66 results on '"Chao HS"'
Search Results
2. Retention, adherence, and acceptability testing of a digital health intervention in a 3-group randomized controlled trial for chronic musculoskeletal pain
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Jennifer Kawi, Chao Hsing Yeh, Lauren Grant, Xinran Huang, Hulin Wu, Chunyan Hua, and Paul Christo
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Chronic pain ,Acupressure ,Exchange, Health Information ,Application, Mobile ,Other systems of medicine ,RZ201-999 - Abstract
Objectives: Evaluate a digital health intervention using Auricular Point Acupressure (APA) for chronic musculoskeletal pain in terms of participant retention, adherence, acceptability, and satisfaction. Chronic musculoskeletal pain is a global concern and there are persistent challenges in pain management. Despite the value of digital health interventions, these interventions need to be fully evaluated for feasibility. Methods: We conducted a 3-group, longitudinal, randomized controlled trial (RCT). After Institutional Review Board approval, we posted recruitment flyers in a university, healthcare clinics, and community settings. Participants were randomized into an in-person + app group (n = 8), virtual + app group (n = 7), and a wait-list, education-enhanced control group (n = 8), evaluating our outcomes using standard feasibility measures. The 4-week intervention consisted of virtual sessions, telecommunications, and our APA app, followed by a 3-month follow-up. Results: Data from 22 participants were subsequently analyzed (95.7%). All app participants adhered to the study protocol and used APA at the minimum recommended frequency and duration. The virtual + app group used APA more during the intervention and follow-up periods. All app participants found the intervention to be acceptable and at least 80% overall were satisfied with APA at the 3-month follow-up. There were no adverse events reported. Conclusions: Our digital health intervention was found to be acceptable and sustainable; participants adhered to and were satisfied with the intervention providing support for a larger RCT. Clinical Trial: #: NCT05020470
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- 2024
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3. Theoretical Foundation and Application of Word Association on Concept Representation
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Jiawei, Qi, primary and Chao-Hs�, Lee, additional
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- 2020
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4. An Explore into the Psychological Mechanism of Folk "Xiang" Culture -- A case study of Jiaxiang County in Southwest Shandong Province
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Yali, An, primary, Chao-Hs�Zhang Yue, Lee, additional, YunLu, Yang, additional, and MengMeng, Gao, additional
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- 2020
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5. Chinese Traditional Faith of Tian: A Social Mentality Perspective
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Yue, Zhang, primary and Chao-Hs�An Yali, Lee, additional
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- 2020
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6. Adapting and Evaluating a Theory-Driven, Non-Pharmacological Intervention to Self-Manage Pain
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Jennifer Kawi, Chao Hsing Yeh, Lauren Grant, Johannes Thrul, Hulin Wu, Paul J. Christo, and Lorraine S. Evangelista
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theory-driven intervention ,chronic pain ,self-management ,auricular point acupressure ,non-pharmacological intervention ,Medicine - Abstract
Background: The existing literature has limited detail on theory-driven interventions, particularly in pain studies. We adapted Bandura’s self-efficacy framework toward a theory-driven, non-pharmacological intervention using auricular point acupressure (APA) and evaluated participants’ perceptions of this intervention on their pain self-management. APA is a non-invasive modality based on auricular acupuncture principles. Methods: We mapped our study intervention components according to Bandura’s key sources of self-efficacy (performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal) to facilitate the self-management of pain. Through a qualitative study design, we conducted virtual interviews at one and three months after a 4-week APA intervention among 23 participants using purposive sampling to describe their experiences in managing their pain based on our theory-driven APA intervention. Results: Using thematic analyses, we found four themes: the enhanced self-management of pain, improved pain outcomes, the feasibility of technology, and the sustainability of APA. Conclusions: Describing how interventions are mapped according to the elements of theoretical frameworks can help to guide intervention development, advance science and knowledge development, and promote the implementation of interventions. As such, using Bandura’s self-efficacy theory as a foundation for the APA intervention, APA was found to be feasible and sustainable, improving self-management, pain intensity, and pain-related outcomes. Participants provided recommendations for the further improvement of this theory-driven intervention.
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- 2024
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7. Use of Information and Communication Technologies to Enhance Self-Acupressure: a Literature Review
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Chan-Young Kwon and Chao Hsing Yeh
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information and communication technologies ,telecommunications ,east asian traditional medicine ,acupressure ,review ,Other systems of medicine ,RZ201-999 - Abstract
Currently, acupressure is widely accepted as a non-pharmacological therapy for managing pain, nausea and vomiting, and mental health conditions. Since acupressure can be self-administered, clinicians and researchers’ interest in information and communication technologies (ICTs) for disseminating acupressure to manage symptoms has increased. This mini review was conducted to examine clinical studies of acupressure using ICTs, with a particular focus on self-acupressure. Through a search of MEDLINE, EMBASE, and CENTRAL, all studies of self-acupressure using ICTs published before December 31, 2021 were collected. Twelve studies met the inclusion criteria. More than half of the studies published since 2020 (4/7, 54.14%) were described as being related to COVID-19. As target conditions, musculoskeletal injuries or pain, cancer-related symptoms, dysmenorrhea, mental health issues, and obesity were considered. The most frequently used acupoints were LI4, LR3, and Shenmen. Moreover, smartphone applications were the most commonly used ICT method to support self-acupressure. In addition to the basic information of self-acupressure, other tools such as timers, reminders, and schedule checkers to facilitate its implementations have been incorporated into the smartphone applications. Recently, there have been some attempts to combine acupressure and ICTs. Although these studies mainly focus on musculoskeletal pain or injuries, recent studies related to mental health have emerged in relation to COVID-19. However, few studies have been conducted to date, making it difficult to fully grasp the trends in this field. Therefore, more studies are needed to evaluate the feasibility and efficacy of combining self-acupressure and ICTs in more diverse clinical areas.
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- 2022
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8. Effects of angel wings on morphological and histological characteristics of White Roman geese
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Shen Chang Chang, Min Jung Lin, Chao Hsien Lee, Li Jen Lin, Jiunn Wang Liao, and Tzu Tai Lee
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angel wing ,morphology ,histological ,white Roman geese ,Animal culture ,SF1-1100 - Abstract
ABSTRACT: This study aims to determine the effects of normal and angel wing on morphological and histological characteristics of white Roman geese. Angel wing is a torsion of a wing at the carpometacarpus all the way down to the end, stretching outward away from the body lateral. In this study, 30 geese were raised for observing the whole appearance, including stretched wings and morphologies of defeathered wings at 14 wk old. A group of 30 goslings was raised to observe the feature of conformation development of wing bones from 4 to 8 wk old by X-ray photography. The results show that normal wing on angles of the metacarpals and radioulnar bones has a trend greater than the angel wing group (P = 0.927) at the age of 10 wk. According to 64-slice images of computerized tomography scanner on a group of 10-wk-old geese, the interstice at the carpus joint of the angel wing was larger than that of the normal wing. The slight to moderate dilated space of the carpometacarpal joint was found in the angel wing group. In conclusion, the angel wing is torqued outward away from the body laterals at the carpometacarpus and has a slight to moderate dilated space in the carpometacarpal joint. The normal wing geese exhibited an angel that is 9.24% greater than those of angel wing geese at the age of 14 wk (130 vs. 118.5°).
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- 2023
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9. Pneumococcal conjugate vaccines in Taiwan: optimizing health gains in children and older adults through constrained optimization modeling
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Chun-Yi Lu, Chao Hsiun Tang, Tiffany Fu, Raoh-Fang Pwu, and Yu-Fan Ho
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constrained optimization model ,pneumococcal disease ,public health ,Taiwan ,vaccine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Objectives: Budgetary constraints force healthcare authorities to set priorities for optimal vaccine interventions. A comprehensive decision-making tool would help inform the best combination and sequence of introduction of vaccines within constrained budgets. Methods: Looking at available vaccines against pneumococcal infections in Taiwan (10/13-valent pneumococcal conjugate vaccines [PCV10, PCV13] and 23-valent pneumococcal polysaccharide vaccine [PPV23]), a constrained optimization (CO) model was used to assess the optimal combination of vaccines in children and older adults that would maximize the quality-adjusted life years under predefined budget constraints. Scenario analyses were carried out to evaluate the impact of vaccine efficacy (VE) on the optimized solution. Results: The CO model demonstrated that the optimal sequence of vaccine introduction was PPV23 in older adults and PCV10 in children. The optimal solution was mostly driven by the potential to reduce disease burden in the older adult population. The VE of PPV23 in older adults and the VE of PCV vaccines against serotype 19A invasive pneumococcal disease had little impact on the optimal solution. Conclusions: The CO approach can be used to set priorities for introducing new vaccines while maximizing health gains per age group within the constrained National Vaccine Fund for the prevention of pneumococcal disease in Taiwan.
