The NBI system identified morphological details that correlate well with polyp histology by chromoendoscopy.

PAI-1 is independently associated with NAFLD after adjusting for other factors, including leptin and adiponectin. Male and female NAFLD patients show distinct patterns of leptin and adiponectin alterations; special attention is required when evaluating these alterations in female NAFLD patients < 45 years.

This study describes the feasibility of magnifying colonoscopy with indigo carmine dye contrast to distinguish neoplastic and nonneoplastic colonic polyps. This study sampled consecutive patients undergoing colonoscopy using an Olympus CF240ZI from January to October 2000 at Chang-Gung Memorial Hospital, Lin-Kou Medical Center. This study analyzed a total of 270 polyps. Indigo carmine (0.2%) was sprayed directly on the mucosa surface before observing the crypts using a magnifying colonoscope (1.5x-100x). The pit patterns were described using the classification proposed by Kudo. Finally, polypectomy or biopsy was performed for histological diagnosis. The study identified 155 adenomas, 99 hyperplastic polyps, 9 adenocarcinomas, and 7 other nonneoplastic lesions (harmatoma, inflammatory polyps, and mucosal tag). The pit pattern was analyzed for all lesions. Further classification into neoplastic (adenoma and adenocarcinoma) and nonneoplastic (hyperplastic and others) polyps revealed 156 neoplastic and 14 nonneoplastic polyps among the type III to type V pits and 92 nonneoplastic and 8 neoplastic polyps among the type I and II pits. The sensitivity of type III to type V pits in detecting neoplastic polyps was 95.1%, with a specificity of 86.8% and diagnostic accuracy of 91.9%. The positive likelihood ratio was 7.3, and the negative likelihood ratio was 0.06. Magnifying colonoscopy with indigo carmine dye contrast provides morphological detail that correlates well with polyp histology. Small flat lesions with typical type II pit pattern should have minimal neoplastic risk, thus endoscopic resection is not necessary.

The well-known, closed-form solution to thermal stresses of a die-substrate assembly is initially provided by Suhir in the mid-1980’s after Timoshenko [1] and Chen and Nelson [2]. It has been revised several times in its die attach (adhesive) peel solution by Suhir [3][4], and Mishkevich and Suhir [5]. However, there still exist some controversies and inconsistencies regarding die stresses, die attach shear and peel stresses, and warpage (deformation) of the assembly. In the study, Suhir’s derivation of the solution is closely examined in details, and the corrections to the solution are suggested and verified by comparing with the finite element results. It is shown that, unlike the original Suhir solution, the corrected one gives very good prediction of thermal stresses and deformations of die-substrate assembly. The limitation of the Suhir solution is also discussed in this study.

Privacy protection is an important issue and challenge in healthcare information systems (HISs). Recently, some privacy-enhanced HISs are proposed. Users' privacy perception, intention, and attitude might affect the adoption of such systems. This paper aims to propose a privacy-enhanced HIS framework and investigate the role of privacy protection in HISs adoption. In the proposed framework, privacy protection, access control, and secure transmission modules are designed to enhance the privacy protection of a HIS. An experimental privacy-enhanced HIS is also implemented. Furthermore, we proposed a research model extending the unified theory of acceptance and use of technology by considering perceived security and information security literacy and then investigate user adoption of a privacy-enhanced HIS. The experimental results and analyses showed that user adoption of a privacy-enhanced HIS is directly affected by social influence, performance expectancy, facilitating conditions, and perceived security. Perceived security has a mediating effect between information security literacy and user adoption. This study proposes several implications for research and practice to improve designing, development, and promotion of a good healthcare information system with privacy protection.

