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Insertion Sequence-Dependent <i>OmpK</i>36 Mutation Associated Ertapenem Resistance in Clinical <i>Klebsiella pneumoniae</i>

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Advances in Microbiology 2018年第4期8卷 253-269页

作者： jen-Jain Lee Yi-Ching Huang Yuting Hsiao Chi-Han Lee Chuan-Shee Liu Chishih Chu Medical Laboratory Division Chiayi Branch Taichung Veterans General Hospital Taiwan Division of Infectious Diseases Chiayi Branch Taichung Veterans General Hospital Taiwan jen-ai hospital-dali branch Taiwan Yuan’s General hospital Taiwan Department of Microbiology Immunology and Biopharmaceutics National Chiayi University Taiwan

Extended-spectrum β-lactamases (ESBLs) and/or AmpC enzymes combined with deficiency of porins OmpK35 and OmpK36 are important for the development of carbapenem-resistant Klebsiella pneumoniae. We characterized the clinical K. pneumoniae human isolates and investigated the effect of meropenem induction on the ompK35 and ompK36 mutation to develop carbapenem resistance from six carbapenem-susceptible ESBL-producing K. pneumoniae strains. 163 clinical K. pneumoniae isolates were grouped mostly into the ESBL + AmpC (44.2%) and ESBL (42.9%) phenotypes. The resistance rate differed between cephalosporins (52.1% for cefepime - 97.5% for cefotaxime) and carbapenems (16% for meropenem - 28.2% for imipenem) (P blaTEM, blaSHV, blaCTX-M-3-like, and blaCTX-M-14-like of AmpA β-lactamase genes and blaDHA and blaCMY of AmpC β-lactamase genes. Compared to all 163 clinical isolates, the 56 carbapenem-resistant isolates carried less frequently of blaTEM, blaCTXM-14-like, and blaCTXM-3-like and more frequently of blaDHA-1 and blaCMY-2. The carbapenem-resistant isolates differed in prevalence against imipenem, ertapenem, and meropenem and lacked OmpK35 more frequently than OmpK36, but abnormal PCR amplicons were detected fewer in the Omp K35-deficient group than in the OmpK36-deficient group (32.5% vs. 68.4%, respectively). The carbapenem-resistant isolate mostly carried blaDHA (91.1%) and three isolates carried blaKPC-2. Following induction with meropenem insertion sequences in ompK36, not ompK36, were identified as IS5 for KP08, IS1 for KP15, and IS903 for KP16 isolates. OmpK36 deficiency increased resistance to ertapenem, but not imipenem and meropenem. Clinical isolates belonged mainly to ESBL + AmpC group and ESBL group with difference in resistance to cephalosporins and carbapenems, the bla genes. Carbapenem resistant isolates lacked OmpK35 expression, than the OmpK36 expression, Meropenem induction developed the carbapenem resistant isolates with insertion of different insertion

关键词： Klebsiella Pneumoniae Carbapenem ESBL AmpC Outer-Membrane Protein Insertion Sequences

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Malignant fibrous histiocytoma presenting as hemoperitoneum mimicking hepatocellular carcinoma rupture

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World Journal of Gastroenterology 2007年第47期13卷 6441-6443页

作者： Hsin-Chi Chen Chi-jen Chen Chin-Ming jeng Chan-Ming Yang Department of Radiology Cathay General Hospital Hospital Sijhih Branch No. 2 Lane 59 Jiancheng Road Sijhih City Taipei Taiwan China Department of Radiology E-Da Hospital No. 1 E-Da Road Jiau-Shu Tsuen Yan-Chau Hsiang Kaohsiung Taiwan China Department of Radiology Cathay General Hospital No. 280 Jen-Ai Road Section 4 Taipei Taiwan China

Malignant fibrous histiocytoma (MFH) is a pleomorphic mesenchynal sarcoma. It is uncommonly arises primarily from the intra-peritoneal cavity. Primary peritoneal MFH with tumor bleeding and rupture is rare. We describe the imaging features of a 70-year-old patient presenting with ruptured hemorrhagic peritoneal MFH at subhepatic area,accompanied by massive hemoperitoneum,mimicking a ruptured pedunculated hepatocellular carcinoma. Computed tomography (CT) revealed a large heterogeneous enhanced subhepatic mass with adjacent liver,gallbladder and colon invasion. Tumor hemorrhage and rupture complicated with peritoneal seeding and massive bloody ascites were also detected. Angiography showed a hypervascular tumor fed by enlarged right hepatic arteries,cystic artery and omental branches of gastroepiploic artery. The patient underwent laparotomy for tumor resection,but the tumor recurred one month after operation. To our knowledge,the CT appearance of ruptured intraperitoneal MFH complicated by hemoperitoneum has not been previously described.