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- 2022
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10. Community canteen services for the rural elderly: determining impacts on general mental health, nutritional status, satisfaction with life, and social capital
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Xiaolei Wang, Minhui Liu, Yuchen Li, Chanyuan Guo, and Chao Hsing Yeh
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Older adults ,Nutrition ,Health ,Social capital ,Satisfaction with life ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The Chinese government is piloting canteen services for older adults, but few studies have explored the influence of canteen services on the health of these older adults. This study aimed to investigate the impact of canteen services on older adults’ general mental health, nutritional status, satisfaction with life, and social capital in rural areas. Methods This study used a cross-sectional design. We selected 14 villages in Jinhua City, Zhejiang Province, China, including seven villages with canteen services and seven villages without canteen services. Participants were 284 senior older adults (aged 75~98), including 140 residing in villages with canteen services (Canteen Group [CG]) and 144 residing in villages without canteen services (Non-Canteen Group [NCG]). We also divided the CG into two sub-groups according to the funding sources (one receiving government support only, the other receiving government support plus enterprise donations). We used a self-designed questionnaire, including sociodemographics, diet-related items (e.g., satisfaction with the meals, diet expenditure, self-evaluation of meal nutrition), and the four scales including the Chinese version of the 12-item General Health Questionnaire (GHQ-12), the Chinese version of the Mini Nutritional Assessment Short-Form (MNA-SF), the Satisfaction with Life Scale (SWLS), and the Social Capital Questionnaire (SCQ). Results The overall mental health, satisfaction with life, and social capital of the CG were better than the NCG (P
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- 2020
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11. A prospective randomized controlled study of auricular point acupressure to manage chronic low back pain in older adults: study protocol
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Chao Hsing Yeh, Cuicui Li, Ronald Glick, Elizabeth A. Schlenk, Kathryn Albers, Lorna Kwai-Ping Suen, Nada Lukkahatai, Nicole Salen, Sonaali Pandiri, Weixia Ma, Nancy Perrin, Natalia E. Morone, and Paul J. Christo
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Chronic low back pain ,Auricular point acupressure ,Older adults ,Cytokines ,Medicine (General) ,R5-920 - Abstract
Abstract Background Chronic low back pain (cLBP) is a major health problem and the most common pain condition among those aged 60 years or older in the US. Despite the development of pharmacological and nonpharmacological interventions, cLBP outcomes have not improved and disability rates continue to rise. This study aims to test auricular point acupressure (APA) as a non-invasive, nonpharmacological self-management strategy to manage cLBP and to address current shortcomings of cLBP treatment. Methods/design For this prospective randomized controlled study, participants will be randomly assigned to three groups: (1) APA group (active points related to cLBP), (2) Comparison group-1 (non-active points, unrelated to cLBP), and (3) Comparison group-2 (enhanced educational control, an educational booklet on cLBP will be given and the treatment used by participants for their cLBP will be recorded). The ecological momentary assessment smartphone app will be used to collect real-time cLBP outcomes and adherence to APA practice. Treatment and nonspecific psychological placebo effects will be measured via questionnaires for all participants. This proposed trial will evaluate the APA sustained effects for cLBP at 12-month follow-up. Monthly telephone follow-up will be used to collect study outcomes. Blood will be collected during study visits at baseline, post APA treatment, and follow-up study visits at 1, 3, 6, 9 and 12 months post completion of treatment for a total of seven assessments. Appointments will start between 9 and 11 am to control for circadian variation in cytokine levels. Discussion This study is expected to provide vital information on the efficacy, sustainability, and underlying mechanism of APA on cLBP necessary for APA to gain acceptance from both healthcare providers and patients, which would provide a strong impetus for including APA as part of cLBP management in clinical and home settings. Trial registration ClinicalTrials.gov, ID: NCT03589703. Registered on 22 May 2018.
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- 2020
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12. Erratum to ‘Pneumococcal conjugate vaccines in Taiwan: optimizing health gains in children and older adults through constrained optimization modeling: Pneumococcal conjugate vaccines optimization in Taiwan’ International Journal of Infectious Diseases, 114 (2022), 155-164/THEIJID-D-21-02640
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Chun-Yi Lu, Chao Hsiun Tang, Tiffany Fu, Raoh-Fang Pwu, and Yu-Fan Ho
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Infectious and parasitic diseases ,RC109-216 - Published
- 2022
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13. Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study
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Dongye Yang, Feng Zhou, Xinyu Fu, Jinsong Hou, Liting Lin, Qiuyu Huang, and Chao Hsing Yeh
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Nursing ,RT1-120 - Abstract
Objective: Osteoradionecrosis of the jaws (ORNJ) is among the most serious oral complications of head and neck cancer treatment with radiation therapy. This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China. Methods: A cross-sectional study was conducted to profile patient reported symptom severity. Ninety-five hospitalized ORNJ patients were recruited. Participants completed the MD Anderson Symptom Inventory–Head and Neck Module-Chinese version. Results: The percentage of participants who reported that they experienced at least one type of symptom was 97.9%, and 85.2% patients reported interference. The 10 most severe symptoms were as follows: limited mouth opening, problem with teeth/gums, difficulty swallowing/chewing, dry mouth, oral malodor, difficulty with voice/speech, dental ulcer, tinnitus/ear obstruction, skin pain/burning/rash, and difficulty hearing. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. The interference of patients positively correlated with core symptoms (r = 0.612), head and neck symptoms (r = 0.709), and ORNJ symptoms (r = 0.440) (P
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- 2019
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14. Auricular Point Acupressure Smartphone Application to Manage Chronic Musculoskeletal Pain: A Longitudinal, One-Group, Open Pilot Trial
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Jennifer Kawi PhD, NP, Chao Hsing Yeh PhD, RN, Mengchi Li RN, Keenan Caswell BS, Maurice Mazraani MD, Nada Lukkahatai PhD, RN, Sylvanus Mensah RN, Janiece Taylor PhD, RN, Chakra Budhathoki PhD, and Paul Christo MD
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Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Background Chronic musculoskeletal pain (CMP) is the most common self-reported chronic pain condition. Current treatment for CMP is limited. Methods This was a two-phase study. In Phase 1, three auricular point acupressure (APA)-naïve participants were recruited to explore their experiences of APA and a smartphone app was developed based on their feedback. In Phase 2, a prospective longitudinal study was used to examine the effectiveness of the smartphone app to self-manage CMP. Results Phase 1 resulted in the successful development of the APA smartphone app. In Phase 2, after four weeks of APA, participants reported reduced pain intensity (30%), pain interference (35%), and disability (40%), as well as improved physical function (47%). The mean score for the participants’ perception of treatment efficacy was 4.94 (SD = 2.08, scale of 0–7) indicating that approximately 70% of participants rated global improvements with noticeable changes. The majority (88%, n = 22) of the participants were satisfied with the treatment: 32% [8] were very satisfied and 56% [n = 14] were somewhat satisfied. The average frequency of pressing APA seeds per day was 2.93 times (SD = 2.27, range 0–10) and 1.60 minutes per time (SD = 2.64, range 0–10); the participants were able to adhere to the suggested pressing time per day, although they only pressed the ear points about 53% of the suggested time. Conclusion It is feasible for individuals to learn APA from the smartphone app and successfully self-administer APA to manage their pain. Participants found the app useful and were satisfied with the information provided through the app.
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- 2021
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15. Study of tri-gate AlGaN/GaN MOS-HEMTs for power application
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Kuan Ning Huang, Yueh Chin Lin, Jin Hwa Lee, Chia Chieh Hsu, Jing Neng Yao, Chieh Ying Wu, Chao Hsin Chien, and Edward Yi Chang
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Tri-gate structure ,AlGaN/GaN HEMT ,High-k dielectric oxide ,HfO2 ,Tri-gate MOS-HEMT ,Subthreshold swing ,Electronics ,TK7800-8360 ,Technology (General) ,T1-995 - Abstract
In this letter, we present high-performance AlGaN/GaN high electron mobility transistor (HEMT) by 3-dimensional (3D) tri-gate. Due to the excellent channel control of tri-gate structure, the tri-gate HEMT shows the low subthreshold swing (SS) of 65 mV/decade, low off-state drain leakage current (Ioff) of 7 nA/mm, and On/Off ratio up to 7.6 × 107. Furthermore, we combined the tri-gate structure and metal oxide semiconductor (MOS) structure. The tri-gate MOS-HEMT with high-k dielectric oxide HfO2 was fabricated. The good interface between HfO2 and AlGaN and strain-induce polarization increase the carrier concentration. Compared to the tri-gate HEMT, the increased maximum drain current, higher On/Off ratio and better breakdown voltage is demonstrated by implanted the high k dielectric HfO2. The improved electrical performance of tri-gate MOS-HEMT shows potential for next generation power application.
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- 2020
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16. Dynamic Brain Activity Following Auricular Point Acupressure in Chemotherapy-Induced Neuropathy: A Pilot Longitudinal Functional Magnetic Resonance Imaging Study
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Chao Hsing Yeh PhD, MSN, RN, Keenan Caswell BSc, BA, Sonaali Pandiri BA, Haris Sair MD, Nada Lukkahatai PhD, MSN, RN, Claudia M Campbell PhD, Vered Stearns MD, Barbara Van de Castle DNP, ACNS, OCN, RN-BC, Nancy Perrin PhD, MA, Thomas J Smith MD, and Leorey N Saligan PhD, RN, CRNP
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Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Background The objective of this study was to investigate the dynamic brain activity following auricular point acupressure (APA) in chemotherapy-induced neuropathy (CIN). Methods Participants received 4 weeks of APA in an open-pilot trial with repeated observation. Along with the clinical self-reported CIN outcomes, objective outcomes were measured over the course of the treatment by physiological changes in pain sensory thresholds from quantitative sensory testing (QST) and repeated functional magnetic resonance imaging scans. Results After 4 weeks of APA, participants had reported clinically significant improvements (ie, ≥30%) in a reduction of CIN symptoms (including pain, numbness, tingling, and stiffness) in lower extremity stiffness (32%), reduced foot sensitivity (13%), and higher pain threshold (13%). Across the 11 intrinsic brain networks examined, there was a trend toward significance of the connectivity of the basal ganglia network (BGN) to the salience network (SAL), which was decreased pre-APA versus immediate-APA (effect size [ES] = 1.04, P = .07). The BGN also demonstrated decreased connectivity with the language network pre-APA versus delayed imaging post-APA (ES = −0.92, P = .07). Furthermore, there was increased executive control network (ECN) and SAL within-network connectivity comparing pre-APA to delayed imaging post-APA, trending toward significance (ES = 0.41, P = .09 and ES = 0.17, P = .09, respectively). Conclusion The changes in connectivity and activity within or between the ECN, SAL, and BGN from pre- to post-APA suggest ongoing alterations in brain functional connectivity following APA, particularly in the insula, anterior cingulate, and dorsolateral prefrontal cortices, which play significant roles in pain, memory, and cognitive function.
