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Huang CC, Yeh HY, Lin R, Liao TL, Shen HC, Yang YY, Lin HC. Inhibition of visceral adipose tissue-derived pathogenic signals by activation of adenosine A 2AR improves hepatic and cardiac dysfunction of NASH mice. Am J Physiol Gastrointest Liver Physiol 2024; 326:G385-G397. [PMID: 38252682 DOI: 10.1152/ajpgi.00104.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
A2AR-disrupted mice is characterized by severe systemic and visceral adipose tissue (VAT) inflammation. Increasing adenosine cyclase (AC), cAMP, and protein kinase A (PKA) formation through A2AR activation suppress systemic/VAT inflammation in obese mice. This study explores the effects of 4 wk A2AR agonist PSB0777 treatment on the VAT-driven pathogenic signals in hepatic and cardiac dysfunction of nonalcoholic steatohepatitis (NASH) obese mice. Among NASH mice with cardiac dysfunction, simultaneous decrease in the A2AR, AC, cAMP, and PKA levels were observed in VAT, liver, and heart. PSB0777 treatment significantly restores AC, cAMP, PKA, and hormone-sensitive lipase (HSL) levels, decreased SREBP-1/FASN, MCP-1, and CD68 levels, reduces infiltrated CD11b+ F4/80+ cells and adipogenesis in VAT of NASH + PSB0777 mice. The changes in VAT were accompanied by the suppression of hepatic and cardiac lipogenic/inflammatory/injury/apoptotic/fibrotic markers, the normalization of cardiac contractile [sarco/endoplasmic reticulum Ca2+ ATPase (SERCA2)] marker, and cardiac dysfunction. The in vitro approach revealed that conditioned media (CM) of VAT of NASH mice (CMnash) trigger palmitic acid (PA)-like lipotoxic (lipogenic/inflammatory/apoptotic/fibrotic) effects in AML-12 and H9c2 cell systems. Significantly, A2AR agonist pretreatment-related normalization of A2AR-AC-cAMP-PKA levels was associated with the attenuation of CMnash-related upregulation of lipotoxic markers and the normalization of lipolytic (AML-12 cells) or contractile (H9C2 cells) marker/contraction. The in vivo and in vitro experiments revealed that A2AR agonists are potential agent to inhibit the effects of VAT inflammation-driven pathogenic signals on the hepatic and cardiac lipogenesis, inflammation, injury, apoptosis, fibrosis, hypocontractility, and subsequently improve hepatic and cardiac dysfunction in NASH mice.NEW & NOTEWORTHY Protective role of adenosine A2AR receptor (A2AR) and AC-cAMP-PKA signaling against nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) possibly via its actions on adipocytes is well known in the past decade. Thus, this study evaluates pharmacological activities of A2AR agonist PSB0777, which has already demonstrated to treat NASH. In this study, the inhibition of visceral adipose tissue-derived pathogenic signals by activation of adenosine A2AR with A2AR agonist PSB0777 improves the hepatic and cardiac dysfunction of high-fat diet (HFD)-induced NASH mice.
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Grants
- MOST-110-2634-F-A49-005,NSTC 112-2314-B-A49 -043 -MY3 MOST | Hsinchu Science Park Bureau, Ministry of Science and Technology, Taiwan (HSP)
- MOST 111-2410-H-075-001 MOST | Hsinchu Science Park Bureau, Ministry of Science and Technology, Taiwan (HSP)
- V112C-018,V112C-030,VTA112-A-3-3& V112EA-009 Taipei Veterans General Hospital
- 112Q58504Y National Yang-Ming Chiao University
- MOST-110-2634-F-A49-005,NSTC 112-2314-B-A49 -043 -MY3 NSTC | Hsinchu Science Park Bureau, Ministry of Science and Technology, Taiwan (HSP)
- MOST 111-2410-H-075-001 NSTC | Hsinchu Science Park Bureau, Ministry of Science and Technology, Taiwan (HSP)
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Affiliation(s)
- Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Yun Yeh
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Roger Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsai-Ling Liao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiao-Chin Shen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology of Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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Yuan EJS, Huang SS, Hsu CA, Lirng JF, Li TH, Huang CC, Yang YY, Li CP, Chen CH. Negative effects on medical students' scores for clinical performance during the COVID-19 pandemic in Taiwan: a comparative study. J Educ Eval Health Prof 2023; 20:37. [PMID: 38148494 PMCID: PMC10810719 DOI: 10.3352/jeehp.2023.20.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) has heavily impacted medical clinical education in Taiwan. Medical curricula have been altered to minimize exposure and limit transmission. This study investigated the effect of COVID-19 on Taiwanese medical students' clinical performance using online standardized evaluation systems and explored the factors influencing medical education during the pandemic. METHODS Medical students were scored from 0 to 100 based on their clinical performance from 1/1/2018 to 6/31/2021. The students were placed into pre-COVID-19 (before 2/1/2020) and midst-COVID-19 (on and after 2/1/2020) groups. Each group was further categorized into COVID-19-affected specialties (pulmonary, infectious, and emergency medicine) and other specialties. Generalized estimating equations (GEEs) were used to compare and examine the effects of relevant variables on student performance. RESULTS In total, 16,944 clinical scores were obtained for COVID-19-affected specialties and other specialties. For the COVID-19-affected specialties, the midst-COVID-19 score (88.513.52) was significantly lower than the pre-COVID-19 score (90.143.55) (P<0.0001). For the other specialties, the midst-COVID-19 score (88.323.68) was also significantly lower than the pre-COVID-19 score (90.063.58) (P<0.0001). There were 1,322 students (837 males and 485 females). Male students had significantly lower scores than female students (89.333.68 vs. 89.993.66, P=0.0017). GEE analysis revealed that the COVID-19 pandemic (unstandardized beta coefficient=-1.99, standard error [SE]=0.13, P<0.0001), COVID-19-affected specialties (B=0.26, SE=0.11, P=0.0184), female students (B=1.10, SE=0.20, P<0.0001), and female attending physicians (B=-0.19, SE=0.08, P=0.0145) were independently associated with students' scores. CONCLUSION COVID-19 negatively impacted medical students' clinical performance, regardless of their specialty. Female students outperformed male students, irrespective of the pandemic.
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Affiliation(s)
- Eunice Jia-Shiow Yuan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shiau-Shian Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chia-An Hsu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Hao Li
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Pin Li
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Long YB, Huang CC, Pan HW, Rong JJ. [The clinical application of the index of microcirculatory resistance in patients with STEMI]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:1130-1136. [PMID: 37963747 DOI: 10.3760/cma.j.cn112148-20230915-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
- Y B Long
- Department of Cardiology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Clinical Medicine Research Center of Heart Failure of Hunan Province, Changsha 410000, China
| | - C C Huang
- Department of Cardiology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Clinical Medicine Research Center of Heart Failure of Hunan Province, Changsha 410000, China
| | - H W Pan
- Department of Cardiology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Clinical Medicine Research Center of Heart Failure of Hunan Province, Changsha 410000, China
| | - J J Rong
- Department of Cardiology, the First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Clinical Medicine Research Center of Heart Failure of Hunan Province, Changsha 410000, China
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Huang CC, Niedzwiecki D, Wan Z, Chino JP. Clinical Outcomes of Sidewall/Parametrial Simultaneous Integrated Boost for Patients with Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e519. [PMID: 37785617 DOI: 10.1016/j.ijrobp.2023.06.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the treatment of cervical cancer, simultaneous integrated boost (SIB) is a common technique to deliver increased dose to gross disease in the para-aortic and pelvic nodal basins. However, SIB to the pelvic sidewall/parametria is not well characterized in the literature. We hypothesized that sidewall simultaneous integrated boost (SIB) in the treatment of cervical cancer is associated with acceptable levels of toxicity. MATERIALS/METHODS From 1/2009-12/2018, patients who received concurrent chemoradiation with external beam radiation therapy, utilizing a sidewall SIB technique, followed by low dose rate or high dose rate brachytherapy treatment were retrospectively identified. Sidewall SIB was defined as treatment at 2.1-2.4Gy/fraction to the parametria-usually performed for those with disease width >4cm at time of treatment start. Acute and late toxicity grading was defined by the Common Terminology Criteria for Adverse Events Version 5.0. Overall survival (OS), local control, progression-free survival (PFS), and toxicity were analyzed utilizing the Kaplan Meier method. Potential associations between cumulative D2cc for bladder and rectum and time to toxicity were investigated using Cox regression. RESULTS Fifty-six patients with IB2-IVB cervical cancer treated with sidewall SIB were identified, with a median follow up of 7.0 years (95% CI: 6.3, 8.3). Patients had a median age of 43 years (range: 26-68); 2 (3.6%) had FIGO stage I, 7 (12.5%) stage II, 46 (82.1%) stage III, and 1 (1.8%) stage IV disease. A majority had squamous cell histology (83.9%). Nearly all patients (96.4%) received concurrent cisplatin chemotherapy. Rates of acute grade ≥3 gastrointestinal (GI), genitourinary (GU), vaginal, and hematologic toxicity were 1.8%, 1.8%, 0%, and 15.9% respectively. Rates of late grade ≥3 GI, GU, and vaginal toxicity were 11.3%, 18.5%, and 11.1% respectively. OS and local control rates at five years were 0.61 (95% CI: 0.46, 0.73) and 0.95 (95% CI: 0.84, 0.98), respectively. Median PFS was 7.8 years (95% CI: 2.4, Not reached). Cumulative D2cc bladder was not significantly associated with time to Grade 2 or greater (HR 1.04, p = 0.33) or Grade 3 or greater (HR 1.02; p = 0.64) GU toxicity. Cumulative D2cc rectum was not significantly associated with time to Grade 2 or greater (HR 1.06, p = 0.06) or Grade 3 or greater (HR 1.08; p = 0.09) GI toxicity. CONCLUSION Sidewall SIB is a feasible technique for dose escalation in the treatment of cervical cancer with rates of acute and late toxicity consistent with other reports.
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Affiliation(s)
- C C Huang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - D Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Z Wan
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - J P Chino
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
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Ho SY, Shieh LT, Huang CC, Chang CP. Hyperbaric Oxygen Therapy Attenuates the Whole Brain Radiotherapy-Induced Progressive Cognitive Dysfunction via Promoting Hippocampal Neurogenesis in Rats. Int J Radiat Oncol Biol Phys 2023; 117:e235-e236. [PMID: 37784936 DOI: 10.1016/j.ijrobp.2023.06.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation therapy is a widely used brain tumor treatment; however, it can cause significant effects on the central nervous system, including neurogenesis impairment, microglia activation, and oxidative stress, leading to brain injury. Hyperbaric oxygen therapy (HBOT) has been shown to benefit various neurological conditions, but its effect on radiation-induced brain injury damage remains limited. This study aims to investigate the impact of HBOT on radiation-induced neurogenesis impairment, microglia activation, and lipid peroxidation levels, and also aim to assess the therapeutic potential of HBOT on preventing irradiation-induced brain injury. MATERIALS/METHODS This study used a rat model that delivered different doses (2, 4, 10 Gy) of whole-brain radiation therapy (WBRT). The rats were divided into two groups: one received HBOT, and the other acted as the control (normal baric air, NBA) group. HBOT was performed on day 8 of post-radiation once per day for five consecutive days a week for four weeks. The rats were subjected to different irradiation dosages as described, followed by administration of 5-chloro-2'-deoxyuridine (CldU) immediately at day 0 or day 0 to day 7 and 5-iodo-2'-deoxyuridine (IdU) at day 2 or day 14 to day 28 following WBRT to detect serially replicating cells. Then the rats underwent behavioral tests to assess their cognitive and motor function every week. Brain tissues were collected and analyzed to evaluate neurogenesis, microglia activation, lipid peroxidation, and antioxidant levels using immunofluorescence stain and ELISA on days 7 and 28 of post-WBRT. RESULTS The radial maze was used to measure spatial learning and memory in rats. Compared with the 0 Gy-WBRT group, the 2 Gy-, 4 Gy-, and 10 Gy-WBRT groups of rats displayed a significant increase in latency. Seven days of post-WBRT, the newly proliferation cells (IdU positive) and serial replicating cells (CldU+IdU double positive) in the hippocampal dentate gyrus were significantly increased but were coupled with apoptosis. The alterations in the cellular composition of the dentate gyrus area were observed on days 7 and 28 post-WBRT, including increased newborn neuroblast and neuron, but half underwent apoptosis, which is associated with microglia phagocytosis and results in cognitive impairment. The lipid peroxidation was significantly increased on day 28 of post-WBRT. HBOT improves cognitive function by attenuating the WBRT-induced lipid oxidation, newly-formed cell apoptosis, and microglia phagocytosis. CONCLUSION Our present study suggests that HBOT may have a potential role in mitigating the effects of irradiation-induced brain injury by maintaining neurogenesis and reducing lipid peroxidation.
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Affiliation(s)
- S Y Ho
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - L T Shieh
- Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - C C Huang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - C P Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
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Huang CC, Qazi JJ, Leng JX, Carpenter DJ, Natarajan BD, Arshad M, Schultz O, Moravan MJ, Mullikin TC, Reitman ZJ, Kirkpatrick JP, Floyd SR, Chmura SJ, Hong JC, Salama JK. Pretreatment Clinical Parameters Associated with Intracranial Progression Burden Following an Initial Stereotactic Radiosurgery Course in a Multi-Institutional Brain Metastases Cohort. Int J Radiat Oncol Biol Phys 2023; 117:e109-e110. [PMID: 37784644 DOI: 10.1016/j.ijrobp.2023.06.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While brain metastasis (BM) velocity is a valuable prognostic metric at time of intracranial progression (ICP), pre-SRS risk factors for post-SRS high-burden intracranial progression (ICP) remain poorly characterized. We hypothesized that pre-SRS clinical parameters are associated with subsequent high-burden (ICP), defined as either ≥5 (ICP5) or new/progressive ≥11 BMs (ICP11). MATERIALS/METHODS All patients completing an initial SRS course for BMs at two institutions from 1/2015-12/2020 were retrospectively identified. Patients with prior whole brain radiation therapy (WBRT) and/or BM resection were eligible. Demographic and clinical parameters were collected. ICP was defined as any radiographic concern for distant and/or in-field progression per multidisciplinary consensus. Overall survival (OS) and freedom from ICP were estimated via the Kaplan Meier method. Cox models assessed association between parameters and freedom from ICP5 and ICP11. RESULTS We identified 1383 patients completed SRS, with a median follow up of 8.7 months. Patients were 54.8% female, 45.6% with KPS ≥90, and a median of 63.4 years old. Primary tumor types included non-small cell lung (48.7%), breast (14.7%), and melanoma (8.5%). 46.9% had oligometastatic disease (≤5 metastatic foci: including BMs) at SRS, and 53.4% underwent SRS for >1 BM. 10.3% of patients had undergone prior WBRT and 26.1% surgical resection. 555 patients (40.1%) experienced ICP following SRS, of whom 72.6% had 1-4, 11.5% had 5-10, and 15.9% had ≥11 new/progressive BMs. Among patients with ICP, 6-month freedom from ICP was 35.5% (95% CI: 31.1-40.5%) for those with 1-4 BMs at time of ICP, 29.7% (95% CI: 20.4-43.3%) for 5-10 BMs, and 20.5% (95% CI: 13.5-30.1%) for ≥11 BMs (p = 0.016). Respective 12-month OS rates were 56.8% (95% CI: 52.1-61.9%), 46.0% (95% CI: 35.1-60.1%), and 38.7% (95% CI: 29.4-50.9%; p<0.001). Neurologic symptoms at time of ICP were observed in 21.1% of patients with 1-4 BMs, 28.1% with 5-10 BMs, and 50.0% with new/progressive ≥11 BMs (p<0.001). On multivariable analysis, superior freedom from high-burden ICP was associated with the following pre-SRS parameters: oligometastatic burden (ICP5: HR 0.68, 95% CI: 0.47-0.99; ICP11: 0.59; 95% CI: 0.36-0.97), no prior immunotherapy (ICP11: HR 0.57, 95% CI: 0.34-0.57), and a single BM at time of initial SRS (1 vs 2 BM, ICP 5: HR 0.51, 95% CI: 0.31-0.82; ICP11: HR 0.45, 95% CI: 0.24-0.84), while primary tumor type was not associated with ICP5 or ICP11. CONCLUSION Pre-SRS parameters including polymetastatic burden, prior receipt of immunotherapy, and >1 BM were associated with post-SRS high-burden ICP. High burden ICP developed earlier following SRS completion and was associated with higher rates of neurologic decline and inferior OS.
