological Research Chang Gung Memorial Hospital at Linkou and Chang Gung University Department of Surgery Chang Gung Memorial Hospital at Linkou and Chang Gung University Department of Pathology Chang Gung Memorial Hospital at Linkou and Chang Gung University Department of Laboratory Medicine Chang Gung Memorial Hospital at Linkou and Chang Gung University Department of Biomedical Science College of Medicine Chang Gung University

BACKGROUND Based on the breakthrough of genomics analysis, The Cancer Genome Atlas Research Group recently proposed an integrative genomic analysis, dividing gastric cancer(GC) into four subtypes, characterized by the chromosomal instability(CIN) status. However, the CIN status of GC is still vaguely characterized and lacking the valuable easy-to-use CIN markers to diagnosis in molecular and histological *** To explore the associations of CIN with downstream lipidomics *** We collected cancerous and noncancerous tissue samples from 18 patients with GC; the samples were divided into CIN and non-CIN types based on the system of The Cancer Genome Atlas Research Group and 409 sequenced oncogenes and tumor suppressor genes. We identified the lipidomics profiles of the GC samples and samples of their adjacent noncancerous tissues by using liquid chromatography–mass spectrometry. Furthermore, we selected leading metabolites based on variable importance in projection scores of > 1.0 and P <*** Twelve men and six women participated in this study; the participants had a median age of 67.5 years(range, 52–87 years) and were divided into CIN(n = 9)and non-CIN(n = 9) groups. The GC samples exhibited distinct profiles of lysophosphocholine, phosphocholine, phosphatidylethanolamine,phosphatidylinositol, phosphoserine, sphingomyelin, ceramide, and triglycerides compared with their adjacent noncancerous tissues. The glycerophospholipid levels(phosphocholine, phosphatidylethanolamine, and phosphatidylinositol)were 1.4-to 2.3-times higher in the CIN group compared with the non-CIN group(P < 0.05). Alterations in the glycerolipid and glycerophospholipid pathways indicated progression of GC toward *** The lipidomics profiles of GC samples were distinct from those of their adjacent noncancerous tissues. CIN status of GC is primarily associated with downstream lipidomics in the glycerophospholipid pathway.

关键词： Chromosomal instability Gastric cancer Glycerophospholipids Metabolomics Lipidomics profile

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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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Interventional radiology in living donor liver transplant

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World Journal of Gastroenterology 2014年第20期20卷 6221-6225页

作者： Yu-Fan Cheng Hsin-You Ou Chun-Yen Yu Leo Leung-Chit Tsang Tung-Liang Huang Tai-Yi Chen Hsien-Wen Hsu Allan M Concerjero Chih-Chi Wang Shih-Ho Wang Tsan-Shiun Lin Yueh-Wei Liu Chee-Chien Yong Yu-Hung Lin Chih-Che Lin King-Wah Chiu Bruno Jawan Hock-Liew Eng Chao-Long Chen Department of Diagnostic Radiology Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Department of Surgery Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Division of Hepatogastroenterology Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Department of Anesthesiology Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine Department of Pathology Kaohsiung Chang Gung Memorial Hospital Chang Gung University College of Medicine

The shortage of deceased donor liver grafts led to the use of living donor liver transplant(LDLT).Patients who un-dergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation(LT).Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and nonvascular post-transplant complications,improving graft and patient survival and avoiding,in the majority of cases,surgical revision and/or *** aim of this paper is to review indications,diagnostic modalities,technical considerations,achievements and potential complications of interventional radiology procedures after LDLT.

关键词： Portal vein Hepatic artery Hepatic vein Bile duct Living donor liver transplantation Liver transplant

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Cognitive impairment and its association with circulating biomarkers in patients with acute decompensated heart failure

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Journal of Geriatric Cardiology 2022年第3期19卷 227-237页

作者： Ying-chang Tung Fu-Chih Hsiao Chia-Pin Lin Wen-Chuin Hsu Pao-Hsien Chu Division of Cardiology Department of Internal MedicineTaipeiTaiwanChina Department of Neurology Chang Gung Memorial HospitalChang Gung University College of MedicineTaipeiTaiwanChina Dementia Center Chang Gung Memorial HospitalTaoyuanTaiwanChina chang gung Memorial Hospital Chang Gung University College of MedicineTaipeiTaiwanChina

BACKGROUND Cognitive impairment(CI)is common in patients with heart failure(HF),but the association between CI and biomarkers related to HF or cognitive decline in patients with HF remains *** This prospective observational study investigated the incidence of CI,subsequent cognitive changes,and the asso-ciation between CI and novel biomarkers in patients with left ventricular ejection fraction1621.1 pg/mL was significantly associated with CI(area under the curve=0.64;P=0.003).An increase in GDF-15 per 1000 units was associated with an increased risk of the primary endpoint(hazard ratio=1.42;95%confidence interval:1.17-1.73;P<0.001).CONCLUSIONS In patients with HF with CI,cognitive function,depression,and quality of life measures improved at the 3-month and 1-year ***-15 predicted CI with moderate discrimination capacity and was associated with worse HF out-comes.

关键词： patients impairment compensated

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Hepatocellular carcinoma in patients with chronic kidney disease

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World Journal of Gastroenterology 2013年第16期19卷 2466-2472页

作者： Chern-Horng Lee Sen-Yung Hsieh Ja-Liang Lin Maw-Sen Liu Tzung-Hai Yen College of Medicine Chang Gung University Department of General Internal Medicine and Geriatrics Chang Gung Memorial Hospital Liver Research Unit Chang Gung Memorial Hospital Department of Nephrology Chang Gung Memorial Hospital

AIM: To investigate outcomes of hepatocellular carcinomas (HCCs) in patients with chronic kidney disease (CKD). METHODS: Four hundred and forty patients referred between 2000 and 2002 for management of HCCs were categorized according to their CKD stage, i.e. , estimated glomerular filtration rate (eGFR) > 90 (stage 1), 60-90 (stage 2), 30-60 (stage 3), 15-30 (stage 4), and univariate Cox regression analysis was performed to compare the frequency of possible risk factors associated with mortality. To control for possible confounding factors, a multivariate Cox regression analysis (stepwise backward approach) was performed to analyze those factors that were significant in univariate models (P < 0.05) and met the assumptions of a proportional hazard model. RESULTS: Most HCC patients with CKD were elderly, with mean age of diagnosis of 60.6 ± 11.9 years, and mostly male (74.8%). Hepatitis B, C and B and C coinfection virus were positive in 61.6%, 45.7% and 14.1% of the patients, respectively. It was found that patients with stages 4 and 5 CKD were not only older (P = 0.001), but also had higher hepatitis C virus carrier rate (P = 0.001), lower serum albumin level (P = 0.001), lower platelet count (P = 0.037), longer prothrombin time (P = 0.001) as well as higher proportions of advanced cirrhosis (P = 0.002) and HCCs (P = 0.001) than patients with stages 1 and 2 CKD. At the end of analysis, 162 (36.9%) patients had died. Kaplan-Meier analysis revealed that patients with stages 4 and 5 CKD suffered lower cumulative survival than stages 1 and 2 CKD (log-rank test, χ 2 = 11.764, P = 0.003). In a multivariate Cox-regression model, it was confirmed that CKD stage [odds ratio (OR) = 1.988, 95

关键词： Hepatocellular carcinoma Hepatitis B virus Hepatitis C virus Chronic kidney disease End-stage renal disease

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