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- 2020
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17. Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis
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Wang Li, Zhang Chuanlin, Mu Shaoyu, Chao Hsing Yeh, Chen Liqun, and Zhang Zeju
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Trombose Venosa profunda de la Extremidad Superior ,Trombose de la Vena ,Eficacia ,Metaanálisis ,Nursing ,RT1-120 - Abstract
ABSTRACT Objectives: To evaluate case series studies that quantitatively assess the effects of catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and anticoagulation in patients with acute lower extremity deep vein thrombosis (DVT). Methods: Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and Scopus, were searched through January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated with CDT or with anticoagulation. In the case series studies, the pooled estimates of efficacy outcomes for patency rate, complete lysis, rethrombosis and post-thrombotic syndrome (PTS) were calculated across the studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Results: Twenty-five articles (six comparing CDT with anticoagulation and 19 case series) including 2254 patients met the eligibility criteria. In the case series studies, the pooled results were a patency rate of 0.87 (95% CI: 0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95% CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the efficacy outcomes of CDT and anticoagulation showed that CDT was associated with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p
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- 2018
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18. Sabbatical as a part of the academic excellence journey: A narrative qualitative study
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Mohammad H Yarmohammadian, Patricia Davidson, and Chao Hsing Yeh
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Academic development ,academic journey ,educational excellence ,field report ,higher education ,medical education ,observational study ,sabbatical ,sabbatical leave ,visiting professor ,visiting scholarship ,visiting scientist ,Special aspects of education ,LC8-6691 ,Public aspects of medicine ,RA1-1270 - Abstract
INTRODUCTION: Sabbaticals were first offered by Harvard University in the late 17th century to provide “renewal” for faculty members. In this period of career development, a professor might learn new techniques, expand a research program, or finish off that book or pile of languishing manuscripts. This article tried to organize lived experiences of a visiting scholar from Isfahan University of Medical Sciences to Johns Hopkins University. The research aimed to study the context and conditions of the sabbatical in an alternative academic setting. METHODS: This article applies a narrative qualitative study integrated with Eisner critical and connoisseurship approach as a combined naturalistic methodology. Using narrative inquiry and reflective analysis in form of observations and audit reports, written dairy notes and memos, the content analyzed thematically and extracted the themes of lived experiences as well as lessons learned and then have been transformed into tables. RESULTS: Extracted themes from research sources are categorized into three main themes: organizational and professional experiences; teaching, instruction, and curricular experiences; and research and technology management experiences. These are resulted in the explanation of the field and events (description), discussion about them (interpretation), followed by concluding remarks (evaluation). . It also represents research questions and findings in descriptive and interpretation phases. DISCUSSION AND CONCLUSIONS: This article addresses some descriptions, interpretations, and evaluations extracted from the experiences through answering the research questions. It categorizes these practical lessons into three categories: (1) lessons about becoming a lifelong learner, (2) lessons about remaining a professor, and (3) innovative experiences.
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- 2018
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19. Association between Auricular Signals and the Risk Factors of Metabolic Syndrome
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Lorna Kwai Ping Suen, Chao Hsing Yeh, Simon Kai Wang Yeung, Jojo Yee Mei Kwan, Hon Fat Wong, David Chan, Alice Siu Ping Cheung, and Vincent Tok Fai Yeung
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Auricular diagnosis ,metabolic syndrome ,auricular signals ,screening ,diabetes ,cardiovascular ,Medicine - Abstract
Objective: This study aims to determine the association between auricular signals and the risk factors of metabolic syndrome (MS). Methods: A case-control study with an equal number of cases and controls matched by age group and gender was conducted. A total of 204 participants were recruited. Patients were verified as having MS based on the International Diabetes Federation (IDF) criteria. Auricular assessment was conducted in the following sequence: visual inspection, electrical skin resistance test (ESRT), and pressure pain test (PPT). Results: MS+ patients tend to have much more oily auricle complexion than the controls. The ‘endocrine’ (right) of the participants with MS indicated a significantly higher electrical conductivity compared to that of the controls. The MS group participants experienced significant tenderness on the ‘heart’ and ‘endocrine’ acupoints. A number of auricular signals were also associated with the risk factors of MS, including age, gender, smoking status, family history of diabetes, and comorbid illnesses. Both the ‘heart’ and ‘endocrine’ acupoints showed the highest sensitivity to tenderness (60.8%), followed by the ‘endocrine’ (59.8%) and ‘pancreas and gallbladder’ (55.9%). Conclusions: The results of this study suggest that electrical conductivity and tenderness of a number of auricular points, including the ‘heart’, ‘pancreas and gall bladder’, and ‘endocrine’, are associated with MS and its risk factors. Further investigations with a larger sample size could be conducted to verify the value of these auricular signals on MS risk prediction so that this method can be used as an early screening method for the population with a high MS risk.
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- 2017
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20. Intensity modulated radiotherapy with concurrent chemotherapy for larynx preservation of advanced resectable hypopharyngeal cancer
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Chao Hsing-Lung, Chang Ying-Nan, Lin Yaoh-Shiang, Lin Chun-Shu, Su Yu-Fu, Chen Chang-Ming, Jen Yee-Min, Huang Wen-Yen, Lin Kuen-Tze, and Chang Li-Ping
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background To analyze the rate of larynx preservation in patients of locally advanced hypopharyngeal cancer treated with intensity modulated radiotherapy (IMRT) plus concurrent chemotherapy, and compare the results with patients treated with primary surgery. Methods Between January 2003 and November 2007, 14 patients were treated with primary surgery and 33 patients were treated with concurrent chemoradiotherapy (CCRT) using IMRT technique. Survival rate, larynx preservation rate were calculated with the Kaplan-Meier method. Multivariate analysis was conducted for significant prognostic factors with Cox-regression method. Results The median follow-up was 19.4 months for all patients, and 25.8 months for those alive. The 5-year overall survival rate was 33% and 44% for primary surgery and definitive CCRT, respectively (p = 0.788). The 5-year functional larynx-preservation survival after IMRT was 40%. Acute toxicities were common, but usually tolerable. The rates of treatment-related mucositis (≥ grade 2) and pharyngitis (≥ grade 3) were higher in the CCRT group. For multivariate analysis, treatment response and cricoid cartilage invasion strongly correlated with survival. Conclusions IMRT plus concurrent chemotherapy may preserve the larynx without compromising survival. Further studies on new effective therapeutic agents are essential.
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- 2010
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21. Characterization of a salt-induced DhAHP, a gene coding for alkyl hydroperoxide reductase, from the extremely halophilic yeast Debaryomyces hansenii
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Ku Maurice SB, Yen Yung-fu, and Chao Hsiu-fung
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Microbiology ,QR1-502 - Abstract
Abstract Background Debaryomyces hansenii is one of the most salt tolerant species of yeast and has become a model organism for the study of tolerance mechanisms against salinity. The goal of this study was to identify key upregulated genes that are involved in its adaptation to high salinity. Results By using forward subtractive hybridization we have cloned and sequenced DhAHP from D. hansenii that is significantly upregulated during salinity stress. DhAHP is orthologous to the alkly hydroperoxide reductase of the peroxiredoxin gene family, which catalyzes the reduction of peroxides at the expense of thiol compounds. The full-lengthed cDNA of DhAHP has 674 bp of nucleotide and contains a 516 bp open reading frame (ORF) encoding a deduced protein of 172 amino acid residues (18.3 kDa). D. hansenii Ahp is a cytosolic protein that belongs to the Ahp of the 1-Cys type peroxiredoxins. Phylogentically, the DhAhp and Candida albicans Ahp11 (Swiss-Prot: Q5AF44) share a common ancestry but show divergent evolution. Silence of its expression in D. hansenii by RNAi resulted in decreased tolerance to salt whereas overexpression of DhAHP in D. hansenii and the salt-sensitive yeasts Saccharomyces cereviasiae and Pichia methanolica conferred a higher tolerance with a reduced level of reactive oxygen species. Conclusion In conclusion, for the first time our study has identified alkly hydroperoxide reductase as a key protein involved in the salt tolerance of the extremely halophilic D. hansenii. Apparently, this enzyme plays a multi-functional role in the yeast's adaptation to salinity; it serves as a peroxidase in scavenging reactive oxygen species, as a molecular chaperone in protecting essential proteins from denaturation, and as a redox sensor in regulating H2O2-mediated cell defense signaling.
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- 2009
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22. A multilevel analysis of neighborhood and individual effects on individual smoking and drinking in Taiwan
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Wu Yi-Hua, Li Yu-Sheng, Chuang Ying-Chih, and Chao Hsing
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background We assessed direct effects of neighborhood-level characteristics and interactive effects of neighborhood-level characteristics and individual socioeconomic position on adult smoking and drinking, after consideration of individual-level characteristics in Taiwan. Methods Data on individual sociodemographic characteristics, smoking, and drinking were obtained from Taiwan Social Change Survey conducted in 1990, 1995, and 2000. The overall response rate was 67%. A total of 5883 women and men aged over 20 living in 434 neighborhoods were interviewed. Participants' addresses were geocoded and linked with Taiwan census data for measuring neighborhood-level characteristics including neighborhood education, neighborhood concentration of elderly people, and neighborhood social disorganization. The data were analyzed with multilevel binomial regression models. Results Several interaction effects between neighborhood characteristics and individual socioeconomic status (SES) were found in multilevel analyses. Our results indicated that different neighborhood characteristics led to different interaction patterns. For example, neighborhood education had a positive effect on smoking for low SES women, in contrast to a negative effect on smoking for high SES women. This result supports the hypothesis of "relative deprivation," suggesting that poor people living in affluent neighborhoods suffer from relative deprivation and relative standing. On the other hand, neighborhood social disorganization has positive effects on drinking for low SES individuals, but not for high SES individuals. These interactive effects support the hypothesis of the double jeopardy theory, suggesting that living in neighborhoods with high social disorganization will intensify the effects of individual low SES. Conclusion The findings of this study show new evidence for the effects of neighborhood characteristics on individual smoking and drinking in Taiwan, suggesting that more studies are needed to understand neighborhood effects in Asian societies.
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- 2007
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23. Personalized prediction of immunotherapy response in lung cancer patients using advanced radiomics and deep learning.