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Affiliation(s)
- C C Huang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - J J Qazi
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - J X Leng
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - D J Carpenter
- Department of Radiation Oncology, Duke University Cancer Center, Durham, NC
| | - B D Natarajan
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - M Arshad
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL
| | - O Schultz
- Department of Radiation Oncology, University of Chicago, Chicago, IL
| | - M J Moravan
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - T C Mullikin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | | | - J P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC; Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - S R Floyd
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - S J Chmura
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL
| | - J C Hong
- University of California, San Francisco, Bakar Computational Health Sciences Institute, San Francisco, CA; Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - J K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC; Durham VA Health Care System, Durham, NC
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Kleber T, Floyd W, Pasli M, Qazi JJ, Huang CC, Leng JX, Carpenter DJ, Ackerson B, Salama JK, Boyer MJ. ChatGPT is an Unreliable Tool for Reviewing Radiation Oncology Literature. Int J Radiat Oncol Biol Phys 2023; 117:e523. [PMID: 37785630 DOI: 10.1016/j.ijrobp.2023.06.1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess whether ChatGPT, a popular deep learning text generation tool, can serve as a resource for in-training and practicing clinicians by accurately identifying and summarizing studies related to radiation oncology. MATERIALS/METHODS Three question templates (Q1-Q3, shown in Table 1) were applied to eight cancer types to compile 24 questions posed to ChatGPT. Cancer types were designated as either common (breast, non-small cell lung, prostate, p16 positive oropharyngeal, and rectal) or uncommon (hypopharyngeal, medulloblastoma, and vulvar). ChatGPT's responses to each question were then reviewed to quantify the number of studies referenced in the response, the percentage of studies listed that were real studies, and the percentage of studies listed that were correctly summarized. Outcomes were compared between cancer types (common vs uncommon) and question types using Wilcoxon rank sum tests. As a secondary analysis, we assessed internal consistency of ChatGPT's responses by querying ChatGPT with three identical iterations of Q1-Q3 for breast cancer and comparing its responses between iterations. RESULTS Across all 24 of ChatGPT's responses, there were 78 studies referenced, of which 37 (47.4%) were real studies and 7 (9.0%) were correctly summarized. On average, each response included 3.25 (standard deviation (SD): 0.74) studies, of which 44.0% (SD: 44.2%) were real studies and 7.8% (SD: 14.6%) were correctly summarized. The proportion of correctly summarized studies was not significantly different between common vs uncommon cancers [p = 0.29], between questions that specified randomized-control trials (Q3) vs not (Q1 or Q2) [p = 0.94], or between questions that specified intensity modulated radiotherapy (Q2) vs not (Q1 or Q3) [p = 0.31]. Across the three iterations of ChatGPT queries for breast cancer, the number of studies listed for Q1, Q2, and Q3 ranged from 3 to 5, 2 to 3, and 3 to 5, respectively; the number of correctly summarized studies listed for each question ranged from 0 to 2, 0 to 1, and 0 to 1, respectively. CONCLUSION ChatGPT's responses consistently included a large proportion of non-existent and incorrectly summarized studies. Furthermore, our secondary analysis suggests variability in the content and accuracy of ChatGPT responses to identical questions, raising further concerns regarding reliability. Overall, our findings argue against the use of ChatGPT as a tool for reviewing literature related to radiation oncology.
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Affiliation(s)
- T Kleber
- Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - W Floyd
- Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - M Pasli
- Brody School of Medicine, East Carolina University, Greenville, NC
| | - J J Qazi
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | | | - J X Leng
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - D J Carpenter
- Department of Radiation Oncology, Duke University Cancer Center, Durham, NC
| | - B Ackerson
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - J K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - M J Boyer
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
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Qazi JJ, Leng JX, Huang CC, Carpenter DJ, Natarajan BD, Arshad M, Schultz O, Moravan MJ, Mullikin TC, Reitman ZJ, Kirkpatrick JP, Floyd SR, Chmura SJ, Hong JC, Salama JK. Multi-Institutional Outcomes Following Stereotactic Radiosurgery for Gastrointestinal Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e146-e147. [PMID: 37784725 DOI: 10.1016/j.ijrobp.2023.06.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Outcomes following stereotactic radiosurgery (SRS) for gastrointestinal (GI) brain metastases (BM) are poorly defined. We analyzed our multi-institutional database of SRS patients, comparing outcomes between GI and non-GI BM patients after SRS. MATERIALS/METHODS We retrospectively identified all patients completing an initial SRS course across two institutions from 1/2015-12/2020. Demographic and clinical parameters were manually captured. Intracranial progression (ICP) was defined as any concern on post-SRS imaging for recurrence determined by multidisciplinary consensus. Overall survival (OS) and freedom from ICP (FFICP) were estimated via Kaplan Meier models. Cox proportional hazard models were used to assess associations between ICP and parameters. RESULTS Among 1383 total patients completing SRS for BM, 102 (7.4%) had GI BM. Among these, 46 (45.1%) were of colorectal (CRC) and 34 (33.3%) esophageal origin. Other GI sites (21.6%) included anal, pancreatic, gastric, GI of unknown origin, and hepatocellular carcinoma. Median follow up was 8.7 mos. GI BM patients were more likely to be younger (mean 59.1 vs 63.5 yrs, p = 0.001), male (56.9% vs 44.3%, p = 0.014 ), have more extracranial metastases (mean 1.9 vs 1.6, p = 0.003), have received systemic therapy (73.5% vs 63.9%, p = 0.049) or resection of BM (45.1% vs 25.0%, p < 0.001) prior to SRS, have larger planned target volumes of all BMs (mean 20.3 ccs vs 15.0 ccs, p = 0.013), and were less likely to receive whole brain radiation therapy (WBRT) prior to SRS (3.9% vs 10.8%, p = 0.028) or systemic therapy after SRS (54.9% vs 68.9%, p = 0.004). Among GI patients, median OS was 28.2 mos (95% CI 16.5-35.3), with no significant differences between GI and non-GI patients (p = 0.220) or among GI subgroups (CRC vs other GI: p = 0.731; esophageal vs other GI: p = 0.478). Median FFICP was significantly worse for GI patients (6.2 mos, 95% CI 4.0-9.6 mos) than for non-GI patients (12.4 mos, 95% CI 10.8-13.9 mos; p = 0.004). After accounting for age, sex, performance status, number of irradiated BMs, extracranial disease burden, extracranial disease control, interval from primary cancer diagnosis to BM diagnosis, resection status, receipt of prior WBRT, and receipt of post-SRS systemic therapy, GI origin was significantly associated with worse FFICP (HR 1.50, 95% CI 1.15-2.02, p = 0.007). FFICP was not significantly different between GI subgroups, with CRC and esophageal patients demonstrating median times to ICP of 5.0 mos (95% CI 3.4-9.6) and 7.2 mos (95% CI 2.7-14.1), respectively. Only 2 GI patients (2.0%) had ICP at site of prior SRS. CONCLUSION Across a modern, multi-institutional SRS cohort comparing GI to non-GI primary patients, BMs of GI origin demonstrated inferior FFICP to those of non-GI origin. OS did not vary significantly across GI and non-GI cases. Among GI subtypes, no significant differences were identified across FFICP or OS. These data may help inform treatment decisions and post-SRS surveillance.
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Affiliation(s)
- J J Qazi
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - J X Leng
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - C C Huang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - D J Carpenter
- Department of Radiation Oncology, Duke University Cancer Center, Durham, NC
| | - B D Natarajan
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - M Arshad
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL
| | - O Schultz
- Department of Radiation Oncology, University of Chicago, Chicago, IL
| | - M J Moravan
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - T C Mullikin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Z J Reitman
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - J P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC; Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - S R Floyd
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - S J Chmura
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - J C Hong
- University of California, San Francisco, Bakar Computational Health Sciences Institute, San Francisco, CA; Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - J K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC; Durham VA Health Care System, Durham, NC
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Leng JX, Huang CC, Qazi JJ, Carpenter DJ, Natarajan BD, Arshad M, Ferreira M, Schultz O, Moravan MJ, Mullikin TC, Reitman ZJ, Kirkpatrick JP, Floyd SR, Salama AKS, Fecci P, Chmura SJ, Hong JC, Salama JK. Clinical Outcomes Following an Initial Stereotactic Radiosurgery Course for Brain Metastases from Melanoma. Int J Radiat Oncol Biol Phys 2023; 117:e128. [PMID: 37784684 DOI: 10.1016/j.ijrobp.2023.06.924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Brain metastases (BM) are common in melanoma patients. The effect of gene mutations is not well characterized since first-line metastatic therapy has shifted from chemotherapy (CHT) to molecularly targeted therapies (TT) and immunotherapy (IO). We report outcomes of melanoma BM patients stratified by molecular subtype and pre-stereotactic radiosurgery (SRS) systemic therapy. MATERIALS/METHODS We identified all patients completing an initial SRS course for BM at two institutions between 1/2015 and 12/2020. Patients who had prior WBRT and/or resection were eligible. Demographic and clinical parameters were collected, along with melanoma tumor molecular characteristics. Intracranial progression (ICP) was defined as any radiographic distant and/or in-field progression per multidisciplinary consensus. Overall survival (OS) and freedom from ICP (FFICP) were estimated via the Kaplan Meier method. RESULTS From a total of 1383 SRS BM patients, we identified 118 (8.5%) with melanoma. Median follow up was 8.7 months, median age 64 years (IQR 51-72), 81% had cutaneous origin, and 55% had a KPS of 90-100. Molecular subtypes included BRAF (45%), NRAS (9.3%), and c-KIT (3.4%). Overall, 61% received IO prior to SRS, while 25% and 9.3% received TT and CHT prior to SRS respectively. 60% of patients harboring a mutation received IO as first line therapy, 10% received TT, and 30% received both TT and IO prior to SRS. BRAFmut patients more likely to have received TT prior to SRS (43% vs 9.2%, p<0.001) compared to BRAFwt patients. Median OS was 9.7 months (95% CI 7.8-13) and was not significantly different from non-melanoma patients (p = 0.6). Median FFICP was worse for melanoma patients (5.9 mos, 95% CI 3.5-8.5) than non-melanoma patients (8.96 mos, 95% CI 8.2-9.7, p = 0.009). A total of 72 ICP events occurred, with 56 (77.8%) distant ICP cases, 3 (4.2%) in-field ICP, and 13 (18%) ICP events that were radionecrosis (RN) only. RN was associated with the presence of a targetable mutation (18% vs 2%, p = 0.006) and receipt of TT pre-SRS (36% vs 9.8%, p = 0.001). BRAFmut patients had significantly worse FFICP (3.8 mos, 95% CI 3.0-6.8) compared to BRAFwt patients (8.5 mos, 95% CI 5.8-30.2, p = 0.006), although median OS was not significantly different (9.6 mos, 95% CI 6.9-16 vs 10.7 mos, 95% CI 6.7-15.5, p = 0.8). NRASmut was associated with better FFICP (29 mos, 95% CI 2.94-NA, p = 0.02). CONCLUSION In this modern, multi-institutional cohort of SRS patients, melanoma BM patients had worse FFICP compared to non-melanoma BM patients, and BRAFmut patients had worse FFICP than BRAFwt patients. RN was associated with mutational status and receipt of TT pre-SRS. OS did not vary significantly across groups. This analysis may help inform systemic therapy decisions and future genomic studies for patients with BMs from melanoma.
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Affiliation(s)
- J X Leng
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - C C Huang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - J J Qazi
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - D J Carpenter
- Department of Radiation Oncology, Duke University Cancer Center, Durham, NC
| | - B D Natarajan
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - M Arshad
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL
| | - M Ferreira
- Duke University Medical Center, Durham, NC
| | - O Schultz
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - M J Moravan
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - T C Mullikin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | | | - J P Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - S R Floyd
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | | | - P Fecci
- Duke University Medical Center, Department of Neurosurgery, Durham, NC
| | - S J Chmura
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - J C Hong
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; University of California, San Francisco, Bakar Computational Health Sciences Institute, San Francisco, CA
| | - J K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC; Durham VA Health Care System, Durham, NC
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Floyd W, Kleber T, Pasli M, Qazi JJ, Huang CC, Leng JX, Ackerson B, Carpenter DJ, Salama JK, Boyer MJ. Evaluating the Reliability of Chat-GPT Model Responses for Radiation Oncology Patient Inquiries. Int J Radiat Oncol Biol Phys 2023; 117:e383. [PMID: 37785294 DOI: 10.1016/j.ijrobp.2023.06.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To determine if ChatGPT, a popular deep learning text generation tool, accurately and comprehensively answers patient questions related to radiation oncology. MATERIALS/METHODS A total of 28 common patient-centered questions were selected across various radiation oncology content domains, including diagnosis (4), workup (3), treatment (8), toxicity (4), and survivorship (9). To assess whether ChatGPT could detect inaccurate assumptions and/or respond negatively, we included two "negative control" questions in the treatment and toxicity domains. All questions were applied to common cancer types (breast, non-small cell lung, prostate, p16+ oropharyngeal, and rectal), uncommon cancer types (hypopharyngeal, medulloblastoma, and vulvar), and colon cancer as an additional "negative control." The ChatGPT responses were graded as 0 for any incorrect information, 1 for missing essential content, and 2 for correct and appropriately comprehensive for the length of the response. Each response was graded by two blinded MD reviewers, with discordant answers resolved by a third MD reviewer. Score distribution was compared across content domains, question type ("negative control" vs other), cancer type, and cancer commonality using the Chi-squared test. RESULTS Overall, a total of 252 questions were submitted to ChatGPT. A total of 86 (34.1%) answers were found to contain inaccurate information, 66 (26.2%) contained correct information but were found to be missing essential context, and 100 (39.7%) responses to questions were graded as correct and comprehensive. There was no significant difference in response score by question domains (p = 0.07). However, there was significant difference in response score across cancer type (p<0.001). The top scoring cancer types were breast (grade 0 = 10%; grade 1 = 21%, grade 2 = 68%) and prostate (grade 0 = 18%, grade 1 = 25%, grade 2 = 57%), while the two lowest scoring cancer types were colon (grade 0 = 61%, grade 1 = 21%, grade 2 = 18%) and vulvar (grade 0 = 50%, grade 1 = 25%, grade 2 = 25%). ChatGPT responses were also significantly different among common, uncommon and negative control questions, with the model performing best with responses to common cancer types (p = 0.003). ChatGPT performed significantly worse when responding to "negative control" questions (p<0.001). CONCLUSION ChatGPT failed to consistently generate accurate and comprehensive responses to the majority of radiation oncology patient centered questions, particularly across less common cancers and with "negative control" questions that included incorrect assumptions. This raises concern for the possible ChatGPT mediated reinforcement of patient misperceptions regarding radiotherapy.
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Affiliation(s)
- W Floyd
- Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - T Kleber
- Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - M Pasli
- Brody School of Medicine, East Carolina University, Greenville, NC
| | - J J Qazi
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | | | - J X Leng
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - B Ackerson
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - D J Carpenter
- Department of Radiation Oncology, Duke University Cancer Center, Durham, NC
| | - J K Salama
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - M J Boyer
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
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11
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Okoya F, Huang CC, Zhang Z, Lecca L, Calderón R, Contreras C, Yataco R, Galea J, Becerra M, Murray M. Culture-negative TB: clinical characteristics, risk factors and treatment outcomes. Int J Tuberc Lung Dis 2023; 27:557-563. [PMID: 37353876 DOI: 10.5588/ijtld.22.0554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND: Although culture remains the standard for TB diagnosis, 15-20% of patients diagnosed and treated for TB are culture-negative. We explored clinical characteristics, risk factors and treatment outcomes for culture-negative TB in a Peruvian cohort.METHODS: We recruited 4,500 index TB patients and 10,160 household contacts in Lima, Peru, and enrolled 692 secondary patients diagnosed with TB during follow-up of household contacts. We analyzed smear and culture status, sociodemographic factors, clinical characteristics and TB treatment outcomes to compare culture-negative and positive patients.RESULTS: Of the 4,880 adult patients, 915 (18.8%) were culture-negative. Culture-negative patients were less likely to report symptoms of TB disease and disease of longer duration. A multivariate analysis showed no statistically significant difference in loss to follow-up, treatment failure or recurrence between the culture-negative and -positive groups but a higher rate of death among culture-negative patients with an adjusted OR of 1.65 (95% CI 1.05-2.60). In a multivariate analysis of determinants of culture negativity, older age, substance use and being a secondary case were associated with culture status.CONCLUSIONS: More recognition and awareness of culture-negative TB is key for early and correct diagnosis to reduce transmission and improve treatment outcomes.