关键词： Malignant fibrous histiocytoma Peritoneum Hemoperitoneum Spontaneous rupture Computed tomography

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Antioxidative status of patients with alcoholic liver disease in southeastern Taiwan

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World Journal of Gastroenterology 2011年第8期17卷 1063-1070页

作者： Ya-Ling Chen Li-Ju Chen Ming-Jong Bair Mei-Lan Yao Hsiang-Chi Peng Sien-Sing Yang Suh-Ching Yang School of Nutrition and HealthSciences College of Public Health and Nutrition Taipei MedicalUniversity 250 Wu-Hsing Street Taipei 110 Taiwan China School of Pharmacy Taipei Medical Univer-sity 250 Wu-Hsing Street Taipei 110 Taiwan China Department of Nutrition Mackay MemorialHospital (Taitung Branch) Chang-Sha street Taitung 95054Taiwan China Division of Gastroenterology Departmentof Internal Medicine Mackay Memorial Hospital (TaitungBranch) Chang-Sha street Taitung 95054 Taiwan China Department of Laboratory Mackay MemorialHospital (Taitung Branch) Chang-Sha street Taitung 95054Taiwan China Liver Unit Cathay General Hospital 280Jen-Ai Road Sec. 4 Taipei 106 Taiwan China

aiM:To investigate the antioxidative status of patients with alcoholic liver disease(ALD) in southeastern ***:Our study comprised 27 patients with ALD recruited from Taitung Mackay Memorial hospital,located in southeastern *** with ALD included 12 non-aborigines(12 men) and 15 aborigines(11 men and 4 women).According to the severity of ALD,patients with ALD included 10 with hepatitis(9 men and 1 woman) and 17 with cirrhosis(14 men and 3 women).Twenty-two age-and gender-matched healthy adultsserved as the control group in this *** blood(10 mL) of each subject was drawn into EDTA-containing tubes after 8 h overnight ***:Compared to the control group,patients with ALD showed significantly lower erythrocytic catalase(11.1 ± 0.7 U/mg Hb vs 8.0 ± 0.7 U/mg Hb,P < 0.05) and superoxide dismutase(9.5 ± 1.6 U/mg Hb vs 3.0 ± 0.2 U/mg Hb,P < 0.05) ***,the erythrocytic reduced glutathione/oxidized glutathione ratio was signif icantly lower in ALD patients than that in the control group(38.1 ± 5.4 vs 15.7 ± 1.9,P < 0.05).The results revealed that patients with ALD experienced more oxidative stress than those in the control *** non-aboriginal,but not the aboriginal,ALD group had higher erythrocytic glutathione peroxidase(GPX) activity than that in the control group(46.1 ± 7.8 U/g Hb vs 27.9 ± 2.2 U/g Hb,P < 0.05).Hepatitis,but not cirrhosis,ALD patients had higher erythrocytic GPX activity than that in the control group(44.3 ± 8.6 U/g Hb vs 27.9 ± 2.2 U/g Hb,P < 0.05).CONCLUSION:Our results indicate that both ethnicity and the severity of ALD may cause different erythrocytic antioxidative enzyme activities especially GPX activity.

关键词： Alcoholic liver disease Antioxidative status Aborigines Hepatitis Cirrhosis

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Successful bailout stenting strategy against rare spontaneous retrograde dissection of partially absorbed magnesium-based resorbable scaffold:A case report

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World Journal of Clinical Cases 2021年第5期9卷 1148-1155页