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Liao CY, Chen YM, Wu YT, Chao HS, Chiu HY, Wang TW, Chen JR, Shiao TH, and Lu CF
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- Humans, Retrospective Studies, Male, Female, Middle Aged, Aged, Progression-Free Survival, Radiomics, Lung Neoplasms diagnostic imaging, Lung Neoplasms pathology, Lung Neoplasms therapy, Deep Learning, Immunotherapy methods, Precision Medicine methods, Tomography, X-Ray Computed methods
- Abstract
Background: Lung cancer (LC) is a leading cause of cancer-related mortality, and immunotherapy (IO) has shown promise in treating advanced-stage LC. However, identifying patients likely to benefit from IO and monitoring treatment response remains challenging. This study aims to develop a predictive model for progression-free survival (PFS) in LC patients with IO based on clinical features and advanced imaging biomarkers., Materials and Methods: A retrospective analysis was conducted on a cohort of 206 LC patients receiving IO treatment. Pre-treatment computed tomography images were used to extract advanced imaging biomarkers, including intratumoral and peritumoral-vasculature radiomics. Clinical features, including age, gene status, hematology, and staging, were also collected. Key radiomic and clinical features for predicting IO outcomes were identified using a two-step feature selection process, including univariate Cox regression and chi-squared test, followed by sequential forward selection. The DeepSurv model was constructed to predict PFS based on clinical and radiomic features. Model performance was evaluated using the area under the time-dependent receiver operating characteristic curve (AUC) and concordance index (C-index)., Results: Combining radiomics of intratumoral heterogeneity and peritumoral-vasculature with clinical features demonstrated a significant enhancement (p < 0.001) in predicting IO response. The proposed DeepSurv model exhibited a prediction performance with AUCs ranging from 0.76 to 0.80 and a C-index of 0.83. Furthermore, the predicted personalized PFS curves revealed a significant difference (p < 0.05) between patients with favorable and unfavorable prognoses., Conclusions: Integrating intratumoral and peritumoral-vasculature radiomics with clinical features enabled the development of a predictive model for PFS in LC patients with IO. The proposed model's capability to estimate individualized PFS probability and differentiate the prognosis status held promise to facilitate personalized medicine and improve patient outcomes in LC., (© 2024. The Author(s).)
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- 2024
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24. Immune killer cells treatment for previously treated stage IV NSCLC patients.
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Tseng YH, Ho CL, Chian CF, Chiang CL, Chao HS, Tsai CL, Perng WC, Hsiao CF, Chuang MH, Ko KH, Cheng YC, Chen SJ, Wang CJ, and Chen YM
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- Humans, Male, Female, Middle Aged, Aged, Quality of Life, Progression-Free Survival, Adult, Treatment Outcome, Immunotherapy, Adoptive methods, Immunotherapy, Adoptive adverse effects, Carcinoma, Non-Small-Cell Lung therapy, Carcinoma, Non-Small-Cell Lung immunology, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Non-Small-Cell Lung mortality, Lung Neoplasms therapy, Lung Neoplasms immunology, Lung Neoplasms pathology, Lung Neoplasms mortality, Neoplasm Staging
- Abstract
The 5-year survival is poor for stage IV non-small cell lung cancer (NSCLC). Recently, cell immunotherapy has emerged as a new treatment strategy. This study aimed to evaluate the efficacy and safety of Immune killer cells (IKC) in patients with stage IV NSCLC after the failure of prior chemotherapy. This study enrolled 26 patients with stage IV NSCLC who failed at least two lines of chemotherapy with or without targeted therapy. The IKC was given alone weekly for 24 weeks. The primary endpoint was progression-free survival (PFS). Secondary outcomes included overall survival (OS), pain intensity, quality of life (QOL), and safety. The median PFS for the intent-to-treat (ITT) population (i.e., all enrolled patients) was 3.8 month. In the per-protocol (PP) population (i.e., patients receiving > 12 IKC infusions), the median PFS was 5.6 months. Moreover, the ITT population showed a 1-year survival rate of 60.0%, while that for the PP population was 85.7%. Only 7 out of 200 AEs (3.5%) were related to the IKC infusion, and they were all rated as grade 1 in severity. The IKC infusion was well tolerated. This novel immunotherapy prolonged the PFS and improved the survival compared with historical data. It might be a potential treatment strategy for stage IV NSCLC patient who failed prior chemotherapy.ClinicalTrials.gov identifier: NCT03499834., (© 2024. The Author(s).)
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- 2024
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25. Determining the optimum high-flow nasal cannula flow rate to achieve the desired fraction of inspired oxygen: A bench study.
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Huang CL, Lu CC, Chiang C, Chao HS, Chiang TY, Teng WN, Chang WK, and Ting CK
- Abstract
Background: Purpose: High-flow nasal cannula (HFNC) has many benefits in various clinical conditions. The original hypothesis suggests that the high and constant fraction of inspired oxygen (FiO
2 ) is one of the main physiological effects. However, increasing evidence shows that there is a gap between the actual FiO2 and administered FiO2 . We aimed to determine the actual FiO2 under different respiratory conditions and develop a regression model using a spontaneous breathing lung model., Methods: A spontaneous breathing simulation model was built using an airway manikin and a model lung. The FiO2 was measured under different respiratory conditions with varying tidal volumes and respiratory and HFNC flow rates. The relationships between the respiratory parameters and actual FiO2 were determined and used to build the predictive model., Results: The actual FiO2 was negatively correlated with respiratory rate and tidal volume and positively correlated with HFNC flow. The regression model could not be developed using simple respiratory parameters. Therefore, we introduced a new variable, defined as flow ratio, which equaled the HFNC flow divided by inspiratory flow. Our equation demonstrated that the actual FiO2 was mainly determined by the flow ratio in a non-linear relationship. Accordingly, a flow ratio greater than 1 did not ensure a constant high FiO2 , whereas a flow ratio >1.435 could produce FiO2 >0.9., Conclusion: The FiO2 during HFNC was not constant even at sufficiently high oxygen flow compared with inspiratory flow. The predictive model showed that the actual FiO2 was mainly determined by the flow ratio., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)- Published
- 2024
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26. Standalone deep learning versus experts for diagnosis lung cancer on chest computed tomography: a systematic review.
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Wang TW, Hong JS, Chiu HY, Chao HS, Chen YM, and Wu YT
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Purpose: To compare the diagnostic performance of standalone deep learning (DL) algorithms and human experts in lung cancer detection on chest computed tomography (CT) scans., Materials and Methods: This study searched for studies on PubMed, Embase, and Web of Science from their inception until November 2023. We focused on adult lung cancer patients and compared the efficacy of DL algorithms and expert radiologists in disease diagnosis on CT scans. Quality assessment was performed using QUADAS-2, QUADAS-C, and CLAIM. Bivariate random-effects and subgroup analyses were performed for tasks (malignancy classification vs invasiveness classification), imaging modalities (CT vs low-dose CT [LDCT] vs high-resolution CT), study region, software used, and publication year., Results: We included 20 studies on various aspects of lung cancer diagnosis on CT scans. Quantitatively, DL algorithms exhibited superior sensitivity (82%) and specificity (75%) compared to human experts (sensitivity 81%, specificity 69%). However, the difference in specificity was statistically significant, whereas the difference in sensitivity was not statistically significant. The DL algorithms' performance varied across different imaging modalities and tasks, demonstrating the need for tailored optimization of DL algorithms. Notably, DL algorithms matched experts in sensitivity on standard CT, surpassing them in specificity, but showed higher sensitivity with lower specificity on LDCT scans., Conclusion: DL algorithms demonstrated improved accuracy over human readers in malignancy and invasiveness classification on CT scans. However, their performance varies by imaging modality, underlining the importance of continued research to fully assess DL algorithms' diagnostic effectiveness in lung cancer., Clinical Relevance Statement: DL algorithms have the potential to refine lung cancer diagnosis on CT, matching human sensitivity and surpassing in specificity. These findings call for further DL optimization across imaging modalities, aiming to advance clinical diagnostics and patient outcomes., Key Points: Lung cancer diagnosis by CT is challenging and can be improved with AI integration. DL shows higher accuracy in lung cancer detection on CT than human experts. Enhanced DL accuracy could lead to improved lung cancer diagnosis and outcomes., (© 2024. The Author(s).)
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- 2024
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27. Real-world osimertinib pretreatment experience in patients with epidermal growth factor receptor T790M mutation-positive locally advanced or metastatic non-small cell lung cancer.
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Chang GC, Shih JY, Yu CJ, Chao HS, Yang CT, Lin CC, Hung JY, Hsiao SY, Wang CC, Chian CF, Hsia TC, and Chen YM
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- Humans, Female, Male, Middle Aged, Aged, Adult, Aged, 80 and over, Antineoplastic Agents therapeutic use, Neoplasm Metastasis, Progression-Free Survival, Indoles, Pyrimidines, Acrylamides therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung genetics, Carcinoma, Non-Small-Cell Lung pathology, Aniline Compounds therapeutic use, ErbB Receptors genetics, ErbB Receptors antagonists & inhibitors, Lung Neoplasms drug therapy, Lung Neoplasms genetics, Lung Neoplasms pathology, Mutation, Protein Kinase Inhibitors therapeutic use
- Abstract
Osimertinib has demonstrated efficacy in patients with epidermal growth factor receptor (EGFR) T790M-positive non-small cell lung cancer (NSCLC) in clinical trials. However, real-world data on its effectiveness remain scarce. Taiwanese patients with T790M-positive locally advanced or metastatic NSCLC and progressive disease following treatment with at least one EGFR tyrosine kinase inhibitor (TKI) were enrolled from the osimertinib early access program. Of the 419 patients (mean age, 63 years; female, 67%), 53% were heavily pretreated (≥ third-line [3L]), making osimertinib a fourth-line (4L) intervention. The median progression-free survival (PFS) was 10.5 months (95% confidence interval [CI]: 8.95-11.41); the 18-month PFS rate was 26.5%. The median overall survival (OS) was 19.0 months (95% CI: 16.30-20.95); the 24-month OS rate was 40.9%. The objective response rate was 32.46%, and the disease control rate was 86.38%. The median time to treatment discontinuation of osimertinib monotherapy was 11.9 months (95% CI: 10.49-13.11). Subgroup analyses of median PFS and OS in the chemotherapy combination group vs. the osimertinib monotherapy group yielded no difference. Central nervous system (CNS) metastasis, number of prior lines of therapy, and types of initial EGFR-TKIs did not significantly impact outcomes. The median PFS values were 9.0 (95% CI: 5.18-11.34) and 10.9 (95% CI: 9.18-11.90) months with and without CNS metastasis, respectively, and 10.8 (95% CI: 8.59-12.69), 13.6 (95% CI: 10.89-16.3), and 9.2 (95% CI: 7.8-10.62) months for second-line (2L), 3L, and ≥4L therapy, respectively. In patients who received osimertinib as 2L therapy, the median PFS values in response to prior afatinib, erlotinib and gefitinib treatment were 11.2 (95% CI: 4.85-4.79), 10.5 (95% CI: 8.59-20.26) and 8.7 (95% CI: 7.21-16.79) months, respectively. Overall, real-world data from Taiwan support the clinical benefits of osimertinib in EGFR T790M -positive NSCLC., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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28. Clinical utility of immunohistochemical subtyping in patients with small cell lung cancer.