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Affiliation(s)
- F Okoya
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C C Huang
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA, Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, USA
| | - Z Zhang
- Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, USA
| | - L Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA, Socios En Salud Sucursal, Lima, Peru
| | | | | | - R Yataco
- Socios En Salud Sucursal, Lima, Peru
| | - J Galea
- School of Social Work & College of Public Health, University of South Florida, Tampa, FL, USA
| | - M Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA, Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, USA
| | - M Murray
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA, Division of Global Health Equity, Brigham and Women´s Hospital, Boston, MA, USA
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12
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Liang JF, Cheng HM, Huang CC, Yang YY, Chen CH. Lessons Learned from a Novel Three-year Longitudinal Stepwise "Residents-as-Teachers" Program. J Chin Med Assoc 2023:02118582-990000000-00206. [PMID: 37055911 DOI: 10.1097/jcma.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Most residents-as-teachers (RaT) programs are delivered over days to weeks without comprehensive evaluation, and stepwise approaches have rarely been applied to RaT activities. OBJECTIVE This study aimed to depict the implementation experience and evaluate the effectiveness of a novel longitudinal three-year, stepwise RaT program. METHODS The longitudinal RaT program included three once yearly face-to-face courses according to the different teaching roles of the residents. To evaluate the effectiveness of the new longitudinal program, we designed a randomized controlled study for first-year residents of all specialties in one medical center. The effectiveness was evaluated by the objective structured teaching exercise (OSTE), feedback from participants and medical students, and evaluation of clinical practice performance by program directors. RESULTS A total of 35 (37.6%) of 93 residents participated in this study, and 13 (37.1%) of all enrolled residents completed all three-year courses, including seven for the longitudinal program and six for the traditional. The serial OSTE revealed significantly higher scores in the longitudinal group in the second and third years (13.43 vs. 9.50, p=0.001 and 14.29 vs. 10.33, p=0.015). Satisfaction was higher when advanced topics were taught in the second and third years compared with those taught in the first year (4.43 vs. 3.89, p=0.02). The feedback from medical students was similar between the two groups, and the evaluation from program directors revealed insignificantly better clinical performance among the longitudinal course participants. CONCLUSION It is challenging to conduct a multi-year longitudinal RaT program on young residents. Nevertheless, this longitudinal program was potentially associated with better learning retention and higher satisfaction and worthy to be promoted.
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Affiliation(s)
- Jen-Feng Liang
- Department of Medical Education, Taipei Veterans General Hospital; Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Neurological Institute, Taipei Veterans General Hospital; Taipei, Taiwan, ROC
- Center for Evidence Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital; Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital; Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital; Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital; Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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13
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Kuo NR, Hou MC, Chu WC, Yang YY, Huang CC, Li TH, Lee TY, Liu CW, Liao TL, Hsieh SL, Lin HC. Low lymphocyte-to-monocyte ratio, calcitriol level, and CD206 level predict the development of acute-on-chronic liver failure in patients cirrhosis with acute decompensation. J Chin Med Assoc 2023; 86:265-273. [PMID: 36727703 DOI: 10.1097/jcma.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cirrhosis-related acute-on-chronic liver failure (ACLF) is associated with high morbidity and mortality rates. Prognostic models of ACLF have been developed; however, few studies have focused on the occurrence of ACLF. This study aimed to identify the factors that predict the development of ACLF, hepatic encephalopathy (HE), and infection in patients with cirrhosis. METHODS Patients with cirrhosis were enrolled, and the serum levels of calcitriol, Cluster of Differentiation 26 (CD206), and macrophage-inducible lectin receptor (Mincle) were measured, and lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio were calculated; all the patients were tracked for 6 months. A generalized estimating equation (GEE) was used to assess the factors associated with ACLF development, HE, and infection. The aforementioned model was derived based on immunological markers, and receiver operating characteristic analysis with area under the curve (AUC) was adopted to evaluate accuracy. RESULTS After screening 325 patients with cirrhosis, 65 patients were eligible. In the GEE model, low levels of calcitriol (odds ratio [OR] = 3.259; 95% confidence interval [CI] = 1.118-8.929) and CD206 (OR = 2.666; 95% CI = 1.082-6.567) were associated with the development of ACLF, and the LMR was a protective factor (OR = 0.356; 95% CI = 0.147-0.861). Low calcitriol levels were a risk factor for HE (OR = 3.827) and infection (OR = 2.489). LMR was found to be a protective factor against HE (OR = 0.388). An immunological model for the discrimination of ACLF development within 6 months was proposed, with an AUC of 0.734 (95% CI = 0.598-0.869). CONCLUSION Single and combined immunological markers, including low LMR and low levels of calcitriol and CD206, were promising for early prediction of the development of ACLF, HE, and infection in patients with cirrhosis.
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Affiliation(s)
- Nai-Rong Kuo
- Department of Medical Education, Medical Innovation and Research Office, Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Chi Chu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Department of Medical Education, Medical Innovation and Research Office, Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Chang Huang
- Department of Medical Education, Medical Innovation and Research Office, Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzu-Hao Li
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Tzung-Yan Lee
- Graduate Institute of Traditional Chinese Medicine, Linkou Chang Guang Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Chih-Wei Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tsai-Ling Liao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Shie-Liang Hsieh
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Genomics Research Center, Academia Sinica, Taipei, Taiwan, ROC
| | - Han-Chieh Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Huang CC, Shen HC, Lin R, Yang YY, Chang YC, Liao TL, Huang SF, Lin HC, Hou MC. Preservation of vascular endothelial glycocalyx and barrier by activation of adenosine A2A receptor (A2AR) improved renal dysfunction in cirrhotic rats. J Pharmacol Sci 2023; 152:50-60. [PMID: 37059491 DOI: 10.1016/j.jphs.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/22/2023] Open
Abstract
Cirrhosis-related hepatic and renal endothelial dysfunction is characterized by macrophage-endothelium adhesion-mediated inflammation, glycocalyx/barrier damage, and impaired vasodilation. Activation of adenosine A2A receptor (A2AR) protects cirrhotic rats from impairment of hepatic microcirculation post hepatectomy. This study evaluates the effects of A2AR activation on the cirrhosis-related hepatic and renal endothelial dysfunction in biliary cirrhotic rats receiving two weeks of A2AR agonist PSB0777 [bile duct ligated (BDL)+PSB0777] treatment. Endothelial dysfunction in cirrhotic liver, renal vessels, and kidney is characterized by downregulation of the A2AR expressions, decreased vascular endothelial vasodilatory (p-eNOS)/anti-inflammatory (IL-10/IL-10R)/barrier [VE-cadherin (CDH5) and β-catenin (CTNNB1)]/glycocalyx [syndecan-1 (SDC1) and hyaluronan synthase-2 (HAS2)] markers, and increased leukocyte-endothelium adhesion molecules (F4/80, CD68, ICAM-1, and VCAM-1). In BDL rats, PSB0777 treatment improves hepatic and renal endothelial dysfunction, ameliorates portal hypertension, and attenuates renal hypoperfusion by restoring of the vascular endothelial anti-inflammatory, barrier, glycocalyx markers and vasodilatory response as well as inhibiting the leukocyte-endothelium adhesion. In an in vitro study, conditioned medium (CM) of bone marrow-derived macrophage (BMDM) of BDL rats [BMDM-CM (BDL)] induced barrier/glycocalyx damage, which was reversed by the PSB0777 pre-treatment. The A2AR agonist is a potential agent that can simultaneously correct cirrhosis-related hepatic and renal endothelial dysfunction, portal hypertension, renal hypoperfusion, and renal dysfunction.
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Affiliation(s)
- Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Chin Shen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Veterans General Hospital, Taipei, Taiwan
| | - Roger Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
| | - Yun-Chien Chang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsai-Ling Liao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shiang-Fen Huang
- Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | | | - Ming-Chih Hou
- Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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Dai L, Tian ML, Zha Y, Liu L, Li ZS, Huang CC, Yuan J. [Association of lean tissue index with arteriovenous fistula dysfunction in maintenance hemodialysis patients]. Zhonghua Gan Zang Bing Za Zhi 2023; 39:32-35. [PMID: 36776012 DOI: 10.3760/cma.j.cn441217-20220621-00633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The clinical data of maintenance hemodialysis (MHD) patients from twenty hemodialysis centers in Guizhou province from June to September 2020 were collected by cross-sectional study. The patients were divided into AFD group and non-AFD group according to whether AFD had occurred. LTI was measured by body composition monitor. The results showed that the incidence of AFD in 2 781 MHD patients was 30.0% (835/2 781). Median LTI level was 15.2 (13.2, 17.5) kg/m2. The LTI level in the AFD group was higher than that in the non-AFD group (P < 0.05). According to the tertiles of LTI, low LTI group (LTI ≤ 13.9 kg/m2) had the highest incidence of AFD (35.5%, 334/940), and the high LTI group had the lowest incidence of AFD (26.3%, 241/916), and the difference among the three groups was statistically significant (χ2=20.182,P < 0.001). Multivariate logistic regression analysis showed that low LTI group as the reference, the risk of AFD in moderate LTI group (13.9 kg/m2 < LTI ≤ 16.6 kg/m2) and high LTI group were associated with the 20.0% (OR=0.800, 95% CI 0.650-0.986, P=0.036) and 22.8% (OR=0.772, 95% CI 0.616-0.966, P=0.024) decrease, respectively. These results suggest that low LTI level is independently associated with an increased risk of AFD in MHD patients.
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Affiliation(s)
- L Dai
- Department of Nephrology, the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550001, China
| | - M L Tian
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Y Zha
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - L Liu
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Z S Li
- Department of Nephrology, the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550001, China
| | - C C Huang
- Graduate School of Guizhou University of Traditional Chinese Medicine, Guiyang 550002, China Dai Lu and Tian Maolu contributed equally to this study
| | - J Yuan
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang 550002, China Key Laboratory of Diagnosis and Treatment of Pulmonary Immune Diseases, NHC, Guiyang 550002, China
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Liu SY, Huang CC, Yang YY, Huang SF, Lee TY, Li TH, Hou MC, Lin HC. Obeticholic acid treatment ameliorates the cardiac dysfunction in NASH mice. PLoS One 2022; 17:e0276717. [PMID: 36490253 PMCID: PMC9733885 DOI: 10.1371/journal.pone.0276717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Suppression of cardiac iinflammasome, which can be inhibited by Farnesoid X receptor (FXR) agonist, can ameliorate cardiac inflammation and fibrosis. Increased cardiac inflammasome decrease the abundance of regulatory T (Treg) cells and exacerbate cardiac dysfunction. Interaction between cardiomyocytes and Treg cells is involved in the development of nonalcoholic steatohepatitis (NASH)-related cardiac dysfunction. AIMS This study evaluates whether the FXR agonist obeticholic acid (OCA) treatment improves NASH-associated cardiac dysfunction. METHODS The in vivo and in vitro mechanisms and effects of two weeks of OCA treatment on inflammasome and Treg dysregulation-related cardiac dysfunction in NASH mice (NASH-OCA) at systemic, tissue and cellular levels were investigated. RESULTS The OCA treatment suppressed the serum and cardiac inflammasome levels, reduced the cardiac infiltrated CD3+ T cells, increased the cardiac Treg-represented anti-inflammatory cytokines (IL-10/IL-10R) and improved cardiac inflammation, fibrosis and function [decreased left ventricle (LV) mass and increased fractional shortening (FS)] in NASH-OCA mice. The percentages of OCA-decreased cardiac fibrosis and OCA-increased FS were positively correlated with the percentage of OCA-increased levels of cardiac FXR and IL-10/IL-10R. In the Treg cells from NASH-OCA mice spleen, in comparison with the Treg cells of the NASH group, higher intracellular FXR but lower inflammasome levels, and more proliferative/active and less apoptotic cells were observed. Incubation of H9c2 cardiomyoblasts with Treg-NASHcm [supernatant of Treg from NASH mice as condition medium (cm)], increased inflammasome levels, decreased the proliferative/active cells, suppressed the intracellular FXR, and downregulated differentiation/contraction marker. The Treg-NASHcm-induced hypocontractility of H9c2 can be attenuated by co-incubation with OCA, and the OCA-related effects were abolished by siIL-10R pretreatment. CONCLUSIONS Chronic FXR activation with OCA is a potential strategy for activating IL-10/IL-10R signalling, reversing cardiac regulatory T cell dysfunction, and improving inflammasome-mediated NASH-related cardiac dysfunction.
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Affiliation(s)
- Szu-Yu Liu
- Department of Medical Education, Clinical Innovation Center, Medical Innovation and Research Office, Taipei Veterans General Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chang Huang
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan,Faculty of Medicine, Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medical Education, Clinical Innovation Center, Medical Innovation and Research Office, Taipei Veterans General Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan,* E-mail: (Y-YY); (H-CL)
| | - Shiang-Fen Huang
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan,Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzung-Yan Lee
- Graduate Institute of Traditional Chinese Medicine, Chang Guang Memorial Hospital, Linkou, Taiwan
| | - Tzu-Hao Li
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan,Faculty of Medicine, Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Foundation, Taipei, Taiwan
| | - Ming-Chih Hou
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan,Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Taipei Veterans General Hospital, Taipei, Taiwan,* E-mail: (Y-YY); (H-CL)
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17
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Fan YH, Wu PW, Huang YL, Lee CC, Lee TJ, Huang CC, Chang PH, Huang CC. Identifying a sphenoid sinus fungus ball using a nomogram model. Rhinology 2022; 61:153-160. [PMID: 36375133 DOI: 10.4193/rhin22.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Sphenoid sinus fungus ball (SSFB) is a rare entity and usually presents with non-specific symptoms. SSFB could potentially lead to serious orbital and intracranial complications. Computed tomography (CT) scan is usually the first imaging test of the diagnostic workup in patients with specific clinical symptoms. This study aimed to compare the clinical characteristics and CT features between SSFB and unilateral (non-fungus ball) chronic sphenoid rhinosinusitis (USRS) and help differentiate between these two most common inflammatory diseases of the sphenoid sinus. Methods: By retrospective database review, 66 patients with a histopathologic diagnosis of isolated SSFB were recruited for analysis. Fifty-four patients who underwent endoscopic sinus surgery with clinical and histopathological diagnoses of USRS were enrolled as the control group. Clinical characteristics and CT features were evaluated. Results: Headache, rhinorrhoea, nasal obstruction, postnasal dripping, and hyposmia were the most common symptoms in both groups. In the univariate analysis, older age, lower white blood cell counts, irregular surface, bony dehiscence, lateral wall sclerosis, and intralesional hyperdensity (IH) were significant predictors for SSFB. Older age, irregular surface, and IH remained statistically significant in the multivariate analysis. Based on the results of the regression analysis, a nomogram for predicting the probability of SSFB was plotted. Conclusions: We developed a nomogram model as a novel preoperative diagnostic tool for identifying SSFB according to the predictors both in clinical characteristics and on CT features. This could help the clinicians in predicting the probability of SSFB, to reduce ineffective or delayed treatment and occurrence of complications.
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Affiliation(s)
- Y H Fan
- Department of Medical Education, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - P W Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Y L Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - C C Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan
| | - T J Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
| | - C C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - P H Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
| | - C C Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan
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Yang YY, Huang PH, Yang LY, Huang CC, Liu CW, Huang SS, Chen CH, Lee FY, Kao SY, Shulruf B. Equal Z standard-setting method to estimate the minimum number of panelists for a medical school’s objective structured clinical examination in Taiwan: a simulation study. J Educ Eval Health Prof 2022; 19:27. [PMID: 36252990 PMCID: PMC9764018 DOI: 10.3352/jeehp.2022.19.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Undertaking a standard-setting exercise is a common method for setting pass/fail cut scores for high-stakes examinations. The recently introduced equal Z standard-setting method (EZ method) has been found to be a valid and effective alternative for the commonly used Angoff and Hofstee methods and their variants. The current study aims to estimate the minimum number of panelists required for obtaining acceptable and reliable cut scores using the EZ method. METHODS The primary data were extracted from 31 panelists who used the EZ method for setting cut scores for a 12-station of medical school’s final objective structured clinical examination (OSCE) in Taiwan. For this study, a new data set composed of 1,000 random samples of different panel sizes, ranging from 5 to 25 panelists, was established and analyzed. Analysis of variance was performed to measure the differences in the cut scores set by the sampled groups, across all sizes within each station. RESULTS On average, a panel of 10 experts or more yielded cut scores with confidence more than or equal to 90% and 15 experts yielded cut scores with confidence more than or equal to 95%. No significant differences in cut scores associated with panel size were identified for panels of 5 or more experts. CONCLUSION The EZ method was found to be valid and feasible. Less than an hour was required for 12 panelists to assess 12 OSCE stations. Calculating the cut scores required only basic statistical skills.
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Affiliation(s)
- Ying-Ying Yang
- Division of Clinical Skills Training Center, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Pin-Hsiang Huang
- National Yang-Ming University, Taipei, Taiwan
- University of New South Wales, Sydney, Australia
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Yu Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chang Huang
- Division of Clinical Skills Training Center, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Chih-Wei Liu
- Division of Clinical Skills Training Center, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Shiau-Shian Huang
- Division of Clinical Skills Training Center, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Chen-Huan Chen
- National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Yauh Lee
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Yen Kao
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Boaz Shulruf
- University of New South Wales, Sydney, Australia
- University of Auckland, Auckland, New Zealand
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Wu JW, Cheng HM, Huang SS, Liang JF, Huang CC, Shulruf B, Yang YY, Chen CH, Hou MC, Huey-Herng Sheu W. Medical school grades may predict future clinical competence. J Chin Med Assoc 2022; 85:909-914. [PMID: 36150103 DOI: 10.1097/jcma.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In real-world medical education, there is a lack of reliable predictors of future clinical competencies. Hence, we aim to identify the factors associated with clinical competencies and construct a prediction model to identify "improvement required" trainees. METHODS We analyzed data from medical students who graduated from National Yang-Ming University with clerkship training and participated in the postgraduate year (PGY) interview at Taipei Veterans General Hospital. Clinical competencies were evaluated using grades of national objective structured clinical examination (OSCEs). This study used data from medical students who graduated in July 2018 as the derivation cohort (N = 50) and those who graduated in July 2020 (n = 56) for validation. RESULTS Medical school grades were associated with the performance of national OSCEs (Pearson r = 0.34, p = 0.017), but the grades of the structured PGY interviews were marginally associated with the national OSCE (Pearson r = 0.268, p = 0.06). A prediction model was constructed to identify "improvement required" trainees, defined: trainees with the lowest 25% of scores in the national OSCEs. According to this model, trainees with the lowest 25% medical school grades predicted a higher risk of the "improvement required" clinical performance (Q1-Q3 vs Q4 = 15% vs 60%, odds ratio = 8.5 [95% confidence interval = 1.8-39.4], p = 0.029). In the validation cohort, our prediction model could accurately classify 76.7% "improvement required" and "nonimprovement required" students. CONCLUSION Our study suggests that interventions for students with unsatisfactory medical school grades are warranted to improve their clinical competencies.