With anti-hepatitis B virus (anti-HBV) therapy using peginterferon, the seroconversion of hepatitis B surface antigen (HBsAg), which is considered a cure of the disease, can be achieved in a small percentage of patients. Eight of 245 consecutive patients (3.27%) with chronic hepatitis B who received peginterferon therapy at our center achieved HBsAg seroclearance. Surprisingly, two of the eight patients remained viremic according to standard HBV DNA assays. The coding regions of the HBV pre-S/S gene, which were derived from serial serum samples, were analyzed. Site-directed mutagenesis experimentation was performed to verify the phenotypic alterations in Huh-7 cells. In patient 1, an sT125A mutant developed during the HBsAgnegative stage and constituted 11.2% of the viral population. The HBV DNA level was 2.73 3 10 4 IU/mL at the time of detection. This mutant was not detectable in the HBsAg-positive stages. A phenotypic study of Huh-7 cells showed a significant reduction of antigenicity. In patient 2, an sW74* truncation mutation was found during the HBsAg-negative stage and constituted 83.1% of the viral population. The HBV DNA level was 4.12 3 10 4 IU/mL at the time of detection. A phenotypic study of Huh-7 cells showed a complete loss of antigenicity. Patient 2 subsequently experienced an episode of hepatitis relapse 7 months after the end of treatment and was negative for HBsAg throughout the hepatitis flare. Conclusion: During antiviral therapy with peginterferon, the achievement of HBsAg seroconversion does not necessarily indicate viral eradication. The emergence of S gene mutants is another possibility, and a relapse with HBsAg-negative hepatitis can occur. (HEPATOLOGY 2011;54:101-108) I t has been estimated that there are currently 350 million patients infected with hepatitis B virus (HBV) worldwide. A chronic HBV infection can lead to severe sequelae such as liver cirrhosis and hepatocellular carcinoma. Presently, there are two major therapeutic strategies for treating chronic hepatitis B: oral nucleoside/nucleotide analogues for HBV polymerase inhibition and interferon-based therapy for immune modulation. Lamivudine is the first clinically approved antiviral nucleoside analogue with a potent inhibitory effect on the RNA-dependent DNA polymerase of HBV, and it has been widely used in the past decade. [1][2][3][4][5][6] Although the suppression of viral replication can be achieved rapidly in most patients, hepatitis B e antigen (HBeAg) clearance is observed in only a minority of patients with short-term treatment. The rapid relapse of HBV replication occurs after drug withdrawal, and this has been attributed to the persistence of HBV covalently closed circular DNA in hepatocytes. 5,7,8 Prolonged use of lamivudine has thus been proposed, but this leads to the emergence of drug resistance. 9-12 Several other oral antiviral agents, including adefovir dipivoxil, entecavir, telbivudine, and tenofovir, have subsequently been approved. Although these agents are all very effective in inhibiting HBV reverse ...

Technical challenges have obstructed the diagnosis and treatment of small intestine disease. An innovative form of enteroscopy-the double balloon method-permits visualization of the complete small intestine, to-and-fro examination of an area of interest, and biopsy and endoscopic procedures which are safer, faster, and less painful than earlier methods. From October 2003 to May 2004, a total of 10 patients with obscure gastrointestinal bleeding received 12 enteroscopic examinations, 8 per oral and 4 per rectal examinations, while 2 patients received per oral enteroscopy first and further per rectal procedures 2 days later. Two cases with intestinal submucosal tumors were discovered by per oral enteroscopy, one with a 5-cm SMT with reddish mucosa at the jejunum and another with a 4-cm SMT and surface ulceration, in which the biopsy showed GIST. Both patients received an operation later. Four patients were found to have intestinal angiodysplasia in jejunum(per oral) and one in ileum (per rectal), and after local therapy bleeding stopped. Multiple angiodysplasias were observed in a patient who was operated on for active bleeding from the ileum after Indian ink tattooing. The two patients who received per oral and per rectal procedures did not display definite small intestinal lesions. All patients underwent the procedures satisfactorily without any complications, and the examination times varied from 90 to 360 min. Double balloon enteroscopy permits deep insertion of an endoscope into the small intestine without excessive stretching of the intestinal tract. This method can use either an oral or an anal approach. To-and-fro observation of almost the complete small intestine is possible, as are interventions.

Recently, many healthcare or health monitoring systems are proposed to improve life quality of the elderly in the aging process. The elderly are generally with poor health and low information literacy. Low information literacy might be an obstacle of using such systems. This research considered the characteristics and the needs of the elderly and developed an intelligent health monitoring system for the elderly with low information literacy living in the nursing home. The system is intelligent since it can monitor the health status of the elderly based on clinical and medical knowledge, provide an easy-to-understand and easy-to-use user interface for the elderly, and automatically send important or emergency feedback to caregivers. Finally, we explored the user acceptance for the elderly using our proposed system based on the unified theory of acceptance and user of technology model. The experimental results indicate the developed system is highly accepted by the elderly in terms of performance expectation, endeavor expectation, social influence, and facilitating condition.