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Chiang CL, Huang HC, Luo YH, Shen CI, Chao HS, Tseng YH, Chou TY, Schrump DS, Yeh YC, and Chen YM
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- Humans, Immune Checkpoint Inhibitors therapeutic use, Transcription Factors metabolism, Small Cell Lung Carcinoma drug therapy, Lung Neoplasms drug therapy, Carcinoma, Non-Small-Cell Lung drug therapy
- Abstract
Objectives: Molecular subtyping of small cell lung cancer (SCLC) tumors based on the expression of four transcription factors (ASCL1, NEUROD1, POU2F3, and YAP1) using immunohistochemical (IHC) staining has recently emerged as a proposed approach. This study was aimed to examine this subtyping method in Asian patients with SCLC and investigate its correlation with treatment efficacy., Materials and Methods: Seventy-two tumor samples from patients with SCLC, including de novo cases and those transformed from EGFR-mutant tumors, were analyzed. IHC staining was used to measure the expression of the four transcription factors and conventional SCLC markers. Subtypes were defined based on relative expression levels. The treatment response and outcome of patients receiving immune checkpoint inhibitors and chemotherapy were also reviewed., Results: ASCL1 was the most common subtype, observed in 55.2 % of the samples, followed by NEUROD1 (26.9 %) and POU2F3 (9 %). No tumor exhibited predominant YAP1 positivity, while 41.8 % of the samples demonstrated positivity for two subtype markers. Approximately 50 % of the patients experienced a subtype switch after disease progression. Patients with the ASCL1/NEUROD1 (SCLC-A/N) subtype had similar progression-free survival (PFS) compared to non-SCLC-A/N patients after treatment with immune checkpoint inhibitors plus chemotherapy. Transformed SCLC patients had significantly worse PFS than de novo SCLC patients after chemoimmunotherapy. (2.1 vs. 5.4 months, P = 0.023) CONCLUSIONS: This study revealed the challenges associated with using IHC alone for molecular subtyping, highlighting the frequent co-expression of subtypes and temporal changes following treatment. Further research is warranted to explore the prognostic and therapeutic implications of IHC subtyping in patients with SCLC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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29. Progress in Serial Imaging for Prognostic Stratification of Lung Cancer Patients Receiving Immunotherapy: A Systematic Review and Meta-Analysis.
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Chiu HY, Wang TW, Hsu MS, Chao HS, Liao CY, Lu CF, Wu YT, and Chen YM
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Immunotherapy, particularly with checkpoint inhibitors, has revolutionized non-small cell lung cancer treatment. Enhancing the selection of potential responders is crucial, and researchers are exploring predictive biomarkers. Delta radiomics, a derivative of radiomics, holds promise in this regard. For this study, a meta-analysis was conducted that adhered to PRISMA guidelines, searching PubMed, Embase, Web of Science, and the Cochrane Library for studies on the use of delta radiomics in stratifying lung cancer patients receiving immunotherapy. Out of 223 initially collected studies, 10 were included for qualitative synthesis. Stratifying patients using radiomic models, the pooled analysis reveals a predictive power with an area under the curve of 0.81 (95% CI 0.76-0.86, p < 0.001) for 6-month response, a pooled hazard ratio of 4.77 (95% CI 2.70-8.43, p < 0.001) for progression-free survival, and 2.15 (95% CI 1.73-2.66, p < 0.001) for overall survival at 6 months. Radiomics emerges as a potential prognostic predictor for lung cancer, but further research is needed to compare traditional radiomics and deep-learning radiomics.
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- 2024
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30. Radiomics of metastatic brain tumor as a predictive image biomarker of progression-free survival in patients with non-small-cell lung cancer with brain metastasis receiving tyrosine kinase inhibitors.
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Wang TW, Chao HS, Chiu HY, Lu CF, Liao CY, Lee Y, Chen JR, Shiao TH, Chen YM, and Wu YT
- Abstract
Background and Objective: Epidermal growth factor receptor (EGFR)-targeted tyrosine kinase inhibitors (TKIs) are the first-line therapy for EGFR-mutant non-small-cell lung cancer (NSCLC). Early prediction of treatment failure in patients with brain metastases treated with EGFR-TKIs may help in making decisions for systemic drug therapy or local brain tumor control. This study examined the predictive power of the radiomics of both brain metastasis tumors and primary lung tumors. We propose a deep learning based CoxCC model based on quantitative brain magnetic resonance imaging (MRI), a prognostic index and clinical data; the model can be used to predict progression-free survival (PFS) after EGFR-TKI therapy in advanced EGFR-mutant NSCLC., Methods: This retrospective single-center study included 271 patients receiving first-line EGFR-TKI targeted therapy in 2018-2019. Among them, 72 patients who had brain metastases before receiving first-line EGFR-TKI treatment. Three radiomic features were extracted from pretreatment brain MRI images. A CoxCC model for the progression risk stratification of EGFR-TKI treatment was proposed on the basis of MRI radiomics, clinical features, and a prognostic index. We performed time-dependent PFS predictions to evaluate the performance of the CoxCC model., Results: The CoxCC model based on a prognostic index, clinical features, and radiomic features of brain metastasis exhibited higher performance than clinical features combined with indexes previously proposed for determining the prognosis of brain metastasis, including recursive partitioning analysis, diagnostic-specific graded prognostic assessment, graded prognostic assessment for lung cancer using molecular markers (lung-molGPA), and modified lung-molGPA, with c-index values of 0.75, 0.67, 0.66, 0.65, and 0.65, respectively. The model achieved areas under the curve of 0.88, 0.73, 0.92, and 0.90 for predicting PFS at 3, 6, 9 and 12 months, respectively. PFS significantly differed between the high- and low-risk groups (p < 0.001)., Conclusions: For patients with advanced-stage NSCLC with brain metastasis, MRI radiomics of brain metastases may predict PFS. The CoxCC model integrating brain metastasis radiomics, clinical features, and a prognostic index provided reliable multi-time-point PFS predictions for patients with advanced NSCLC and brain metastases receiving EGFR-TKI treatment., Competing Interests: Declaration of Competing Interest All authors declare no potential conflicts of interest., (Copyright © 2023. Published by Elsevier Inc.)
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- 2024
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31. Evaluating the Potential of Delta Radiomics for Assessing Tyrosine Kinase Inhibitor Treatment Response in Non-Small Cell Lung Cancer Patients.
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Wang TW, Chao HS, Chiu HY, Lin YH, Chen HC, Lu CF, Liao CY, Lee Y, Shiao TH, Chen YM, Huang JW, and Wu YT
- Abstract
Our study aimed to harness the power of CT scans, observed over time, in predicting how lung adenocarcinoma patients might respond to a treatment known as EGFR-TKI. Analyzing scans from 322 advanced stage lung cancer patients, we identified distinct image-based patterns. By integrating these patterns with comprehensive clinical information, such as gene mutations and treatment regimens, our predictive capabilities were significantly enhanced. Interestingly, the precision of these predictions, particularly related to radiomics features, diminished when data from various centers were combined, suggesting that the approach requires standardization across facilities. This novel method offers a potential pathway to anticipate disease progression in lung adenocarcinoma patients treated with EGFR-TKI, laying the groundwork for more personalized treatments. To further validate this approach, extensive studies involving a larger cohort are pivotal.
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- 2023
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32. Personalized cancer avatars for patients with thymic malignancies: A pilot study with circulating tumor cell-derived organoids.
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Wu YH, Chao HS, Chiang CL, Luo YH, Chiu CH, Yen SH, Liu CY, Chiou JF, Burnouf T, Chen YJ, Wang PY, Chao TY, Hsu SM, and Lu LS
- Subjects
- Humans, Pilot Projects, Organoids pathology, Neoplastic Cells, Circulating pathology, Thymus Neoplasms pathology, Pancreatic Neoplasms pathology
- Abstract
Background: Systemic therapy is the primary treatment for advanced thymic malignancies. However, there is an urgent need to improve clinical outcome. Personalized treatment based on predictive biomarkers is a potential approach to address this requirement. In this study, we aimed to show the correlation between drug sensitivity tests on CTCs-derived organoids and clinical response in patients with thymic malignancies. This approach carries the potential to create personalized cancer avatars and improve treatment outcome for patients., Methods: We previously reported potential treatment outcome prediction with patient-derived organoids (cancer avatars) in patients with pancreatic ductal adenocarcinoma. To further investigate the feasibility of this approach in advanced thymic malignancies, we conducted a study in which 12 patients were enrolled and 21 liquid biopsies were performed., Results: Cancer avatars were successfully derived in 16 out of 21 samples (success rate 76.2%). We found a sensitivity of 1.0 and specificity of 0.6 for drug sensitivity tests on the cancer avatars, and a two-tailed Fisher's exact test revealed a significant correlation between drug sensitivity tests and clinical responses (p = 0.0275)., Conclusion: This study supports the potential of circulating tumor cell-derived organoids to inform personalized treatment for advanced thymic malignancies. Further validation of this proof of concept finding is ongoing., (© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)
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- 2023
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33. Characteristics, treatment patterns, and clinical outcomes in patients with advanced non-small cell lung cancer harboring EGFR exon 20 insertions.