作者： Zhen-Yu Liao Jer-Young Liou Shen-Chang Lin Huei-Fong Hung Che-Ming Chang Lung-Ching Chen Su-Kiat Chua Huey-Ming Lo Chi-Feng Hung Division of Cardiology Department of Internal MedicineShin Kong Wu Ho-Su Memorial HospitalTaipei 11101Taiwan Ph.D.Program in Nutrition and Food Science Fu Jen Catholic UniversityNew Taipei 24205Taiwan School of Medicine Fu Jen Catholic UniversityNew Taipei 24205Taiwan MS Program Transdisciplinary Long-Term Care Fu Jen Catholic UniversityNew Taipei 24205Taiwan Ph.D.Program in Pharmaceutical Biotechnology Fu Jen Catholic UniversityNew Taipei 24205Taiwan

BACKGROUND In the development of coronary stent technology,bioresorbable scaffolds are promising milestones in improving the clinical treatment of coronary artery ***“leave nothing behind”motto is the premise of the fourth revolution in percutaneous coronary intervention(PCI).Studies proving the safety and efficacy of the magnesium-based resorbable scaffolds(MgBRSs)include the BIOSOLVE-I and BIOSOLVE-II trials and the latest BIOSOLVE-IV ***,spontaneous retrograde dissection of a partially absorbed MgBRS may still occur,albeit *** SUMMARY We describe an unusual case of coronary artery disease in a patient who had undergone a successful PCI 8 mo earlier,where an MgBRS was implanted into the left anterior descending artery(LAD)and left circumflex artery with drug-coated balloons for a ramus intermedius branch stenosis to achieve the“leave nothing behind”therapeutic intention and was currently presenting with a gradual worsening of chest *** distal edge vascular response,during subsequent attempts with balloon angioplasty was performed ***,spontaneous retrograde dissection of a partially absorbed MgBRS in the LAD *** bailout stenting was performed with revascularization of the entry and exit sites created by spontaneous dissection and complete sealing of the intramural *** patient recovered well and was discharged after 2 d of *** followed up in August 2020(7 mo later),the patient showed uneventful *** Spontaneous retrograde dissection of a partially absorbed MgBRS was successfully treated using bailout sirolimus-eluting coronary stent strategy.

关键词： Coronary artery disease Percutaneous coronary intervention Magnesium Stents Dissection Case report

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Can composite performance measures predict survival of patients with colorectal cancer?

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World Journal of Gastroenterology 2014年第42期20卷 15805-15814页

作者： Kuo-Piao Chung Li-Ju Chen Yao-jen Chang Yun-Jau Chang Graduate Institute of Health Policy and Management College of Public Health National Taiwan University Department of Ophthalmology Heping Branch Taipei City Hospital Department of General Surgery Buddhist Xindian Tzu Chi General Hospital Department of General Surgery National Taiwan University Hospital Department of General Surgery Zhongxing Branch Taipei City Hospital

aiM: To assess the relationship between long-term colorectal patient survival and methods of calculating composite performance scores.

关键词： Performance measure Composite performance score Colon cancer Rectal cancer Patient survival Analytic hierarchy process Principal component analysis

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Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis

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World Journal of Gastroenterology 2013年第43期19卷 7743-7750页

作者： Shu-Hung Chuang Pai-Hsi Chen Chih-Ming Chang Chih-Sheng Lin Department of Biological Science and Technology National Chiao Tung University Department of Surgery Mackay Memorial HospitalHsin-Chu Branch College of Management Fu Jen Catholic University Department of Nursing Mackay Memorial HospitalHsin-Chu Branch

aiM:To compare the clinical outcome of single-incision laparoscopic cholecystectomy(SILC)and three-incision laparoscopic cholecystectomy(3ILC)for acute ***:From July 2009 to September 2012,136patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral *** experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes,straight instruments,and conventional *** patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were *** remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic *** demography,clinical data,operative results and complications were recorded and ***:Fifty patients with gangrenous cholecystitis,gallbladder empyema,or hydrops were classified as the complicated group,and 58 patients with acute cholecystitis were classified as the uncomplicated ***-three(46.0%)of the patients in the complicated group(n=50)and 39(67.2%)of the patients in the uncomplicated group(n=58)underwent SILC;all others underwent *** postoperative length of hospital stay(PLOS)was significantly shorter in the SILC subgroups than the 3ILC subgroups(3.5±1.1 d vs 4.6±1.3 d,Phospital stay,conversion rates,and complication rates were similar in both SILC and 3ILC *** complicated group had longer operative time(122.2±35.0 min vs 106.6±43.6 min,P<0.05),longer PLOS(4.1±1.3 d vs 3.2±1.2 d,P<0.