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Affiliation(s)
- Jr-Wei Wu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
- Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, ROC
| | - Shiau-Shian Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
| | - Jen-Feng Liang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
| | - Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Boaz Shulruf
- University of New South Wales, Sydney, Australia
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
- Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Clinical Skills Training Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, ROC
| | - Wayne Huey-Herng Sheu
- College of Medicine, National Yang Ming Tung University, Taipei, Taiwan, ROC
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan, ROC
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20
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Tai CC, Huang CC, Chou BH, Chen CY, Chen SY, Huang YH, Sun JS, Chao YH. Profiled polyethylene terephthalate filaments that incorporate collagen and calcium phosphate enhance ligamentisation and bone formation. Eur Cell Mater 2022; 43:252-266. [PMID: 35652679 DOI: 10.22203/ecm.v043a17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Polyethylene terephthalate (PET) artificial ligaments offer an unlimited source of ligaments without donor-site-related morbidity and with good mechanical properties for a rapid return to sporting activities. Developing PET artificial ligaments with excellent ligamentisation and ligament-bone healing is still a considerable challenge. This study aimed to investigate the effects of the profiled PET/collagen/calcium phosphate (PET/C/CaP) ligament upon cell growth, ligamentisation and ligament-bone healing in vitro and in vivo. Profiled PET/C/CaP filaments were made by melt-spinning process with 2 % CaP hybrid spinning and collagen coating. Rat mesenchymal stem cells (MSCs) were cultured on the profiled PET/C filaments for cytotoxicity, viability, scanning electron microscopy (SEM) and ligament-related gene expression analysis. MSCs' osteogenic capacity on the profiled PET/CaP filaments was identified by detecting osteogenic gene expression and alizarin red S staining. For in vivo verification, an animal study was performed to evaluate the effect of the profiled PET/C/CaP ligament in a rabbit knee medial collateral ligament reinforcement reconstruction model. The graft ligamentisation and bone formation were investigated by SEM, histology, microcomputed tomography and mechanical tests. The profiled PET/C filaments enhanced MSC proliferation and ligament-related gene expression. Furthermore, they enhanced osteogenic gene expression, alkaline phosphatase activity and mineralisation of MSCs. The in vivo study indicated that the profiled PET/C/CaP ligament enhanced ligamentous matrix remodelling and bone formation. Therefore, their use is an effective strategy for promoting MSCs' ligamentous and osteogenic potential in vitro and enhancing ligamentous matrix remodelling and bone formation in vivo.
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Affiliation(s)
| | | | | | | | | | | | | | - Y-H Chao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University No. 17, Xuzhou Road, Zhongzheng District, Taipei 10055,
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21
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Huang SF, Huang YC, Lee CT, Chou KT, Chen HP, Huang CC, Ji DD, Chan YJ, Yang YY. Cytomegalovirus viral interleukin-10 (cmvIL-10) in patients with Aspergillus infection and effects on clinical outcome. Mycoses 2022; 65:760-769. [PMID: 35559581 DOI: 10.1111/myc.13472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human cytomegalovirus (CMV) is associated with aspergillosis, but the simultaneous presence of cytomegalovirus viral interleukin-10 (cmvIL-10) and aspergillosis has never been investigated. CmvIL-10 is produced by CMV-infected cells and acts as an immune modulator during CMV infection. The aim of this study was to evaluate cmvIL-10 levels in peripheral blood and its influence on the clinical outcomes of Aspergillus infection. METHODS Patients who visited or were admitted to the hospital with suspected Aspergillus infection, including invasive aspergillosis (IA) and chronic pulmonary aspergillosis (CPA), were prospectively enrolled. The cmvIL-10, human IL-10 (hIL-10), IL-1B, IL-6, IL-8, IFN-γ, and TNF-α levels in peripheral blood were measured. RESULTS Patients with Aspergillus infection had a higher level of cmvIL-10 than the control group (158±305 vs. 27.9±30.4 pg/mL, p<0.05). The level of cmvIL-10 was not correlated with CMV viremia or end-organ disease. The cmvIL-10 but not hIL-10 level was positively correlated with the IFN-γ level (p<0.05) and marginally negatively correlated with IL-1B and IL-8 levels (p<0.1). In patients with CPA, a high level of cmvIL-10 (≥100 pg/mL) was a poor prognostic factor for long-term survival (p<0.05). In contrast, CMV viremia or end-organ disease was associated with poor survival in patients with IA (p=0.05). CONCLUSIONS Aspergillus infection was associated with CMV coinfection with cmvIL-10 in blood. A cmvIL-10 concentration ≥100 pg/mL was a predictor for unfavourable outcome in CPA patients.
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Affiliation(s)
- Shiang-Fen Huang
- Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taiepi.,School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yu-Chi Huang
- Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taiepi
| | - Chen-Te Lee
- Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taiepi
| | - Kun-Ta Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei
| | - Hsin-Pai Chen
- Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taiepi.,School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chia-Chang Huang
- Division of General Medicine, Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei.,Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei
| | - Dar-Der Ji
- Department of Tropical Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Yu-Juin Chan
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei
| | - Ying-Ying Yang
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei.,Institute of Clinical Medicine, Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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22
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Chiang DH, Huang CC, Cheng SC, Cheng JC, Wu CH, Huang SS, Yang YY, Yang LY, Kao SY, Chen CH, Shulruf B, Lee FY. Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills: A prospective pre-post study. Medicine (Baltimore) 2022; 101:e28570. [PMID: 35029229 PMCID: PMC8757958 DOI: 10.1097/md.0000000000028570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Virtual reality (VR)-based simulation in hospital settings facilitates the acquisition of skills without compromising patient safety. Despite regular text-based training, a baseline survey of randomly selected healthcare providers revealed deficiencies in their knowledge, confidence, comfort, and care skills regarding tracheostomy. This prospective pre-post study compared the effectiveness of regular text- and VR-based intervention modules in training healthcare providers' self-efficacy in tracheostomy care skills. METHODS Between January 2018 and January 2020, 60 healthcare providers, including physicians, nurses, and respiratory therapists, were enrolled. For the intervention, a newly developed head-mounted display (HMD) and web VR materials were implemented in training and clinical services. Subsequently, in-hospital healthcare providers were trained using either text or head-mounted display virtual reality (HMD-VR) materials in the regular and intervention modules, respectively. For tracheostomy care skills, preceptors directly audited the performance of trainees and provided feedback. RESULTS At baseline, the degree of trainees' agreement with the self-efficacy-related statements, including the aspects of familiarity, confidence, and anxiety about tracheostomy-related knowledge and care skills, were not different between the control and intervention groups. At follow-up stage, compared with the regular group, a higher percentage of intervention group' trainees reported that they are "strongly agree" or "somewhat agree" that the HMD-VR simulation increases their self-efficacy, including the aspects of familiarity and confidence, and reduced their anxiety about tracheostomy-related knowledge and care skills. After implementation, a higher degree of trainees' average satisfaction with VR-based training and VR materials was observed in the intervention group than in the regular group. Most reported that VR materials enabled accurate messaging and decreased anxiety. The increasing trend of the average written test and hands-on tracheostomy care skills scores among the intervention group trainees was significant compared to those in the regular group. The benefits of HMD-VR simulations and web-VR material-based clinical services for in-hospital healthcare providers and patient families persisted until 3 to 4 weeks later. CONCLUSION The current study suggests that VR materials significantly enhance trainees' self-efficacy (increased familiarity, increased confidence, and reduced anxiety) and their satisfaction with the training, while motivating them to use acquired knowledge and skills in clinical practice.
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Affiliation(s)
- Dung-Hung Chiang
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chang Huang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Chuan Cheng
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jui-Chun Cheng
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsien Wu
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiau-Shian Huang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Yu Yang
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Yen Kao
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Family Dentistry, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Fa-Yauh Lee
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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Chiang DH, Chen CT, Wang TY, Yang YY, Huang CC, Li TH, Huang SS, Kao SY, Chen CH, Hou MC, Sheu WHH. Enhancing the learning and transfer of preprocedural communication skills during clerkship using audio-visual material: a prospective case-controlled study over 2 years. BMJ Open 2022; 12:e055953. [PMID: 34987046 PMCID: PMC8734007 DOI: 10.1136/bmjopen-2021-055953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE/DESIGN/SETTING This study aims to develop preprocedural communication-specific framework that emphasises the use of audiovisual materials and compares its acceptability by trainees with a regular module. TRAINEES Between October 2018 and July 2021, 96 medical clerks were enrolled and randomly divided into regular and intervention groups. Another 48 trainees whose did not join the framework-based training but complete self-assessments were enrolled as the control group. INTERVENTIONS In the intervention training module, the key steps of preprocedural communication-specific skills were structuralised into a framework using the acronym of OSCAR. PRIMARY AND SECONDARY OUTCOME MEASURES This study compared the acceptability of trainees for two modules by measuring the degree of increase in the end-of-rotation and follow up (4 weeks later) competency from baseline by trainees' self-assessments and physician assessments after serial trainings. RESULTS In comparison with regular group trainees, greater degree of improvements (framework-1 statement: 111%±13% vs 27%±5%, p<0.001; framework-2 statement: 77%±9% vs 48%±2%, p<0.05; skill-1 statement: 105%±9% vs 48%±3%, p<0.001); skill-2 statement: 71%±11% vs 50%±9%, p<0.05) were noted in the framework-related and skill-related statement 1-2 (the familiarity and confidence to use the framework and skills) than those of intervention group. At the end-of-rotation stage, the trainees ability to use the 'A-step: using audiovisual materials' of the OSCAR was significantly improved (229%±13%, p<0.001), compared with other steps. In the intervention group, the degree of improvement of the end-of-rotation data of trainees' self-assessment from baseline was significantly correlated with the degree of the improvement in physicians' assessment data in the aspects of skills, framework and steps in framework (R=0.872, p<0.01; R=0.813, p<0.001; R=0.914, p<0.001). CONCLUSIONS The OSCAR framework-based intervention module is well accepted by medical clerks and motivates them to integrate the acquired skills in clinical practice, which leads to trainees' primary care patients being satisfied with their preprocedural communication.
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Affiliation(s)
- Dung-Hung Chiang
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical college, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Ting Chen
- Medical college, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Emergency, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tse-Yao Wang
- Medical college, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Emergency, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Medical college, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation and Research Center, Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chang Huang
- Medical college, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Clinical Skill Training Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Hao Li
- Medical Innovation and Research Center, Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Shiau-Shian Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Yen Kao
- Medical education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Medical college, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- Medical college, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
- Division of metabolism and endoscrinology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Wu JW, Cheng HM, Huang SS, Liang JF, Huang CC, Yang LY, Shulruf B, Yang YY, Chen CH, Hou MC, Sheu WHH. Comparison of OSCE performance between 6- and 7-year medical school curricula in Taiwan. BMC Med Educ 2022; 22:15. [PMID: 34983486 PMCID: PMC8725566 DOI: 10.1186/s12909-021-03088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The year 2013 marks a watershed in the history of medical education in Taiwan. Following Taiwan's Taskforce of Medical School Curriculum Reform recommendations, the medical school curriculum was reduced from 7 to 6 years. This study aimed to analyze the impact of medical school curriculum reform on medical students' performance in objective structured clinical examinations (OSCEs). METHODS We retrospectively analyzed the OSCE records at Taipei Veterans General Hospital (Taipei VGH), one of Taiwan's largest tertiary medical centers, between November 2016 and July 2020. The eligibility criteria were medical students receiving a full one-year clinical sub-internship training at Taipei VGH and in their last year of medical school. All medical students received a mock OSCE-1 at the beginning of their sub-internship, a mock OSCE-2 after six months of training, and a national OSCE at the end of their sub-internship. The parameters for performance in OSCEs included "percentage of scores above the qualification standard" and "percentage of qualified stations." RESULTS Between November 2016 and July 2020, 361 undergraduates underwent clinical sub-internship training at Taipei VGH. Among them, 218 were taught under the 7-year curriculum, and 143 were instructed under the 6-year curriculum. Based on baseline-adjusted ANCOVA results, medical students under the 7-year curriculum had a higher percentage of scores above the qualification standard than those under the 6-year curriculum at the mock OSCE-1 (7-year curriculum vs. 6-year curriculum: 33.8% [95% CI 32.0-35.7] vs. 28.2% [95% CI 25.9-30.4], p < 0.001), and mock OSCE-2 (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 87.4-91.4] vs. 84.0% [95% CI 81.5-86.4], p = 0.001). Moreover, medical students in the 7-year curriculum had a higher percentage of qualified stations in mock OSCE-1 (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 87.4-91.4] vs. 84.0% [95% CI 81.5-86.4], p = 0.001) and mock OSCE-2 (7-year curriculum vs. 6-year curriculum: 91.9% [95% CI 90.1-93.8] vs. 86.1% [95% CI 83.8-88.3], p = 0.001). After clinical sub-internship training, there were no differences in the percentage of scores above the qualification standard (7-year curriculum vs. 6-year curriculum: 33.5% [95% CI 32.2-34.9] vs. 34.6 [95% CI 32.9-36.3], p = 0.328) and percentage of qualified stations (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 88.1-90.7] vs. 90.2% [95% CI 88.6-91.8], p = 0.492). CONCLUSIONS At the beginning of the sub-internship, medical students under the 7-year curriculum had better OSCE performance than those under the 6-year curriculum. After the clinical sub-internship training in Taipei VGH, there was no difference in the national OSCE score between the 6- and 7-year curricula. Our study suggests that clinical sub-internship is crucial for the development of clinical skills and performance in the national OSCE.
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Affiliation(s)
- Jr-Wei Wu
- Department of Medical Education, Taipei Veterans General Hospital and College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital and College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiau-Shian Huang
- Department of Medical Education, Taipei Veterans General Hospital and College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jen-Feng Liang
- Department of Medical Education, Taipei Veterans General Hospital and College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital and College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Clinical Skills Training Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Yu Yang
- Department of Medical Education, Taipei Veterans General Hospital and College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Boaz Shulruf
- University of New South Wales, Sydney, Australia
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital and College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Clinical Innovation Center, Taipei Veterans General Hospital, Taipei, Taiwan.
- Division of Clinical Skills Training Center, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital and College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Hou
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan
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Hsu CF, Huang CC, Liu TT, Yang UC, Liu CW, Huang SF, Yang YY, Huang YH, Hou MC, Lin HC. Deletion of intestinal SIRT1 exacerbated muscle wasting in cirrhotic mice by decreasing the intestinal concentration of short-chain fatty acids and inflammation. J Pharmacol Sci 2021; 147:376-385. [PMID: 34663520 DOI: 10.1016/j.jphs.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/28/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Systemic sirtuin 1 (SIRT1) activation alleviates muscle wasting and improves muscle function by downregulation of myotropic and proteolytic markers. In this study, we evaluated the effects of the intestinal Sirt1 deletion on the dysregulated gutmuscle axis in cirrhotic mice. Cirrhosis-related muscle wasting was induced by common bile duct ligated (BDL) in either wild-type (WT) or intestine-specific Sirt1-deleted (Sirt1IEC-KO) mice, including WT-BDL, WT-sham, Sirt1IEC-KO-BDL and Sirt1IEC-KO-sham mice. Compared with WT-BDL mice, Sirt1IEC-KO-BDL mice showed worsened low lean mass, exacerbated muscle wasting, increased expression of myotropic markers, increased muscular protein degradation, and decreased expression of myogenic markers through aggravation of intestinal inflammation (as evidenced by increased fecal calprotectin/lipocalin-2 levels, increased intestinal macrophage infiltration, and increased intestinal TNFα/IL-6 levels), decrease in abundance of short-chain fatty acid (SCFA)-producing bacteria, decrease in levels of intestinal SCFAs (with anti-inflammatory effects), and downregulation of SCFA receptor GPR43. In biliary cirrhotic mice, a decrease in the abundance of SCFA-producing bacteria and an increase in the levels of intestinal/muscular inflammatory markers are involved in the pathogenesis of dysregulated gut-muscle axis-related muscle wasting, and intestinal deletion of Sirt1 exacerbated these changes.