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Liao YT, Wang LC, Sun RL, Yeh YC, Huang HC, Shen CI, Tseng YH, Hsiao TH, Chao HS, Luo YH, Chen YM, and Chiang CL
- Subjects
- Humans, Male, Exons genetics, Mutation, Neoplasm Recurrence, Local drug therapy, Platinum therapeutic use, Protein Kinase Inhibitors pharmacology, Retrospective Studies, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung genetics, Carcinoma, Non-Small-Cell Lung pathology, ErbB Receptors genetics, Lung Neoplasms drug therapy, Lung Neoplasms genetics, Lung Neoplasms pathology
- Abstract
Purpose: Epidermal growth factor receptor (EGFR) exon 20 insertions (ex20ins) are associated with poor prognosis and resistance to traditional therapies in patients with non-small cell lung cancer (NSCLC). We aimed to elucidate the characteristics and treatment patterns to improve outcomes among this population in Taiwan., Methods: Patients with advanced or recurrent NSCLC harboring EGFR ex20ins from 2011 to 2021 were reviewed. The treatment groups were classified as platinum-based chemotherapy (PtC), EGFR tyrosine kinase inhibitor (TKI), and others. The response to therapy, objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and factors associated with survival were analyzed., Results: Among the 71 patients, most were never-smoking males with stage IVB adenocarcinoma. The most common first-line (1L) regimen was PtC, followed by TKI. The most common second-line (2L) regimen was TKI. The median PFS of 1L treatment was 5.03 months, and the median OS was 18.43 months. Compared with that of TKI, 1L PtC use was associated with a higher ORR (26.3% vs. 9.1%) and DCR (60.5% vs. 18.2%) and a longer PFS (5.37 vs. 3.13 months, p = 0.044). PFS was also significantly longer in the 2L PtC group than in the 2L TKI group (4.73 vs. 2.25 months, p = 0.047). No patients receiving an immune checkpoint inhibitor-based regimen exhibited a therapeutic response., Conclusion: This study demonstrated the heterogeneous clinical characteristics and treatment pattern of NSCLC patients with EGFR ex20ins, underscoring the need for more effective therapies for this distinct molecular subtype., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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34. Application of Radiomics in Prognosing Lung Cancer Treated with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors: A Systematic Review and Meta-Analysis.
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Wang TW, Hsu MS, Lin YH, Chiu HY, Chao HS, Liao CY, Lu CF, Wu YT, Huang JW, and Chen YM
- Abstract
In the context of non-small cell lung cancer (NSCLC) patients treated with EGFR tyrosine kinase inhibitors (TKIs), this research evaluated the prognostic value of CT-based radiomics. A comprehensive systematic review and meta-analysis of studies up to April 2023, which included 3111 patients, was conducted. We utilized the Quality in Prognosis Studies (QUIPS) tool and radiomics quality scoring (RQS) system to assess the quality of the included studies. Our analysis revealed a pooled hazard ratio for progression-free survival of 2.80 (95% confidence interval: 1.87-4.19), suggesting that patients with certain radiomics features had a significantly higher risk of disease progression. Additionally, we calculated the pooled Harrell's concordance index and area under the curve (AUC) values of 0.71 and 0.73, respectively, indicating good predictive performance of radiomics. Despite these promising results, further studies with consistent and robust protocols are needed to confirm the prognostic role of radiomics in NSCLC.
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- 2023
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35. Temporal changes in biomarkers in individuals with and without acute mountain sickness following rapid ascent.
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Lin FC, Chao HS, Chou CW, Tsai HC, and Chang SC
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- Humans, E-Selectin, Plasminogen Activator Inhibitor 1, Vascular Endothelial Growth Factor A, Vascular Cell Adhesion Molecule-1, Acute Disease, Biomarkers, Altitude Sickness diagnosis
- Abstract
Background: Field studies have reported conflicting results regarding changes in biomarkers at high altitude. This study measured temporal changes in biomarkers and compared the differences between individuals with and without acute mountain sickness (AMS)., Materials and Methods: This study included 34 nonacclimatized healthy participants. Ten-milliliters of blood were collected at four time points: 3 days before ascent (T0), on two successive nights at 3150 m (T1 and T2), and 2 days after descent (T3). Participants were transported by bus from 555 m to 3150 m within 3 hours. AMS was diagnosed using the self-reported Lake Louise Scoring (LLS) questionnaire., Results: Compared with T0, significant increases in E-selectin and decreases in vascular endothelial growth factor (VEGF) levels were observed at high altitude. Significantly increased C-reactive protein (CRP), monocyte chemoattractant protein-1 (MCP-1), and S100 calcium-binding protein B (S100B) levels were observed at T2, and significantly decreased vascular cell adhesion molecule-1 (VCAM-1) levels were observed at T3. Eighteen (53%) participants developed AMS. Changes in E-selectin, CRP, MCP-1, and S100B levels were independent of AMS. Relative to individuals without AMS, those with AMS had significantly higher atrial natriuretic peptide (ANP) and VCAM-1 levels and lower plasminogen activator inhibitor-1 (PAI-1) levels at T1 and higher brain natriuretic peptide and lower VEGF and PAI-1 levels at T3. LLSs were positively correlated with ANP and VCAM-1 levels and negatively correlated with PAI-1 levels measured at T1., Conclusions: After acute ascent, individuals with and without AMS exhibited different trends in biomarkers associated with endothelial cell activation and natriuretic peptides., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest., (Copyright © 2023 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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36. Old age and EGFR mutation status in inoperable early-stage non-small cell lung cancer patients receiving stereotactic ablative radiotherapy: A single institute experience of 71 patients in Taiwan.
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Wu YH, Kang YM, Hu YW, Lan KL, Yen SH, Lai TY, Lan TL, Chen YM, Chiu CH, Luo YH, Chao HS, Chiang CL, Shiao TH, Yang CN, Hsu WH, Wu YC, Hsu HS, Hung JJ, Huang CS, Hsu PK, and Chen YW
- Subjects
- Aged, Aged, 80 and over, Humans, Male, ErbB Receptors genetics, Neoplasm Staging, Taiwan, Treatment Outcome, Carcinoma, Non-Small-Cell Lung genetics, Carcinoma, Non-Small-Cell Lung radiotherapy, Lung Neoplasms genetics, Lung Neoplasms radiotherapy, Radiosurgery adverse effects, Small Cell Lung Carcinoma etiology
- Abstract
Background: Stereotactic ablative radiotherapy (SABR) is now the standard of care for patients with inoperable early-stage lung cancer. Many of these patients are elderly. EGFR (epidermal growth factor receptor) mutation is also common in the Asian population., Methods: To evaluate the effects of old age and EGFR mutation on treatment outcomes and toxicity, we reviewed the medical records of 71 consecutive patients with inoperable early-stage non-small cell lung cancer (NSCLC) who received SABR at Taipei Veterans General Hospital between 2015 and 2021., Results: The study revealed that median age, follow-up, Charlson comorbidity index, and ECOG score were 80 years, 2.48 years, 3, and 1, respectively. Of these patients, 37 (52.1%) were 80 years or older, and 50 (70.4%) and 21 (29.6%) had T1 and T2 diseases, respectively. EGFR mutation status was available for 33 (46.5%) patients, of whom 16 (51.5%) had a mutation. The overall survival rates at 1, 3, and 5 years were 97.2, 74.9, and 58.3%, respectively. The local control rate at 1, 3, and 5 years was 97.1, 92.5, and 92.5%, respectively. Using Cox proportional hazards regression we found that male sex was a risk factor for overall survival (p = 0.036, 95% CI: 1.118-26.188). Two patients had grade 2 pneumonitis, but no other grade 2 or higher toxicity was observed. We did not find any significant differences in treatment outcomes or toxicity between patients aged 80 or older and those with EGFR mutations in this cohort., Conclusion: These findings indicate that age and EGFR mutation status do not significantly affect the effectiveness or toxicity of SABR for patients with inoperable early-stage NSCLC., (© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)
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- 2023
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37. Endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of pulmonary sarcoidosis: A 9-year experience at a single center.
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Shen HS, Lin FC, Tung SM, Chang CY, Chen YM, and Chao HS
- Subjects
- Humans, Retrospective Studies, Bronchoscopy methods, Sensitivity and Specificity, Endoscopic Ultrasound-Guided Fine Needle Aspiration methods, Lymph Nodes pathology, Inflammation, Sarcoidosis, Pulmonary diagnostic imaging, Sarcoidosis, Pulmonary pathology, Sarcoidosis pathology
- Abstract
Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is valuable for diagnosing pulmonary sarcoidosis. We aimed to evaluate the diagnostic yield of EBUS-TBNA and cytology in sarcoidosis during the first 9 years at our institution., Methods: Patients who underwent EBUS-TBNA for suspected sarcoidosis between January 2011 and November 2019 were identified retrospectively. EBUS-TBNA was performed with rapid on-site cytological evaluation of the samples. The final diagnosis was based on the pathology and/or cytology results, radiologic features, and clinical follow-up findings. The yield rate was analyzed annually., Results: Eighty patients underwent 83 EBUS-TBNA procedures for suspected sarcoidosis. In total, 136 lymph nodes were sampled. The mean number of lymph node stations sampled was 2.0 ± 0.6; the mean number of needle passes per lymph node was 3.5 ± 0.8. Sixty-five patients were diagnosed with sarcoidosis, with a total of 68 procedures. Nonnecrotizing granulomatous inflammation was detected in the EBUS-TBNA samples from 49/68 procedures (yield rate: 72.1%). Of 19 patients with sarcoidosis who did not obtain a pathological diagnosis with EBUS-TBNA, epithelioid cells and/or multinuclear giant cells suggestive of granulomatous inflammation were detected in five. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) for pathological diagnosis of sarcoidosis using EBUS-TBNA were 72.1%, 100%, 100%, and 24.0%, respectively. On using cytology, the sensitivity and NPV increased to 79.4% and 26.3%, respectively. The yield rate did not increase until 2016., Conclusion: EBUS-TBNA is useful for diagnosing sarcoidosis. Cytology resulted in an additional yield rate of 7.3%, which improved as the number of cases increased., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2022, the Chinese Medical Association.)
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- 2023
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38. A radiomics-based deep learning approach to predict progression free-survival after tyrosine kinase inhibitor therapy in non-small cell lung cancer.