关键词： Single-incision laparoscopic cholecystectomy Single-incision laparoscopic surgery Laparoen doscopic single site surgery Cholecystectomy Acute cholecystitis Complicated cholecystitis Gangrenous cholecystitis

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FANCA D1359Y mutation in a patient with gastric polyposis and cancer susceptibility: A case report and review of literature

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World Journal of Gastroenterology 2018年第38期24卷 4412-4418页

作者： Jeffrey Peng Huang Johnson Lin Chi-Yuan Tzen Wen-Yu Huang Chia-Chi Tsai Chih-jen Chen Yen-Jung Lu Kuei-Fang Chou Ying-Wen Su Division of Hematology and Medical Oncology Department of Internal Medicine Mackay Memorial Hospital Department of Pathology Mackay Memorial Hospital Laboratory of Good Clinical Research Center Mackay Memorial Hospital Tamsui Branch Department of General Surgery Mackay Memorial Hospital Division of Gastroenterology Department of Internal Medicine Mackay Memorial Hospital ACT Genomics Co. Ltd.

Gastric polyposis is a rare disease. Not all polyps progress to cancer. Monoallelic mutation in Fanconi anemia(FA) genes, unlike biallelic gene mutations that causes typical FA phenotype, can increase risks of cancers in a sporadic manner. Aberrations in the FA pathway were reported in all molecular subtypes of gastric cancer. We studied a patient with synchronous gastric cancer from gastric polyposis by conducting a 13-year long-term follow up. Via pathway-driven massive parallel genomic sequencing, a germline mutation at FANCA D1359Y was identified. We identified several recurrent mutations in DNA methylation(TET1, V873I), the β-catenin pathway(CTNNB1, S45F) and RHO signaling pathway(PLEKHG5, R203C) by comparing the genetic events between benign and malignant gastric polyps. Furthermore, we revealed gastric polyposis susceptible genes and genetic events promoting malignant transformation using pathway-driven targeted gene sequencing.

关键词： Gastric polyposis Gastric cancer Adenocarcinoma Fanconi’s anemia Malignant transformation

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Nonalcoholic fatty liver disease:Updates in noninvasive diagnosis and correlation with cardiovascular disease

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World Journal of Gastroenterology 2014年第24期20卷 7718-7729页

作者： Kuang-Chun Hu Horng-Yuan Wang Sung-Chen Liu Chuan-Chuan Liu Chung-Lieh Hung Ming-Jong Bair Chun-jen Liu Ming-Shiang Wu Shou-Chuan Shih Mackay Medical College Division of Gastroenterology Department of Internal MedicineHealth Evaluation CenterMackay Memorial Hospital Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Division of Endocrine Department of Internal MedicineDM CenterMackay Memorial Hospital Division of Cardiology Department of Internal MedicineMackay Memorial Hospital Gastroenterology Division Department of Internal MedicineMackay Memorial HospitalTaitung Branch

Nonalcoholic fatty liver disease(NAFLD)refers to the accumulation of fat(mainly triglycerides)within *** 20%-30%of adults in the general population in developed countries have NAFLD;this trend is increasing because of the pandemicity of obesity and diabetes,and is becoming a serious public health *** percent of individuals with NAFLD develop chronic hepatic inflammation[nonalcoholic steatohepatitis(NASH)],which can be associated with the development of cirrhosis,portal hypertension,and hepatocellular carcinoma in a minority of *** thus,the detection and diagnosis of NAFLD is important for general *** biopsy is the gold standard for diagnosing NAFLD and confirming the presence of ***,the invasiveness of this procedure limits its application to screening the general population or patients with contraindications for liver *** development of noninvasive diagnostic methods for NAFLD is of paramount *** review focuses on the updates of noninvasive diagnosis of ***,we review clinical evidence supporting a strong association between NAFLD and the risk of cardiovascular disease because of the cross link between these two disorders.