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Affiliation(s)
- Chien-Fu Hsu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chang Huang
- Division of Clinical Skills Training Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tze-Tze Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ueng-Cheng Yang
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Wei Liu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shiang-Fen Huang
- Division of Infection, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Ying Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Liu SY, Huang CC, Huang SF, Liao TL, Kuo NR, Yang YY, Li TH, Liu CW, Hou MC, Lin HC. Pioglitazone Ameliorates Acute Endotoxemia-Induced Acute on Chronic Renal Dysfunction in Cirrhotic Ascitic Rats. Cells 2021; 10:3044. [PMID: 34831270 PMCID: PMC8616474 DOI: 10.3390/cells10113044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 01/23/2023] Open
Abstract
Endotoxemia-activated tumor necrosis factor (TNFα)/nuclear factor kappa B (NFκB) signals result in acute on chronic inflammation-driven renal dysfunction in advanced cirrhosis. Systemic activation of peroxisome proliferator-activated receptor gamma (PPARγ) with pioglitazone can suppress inflammation-related splanchnic and pulmonary dysfunction in cirrhosis. This study explored the mechanism and effects of pioglitazone treatment on the abovementioned renal dysfunction in cirrhotic rats. Cirrhotic ascitic rats were induced with renal dysfunction by bile duct ligation (BDL). Then, 2 weeks of pioglitazone treatment (Pio, PPAR gamma agonist, 12 mg/kg/day, using the azert osmotic pump) was administered from the 6th week after BDL. Additionally, acute lipopolysaccharide (LPS, Escherichia coli 0111:B4; Sigma, 0.1 mg/kg b.w, i.p. dissolved in NaCl 0.9%) was used to induce acute renal dysfunction. Subsequently, various circulating, renal arterial and renal tissue pathogenic markers were measured. Cirrhotic BDL rats are characterized by decreased mean arterial pressure, increased cardiac output and portal venous pressure, reduced renal arterial blood flow (RABF), increased renal vascular resistance (RVR), increased relative renal weight/hydroxyproline, downregulated renal PPARγ expression, upregulated renal inflammatory markers (TNFα, NFκB, IL-6, MCP-1), increased adhesion molecules (VCAM-1 and ICAM-1), increased renal macrophages (M1, CD68), and progressive renal dysfunction (increasing serum and urinary levels of renal injury markers (lipocalin-2 and IL-18)). In particular, acute LPS administration induces acute on chronic renal dysfunction (increasing serum BUN/creatinine, increasing RVR and decreasing RABF) by increased TNFα-NFκB-mediated renal inflammatory markers as well as renal M1 macrophage infiltration. In comparison with the BDL+LPS group, chronic pioglitazone pre-treatment prevented LPS-induced renal pathogenic changes in the BDL-Pio+LPS group. Activation of systemic, renal vessel and renal tissue levels of PPARγ by chronic pioglitazone treatment has beneficial effects on the endotoxemia-related TNFα/NFκB-mediated acute and chronic renal inflammation in cirrhosis. This study revealed that normalization of renal and renal arterial levels of PPARγ effectively prevented LPS-induced acute and chronic renal dysfunction in cirrhotic ascitic rats.
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Affiliation(s)
- Szu-Yu Liu
- Department of Medical Education, Medical Innovation and Research Office (MIRO), Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-Y.L.); (C.-C.H.); (N.-R.K.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-F.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
| | - Chia-Chang Huang
- Department of Medical Education, Medical Innovation and Research Office (MIRO), Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-Y.L.); (C.-C.H.); (N.-R.K.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-F.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
| | - Shiang-Fen Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-F.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
| | - Tsai-Ling Liao
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 11217, Taiwan
| | - Nai-Rong Kuo
- Department of Medical Education, Medical Innovation and Research Office (MIRO), Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-Y.L.); (C.-C.H.); (N.-R.K.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-F.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
| | - Ying-Ying Yang
- Department of Medical Education, Medical Innovation and Research Office (MIRO), Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-Y.L.); (C.-C.H.); (N.-R.K.)
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-F.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
| | - Tzu-Hao Li
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Foundation, Taipei 11217, Taiwan
| | - Chih-Wei Liu
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
| | - Ming-Chih Hou
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-F.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
| | - Han-Chieh Lin
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-F.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao Tung University, Taipei 11217, Taiwan; (T.-L.L.); (T.-H.L.); (C.-W.L.)
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Huang SF, Huang CC, Chou KT, Chan YJ, Yang YY, Wang FD. Chronic Pulmonary Aspergillosis: Disease Severity Using Image Analysis and Correlation with Systemic Proinflammation and Predictors of Clinical Outcome. J Fungi (Basel) 2021; 7:jof7100842. [PMID: 34682263 PMCID: PMC8537715 DOI: 10.3390/jof7100842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: The presentation of chronic pulmonary aspergillosis (CPA) ranges from single granuloma to fibrosis in the affected lung. CPA can be divided into five categories according to European Respirology Society (ERS) guidance but is usually assessed by clinical physicians. Computer-based quantitative lung parenchyma analysis in CPA and its correlation with clinical manifestations, systemic inflammation, and angiogenesis have never been investigated. (2) Method: Forty-nine patients with CPA and 36 controls were prospectively enrolled. Pulmonary function tests (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FCV) and biomarkers in the peripheral blood (the chemokines interleukin (IL)-1B, IL-6, IL-10, IL-8, CRP, ESR, MMP1, MMP7, MMP8, TNF-α, calprotectin, SDF-1α, and VEGFA) were measured before antifungal treatment. The disease severity was categorized into mild, moderate, and severe based on chest computed tomography (CT) images. The oxygen demand and overall mortality until the end of the study were recorded. Quantitative parenchyma analysis was performed using the free software 3Dslicer. (3) Results: The results of quantitative parenchyma analysis concorded with the visual severity from the chest CT, oxygen demand, FVC, and FEV1 in the study subjects. The decrease in kurtosis and skewness of the lung density histograms on CT, increase in high attenuation area (HAA), and reduced lung volume were significantly correlated with increases in the PMN %, CRP, IL-1B, SDF-1α, MMP1, and Calprotectin in peripheral blood in the multivariable regression analysis. TNF-α and IL-1B at study entry and the CPA severity from either a visual method or computer-based evaluation were predictors of long-term mortality. (4) Conclusion: The computer-based parenchyma analysis in CPA agreed with the categorization on a visual basis and was associated with the clinical outcomes, chemokines, and systemic proinflammation profiles.
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Affiliation(s)
- Shiang-Fen Huang
- Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan;
- Correspondence:
| | - Chia-Chang Huang
- Division of Endocrinology and Metabolism, Department of Medicine, Veterans General Hospital, Taipei 112201, Taiwan;
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Kun-Ta Chou
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan;
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Yu-Jiun Chan
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Ying-Ying Yang
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
- Department of Medicine, Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan
| | - Fu-Der Wang
- Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112304, Taiwan;
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Hsu CF, Lin MW, Huang CC, Li TH, Liu CW, Huang SF, Yang YY, Huang YH, Hou MC, Lin HC. Roles and mechanisms of circulating CEACAM1 in the cirrhosis-related intestinal hyperpermeability: in vitro approach. J Chin Med Assoc 2021; 84:851-859. [PMID: 34261981 DOI: 10.1097/jcma.0000000000000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cirrhosis-related intestinal hyperpermeability and endotoxemia are characterized by intestinal epithelial cell apoptosis, impaired restitution (proliferation and migration), decreased tight junction protein levels, and subsequent barrier dysfunction. In addition to endotoxin and tumor necrosis factor-α (TNFα), carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) plays crucial roles in the regulation of apoptosis, restitution, tight junction protein-maintained barrier function of intestinal epithelial cells. METHODS This study aims to explore the roles and underlying mechanisms of CEACAM1 in cirrhosis-related intestinal hyperpermeability through in vitro approach. RESULTS In cirrhotic patients, high serum levels of intestinal hyperpermeability (zonulin and endotoxin) markers were accompanied by elevated serum levels of TNFα and soluble CEACAM1. In in vitro experiments, we evaluated the individual and interacted roles of TNFα and human recombinant CEACAM1 (hrCEACAM1) in LC-sera (sera of cirrhotic patients)-induced intestinal hyperpermeability-related pathogenic signals. In the cell Line human from human colon (Caucasian colon adenocarcinoma) (Caco-2) cell culture, LC-sera, TNFα, and hrCEACAM1 increased apoptosis (measured by Terminal deoxynucleotidyl transferase [TdT] dUTP nick end labeling+/annexin-5+propidium iodide+ cells and caspase-3 activity), decreased restitution capacity (proliferation and migration), and disrupted tight junction protein-maintained barrier function in Caco-2 cells. The pathogenic changes mentioned above were accompanied by an increase in intracellular reactive oxygen species (ROS) levels, lactate dehydrogenase release, and endoplasmic reticulum stress-related signals in the LC-sera or TNFα-pretreated Caco-2 cells. Concomitant incubation of Caco-2 cells with anti-CEACAM1 suppressed these LC-sera or TNFα-induced negative effects on restitution, barrier function, and cell viability. CONCLUSION This study demonstrated that sera from cirrhotic patients contain soluble CEACAM1, which is involved in the pathogenesis of intestinal hyperpermeability. Accordingly, it is noteworthy to explore the potential use of anti-CEACAM1 treatment for cirrhosis-related intestinal hyperpermeability and endotoxemia.
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Affiliation(s)
- Chien-Fu Hsu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
| | - Ming-Wei Lin
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
- Division of Preventive Medicine, Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzu-Hao Li
- Division of Preventive Medicine, Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Chih-Wei Liu
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
- Division of Allergy, Immunology and Rheumatology Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shiang-Fen Huang
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
- Division of Infection, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Han-Chieh Lin
- Faculty of Medicine, National Yang Ming Chiao Tung Universityl, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Lee CI, Su YR, Chen CH, Chang TA, Kuo EES, Hsieh WT, Huang CC, Lee MS, Liu M. O-086 End-to-end deep learning for recognition of ploidy status using time-lapse videos. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Our Retrospective study is to investigate an end-to-end deep learning model in identifying ploidy status through raw time-lapse video.
Summary answer
Our deep learning model demonstrates a proof of concept and potential in recognizing the ploidy status.
What is known already
Since the time-lapse system has been introduced into the IVF lab, the relationship between morphogenetic and ploidy status has been often discussed. However, the result has not yet reached a united conclusion due to some limitations such as human labeling. Besides the statistical approach, deep learning models have been utilized for ploidy prediction. As such approaches are single image-based, the performance remains unpromising as previous statistical-based research. Therefore, in order to move further toward clinical application, better research design and approach are needed.
Study design, size, duration
A retrospective analysis of the time-lapse videos and chromosomal status from 690 biopsied blastocysts cultured in a time-lapse incubator (EmbryoScope+, Vitrolife) between January 2017 and August 2018 in the Lee Women’s Hospital were assessed. The ploidy status of the blastocyst was derived from the PGT-A using high-resolution next-generation sequencing (hr-NGS). Embryo videos were obtained after normal fertilization through the intracytoplasmic sperm injection or conventional insemination.
Participants/materials, setting, methods
By randomly dividing the data into 80% and 20%, we developed our deep learning model based on Two-Stream Inflated 3D ConvNets(I3D) network. This model was trained by the 80% time-lapse videos and the PGT-A result. The remaining 20% has been tested by feeding the time-lapse video as input and the PGT-A prediction as output. Ploidy status was classified as Group 1 (aneuploidy) and Group 2 (euploidy and mosaicism).
Main results and the role of chance
Time-lapse videos were divided into 3-time partitions: day 1, day 1 to 3, and day 1 to 5. Deep learning models have been fed by RGB and optical flow. Combining 3 different time partitions with RGB, optical flow, and fused result from RGB and optical flow, we received nine sets of test results. According to the results, the longest time partition with the fusion method has the highest AUC result as 0.74, which appeared higher than the other eight experimental settings with a maximum increase of 0.17.
Limitations, reasons for caution
The present study is retrospective and future prospective research would help us to identify more key factors and improve this model. In addition, expanding sample size combined with cross-centered validation will also be considered in our future approach.
Wider implications of the findings
Group 1 and Group 2 approach provided deselection of aneuploidy embryos, while future deep learning approaches toward high mosaicism, low mosaicism, and euploidy will be needed, in order to provide a better clinical application.
Trial registration number
CS18082
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Affiliation(s)
- C I Lee
- Lee Women’s Hospital, Division of Infertility, Taichung, Taiwan R.O.C
| | - Y R Su
- Binflux Inc, R&D Department, Taipei, Taiwan R.O.C
| | - C H Chen
- Lee Women’s Hospital, Division of Infertility, Taichung, Taiwan R.O.C
| | - T A Chang
- University of Texas Health Science Center, Department of Obstetrics and Gynecology, San Antonio, USA
| | - E E S Kuo
- Binflux Inc, R&D Department, Taipei, Taiwan R.O.C
| | - W T Hsieh
- Binflux Inc, R&D Department, Taipei, Taiwan R.O.C
| | - C C Huang
- Lee Women’s Hospital, Division of Infertility, Taichung, Taiwan R.O.C
| | - M S Lee
- Lee Women’s Hospital, Division of Infertility, Taichung, Taiwan R.O.C
| | - M Liu
- Binflux Inc, R&D Department, Taipei, Taiwan R.O.C
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Chang LS, Lee HC, Hsu CT, Tsao HM, Huang CC, Lee MS. P–009 A modified sperm chromatin dispersion test, LensHooke® R10, for quick and accurate determination of human sperm DNA fragmentation. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
The performance and efficiency of the LensHooke® R10 test kit were evaluated by the clinical examination for precision, accuracy, and time.
Summary answer
The LensHooke® R10 based on sperm chromatin dispersion test offers not only quick testing for sperm DNA fragmentation but also reliable and accurate test results.
What is known already
Sperm chromatin dispersion (SCD) test, one of the most commonly used testing for sperm DNA fragmentation (SDF), can be conducted promptly and without the need for expensive laboratory instruments. However, the main disadvantage of the SCD test is inter-observer variability in categorizing the size of characteristics halos surrounding the core of sperm. Moreover, it takes more than one hour to accomplish whole assay procedures making this testing an inefficient diagnostic tool. These may hinder its broad availability among andrology laboratories or prevent it from being routinely used for the evaluation of male infertility.
Study design, size, duration
A total of 108 participants was included in this prospective study. Data was collected from the reproductive medicine center between June and December 2020.
Participants/materials, setting, methods
This study included 108 consecutive male partners of couples attending for assisted reproductive treatment. SDF was simultaneously tested by using LensHooke® R10 (R10) and Halosperm® G2 (G2) respectively. We evaluated the correlation and agreement between two SCD-based test kits. The repeatability and reproducibility of the SCD kits were assessed by intra-and inter-observer agreement experiments. The sensitivity, specificity, positive predictive value, negative predictive value for the R10 was determined by receiver operator characteristics (ROC) curve analysis.
Main results and the role of chance
The R10 produced more clear sperm core and dispersed chromatin, therefore highly recognizable images can be easily and accurately categorized when scoring of SDF. It took 50% less time for SDF testing by the R10 compared to the G2 (38.26 ± 9.85 minutes vs. 76.52 ± 19.7 minutes, P < 0.0001). The SDF% results showed a strong correlation for the R10 and G2 with Spearman’s coefficients of rank correlation (rho) above 0.8 (P < 0.0001, N = 108). The R10 showed 89.8% accuracy with 87.9% sensitivity, 90.8% specificity, 82.9% PPV, and 93.7% NPV on the measurement of SDF% at the threshold value of 22%. Intraclass correlation coefficients (ICC) >0.9 showed a strong agreement between two observers on the testing of SDF using the R10. ICC >0.9 showed a high intra-observer agreement within 4 repeated testing on SDF using the R10. The R10 showed an intra-observer’s precision of coefficient variation, CV < 10% for SDF%. In addition, SDF% test results obtained by the R10 for asthenospermic (31.8% ± 16.7%), teratospermic (22.9% ± 14.4%), and oligoasthenoteratozoospermic samples (36.6% ± 14.4%) were significantly higher than that observed in normozoospermic samples (15.3% ± 10.2%, p < 0.05), was comparable with the G2.
Limitations, reasons for caution
The sample size of 4 semen specimens used to evaluate the intra-and inter-observer agreement was a limitation. Besides, evaluating the relationship between the SDF and clinical outcome of ART is necessary for further study.
Wider implications of the findings: The new in vitro diagnostics reagent, LensHooke® R10, is a simple and quick test kit that offers reliable and accurate test results of sperm DNA fragmentation, can be routinely used in male infertility evaluation.