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Lu CF, Liao CY, Chao HS, Chiu HY, Wang TW, Lee Y, Chen JR, Shiao TH, Chen YM, and Wu YT
- Subjects
- Humans, Progression-Free Survival, Tyrosine Kinase Inhibitors, Disease-Free Survival, Protein Kinase Inhibitors therapeutic use, ErbB Receptors genetics, Mutation, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung genetics, Lung Neoplasms diagnostic imaging, Lung Neoplasms drug therapy, Lung Neoplasms genetics, Deep Learning
- Abstract
Background: The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are a first-line therapy for non-small cell lung cancer (NSCLC) with EGFR mutations. Approximately half of the patients with EGFR-mutated NSCLC are treated with EGFR-TKIs and develop disease progression within 1 year. Therefore, the early prediction of tumor progression in patients who receive EGFR-TKIs can facilitate patient management and development of treatment strategies. We proposed a deep learning approach based on both quantitative computed tomography (CT) characteristics and clinical data to predict progression-free survival (PFS) in patients with advanced NSCLC after EGFR-TKI treatment., Methods: A total of 593 radiomic features were extracted from pretreatment chest CT images. The DeepSurv models for the progression risk stratification of EGFR-TKI treatment were proposed based on CT radiomic and clinical features from 270 stage IIIB-IV EGFR-mutant NSCLC patients. Time-dependent PFS predictions at 3, 12, 18, and 24 months and estimated personalized PFS curves were calculated using the DeepSurv models., Results: The model combining clinical and radiomic features demonstrated better prediction performance than the clinical model. The model achieving areas under the curve of 0.76, 0.77, 0.76, and 0.86 can predict PFS at 3, 12, 18, and 24 months, respectively. The personalized PFS curves showed significant differences (p < 0.003) between groups with good (PFS > median) and poor (PFS < median) tumor control., Conclusions: The DeepSurv models provided reliable multi-time-point PFS predictions for EGFR-TKI treatment. The personalized PFS curves can help make accurate and individualized predictions of tumor progression. The proposed deep learning approach holds promise for improving the pre-TKI personalized management of patients with EGFR-mutated NSCLC., (© 2023. The Author(s).)
- Published
- 2023
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39. Artificial Intelligence Assisted Computational Tomographic Detection of Lung Nodules for Prognostic Cancer Examination: A Large-Scale Clinical Trial.
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Chao HS, Tsai CY, Chou CW, Shiao TH, Huang HC, Chen KC, Tsai HH, Lin CY, and Chen YM
- Abstract
Low-dose computed tomography (LDCT) has emerged as a standard method for detecting early-stage lung cancer. However, the tedious computer tomography (CT) slide reading, patient-by-patient check, and lack of standard criteria to determine the vague but possible nodule leads to variable outcomes of CT slide interpretation. To determine the artificial intelligence (AI)-assisted CT examination, AI algorithm-assisted CT screening was embedded in the hospital picture archiving and communication system, and a 200 person-scaled clinical trial was conducted at two medical centers. With AI algorithm-assisted CT screening, the sensitivity of detecting nodules sized 4−5 mm, 6~10 mm, 11~20 mm, and >20 mm increased by 41%, 11.2%, 10.3%, and 18.7%, respectively. Remarkably, the overall sensitivity of detecting varied nodules increased by 20.7% from 67.7% to 88.4%. Furthermore, the sensitivity increased by 18.5% from 72.5% to 91% for detecting ground glass nodules (GGN), which is challenging for radiologists and physicians. The free-response operating characteristic (FROC) AI score was ≥0.4, and the AI algorithm standalone CT screening sensitivity reached >95% with an area under the localization receiver operating characteristic curve (LROC-AUC) of >0.88. Our study demonstrates that AI algorithm-embedded CT screening significantly ameliorates tedious LDCT practices for doctors.
- Published
- 2023
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40. Generating High-Resolution CT Slices from Two Image Series Using Deep-Learning-Based Resolution Enhancement Methods.
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Chao HS, Wu YH, Siana L, and Chen YM
- Abstract
Medical image super-resolution (SR) has mainly been developed for a single image in the literature. However, there is a growing demand for high-resolution, thin-slice medical images. We hypothesized that fusing the two planes of a computed tomography (CT) study and applying the SR model to the third plane could yield high-quality thin-slice SR images. From the same CT study, we collected axial planes of 1 mm and 5 mm in thickness and coronal planes of 5 mm in thickness. Four SR algorithms were then used for SR reconstruction. Quantitative measurements were performed for image quality testing. We also tested the effects of different regions of interest (ROIs). Based on quantitative comparisons, the image quality obtained when the SR models were applied to the sagittal plane was better than that when applying the models to the other planes. The results were statistically significant according to the Wilcoxon signed-rank test. The overall effect of the enhanced deep residual network (EDSR) model was superior to those of the other three resolution-enhancement methods. A maximal ROI containing minimal blank areas was the most appropriate for quantitative measurements. Fusing two series of thick-slice CT images and applying SR models to the third plane can yield high-resolution thin-slice CT images. EDSR provides superior SR performance across all ROI conditions.
- Published
- 2022
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41. Artificial Intelligence for Early Detection of Chest Nodules in X-ray Images.
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Chiu HY, Peng RH, Lin YC, Wang TW, Yang YX, Chen YY, Wu MH, Shiao TH, Chao HS, Chen YM, and Wu YT
- Abstract
Early detection increases overall survival among patients with lung cancer. This study formulated a machine learning method that processes chest X-rays (CXRs) to detect lung cancer early. After we preprocessed our dataset using monochrome and brightness correction, we used different kinds of preprocessing methods to enhance image contrast and then used U-net to perform lung segmentation. We used 559 CXRs with a single lung nodule labeled by experts to train a You Only Look Once version 4 (YOLOv4) deep-learning architecture to detect lung nodules. In a testing dataset of 100 CXRs from patients at Taipei Veterans General Hospital and 154 CXRs from the Japanese Society of Radiological Technology dataset, the sensitivity of the AI model using a combination of different preprocessing methods performed the best at 79%, with 3.04 false positives per image. We then tested the AI by using 383 sets of CXRs obtained in the past 5 years prior to lung cancer diagnoses. The median time from detection to diagnosis for radiologists assisted with AI was 46 (3-523) days, longer than that for radiologists (8 (0-263) days). The AI model can assist radiologists in the early detection of lung nodules.
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- 2022
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42. Real-world evidence of the intrinsic limitations of PCR-based EGFR mutation assay in non-small cell lung cancer.
- Author
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Shen CI, Chiang CL, Shiao TH, Luo YH, Chao HS, Huang HC, and Chiu CH
- Subjects
- ErbB Receptors genetics, Female, Humans, Male, Middle Aged, Mutation, Protein Kinase Inhibitors therapeutic use, Real-Time Polymerase Chain Reaction, Retrospective Studies, Carcinoma, Non-Small-Cell Lung pathology, Lung Neoplasms pathology
- Abstract
Detection of driver gene mutations is important in advanced NSCLC. The cobas EGFR mutation test is a mutant allele-specific real-time PCR assay with limitation owing to its primer design. Next-generation sequencing-based assay has a higher mutation detection coverage; however, its clinical impact remains unclear. We retrospectively collected the records of stage IV NSCLC patients with wild-type EGFR tested by cobas test. FoundationOne CDx was used for comprehensive genomic profiles. We then evaluated the missed EGFR mutations by the cobas test. We studied 62 patients. The median age was 60 (range: 35-86 years). Most patients were male and 58.1% were smokers. 91.9% were adenocarcinomas. Of the 62 samples, 7 (11.3%) were detected with EGFR mutations by NGS. Among these overlooked EGFR mutations, five were exon 20 insertions, and two were exon 19 deletions. Two patients received EGFR TKIs and showed durable response with PFS 5.9 months and 10.1 months, respectively. Using NGS as the standard, the false-negative rate of the cobas EGFR mutation test was 11.3%-in a population with a high prevalence of EGFR mutations. The most overlooked mutations were exon 20 insertions. A comprehensive EGFR mutation assay can provide significant benefits to patients with NSCLC., (© 2022. The Author(s).)
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- 2022
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43. Application of Artificial Intelligence in Lung Cancer.
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Chiu HY, Chao HS, and Chen YM
- Abstract
Lung cancer is the leading cause of malignancy-related mortality worldwide due to its heterogeneous features and diagnosis at a late stage. Artificial intelligence (AI) is good at handling a large volume of computational and repeated labor work and is suitable for assisting doctors in analyzing image-dominant diseases like lung cancer. Scientists have shown long-standing efforts to apply AI in lung cancer screening via CXR and chest CT since the 1960s. Several grand challenges were held to find the best AI model. Currently, the FDA have approved several AI programs in CXR and chest CT reading, which enables AI systems to take part in lung cancer detection. Following the success of AI application in the radiology field, AI was applied to digitalized whole slide imaging (WSI) annotation. Integrating with more information, like demographics and clinical data, the AI systems could play a role in decision-making by classifying EGFR mutations and PD-L1 expression. AI systems also help clinicians to estimate the patient's prognosis by predicting drug response, the tumor recurrence rate after surgery, radiotherapy response, and side effects. Though there are still some obstacles, deploying AI systems in the clinical workflow is vital for the foreseeable future.
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- 2022
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44. Comparison of the outcome between immunotherapy alone or in combination with chemotherapy in EGFR-mutant non-small cell lung cancer.
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Shen CI, Chao HS, Shiao TH, Chiang CL, Huang HC, Luo YH, Chiu CH, and Chen YM
- Subjects
- Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung genetics, Carcinoma, Non-Small-Cell Lung immunology, ErbB Receptors genetics, Female, Humans, Immunotherapy methods, Lung Neoplasms genetics, Lung Neoplasms immunology, Male, Middle Aged, Mutation genetics, Progression-Free Survival, Protein Kinase Inhibitors therapeutic use, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung therapy, Lung Neoplasms drug therapy, Lung Neoplasms therapy
- Abstract
Whether ICIs combined with chemotherapy can improve outcomes in EGFR-mutant non-small cell lung cancer (NSCLC) remains uncertain. Patients with EGFR-mutant NSCLC and who progressed on first-line EGFR-TKIs treatment were retrospectively collected. We reviewed the outcome of these patients treated with ICIs or ICIs combined chemotherapy (ICI + C). Total 30 patients were included. The ORR were 9.1% and 25.0% for the ICI and ICI + C groups. The ICI + C group showed the trend of longer progression-free survival and overall survival periods. Patients without the T790M mutation had a significantly longer PFS than did those without this mutation (4.23 [95% CI: 2.75-5.72] vs. 1.70 [95% CI: 0.00-3.51] months, HR:4.45, p = 0.019). ICIs combined with chemotherapy tended to be more effective than ICIs alone in pretreated EGFR-mutant NSCLC. The T790M mutation may be a potential biomarker., (© 2021. The Author(s).)
- Published
- 2021
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45. Successful rechallenge of alectinib after remission of severe alectinib-induced interstitial lung disease.