关键词： Nonalcoholic fatty liver disease Noninvasive diagnosis Laboratory biochemistry Image assessment Cardiovascular disease

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Clonal Dissemination of Genetically Diverse Fluoroquinolone-Resistant Extended-Spectrum Beta-Lactamase (ESBL)-Producing Escherichia coli ST131 in a Veterans hospital in Southern Taiwan

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Advances in Microbiology 2016年第9期6卷 590-601页

作者： Wen-Chung Chang Chung-Jung Wu Chuan-Shee Liu Yilin Tsai jen-Jain Lee Yuting Hsiao Shu-Ling Chou Chih-Hao Sun Chishih Chu Dentistry Division Chiayi Branch Taichung Veterans General Hospital Taiwan Internal Medicine Department Chiayi Branch Taichung Veterans General Hospital Taiwan Medical Laboratory Division Chiayi Branch Taichung Veterans General Hospital Taiwan Department of Microbiology Immunology and Biopharmaceutics National Chiayi University Taiwan

Uropathogenic Escherichia coli is the common pathogen to cause urinary tract infections (UTIs) and have become multidrug-resistant (MDR) extended-spectrum β-lactamase (ESBL) producers. The differences in the antimicrobial susceptibility, 5 bla genes, 12 virulence genes of 87 clinical ESBL-producing E. coli isolates and genomic variations and sequence types of 18 recurrent and repeated isolates from 9 patients were investigated. The 87 MDR-ESBL isolates collected mainly from indwelling urinary catheters (IUCs) and UTIs were highly resistant to fluoroquinolones, with over 50% of the isolates being resistant to cefepime and piperacillin/tazobactam and a few being resistant to carbapenem. These isolates carried at least two of the five bla genes examined, with the highest prevalence (87.4%) found for blaCTX-M (blaCTX-M3-like and blaCTX-M14-like), followed by blaCMY-2 (80.5%) and blaSHV (56.3%). The predominant virulence genes were the fimbriae gene fimH and the toxin genes cnf1 and hlyA in blood isolates and the capsule gene kpsMTII in UTI and blood isolates. Over 80% of the isolates carried yersiniabactin and aerobactin of siderophores. In 18 isolates, the fluoroquinolone-resistant ST131 isolate of pulsotypes I and II with blaCTX-M-15 was clonally disseminated in the hospital. The genomic plasticity of these ST131 occurred mainly through the conjugative plasmids with differences in replicon types A/C, I1, FIA, FIB and Y, size and number. In conclusion, MDR ESBL-producing E. coli isolates differed in virulence genes of UPEC and antibiotic resistance associated with the sources. Plasmid acquisition and chromosomal variations increase the spread of fluoroquinolone-resistant UPEC ST131 worldwide.

关键词： E. coli ESBL Virulence Genes Antimicrobial Resistance MLST

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Perioperative topical ascorbic acid for the prevention of phacoemulsification-related corneal endothelial damage:Two case reports and review of literature

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World Journal of Clinical Cases 2019年第5期7卷 642-649页

作者： Chia-Yi Lee Hung-Ta Chen Yi-jen Hsueh Hung-Chi Chen Chieh-Cheng Huang Yaa-Jyuhn James Meir Chao-Min Cheng Wei-Chi Wu Department of Ophthalmology Show Chwan Memorial Hospital Department of Optometry College of Medicine and Life Science Chung Hwa University of Medical Technology Department of Internal Medicine Taipei City Hospital-Heping Branch Department of Ophthalmology Chang Gung Memorial Hospital Center for Tissue Engineering Chang Gung Memorial Hospital Department of Medicine College of Medicine Chang Gung University Institute of Biomedical Engineering National Tsing Hua University Department of Biomedical Sciences College of Medicine Chang Gung University

BACKGROUND The current case report describes successful phacoemulsification with the aid of perioperative topical ascorbic acid(AA) in two patients with corneal endothelial disorders to prevent postoperative corneal endothelial *** SUMMARY Two eyes of two patients underwent phacoemulsification with pre-existing corneal endothelial disorders including Fuchs corneal endothelial dystrophy(Patient 1) and endotheliitis(Patient 2). Topical AA was applied to both patients at least one month before and after with a frequency of four times per day. After the surgery, both eyes improved best-corrected visual acuity(BCVA) and there was limited human corneal endothelial cell loss without signs of corneal endothelial decompensation, such as deteriorated BCVA or persistent corneal edema during the follow-up of at least two *** Perioperative administration of topical AA may be an alternative therapy to the triple procedure in patients expecting to undergo cataract surgery.

关键词： Ascorbic acid Fuchs corneal endothelial dystrophy Endotheliitis Human corneal endothelial cell Phacoemulsification Case report

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