Trial registration number
CS2–20012
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Affiliation(s)
- L S Chang
- Bonraybio Co.- Ltd, Clinical Medicine Dept., Taichung, Taiwan R.O.C
| | - H C Lee
- Bonraybio Co.- Ltd, Clinical Medicine Dept., Taichung, Taiwan R.O.C
| | - C T Hsu
- Bonraybio Co.- Ltd, Executive Office, Taichung, Taiwan R.O.C
| | - H M Tsao
- Lee Women’s Hospital, IVF Center, Taichung, Taiwan R.O.C
| | - C C Huang
- Lee Women’s Hospital, IVF Center, Taichung, Taiwan R.O.C
| | - M S Lee
- Lee Women’s Hospital, IVF Center, Taichung, Taiwan R.O.C
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Huang CC, Huang SS, Yang YY, Kao SY. Effects of a simulation-based blended training model on nurses’ treatment decision-related knowledge about oral cancer in Taiwan: a pilot survey. J Educ Eval Health Prof 2021; 18:10. [PMID: 34034443 PMCID: PMC8241583 DOI: 10.3352/jeehp.2021.18.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
The present study aimed to evaluate the effects of virtual reality (VR) simulations combined with bedside assignments on nurses’ self-efficacy in providing pre-treatment educational services. Between March 2019 and November 2020, we conducted a study of VR educational materials that were developed to cover information about the treatment of oral cancers. The effects of the VR simulation, the thinking-path tracking map method, and bedside assignments on the nurses’ treatment decision-related knowledge were evaluated in a ward for oral cancer patients at Taipei Veterans General Hospital, Taipei, Taiwan. The blended training model significantly increased nurses’ familiarity (P<0.01) and confidence (P<0.03) regarding their knowledge of treatments and treatment decision-related knowledge. This model also significantly increased their confidence in their skills in bedside pre-treatment education for admitted oral cancer patients (P<0.002). Oral cancer-specific VR materials enhanced the effectiveness of skills training among nurses in the oral cancer ward.
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Affiliation(s)
- Chia-Chang Huang
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Shiau-Shian Huang
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Ying Yang
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Shou-Yen Kao
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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Li TH, Liu CW, Huang CC, Tsai YL, Huang SF, Yang YY, Tsai CY, Hou MC, Lin HC. Non-Selective Beta-Blockers Decrease Infection, Acute Kidney Injury Episodes, and Ameliorate Sarcopenic Changes in Patients with Cirrhosis: A Propensity-Score Matching Tertiary-Center Cohort Study. J Clin Med 2021; 10:jcm10112244. [PMID: 34064207 PMCID: PMC8196849 DOI: 10.3390/jcm10112244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Cirrhotic complications resulting from portal hypertension can be considerably reduced by non-selective beta-blockers (NSBBs); however, scarce studies have investigated therapeutic agents for other complications. We aimed to investigate the effects of NSBBs on common cirrhotic complications of infection, acute kidney injury (AKI), chronic renal function declination, and sarcopenic changes. Methods: Medical records of hospitalization for cirrhosis with at least a 4-year follow-up were analyzed and selected using propensity-score matching (PSM). Generalized estimating equation (GEE) was applied to assess the association of NSBBs with infection requiring hospitalization and AKI. Chronic renal function declination was evaluated by slope of regression lines derived from reciprocal of the serum creatinine level. The covariates of CT-measured skeletal muscle index (SMI) alterations were analyzed by generalized linear mixed model. Results: Among the 4946 reviewed individuals, 166 (83 NSBB group, 83 non-NSBB group) were eligible. Using GEE, Charlson comorbidity index, Child-Pugh score and non-NSBB were risk factors for infection; non-NSBB group revealed a robust trend toward AKI, showed no significant difference with chronic renal function declination of NSBB group, and was negatively associated with SMI alteration. Conclusion: Chronic NSBB use lowered the episodes of infection requiring hospitalization and AKIs, whereas non-NSBB was associated with sarcopenic changes.
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Affiliation(s)
- Tzu-Hao Li
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No.95, Wen Chang Rd., Shihlin District, Taipei 111, Taiwan;
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (C.-W.L.); (C.-C.H.); (S.-F.H.); (C.-Y.T.)
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
- School of Medicine, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 242, Taiwan
| | - Chih-Wei Liu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (C.-W.L.); (C.-C.H.); (S.-F.H.); (C.-Y.T.)
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 112, Taiwan
| | - Chia-Chang Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (C.-W.L.); (C.-C.H.); (S.-F.H.); (C.-Y.T.)
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 112, Taiwan
| | - Yu-Lien Tsai
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
- Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 112, Taiwan
| | - Shiang-Fen Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (C.-W.L.); (C.-C.H.); (S.-F.H.); (C.-Y.T.)
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
| | - Ying-Ying Yang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (C.-W.L.); (C.-C.H.); (S.-F.H.); (C.-Y.T.)
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 112, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 112, Taiwan
- Correspondence:
| | - Chang-Youh Tsai
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (C.-W.L.); (C.-C.H.); (S.-F.H.); (C.-Y.T.)
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 112, Taiwan
| | - Ming-Chih Hou
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 112, Taiwan
| | - Han-Chieh Lin
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei City 112, Taiwan; (Y.-L.T.); (M.-C.H.); (H.-C.L.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City 112, Taiwan
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Chou YT, Liu TT, Yang UC, Huang CC, Liu CW, Huang SF, Li TH, Liu HM, Lin MW, Yang YY, Lee TY, Huang YH, Hou MC, Lin HC. Intestinal SIRT1 Deficiency-Related Intestinal Inflammation and Dysbiosis Aggravate TNFα-Mediated Renal Dysfunction in Cirrhotic Ascitic Mice. Int J Mol Sci 2021; 22:ijms22031233. [PMID: 33513830 PMCID: PMC7865325 DOI: 10.3390/ijms22031233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
In advanced cirrhosis, the TNFα-mediated intestinal inflammation and bacteria dysbiosis are involved in the development of inflammation and vasoconstriction-related renal dysfunction. In colitis and acute kidney injury models, activation of SIRT1 attenuates the TNFα-mediated intestinal and renal abnormalities. This study explores the impacts of intestinal SIRT1 deficiency and TNFα-mediated intestinal abnormalities on the development of cirrhosis-related renal dysfunction. Systemic and renal hemodynamics, intestinal dysbiosis [cirrhosis dysbiosis ratio (CDR) as marker of dysbiosis], and direct renal vasoconstrictive response (renal vascular resistance (RVR) and glomerular filtration rate (GFR)) to cumulative doses of TNFα were measured in bile duct ligated (BDL)-cirrhotic ascitic mice. In SIRT1IEC-KO-BDL-ascitic mice, the worsening of intestinal dysbiosis exacerbates intestinal inflammation/barrier dysfunction, the upregulation of the expressions of intestinal/renal TNFα-related pathogenic signals, higher TNFα-induced increase in RVR, and decrease in GFR in perfused kidney. In intestinal SIRT1 knockout groups, the positive correlations were identified between intestinal SIRT1 activity and CDR. Particularly, the negative correlations were identified between CDR and RVR, with the positive correlation between CDR and GFR. In mice with advanced cirrhosis, the expression of intestinal SIRT1 is involved in the linkage between intestinal dysbiosis and vasoconstriction/hypoperfusion-related renal dysfunction through the crosstalk between intestinal/renal TNFα-related pathogenic inflammatory signals.
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Affiliation(s)
- Yu-Te Chou
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11267, Taiwan; (Y.-T.C.); (C.-W.L.); (Y.-H.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
| | - Tze-Tze Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Genomic Research Center, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan
| | - Ueng-Cheng Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Institute of Biomedical Informatics, Taipei 11267, Taiwan
| | - Chia-Chang Huang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Division of Clinical Skills Training Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11267, Taiwan
| | - Chih-Wei Liu
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11267, Taiwan; (Y.-T.C.); (C.-W.L.); (Y.-H.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11267, Taiwan
| | - Shiang-Fen Huang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Division of Infection, Taipei Veterans General Hospital, Taipei 11267, Taiwan
| | - Tzu-Hao Li
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11267, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11267, Taiwan
| | - Hsuan-Miao Liu
- Graduate Institute of Traditional Chinese Medicine, Chang Guang Memorial Hospital, Linkou 33371, Taiwan; (H.-M.L.); (T.-Y.L.)
| | - Ming-Wei Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Institute of Public Health, National Yang-Ming University, Taipei 11267, Taiwan
| | - Ying-Ying Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Division of Clinical Skills Training Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11267, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei 11267, Taiwan
- Correspondence: (Y.-Y.Y.); (H.-C.L.); Tel.: +886-2-2875-7725 (Y.-Y.Y.); +886-2-2875-2249 (H.-C.L.); Fax: +886-2-2875-7726 (Y.-Y.Y.); +886-2-2875-7809 (H.-C.L.)
| | - Tzung-Yan Lee
- Graduate Institute of Traditional Chinese Medicine, Chang Guang Memorial Hospital, Linkou 33371, Taiwan; (H.-M.L.); (T.-Y.L.)
| | - Yi-Hsiang Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11267, Taiwan; (Y.-T.C.); (C.-W.L.); (Y.-H.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Institute of Public Health, National Yang-Ming University, Taipei 11267, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei 11267, Taiwan
| | - Ming-Chih Hou
- Department of Medicine, Taipei Veterans General Hospital, Taipei 11267, Taiwan; (Y.-T.C.); (C.-W.L.); (Y.-H.H.); (M.-C.H.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
| | - Han-Chieh Lin
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan; (T.-T.L.); (U.-C.Y.); (C.-C.H.); (S.-F.H.); (T.-H.L.); (M.-W.L.)
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei 11267, Taiwan
- Correspondence: (Y.-Y.Y.); (H.-C.L.); Tel.: +886-2-2875-7725 (Y.-Y.Y.); +886-2-2875-2249 (H.-C.L.); Fax: +886-2-2875-7726 (Y.-Y.Y.); +886-2-2875-7809 (H.-C.L.)
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Chiou WR, Chuang JY, Huang CC, Lin PL, Lee YH. 75Safety and efficacy of rivaroxaban in combination with anti-arrhythmic drugs in patients with non-permanent atrial fibrillation. Europace 2020. [DOI: 10.1093/europace/euaa162.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Rivaroxaban is useful for stroke prevention in atrial fibrillation (AF) patients. Most patients with non-permanent AF also treated with anti-arrhythmic drugs (AADs) to prevent the recurrence of arrhythmia. But there are limited data regarding drug-drug interactions between rivaroxaban and AADs despite its high clinical relevance.
Purpose
To compare the bleeding risks and ischemic events between the use of rivaroxaban alone and the concomitant use of AADs.
Methods
This is a multicenter retrospective study, which identified patients with a diagnosis of non-permanent AF who received rivaroxaban more than 1 month between December 1, 2011 and November 30, 2016. The study divided patients into 4 groups : rivaroxaban alone, combined with amiodarone, dronedarone and propafenone. We compared the clinical events and cumulative incidences to compare the endpoints including efficacy endpoint (new ischemic stroke, intracranial hemorrhage, or new
embolism), safety endpoints (Hb fall more than 2g/dL or transfusion more than 2U PRBC, critical site bleeding, or fatal bleeding.) and major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, new ischemic stroke, new embolism, or intracranial hemorrhage.
Results
Of 1777 enrolled patients, the rivaroxaban alone was 1205 cases, 177 in amiodarone group, 231 in dronedarone group and 164 in propafenone group. There was no statistically significant difference on efficacy endpoints, safety endpoints and MACE between the 4 groups. The average dosage of rivaroxaban was insignificantly the lowest in the group combined with dronedarone (12.3mg, p = 0.146). The rate of new embolism (0%, p = 0.029), recurrent heart failure admission rate (3.9%, p < 0.001), and all-cause mortality (3.0%, p = 0.013) in dronedarone group showed a significant lower occurrence rate. The occurrence rate of new ischemic stroke (0.9%, p = 0.549), new hemorrhagic stroke (0.4%, p = 0.546), efficacy endpoints (1.7%, p = 0.369) and MACE (3.9%, p = 0.72) in dronedarone droup were the lowest but insignificant. The cumulative incidences of efficacy endpoints, safety endpoints and MACE during follow-up period were also similar in these four groups.(Picture 1)
Conclusions
In patients with non-permanent atrial fibrillation, this real-world study showed that there were no significant differences between using rivaroxaban alone or concomitant with an AAD (dronedarone/amiodarone/propafenone) on events such as new ischemic stroke, intracranial hemorrhage, GI bleeding and MACEs. The happening of new embolism was lower especially in the group combined with dronedarone. The safety and efficacy between rivaroxaban alone and combined with rhythm control using AADs proved to be the same. Relative low dose rivaroxaban combined with dronedarone did not increase the bleeding risk, and may decrease the probability of thromboembolism.
Abstract Figure. Picture 1
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Affiliation(s)
- W R Chiou
- Taitung MacKay Memorial Hospital, Division of Cardiology, Taitung, Taiwan
| | - J Y Chuang
- MacKay Medical College, New Taipei City, Taiwan
| | - C C Huang
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - P L Lin
- Hsinchu MacKay Memorial Hospital, Division of Cardiology, Hsinchu, Taiwan
| | - Y H Lee
- MacKay Memorial Hospital, Cardiovascular Center, Taipei, Taiwan
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Chiou WR, Hsieh MC, Chuang HN, Huang CC, Chuang JY, Lin PL, Lee YH. P1064Using Data Mining to Predict Bleeding Events caused by Novel Oral Anticoagulants. Europace 2020. [DOI: 10.1093/europace/euaa162.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Novel oral anticoagulants (NOAC) is important in preventing thromboembolism in atrial fibrillation (AF) patients. Bleeding risk was evaluated by HAS-BLED score traditionally. Data mining is a relatively new discipline that has sprung up at the confluence of several other disciplines, driven primarily by the growth of large databases.
Purpose
This study aimed to find a useful predictive model by data mining to assess the risk of rivaroxaban, an antithrombotic drug that causes bleeding in AF patients. The seven parameters of the HAS-BLED score were used to predict the effect of rivaroxaban on bleeding tendency in AF patients and may provide clinicians with appropriate treatments to avoid complications from bleeding events and reduce the incidence of health damage.
Methods
Through conducting a multicenter retrospective study, we identified patients with AF who were treated with rivaroxaban for more than 1 month between December 1, 2011 and November 30, 2016. After preprocessing, the established data were used for training and testing of data mining models. This study evaluated four models, including association rules, neural networks, Bayesian classification, and decision trees.
Result
Of the 872 enrolled cases, 432 were in any of the bleeding groups and 432 were in the non-bleeding randomized control group. After comparing the overall classification accuracy, omission error and over-prediction error, the decision tree proved to be the most accurate model for bleeding prediction. The overall classification accuracy is 77%, the omission error is 15%, the over-prediction error is 21.9%, and the AUC score is 0.84. The results show that the model has good discriminative ability and visibility of decision rules.
Conclusion
Among several data mining models, decision tree proved to be the most accurate model for bleeding prediction. The conclusion of this study can be used as a reference for supporting decision making before anticoagulation treatment and suggest future research to compare efficacy of bleeding prediction between HAS-BLED score and decision tree.
Data mining comparison Model Omission error Commission error Overall accuracy AUC score Ranking Decision tree 15.0% 21.90% 77.00% 0.84 1 Association rules 16.8% 27.20% 76.50% 0.81 2 Neural networks 12.0% 26.40% 78.20% 0.83 3 Bayesian classification 16.1% 27.50% 76.50% 0.83 4
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Affiliation(s)
- W R Chiou
- Taitung MacKay Memorial Hospital, Division of Cardiology, Taitung, Taiwan
| | - M C Hsieh
- National Taitung University, Department of Information Science and Management Systems, Taitung, Taiwan
| | - H N Chuang
- National Taitung University, Department of Information Science and Management Systems, Taitung, Taiwan
| | - C C Huang
- Taichung Veterans General Hospital, Department of Medical Research, Taichung, Taiwan
| | - J Y Chuang
- MacKay Medical College, New Taipei City, Taiwan
| | - P L Lin
- Hsinchu MacKay Memorial Hospital, Division of Cardiology, Hsinchu, Taiwan
| | - Y H Lee
- Mackay Memorial Hospital, Cardiovascular Center, Taipei, Taiwan
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Shulruf B, Yang YY, Huang PH, Yang LY, Huang CC, Huang CC, Liu CW, Huang SS, Chen CH, Lee FY, Kao SY. Standard setting made easy: validating the Equal Z-score (EZ) method for setting cut-score for clinical examinations. BMC Med Educ 2020; 20:167. [PMID: 32450878 PMCID: PMC7249316 DOI: 10.1186/s12909-020-02080-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND This study aims to assess the feasibility, reliability and validity of the panel-based Equal Z-score (EZ) method applied to objective structural clinical examination (OSCE) of Chinese medical students and undertaking a comparison with the statistical techniques-based Borderline Regression Method (BRM). METHODS Data received from two cohorts of 6th and 7th year medical students in Taiwan who set the mock OSCE as a formative assessment. Traditionally this medical school uses BRM to set the pass/fail cut-score. For the current study, 31 OSCE panellists volunteered to participate in the EZ method in parallel to the BRM. RESULTS In the conduct of this study, each panel completed this task for an OSCE exam comprising 12 stations within less than 60 min. Moreover, none of the 31 panellists, whose are busy clinicians, had indicated that the task was too difficult or too time-consuming. Although EZ method yielded higher cut-scores than the BRM it was found reliable. Intraclass correlation (ICC) measuring absolute agreement, across the three groups of panellists was .893 and .937 for the first and second rounds respectively, demonstrating high level of agreement across groups with the EZ method and the alignment between the BRM and the EZ method was visually observed. The paired t-test results identified smaller differences between the cut-scores within methods than across methods. CONCLUSIONS Overall this study suggests that the EZ method is a feasible, reliable and valid standard setting method. The EZ method requires relatively little resources (takes about an hour to assess a 12 station OSCE); the calculation of the cut-score is simple and requires basic statistical skills; it is highly reliable even when only 10 panellists participate in the process; and its validity is supported by comparison to BRM. This study suggests that the EZ method is a feasible, reliable and valid standard setting method.