- Author
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Huang JR, Chou CW, and Chao HS
- Subjects
- Aged, Carbazoles administration & dosage, Female, Humans, Piperidines administration & dosage, Protein Kinase Inhibitors therapeutic use, Adenocarcinoma of Lung drug therapy, Carbazoles adverse effects, Lung Diseases, Interstitial chemically induced, Lung Neoplasms drug therapy, Piperidines adverse effects
- Abstract
Introduction: Even though alectinib is a potent second-generation ALK inhibitor with a favorable safety profile, alectinib-induced interstitial lung disease (ILD) could be fatal. There are case reports described successful alectinib rechallenge in mild ILD. However, the feasibility and safety of rechallenge in severe cases remains to be elucidated., Case Report: A 76-year-old female was a case of stage IV lung adenocarcinoma harboring ALK rearrangement. Respiratory failure following severe ILD developed one month after alectinib administration. She received mechanical ventilation in intensive care uint. ILD subsided gradually after methylprednisolone pulse therapy and discontinuation of alectinib. Management and outcome: After the recovery from ILD, the patient attempted a re-escalation of alectinib from a lower dose under close clinical and radiological monitoring. No ILD happened even after 480 days of alectinib rechallenge., Discussion: Given that the ALK inhibitors are the treatment of choice for advanced lung cancer patients with ALK rearrangement. Our report demonstrated the potential feasibility of alectinib re-use in cases of severe druginduced ILD.
- Published
- 2021
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46. Multidisciplinary team discussion results in survival benefit for patients with stage III non-small-cell lung cancer.
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Hung HY, Tseng YH, Chao HS, Chiu CH, Hsu WH, Hsu HS, Wu YC, Chou TY, Chen CK, Lan KL, Chen YW, Wu YH, and Chen YM
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Non-Small-Cell Lung therapy, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Lung Neoplasms pathology, Lung Neoplasms therapy, Male, Middle Aged, Neoplasm Staging, Retrospective Studies, Survival Rate, Young Adult, Carcinoma, Non-Small-Cell Lung mortality, Interdisciplinary Communication, Lung Neoplasms mortality, Patient Care Team statistics & numerical data, Quality of Life
- Abstract
Background: The treatment for stage III non-small cell lung cancer (NSCLC) often involves multi-modality treatment. This retrospective study aimed to evaluate whether multidisciplinary team (MDT) discussion results in better patient survival., Materials and Methods: MDT discussion was optional before February 2016 and was actively encouraged by the MDT committee beginning February 2016. We reviewed the medical charts and computer records of patients with stage III NSCLC between January 2013 and December 2018., Results: A total of 515 patients were included. The median survival of all the patients was 33.9 months (M). The median survival of patients who were treated after MDT discussion was 41.2 M and that of patients treated without MDT discussion was 25.7 M (p = 0.018). The median survival of patients treated before February 2016 was 25.7 M and that of patients treated after February 2016 was 33.9 M (p = 0.003). The median survival of patients with stage IIIA tumors and those with stage IIIB tumors was 39.4 M and 25.7 M, respectively (p = 0.141). Multivariate analysis showed that MDT or not (p<0.001), T staging (p = 0.009), performance status (p<0.001), and surgery (p = 0.016) to be significant prognostic factors., Conclusion: The results of the study show that MDT discussion results in survival benefit in patients with stage III NSCLC. The MDT discussion, performance status, and if surgery was performed were independent prognostic factors for patients with stage III NSCLC., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2020
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47. Clinical usefulness of bronchoalveolar lavage in patients with interstitial lung diseases: a pilot study.
- Author
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Chang SL, Tsai HC, Lin FC, Chao HS, Chou CW, and Chang SC
- Abstract
Background: Bronchoalveolar lavage (BAL) is a useful tool in the diagnostic work-up of patients with interstitial lung diseases (ILDs). In this prospective study, we investigated the clinical usefulness of BAL in patients with ILD radiographically., Methods: The enrolled patients were classified into outpatient department (OPD), and inpatients groups who was admitted to general ward (GW) or intensive care unit (ICU) groups based on the time when BAL done. The clinical usefulness of BAL was defined as a new diagnosis established and/or treatment significantly changed. The clinical usefulness of BAL among the three groups of patients and the patients divided by underlying diseases was compared using the χ
2 test with or without Fisher's exact test., Results: Among our 184 patients, there were 37 in OPD group, 86 in GW group and 61 in ICU group. The final diagnoses were infectious in 23, non-infectious in 102, mixed etiologies in 19, and non-diagnostic in 40 patients. The diagnostic yields (revised diagnosis after BAL) of BAL among ICU patients, GW patients and OPD patients were 60.6%, 69.7% and 21.6%, respectively (P<0.001), and was 57.1% in total patients. The diagnostic yields of BAL among patients with cancer, organ transplantation and collagen vascular disease were statistically different (P=0.009)., Conclusions: BAL is of use in establishing a diagnosis of ILD and is mandatary especially in the admitted patients with ILD because diagnostic yield was relatively higher in admitted patients than in OPD patients. In addition, BAL should be done more early in the admitted patients with malignancy, stem cell and/or organ transplantation and collagen vascular disease especially when they showed poor response to initial medications., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-19-3659). The authors have no conflicts of interest to declare., (2020 Journal of Thoracic Disease. All rights reserved.)- Published
- 2020
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48. Efficacy of Paclitaxel plus TS1 against previously treated EGFR mutated non-small cell lung cancer.
- Author
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Tseng YH, Shih JF, Chao HS, and Chen YM
- Abstract
Background: Later line chemotherapy (≥2nd lines) such as Docetaxel or immunotherapy is frequently used. As the life expectancy of lung cancer patients is getting longer, we need to provide more treatment options. Other treatment options are not well documented except for Doxetaxel and immunotherapy. Therefore, the efficacy of paclitaxel plus TS1 (TTS1) is warranted., Methods: We retrospectively reviewed the chart records of our non-small cell lung cancer patients who were treated between 2010 and 2013. Clinical characteristics, type of tumor, EGFR mutation status, and treatment response to first-line EGFR-TKI therapy and efficacy of TTS1, were collected., Results: Twenty eight patients were enrolled in this study. No patients archived complete response and seven patients had partial response (ORR: 25%). The disease control rate was 60.7% (17/28). The progression free survival (PFS) was 4.0 months and overall survival (OS) was 15.8 months. Of them, 17 had EGFR mutations, eight EGFR wild type, and three were unknown EGFR status. After TTS1 treatment, patients with EGFR mutations had better PFS (4.9 months vs. 1.8 months) and OS (15.5 months vs. 7.2 months) compared with those of EGFR wild type., Conclusions: TTS1 are effective later line chemotherapy, especially in tumor EGFR mutated patients. Paclitaxel plus TS1 is another treatment of choice for NSCLC patients before a more effective treatment strategy is found., Competing Interests: The authors declare there are no competing interests., (©2019 Tseng et al.)
- Published
- 2019
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49. The usefulness of prophylactic use of acetazolamide in subjects with acute mountain sickness.
- Author
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Hung PH, Lin FC, Tsai HC, Chao HS, Chou CW, and Chang SC
- Subjects
- Acetazolamide adverse effects, Acute Disease, Adult, Altitude Sickness physiopathology, Carbon Dioxide blood, Female, Heart Rate drug effects, Humans, Male, Middle Aged, Oxygen blood, Polysomnography, Sleep drug effects, Sleep physiology, Acetazolamide therapeutic use, Altitude Sickness prevention & control
- Abstract
Background: The mechanisms of acetazolamide (ACZ) in the prophylaxis of acute mountain sickness (AMS) remain unclear. This study evaluated the changes in physiological variables of sleep and heart rate variability (HRV) in subjects with earlier history of AMS who underwent prophylactic treatment of ACZ., Methods: Nonacclimatized healthy subjects were transported using a bus from 555 m to 3150 m within 3 hours. Polysomnography (PSG) was performed 3 days before ascent (T0), for two consecutive nights at 3150 m (T1 and T2), and 2 days after descent (T3). HRV was measured before sleep and after awakening from T0 to T3. AMS was diagnosed using a self-reported Lake Louise score questionnaire. Subjects found confirmed to have AMS were enrolled in this study. The physiological variables and HRV were compared in AMS subjects without (control group) and with prophylactic ACZ (prophylactic ACZ group)., Results: Thirteen AMS subjects were enrolled. The PSG results were analyzed in eight and HRV were analyzed in nine of the 13 subjects. The prophylactic use of ACZ in the subjects with a history of AMS significantly improved sleep efficiency (p = 0.012) and awakening percentages (p = 0.017) at T1, significantly higher levels of arterial oxygen saturation (SaO2) and lower values of partial pressure end-tidal carbon dioxide tension (PETCO2) at four time points. Furthermore, they had a higher rapid eye movement sleep percentage (p = 0.05) at T2. Prophylactic ACZ treatment significantly increased the normalized unit of high frequency at T1 after awakening (p = 0.028)., Conclusion: Significantly higher quality of sleep, higher SaO2 during sleep, and lower PETCO2 at high altitude were found in the subjects with a history of AMS using prophylactic ACZ before rapid ascent. ACZ may accelerate the acclimatization process for rapid ascents to high altitudes by increasing parasympathetic tone based on HRV analyses.
- Published
- 2019
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50. The impact of open to collaborative care model in cardiovascular surgical unit.
- Author
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Wu HY, Chao HS, Shih HC, Shih CC, and Chang SC
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Intersectoral Collaboration, Male, Middle Aged, Retrospective Studies, Cardiovascular Surgical Procedures, Delivery of Health Care, Intensive Care Units
- Abstract
Background: When compared with open care model, a closed one improves patient care in intensive care units (ICUs), mixed ICUs, surgical ICUs and trauma centers. We wanted to evaluate the benefit of a collaborative care model in highly specialized cardiovascular care unit., Methods: This study was a retrospective, observational study conducted in the cardiovascular care unit of a teaching hospital. All patients who were above 20 years old and had received cardiovascular operation were enrolled for data collection and analysis., Results: A total of 270 subjects were enrolled for analysis during the 2-year study period. In the collaborative care model, the CVSU length of stay (p = 0.001) and CVSU-free days (p = 0.0008) were significantly better than those in an open care model., Discussion: The collaborative care model improved postoperative outcome in the cardiovascular surgical unit for those needing prolonged ICU care., (Copyright © 2017. Published by Elsevier Taiwan LLC.)
- Published
- 2018
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