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Pu D.,Clinical Skills Training Center | Wang W.,University of Sichuan
Experimental and Therapeutic Medicine | Year: 2014

Toll-like receptors (TLRs) are members of the pattern recognition receptor family and are essential in the innate immune response. In total, 11 TLRs exist in humans, which are expressed in a variety of cells, including peripheral blood cells. TLR4 plays a significant role in the defense against gram-negative pathogens by recognizing the lipopolysaccharide (LPS) molecules in these bacteria. The aim of the present study was to detect the expression level variation of a number of major immune molecules in peripheral blood mononuclear cells (PBMCs) stimulated by LPS, in order to identify candidate genes involved in the biological functions mediated by TLR4. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) analysis and an antibody chip were performed in the current study. The RT-qPCR results revealed a marked enhancement in the expression levels of various molecules, including cytokines, chemokines, growth factors and protein kinases. In addition, the antibody chip identified the increased secretion of crucial proinflammatory molecules in the supernatants collected from LPS-treated PBMCs. In conclusion, a large number of molecules were found to be involved in TLR4-mediated functions. © 2014, Spandidos Publications. All rights reserved.

Wang T.-E.,Mackay Memorial Hospital | Wang H.-Y.,Mackay Memorial Hospital | Lin C.-C.,Mackay Memorial Hospital | Lin C.-C.,Clinical Skills Training Center | And 8 more authors.
Gastrointestinal Endoscopy | Year: 2011

Background: Currently, there is no training model that simulates the target lesion encountered during endoscopic submucosal dissection. Objective: To develop a novel method simulating a target lesion for endoscopic submucosal dissection. Design: Training program with the use of an ex vivo porcine stomach model. Setting: Clinical skills training center. Intervention: A pseudopolyp was created by using an esophageal variceal ligation device to simulate a protruding (0-Ip) lesion, and the pseudopolyp was transected with a snare cautery to simulate a depressed (0-IIc) lesion. Main Outcome Measurements: Evaluate the histological depth of the target lesions and resected specimens. Results: Histological findings of the simulated targets showed artificial ulcerative or polypoid lesions involving the muscularis mucosa or superficial submucosa. The resected specimen was limited to the submucosal layer, and no perforation was noted. Limitations: Pilot study in an ex vivo porcine stomach model. Conclusion: The most important advantage of the model is to simulate realistic target lesions like those encountered in clinical practice in endoscopic submucosal dissection training. It allows trainees to practice how to make proper markings, delineate adequate safety margins, and properly manage different subtypes of early gastric cancer. © 2011 American Society for Gastrointestinal Endoscopy.

Lin C.-C.,Mackay Memorial Hospital | Lin C.-C.,Clinical Skills Training Center | Lin C.-C.,Nursing and Management College | Lin C.-C.,Mackay Medical College | And 19 more authors.
Digestive Diseases and Sciences | Year: 2012

Introduction Direct peroral cholangioscopy (DPOCS) was reported to present clinical potential, and creating a targetspecific training program for biliary endoscopists who lack experience with DPOCS is an important task. Methods This prospective and observational study used five male domestic pigs. Optimal procedures were decided after pilot tests using an in vivo live porcine model. A total of three ERCP men were enrolled into the training program. The objective parameters, including the rate of success and complications, and the length of the procedure, were recorded for each participant. Results In the training program, all the trainees successfully performed DPOCS and biopsies without significant complications. Close observation, free discussions, and the sharing of experiences helped shorten the total procedure time from 37.3 to 18.5 min. Conclusions This training program is a feasible approach to help biliary endoscopists acquire the experience for DPOCS with the ultrathin endoscope. © Springer Science+Business Media, LLC 2012.

Chen M.-J.,Mackay Memorial Hospital | Chen M.-J.,Nursing and Management College | Chen M.-J.,Clinical Skills Training Center | Chen M.-J.,Mackay Medical College | And 19 more authors.
World Journal of Gastroenterology | Year: 2011

AIM: To evaluate the effect of hands-on training of gastroenterology fellows in gastric polypectomy using an ex vivo simulator. METHODS: Eight gastroenterology fellows at Mackay Memorial Hospital, Taipei were evaluated in gastric polypectomy techniques using a pig stomach with artificial polyps created by a rubber band ligation device. The performance of four second year (year-2) fellows who had undergone one year of clinical training was compared with that of four first year (year-1) fellows both before and after a 4-h workshop using the ex vivo simulator. The workshop allowed for hands-on training in the removal of multiple artificial polyps and the placement of hemoclips at the excision site. Evaluation included observation of technical skills, procedure time, and the fellows' confidence scale. RESULTS: One week after the workshop, the year-1 fellows were re-evaluated and had significantly improved mean performance scores (from 17.9 ± 1.8 to 22.5 ± 0.7), confidence scale (from 4.5 ± 1.0 to 7.8 ± 0.5) and procedure time (from 615.0 ± 57.4 s to 357.5 ± 85.0 s) compared with their baseline performance. After 4 h of training using the ex vivo simulator, the skills of the year-1 fellows were statistically similar to those of the year-2 fellows. CONCLUSION: Use of this ex vivo simulator significantly improved the endoscopic gastric polypectomy skills of gastroenterology fellows who had not had previous clinical training in gastric polypectomy. © 2011 Baishideng. All rights reserved.

Wang H.-Y.,Mackay Memorial Hospital | Wang H.-Y.,Clinical Skills Training Center | Wang H.-Y.,Mackay Medical College | Shih S.-C.,Mackay Memorial Hospital | And 10 more authors.
Gut and Liver | Year: 2014

Background/Aims: In endoscopic submucosal dissection (ESD) training, only a flat target lesion can usually be simulated in the normal mucosa. This study aimed to evaluate the feasibility of simulated targets in the stomachs of live pigs for complete training. Methods: Six trained endoscopists with hands-on experience with ex vivo , isolated pig stomachs were enrolled in this pilot study. An endoscopic banding device was used to create a polyp that was snared, leaving an ulcerated lesion. This simulated target model was used to perform ESD in pigs. The en bloc resection rate, procedure time, complications, quality of resection, and participants' opinions on the simulated targets were compared with the conventional model. Results: En bloc resections were achieved in all 6 simulated targets and 6 conventional models. The mean size of the resected specimens was 32.2 mm (range, 20 to 39 mm) in the simulated target group and 23.5 mm (range, 11 to 40 mm) in the conventional group. The target model had a high quality of resection and had a high satisfaction rate for margin identification and correct peripheral marking. Conclusions: Good identification of the lesion and ease of periphery marking in the target model may improve resection quality.

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