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Affiliation(s)
- Boaz Shulruf
- University of New South Wales, Sydney, Australia.
| | - Ying-Ying Yang
- National Yang-Ming University, Taipei, Taiwan.
- Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Pin-Hsiang Huang
- University of New South Wales, Sydney, Australia
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | - Chih-Wei Liu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Chen-Huan Chen
- National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Yauh Lee
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Yen Kao
- Taipei Veterans General Hospital, Taipei, Taiwan
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Wu SH, Yang YY, Huang CC, Liu CW, Yang LY, Chen CH, Kao SY, Lee FY. Virtual reality simulation increases Chinese physicians’ and lab technicians’ familiarity and confidence regarding proper clinical wastes segregation/disposal: a 2-year pilot study. BMJ Simul Technol Enhanc Learn 2020; 7:38-40. [PMID: 35521086 PMCID: PMC8936531 DOI: 10.1136/bmjstel-2019-000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/26/2019] [Accepted: 05/01/2020] [Indexed: 11/16/2022]
Abstract
Although they receive regular training, the survey we administered to our junior physicians and lab technicians revealed that they lack familiarity and confidence regarding the proper segregation/disposal of clinical wastes. In this pilot prospective study, carried out between September 2017 and September 2019, we developed a virtual reality (VR) simulation and integrated it into the steps of Gangen’s training flow. Next, we analysed objective performance, recorded by the App in the VR system as well as the subjective self-assessments of 96 junior physicians and lab technicians after two practices of VR games. Before receiving training, lab technicians' self-assessed familiarity and confidence regarding proper clinical wastes segregation/disposal were higher than among physicians. Compared with the first VR game, we noted greater improvement in accuracy as well as a higher percentage of shortened time to complete 10 actions of segregation/disposal of VR clinical wastes, among junior physicians/male trainees, that of junior lab technicians/female trainees in the second VR game. Most of the trainees (81%–88%) reported that they found the VR game-based training to be useful, in contrast to poster-mass media-based training. Our initial positive results indicated the possibility of applying this VR game-based simulation system to regular institution-wide staff education in future.
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Affiliation(s)
- Szu-Hsien Wu
- Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Ying Yang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chang Huang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Wei Liu
- Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Yu Yang
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Yen Kao
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Yauh Lee
- Taipei Veterans General Hospital, Taipei, Taiwan
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Lee FY, Yang YY, Huang CC, Huang LJ, Chang CC, Liang JF, Huang SS, Lee WS, Lu DY, Chuang CL, Yang LY, Huang HC, Shulruf B, Chen CH, Kao SY. Sustained effects of faculty leadership development modules for clinical instructors of core competences education in Taiwan: a four-year explanatory case study. BMC Med Educ 2020; 20:155. [PMID: 32414406 PMCID: PMC7226719 DOI: 10.1186/s12909-020-02065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) core competencies (CC) in general medicine-based primary care are essential for junior medical trainees. In this country, a regular faculty development (FD) program aimed at training faculty in instructing (teaching and assessing) these CC had operated. However, leadership was not emphasized. In a new intervention module, the roles and associated responsibilities of clinical instructors to conduct, design, and lead CC-based education were emphasis. AIMS This follow-up explanatory case study compares the effectiveness of intervention module with that of the previous regular module. METHODS The regular group (n = 28) comprised clinical instructors who participated in the FD module during the 2013-2014 year while the intervention group (n = 28) was composed of 2015-2016 participants. Prior to the formal (hands-on) training, participants in the intervention group were asked to study the online materials of the regular module. These participants then received a 30-h hands-on training in conducting, designing, and leading skills. Finally, they prepared a 10-h reflective end-of-module presentation of their real-world practices. RESULTS Following the training, a higher degree improvement in participants self-reported familiarity with CC education, self-confidence in their ability to deliver CC education and sustained involve CC education were noted among the intervention FD group, compared with the regular FD group. In the intervention group, senior academicians (associate and full professor) are more substantially involved in designing and leading CC-based courses than junior academicians (lecturers and assistant professors). Among non-teaching award winners of in the intervention FD group, the follow-up degree of sustained involvement in delivering, designing and leading CC-based courses was significantly higher than that of the regular group. CONCLUSIONS Our study demonstrated that leadership training in the intervention FD modules substantially motivated clinical instructors to become leaders in CC education.
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Affiliation(s)
- Fa-Yauh Lee
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Ying-Ying Yang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.
- Division of Clinical Skills Training Center, Taipei Veteran General Hospital , Taipei, Taiwan.
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Department of Medicine, Taipei Veteran General Hospital , Taipei, Taiwan.
| | - Chia-Chang Huang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Division of Clinical Skills Training Center, Taipei Veteran General Hospital , Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Ju Huang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Chih Chang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Feng Liang
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veteran General Hospital , Taipei, Taiwan
| | - Shiau-Shian Huang
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, Bali, Taiwan
| | - Wei-Shin Lee
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Dai-Yin Lu
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiao-Lin Chuang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Yu Yang
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veteran General Hospital , Taipei, Taiwan
| | - Hui-Chun Huang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Boaz Shulruf
- New South Wales Sydney University, Sydney, Australia
| | - Chen-Huan Chen
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veteran General Hospital , Taipei, Taiwan
| | - Shou-Yen Kao
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veteran General Hospital , Taipei, Taiwan
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Liu CW, Huang CC, Hsu CF, Li TH, Tsai YL, Lin MW, Tsai HC, Huang SF, Yang YY, Hsieh YC, Lee TY, Tsai CY, Huang YH, Hou MC, Lin HC. SIRT1-dependent mechanisms and effects of resveratrol for amelioration of muscle wasting in NASH mice. BMJ Open Gastroenterol 2020; 7:bmjgast-2020-000381. [PMID: 32371503 PMCID: PMC7228468 DOI: 10.1136/bmjgast-2020-000381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 12/21/2022] Open
Abstract
Background In non-alcoholic steatohepatitis (NASH), muscle wasting was an aggravating factor for the progression of hepatic steatosis. This study explores the potential benefits of chronic treatment with resveratrol, a strong activator of SIRT1 on the muscle wasting of NASH mice. Methods In vivo and in vitro study, we evaluate the SIRT1-dependent mechanisms and effects of resveratrol administration for 6 weeks with high-fat-methionine and choline deficient diet-induced NASH mice and palmitate-pretreated C2C12 myoblast cells. Results Resveratrol treatment improved grip strength and muscle mass of limbs, increased running distance and time on exercise wheels in NASH mice. There is a negative correlation between muscular SIRT1 activity and 3-nitrotyrosine levels of NASH and NASH-resv mice. The SIRT1-dependent effect of muscle wasting was associated with the suppression of oxidative stress, upregulation of antioxidants, inhibition of protein degradation, activation of autophagy, suppression of apoptotic activity, upregulation of lipolytic genes and the reduction of fatty infiltration in limb muscles of NASH mice. In vitro, resveratrol alleviated palmitate acid-induced oxidative stress, lipid deposition, autophagy dysfunction, apoptotic signals, and subsequently reduced fusion index and myotube formation of C2C12 cells. The beneficial effects of resveratrol were abolished by EX527. Conclusions Our study suggests that chronic resveratrol treatment is a potential strategy for amelioration of hepatic steatosis and muscle wasting in NASH mouse model.
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Affiliation(s)
- Chih-Wei Liu
- Division of Allergy, Immunology and Rheumatology, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, Taipei, Taiwan
| | - Chia-Chang Huang
- Institute of Clinical Medicine, Taipei, Taiwan.,Division of Clinical Skills Center, Department of Medical Education, Taipei Veterans General Hospital, Taoyuan, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chien-Fu Hsu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Hao Li
- Institute of Clinical Medicine, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yu-Lien Tsai
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Wei Lin
- Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Cheng Tsai
- Division of Allergy, Immunology and Rheumatology, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiang-Fen Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Infection Disease, Taipei, Taiwan
| | - Ying-Ying Yang
- Institute of Clinical Medicine, Taipei, Taiwan .,Division of Clinical Skills Center, Department of Medical Education, Taipei Veterans General Hospital, Taoyuan, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei, Taiwan
| | - Yun-Cheng Hsieh
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei, Taiwan
| | - Tzung-Yan Lee
- Graduate Institute of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology and Rheumatology, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Institute of Clinical Medicine, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei, Taiwan
| | - Ming-Chih Hou
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei, Taiwan
| | - Han-Chieh Lin
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei, Taiwan
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Tsai YL, Liu CW, Huang SF, Yang YY, Lin MW, Huang CC, Li TH, Huang YH, Hou MC, Lin HC. Urinary fatty acid and retinol binding protein-4 predict CKD progression in severe NAFLD patients with hypertension: 4-year study with clinical and experimental approaches. Medicine (Baltimore) 2020; 99:e18626. [PMID: 31914044 PMCID: PMC6959901 DOI: 10.1097/md.0000000000018626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Detection of the chronic kidney disease (CKD) progression can begin early intervention to improve the prognosis of severe non-alcoholic fatty liver disease (NAFLD). This bi-directional cross-sectional study evaluates the roles of fatty acid-binding protein (FABP) and retinol binding protein (RBP4), which are produced from inflamed liver, adipose tissue and immune cells, for the prediction of CKD progression in severe NAFLD. Ninety severe NAFLD patients with hypertension and proteinuria (NAFLDHTN) were enrolled and divided into CKD (n = 39) and non-CKD groups (n = 51). Among 39 NAFLDHTN patients, 18 cases were categorized as CKD progression group. In comparison with CKD stable group (n = 21), the positive correlation between fold change values of hepatic fibrotic score (KPa), urinary FABP4 or urinary RBP4 versus severity of albuminuria were noted among CKD progression group. On multivariate analysis, high body mass index (BMI, >25 kg/m), high hepatic fibrosis score (>9.5 KPa), high urinary level of vascular cell adhesion molecule-1 (VCAM-1, >2239 μg/g cr), high urinary level of FABP4 (>115 ng/g cr) and high urinary level of RBP4 (>33.5 mg/g cr) are 5 independent predictors for progressive CKD during 24 months of follow-up. Synergetic effect was noted among these 5 risk factors for the prediction of CKD progression in NAFLDHTN patients. The in vitro experiments revealed that both FABP4 and RBP4 directly enhanced albumin-induced ER stress and apoptosis of human renal tubular epithelial cell line HK-2 cells and human podocytes cell lines. Through clinical and experimental approaches, this study revealed new 5 synergetic predictors including high BMI, hepatic fibrosis score, urinary level of VCAM-1, urinary level of FABP4 and RBP4, for the CKD progression in severe NAFLD patients with hypertension and proteinuria.
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Affiliation(s)
- Yu-Lien Tsai
- Department of Medicine
- National Yang-Ming University School of Medicine, Taipei
| | - Chih-Wei Liu
- Division of Allergy and Immunology
- Department of Medicine
- Institute of Clinical Medicine, Taipei Veterans General Hospital
- National Yang-Ming University School of Medicine, Taipei
| | - Shiang-Fen Huang
- Division of Infection
- Department of Medicine
- Institute of Clinical Medicine, Taipei Veterans General Hospital
- National Yang-Ming University School of Medicine, Taipei
| | - Ying-Ying Yang
- Division of Gastroenterology and Hepatology
- Division of General Medicine
- Institute of Clinical Medicine, Taipei Veterans General Hospital
- National Yang-Ming University School of Medicine, Taipei
- Division of clinical skills training center, Department of medical education, Taipei, Taiwan
| | - Ming-Wei Lin
- Division of Preventive Medicine, Institute of public Health
- National Yang-Ming University School of Medicine, Taipei
| | - Chia-Chang Huang
- Department of Medicine
- National Yang-Ming University School of Medicine, Taipei
| | - Tzu-Hao Li
- Division of Allergy and Immunology
- Institute of Clinical Medicine, Taipei Veterans General Hospital
- National Yang-Ming University School of Medicine, Taipei
- Chia-Yi Branch of Taichung Veterans General Hospital, Chiayi
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology
- Department of Medicine
- Institute of Clinical Medicine, Taipei Veterans General Hospital
- National Yang-Ming University School of Medicine, Taipei
| | - Ming-Chih Hou
- Department of Medicine
- National Yang-Ming University School of Medicine, Taipei
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology
- National Yang-Ming University School of Medicine, Taipei
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Wu SH, Huang CC, Huang SS, Yang YY, Liu CW, Shulruf B, Chen CH. Effect of virtual reality training to decreases rates of needle stick/sharp injuries in new-coming medical and nursing interns in Taiwan. J Educ Eval Health Prof 2020; 17:1. [PMID: 31955547 PMCID: PMC7054630 DOI: 10.3352/jeehp.2020.17.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/20/2020] [Indexed: 05/14/2023]
Abstract
PURPOSE Senior nursing and medical interns' lack of familiarity and confidence with respect to practicing universal precaution for the prevention of occupational needle stick (NSI)/sharp (SI) injuries may harm themselves. Trainees' self-reported NSI/SI rate was known to be especially high during the first two months of internship in Taiwan. This prospective cohort study aimed to know the effect of new developed (virtual reality (VR) game, which uses the Gangne's learning model to improved universal precaution for NSI/SI prevention and decrease the rates of needle stick/sharp injuries in new-coming medical and nursing interns in Taiwan. . METHODS From 2017 to 2019, the VR system was developed and applied in training of 59 new-coming nursing and 50 medical interns. Occupational NSI/SI prevention was sought to be achieved through a game of right and wrong choices for safe or unsafe universal precaution behaviors. RESULTS In comparison with medical interns, a higher proportion of nursing interns have had the past experiences of deep occupational NSI/SI. Before VR training, the familiarity and confidence for NSI/SI prevention were higher among nursing interns than medical interns. Trainees with past experiences of deep NSI/SI exhibited better performance on the accuracy rate and time need for complete 20 decisions than those without past experiences in VR practice. The performances of all trainees were improved after VR training. A high proportion of trainees reported that the VR-based training significantly decreased their anxiety about NSI/SI prevention. CONCLUSION This self-developed VR game system using Gangne's flow improved universal precaution for NSI/SI prevention and reduced the NSI/SI rates in the first two months of nursing and medical internship.
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Affiliation(s)
- Szu-Hsien Wu
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Chang Huang
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shiau-Shian Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ying-Ying Yang
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Corresponding
| | - Chih-Wei Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Boaz Shulruf
- Office of Medical Education, University of New South Wales Australia, Sydney, Australia
| | - Chen-Huan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Taipei Veterans General Hospital, Taipei, Taiwan
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Huang SS, Huang CC, Yang YY, Wang SJ, Shulruf B, Chen CH. Dreyfus scale-based feedback increases the medical student's satisfaction with the complex cluster part of the interviewing and physical examination course and skills' readiness in Taiwan. J Educ Eval Health Prof 2019; 16:30. [PMID: 31614407 PMCID: PMC6848653 DOI: 10.3352/jeehp.2019.16.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Different from the basic core part of the clinical interviewing and physical examination (PE) skills course in basic, head-to-toe, and thorax systems, learners need structural feedback for the development of the complex skills in cluster part including abdominal, neuromuscular and musculoskeletal systems. It aimed to evaluate the effects of replacing Dreyfus scale, which having elements of continuous professional development, with Likert scale in the feedback in cluster part of training in Taiwan. METHODS Instructors and final-year medical students of class 2015-2016 comprised the regular cohort, whereas those of class 2017-2018 formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback rather than Likert scale based feedback was used in the cluster part of the course in National Yang-Ming university, Taiwan. RESULTS Among the regular cohort, poor pre-trained standardized patients (SPs) rated class climate, low grouped students satisfaction with the instructors and course, and low grouped student self-assessed readiness were noted in the cluster part than those in the core part. In comparison with regular cohort, greater improvement of post-cluster part end-of-course group objective structured clinical examination (GOSCE) scores was noted in intervention cohort. In other word, the implementation of Dreyfus scale-based feedback in the cluster part improved the deficit in this part of the course among the intervention cohort. CONCLUSION The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster parts of clinical interviewing plus PE skills course in our study. Simultaneously, this new intervention achieved the goal of medical students competency in interviewing, PE and self-directed learning (SDL) skills.
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Affiliation(s)
- Shiau-Shian Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chia-Chang Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Boaz Shulruf
- Office of Medical Education, University of New South Wales Australia, Sydney, Australia
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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Shiao TH, Yang YY, Wu CY, Yang LY, Hwang SJ, Huang CC, Liang JF, Kao SY, Lee FY. Creation of nurse-specific integrated interprofessional collaboration and team-efficiency scenario/video improves trainees' attitudes and performances. J Chin Med Assoc 2019; 82:546-553. [PMID: 31274786 DOI: 10.1097/jcma.0000000000000116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is importance to train the interprofessional collaboration (IPC) and team-efficiency (TE) of medical trainees. This prospective study evaluates whether implementation of scenario/video-created workshops in integrated IPC and TE (IIT) program provides additional benefits for IPC-TE skills of nursing trainees. METHODS Mock simulation with two IIT scenarios was held as preintervention IPC-TE assessment. Basic and advanced workshops were arranged for teams of intervention groups for creation of discipline-specific scenario and video. Thirty-six nursing trainees were randomized into teams of five members (three nursing students, one standardized medical student, and one standardized trainees of other profession) in either intervention (scenario plus video and scenario) or control groups. After intervention, all groups received the formal simulation-based assessment using another two IIT scenario. In addition to instructors-based assessment of team' performance in mock and formal IIT simulation using interprofessional team collaboration scale (AITCS), self-assessment of attitudes and program-value score were completed by each trainee, using attitudes toward interprofessional health care teams scale (ATIHCTS) at all stages. RESULTS Nursing trainees in intervention group gave high satisfaction score to this IIT intervention. In comparison with control group, greater increase in instructor-assessed team performance in the "partnership," "cooperation," and "shared decision making" domains of AITCS and the self-assessed "quality of care delivery" and TE domains of ATIHCTS were noted in the intervention groups. The overall improvement was greater in the scenario plus video group than those in the scenario group. Further, these improvements among nursing trainees persisted until follow-up stage at 4-weeks later. CONCLUSION For nursing trainees, our study suggested that implementation of a scenario creation-based training resulted in additional improvement in trainee' IPC and TE behaviors and attitudes. Additionally, making video of newly created nurse-specific scenario enhances partnership and cooperation among nursing trainees and their interprofessional team members.
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Affiliation(s)
- Tsu-Hui Shiao
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chen-Yi Wu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shinn-Jang Hwang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Chang Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jen-Feng Liang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shou-Yen Kao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Huang CC, Hsu HC, Yang LY, Chen CH, Yang YY, Chang CC, Chuang CL, Lee WS, Lee FY, Hwang SJ. Peer-assisted learning model enhances clinical clerk's procedural skills. J Chin Med Assoc 2018; 81:747-753. [PMID: 29779999 DOI: 10.1016/j.jcma.2017.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Failure to transfer procedural skills learned in a laboratory to the bedside is commonly due to a lack of peer support/stimulation. A digital platform (Facebook) allows new clinical clerks to share experiences and tips that help augment their procedural skills in a peer-assisted learning/teaching method. This study aims to investigate the effectiveness of the innovation of using the digital platform to support the transfer of laboratory-trained procedural skills in the clinical units. METHODS Volunteer clinical clerks (n = 44) were enrolled into the peer-assisted learning (PAL) group, which was characterized by the peer-assisted learning of procedural skills during their final 3-month clinical clerkship block. Other clerks (n = 51) did not join the procedural skills-specific Facebook group and served as the self-directed learning regular group. The participants in both the PAL and regular groups completed pre- and post-intervention self-assessments for general self-assessed efficiency ratings (GSER) and skills specific self-assessed efficiency ratings (SSSER) for performing vein puncture, intravenous (IV) catheter and nasogastric (NG) tube insertion. Finally, all clerks received the post-intervention 3-station Objective Structured Clinical Skills Examination (OSCE) to test their proficiency for the abovementioned three procedural skills. RESULTS Higher cumulative numbers of vein punctures, IV catheter insertions and NG tube insertions at the bedside were carried out by the PAL group than the regular group. A greater improvement in GSERs and SSSERs for medical procedures was found in the PAL group than in the regular group. The PAL group obtained higher procedural skills scores in the post-intervention OSCEs than the regular group. CONCLUSION Our study suggested that the implementation of a procedural skill-specific digital platform effectively helps clerks to transfer laboratory-trained procedural skills into the clinical units. In comparison with the regular self-directed learning group, the peer-assisted learning characteristics of Facebook give additional benefits to the PAL group by enhancing their procedural skills.
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Affiliation(s)
- Chia-Chang Huang
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hui-Chi Hsu
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Camillians Saint Mary's Hospital, Luodong, Yilan, Taiwan, ROC
| | - Ling-Yu Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Ching-Chih Chang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Shin Lee
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shinn-Jang Hwang
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Huang CC, Chen YH, Hung CS, Lee JK, Hsu TP, Chuang PY, Chen MF, Ho YL. P951Short-term exposure to ambient air pollutants affected home blood pressure in patients with chronic cardiovascular diseases. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C C Huang
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - Y H Chen
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - C S Hung
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - J K Lee
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - T P Hsu
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - P Y Chuang
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - M F Chen
- National Taiwan University Hospital, Taipei, Taiwan ROC
| | - Y L Ho
- National Taiwan University Hospital, Taipei, Taiwan ROC
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Kawakita T, Reddy UM, Huang CC, Auguste TC, Bauer D, Overcash RT. Predicting Vaginal Delivery in Nulliparous Women Undergoing Induction of Labor at Term. Am J Perinatol 2018; 35:660-668. [PMID: 29212131 DOI: 10.1055/s-0037-1608847] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to develop a model to calculate the likelihood of vaginal delivery in nulliparous women undergoing induction at term. STUDY DESIGN We obtained data from the Consortium on Safe Labor by including nulliparous women with term singleton pregnancies undergoing induction of labor at term. Women with contraindications for vaginal delivery were excluded. A stepwise logistic regression analysis was used to identify the predictors associated with vaginal delivery by considering maternal characteristics and comorbidities and fetal conditions. The receiver operating characteristic curve, with an area under the curve (AUC) was used to assess the accuracy of the model. RESULTS Of 10,591 nulliparous women who underwent induction of labor, 8,202 (77.4%) women had vaginal delivery. Our model identified maternal age, gestational age at delivery, race, maternal height, prepregnancy weight, gestational weight gain, cervical exam on admission (dilation, effacement, and station), chronic hypertension, gestational diabetes, pregestational diabetes, and abruption as significant predictors for successful vaginal delivery. The overall predictive ability of the final model, as measured by the AUC was 0.759 (95% confidence interval, 0.749-0.770). CONCLUSION We identified independent risk factors that can be used to predict vaginal delivery among nulliparas undergoing induction at term. Our predictor provides women with additional information when considering induction.
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Affiliation(s)
- T Kawakita
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - U M Reddy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - C C Huang
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland.,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia
| | - T C Auguste
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia.,MedStar Simulation Training & Education Lab, Washington, District of Columbia
| | - D Bauer
- MedStar Simulation Training & Education Lab, Washington, District of Columbia
| | - R T Overcash
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
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Liu CW, Tsai HC, Huang CC, Tsai CY, Su YB, Lin MW, Lee KC, Hsieh YC, Li TH, Huang SF, Yang YY, Hou MC, Lin HC, Lee FY, Lee SD. Effects and mechanisms of caffeine to improve immunological and metabolic abnormalities in diet-induced obese rats. Am J Physiol Endocrinol Metab 2018; 314:E433-E447. [PMID: 29118012 DOI: 10.1152/ajpendo.00094.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In obesity, there are no effective therapies for parallel immune and metabolic abnormalities, including systemic/tissue insulin-resistance/inflammation, adiposity and hepatic steatosis. Caffeine has anti-inflammation, antihepatic steatosis, and anti-insulin resistance effects. In this study, we evaluated the effects and molecular mechanisms of 6 wk of caffeine treatment (HFD-caf) on immunological and metabolic abnormalities of high-fat diet (HFD)-induced obese rats. Compared with HFD vehicle (HFD-V) rats, in HFD-caf rats the suppressed circulating immune cell inflammatory [TNFα, MCP-1, IL-6, intercellular adhesion molecule 1 (ICAM-1), and nitrite] profiles were accompanied by decreased liver, white adipose tissue (WAT), and muscle macrophages and their intracellular cytokine levels. Metabolically, the increase in metabolic rates reduced lipid accumulation in various tissues, resulting in reduced adiposity, lower fat mass, decreased body weight, amelioration of hepatic steatosis, and improved systemic/muscle insulin resistance. Further mechanistic approaches revealed an upregulation of tissue lipogenic [(SREBP1c, fatty acid synthase, acetyl-CoA carboxylase)/insulin-sensitizing (GLUT4 and p-IRS1)] markers in HFD-caf rats. Significantly, ex vivo experiments revealed that the cytokine release by the cocultured peripheral blood mononuclear cell (monocyte) and WAT (adipocyte), which are known to stimulate macrophage migration and hepatocyte lipogenesis, were lower in HFD-V groups than HFD-caf groups. Caffeine treatment simultaneously ameliorates immune and metabolic pathogenic signals present in tissue to normalize immunolgical and metabolic abnormalities found in HFD-induced obese rats.
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Affiliation(s)
- Chih-Wei Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Hung-Cheng Tsai
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Chia-Chang Huang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Yen-Bo Su
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Ming-Wei Lin
- Division of Preventive Medicine, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Kuei-Chuan Lee
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Yun-Cheng Hsieh
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Tzu-Hao Li
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
- Chia-Yi Branch of Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Shiang-Fen Huang
- Division of Infection, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Ying-Ying Yang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
| | - Shou-Dong Lee
- Department of Medicine, National Yang-Ming University School, Taipei, Taiwan
- Cheng Hsin General Hospital, Taipei, Taiwan
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Su YB, Li TH, Huang CC, Tsai HC, Huang SF, Hsieh YC, Yang YY, Huang YH, Hou MC, Lin HC. Chronic calcitriol supplementation improves the inflammatory profiles of circulating monocytes and the associated intestinal/adipose tissue alteration in a diet-induced steatohepatitis rat model. PLoS One 2018; 13:e0194867. [PMID: 29684027 PMCID: PMC5912737 DOI: 10.1371/journal.pone.0194867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/12/2018] [Indexed: 01/10/2023] Open
Abstract
Vitamin D deficiency and up-regulated TNFα-related signals are reported to be involved in abnormalities including intestinal hyper-permeability, bacterial translocation, systemic/portal endotoxemia, intestinal/adipose tissue/hepatic inflammation, and hepatic steatosis in nonalcoholic steatohepatitis (NASH). This study aims to explore the molecular mechanisms and effects of chronic calcitriol [1,25-(OH)2D3, hormonal form of vitamin D] on gut-adipose tissue-liver axis abnormalities using a high-fat diet (HFD)-fed rat model of NASH. In HFD-fed obese rats on a 10-week calcitriol (0.3 μg/kg/TIW) or vehicle treatment (NASH-vit. D and NASH-V rats) reigme, various in vivo and in vitro experiments were undertaken. Through anti-TNFα-TNFR1-NFκB signaling effects, chronic calcitriol treatment significantly restored plasma calcitriol levels and significantly improved vitamin D receptor (VDR) expression in monocytes and the small intestine of NASH-vit. D rats. Significantly, plasma and portal endotoxin/TNFα levels, bacterial translocation to mesenteric lymph nodes, plasma DX-4000-FITC, fecal albumin-assessed intestinal hyper-permeability, over-expression of TNFα-related immune profiles in monocytes, inflammation of intestinal/mesenteric adipose tissue (MAT)/liver and hepatic steatosis were improved by chronic calcitriol treatment of NASH rats. Additionally, in vitro experiments with acute calcitriol co-incubation reversed NASH-V rat monocyte supernatant/TNFα-induced monolayer barrier dysfunction in caco-2 cells, cytokine release from MAT-derived adipocytes, and triglyceride synthesis by lean-V rat hepatocytes. Using in vivo and in vitro experiments, our study reported calcitriol signaling in the gut as well as in adipose tissue. Meanwhile, our study suggests that restoration of systemic and intestinal vitamin D deficiency using by chronic vitamin D treatment effectively reduces TNFα-mediated immunological abnormalities associated with the gut-adipose tissue-liver axis and hepatic steatosis in NASH rats.
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Affiliation(s)
- Yen-Bo Su
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tzu-Hao Li
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Allergy and Immunology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Chia-Yi Branch of Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Chia-Chang Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hung-Cheng Tsai
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shiang-Fen Huang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Infection, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Cheng Hsieh
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (YYY); (HCL)
| | - Yi-Hsiang Huang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chih Hou
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (YYY); (HCL)
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Orsi Gordo V, Balanta MAG, Galvão Gobato Y, Covre FS, Galeti HVA, Iikawa F, Couto ODD, Qu F, Henini M, Hewak DW, Huang CC. Revealing the nature of low-temperature photoluminescence peaks by laser treatment in van der Waals epitaxially grown WS 2 monolayers. Nanoscale 2018; 10:4807-4815. [PMID: 29469923 DOI: 10.1039/c8nr00719e] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Monolayers of transition metal dichalcogenides (TMD) are promising materials for optoelectronics devices. However, one of the challenges is to fabricate large-scale growth of high quality TMD monolayers with the desired properties in order to expand their use in potential applications. Here, we demonstrate large-scale tungsten disulfide (WS2) monolayers grown by van der Waals Epitaxy (VdWE). We show that, in addition to the large structural uniformity and homogeneity of these samples, their optical properties are very sensitive to laser irradiation. We observe a time instability in the photoluminescence (PL) emission at low temperatures in the scale of seconds to minutes. Interestingly, this change of the PL spectra with time, which is due to laser induced carrier doping, is employed to successfully distinguish the emission of two negatively charged bright excitons. Furthermore, we also detect blinking sharp bound exciton emissions which are usually attractive for single photon sources. Our findings contribute to a deeper understanding of this complex carrier dynamics induced by laser irradiation which is very important for future optoelectronic devices based on large scale TMD monolayers.
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Affiliation(s)
- V Orsi Gordo
- Departamento de Física, Universidade Federal de São Carlos, 13565-905, São Carlos, SP, Brazil.
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50
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Liu CW, Huang CC, Tsai HC, Su YB, Huang SF, Lee KC, Hsieh YC, Li TH, Tsai CY, Chong LW, Ou SM, Yang YY, Fan WC, Hou MC, Lin HC, Lee SD. Serum adrenomedullin and urinary thromboxane B 2 help early categorizing of acute kidney injury in decompensated cirrhotic patients: A prospective cohort study. Hepatol Res 2018; 48:E9-E21. [PMID: 28544540 DOI: 10.1111/hepr.12917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 02/08/2023]
Abstract
AIMS Increases in the systemic vasodilator adrenomedullin and the renal vasoconstrictors thromboxane A2 in cirrhotic patients are pathogenic factors for the development of functional acute kidney injury (AKI), including pre-renal azotemia (PRA) and hepatorenal syndrome (HRS), which is associated with high mortality. This study aims to find biomarkers that can diagnose HRS at an early stage, to enable treatment as soon as possible. METHODS Acute decompensated cirrhotic patients who had been admitted to hospital were enrolled in this prospective cohort study. Blood and urinary samples were collected immediately after admission. In addition to initially categorizing AKI cases into PRA, acute tubular necrosis (ATN), and HRS groups, their final diagnosis was adjudicated by a nephrologist and a hepatologist who checked the corrected and misclassification rates for significant biomarkers. RESULTS The cut-off values for serum adrenomedullin and urinary thromboxane B2 (TXB2 ), when used as predictors for functional AKI (adrenomedullin >283 pg/mL, urinary TXB2 >978 [pg/mg urinary creatinine]), for HRS (adrenomedullin >428, urinary TXB2 >1604), and for good terlipressin plus albumin treatment responders (adrenomedullin >490, urinary TXB2 >1863), were observed. Patients with HRS who could be treated, due to high mortality, had significantly higher serum adrenomedullin and urinary TXB2 levels compared to HRS patients receiving standard treatment. In addition to predicting 60-day mortality, a combination of these two markers further increased diagnostic accuracy for HRS among functional AKI. CONCLUSIONS Prompt diagnosis of HRS by differentiating it from PRA and ATN can be achieved by using serum adrenomedullin and urinary TXB2 in acute decompensated cirrhotic patients. In combination with severe clinical courses, these two markers are useful to select HRS patients who cannot be treated.
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Affiliation(s)
- Chih-Wei Liu
- Division of Allergy and Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chia-Chang Huang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hung-Cheng Tsai
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Bo Su
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiang-Fen Huang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Infection, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuei-Chuan Lee
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Cheng Hsieh
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Hao Li
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Chia-Yi Branch of Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy and Immunology and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Lee-Won Chong
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shuo-Ming Ou
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chien Fan
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Chih Hou
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chieh Lin
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Dong Lee
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Cheng Hsin General Hospital, Taipei, Taiwan
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