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Hung KF, Lin KP. Bio-Inspired Dark Adaptive Nighttime Object Detection. Biomimetics (Basel) 2024; 9:158. [PMID: 38534843 DOI: 10.3390/biomimetics9030158] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Nighttime object detection is challenging due to dim, uneven lighting. The IIHS research conducted in 2022 shows that pedestrian anti-collision systems are less effective at night. Common solutions utilize costly sensors, such as thermal imaging and LiDAR, aiming for highly accurate detection. Conversely, this study employs a low-cost 2D image approach to address the problem by drawing inspiration from biological dark adaptation mechanisms, simulating functions like pupils and photoreceptor cells. Instead of relying on extensive machine learning with day-to-night image conversions, it focuses on image fusion and gamma correction to train deep neural networks for dark adaptation. This research also involves creating a simulated environment ranging from 0 lux to high brightness, testing the limits of object detection, and offering a high dynamic range testing method. Results indicate that the dark adaptation model developed in this study improves the mean average precision (mAP) by 1.5-6% compared to traditional models. Our model is capable of functioning in both twilight and night, showcasing academic novelty. Future developments could include using virtual light in specific image areas or integrating with smart car lighting to enhance detection accuracy, thereby improving safety for pedestrians and drivers.
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Affiliation(s)
- Kuo-Feng Hung
- Electrical Engineering Department, Chung Yuan Christian University, Taoyuan City 320314, Taiwan
| | - Kang-Ping Lin
- Electrical Engineering Department, Chung Yuan Christian University, Taoyuan City 320314, Taiwan
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Yen HH, Wu PY, Wu TL, Huang SP, Chen YY, Chen MF, Lin WC, Tsai CL, Lin KP. Forrest Classification for Bleeding Peptic Ulcer: A New Look at the Old Endoscopic Classification. Diagnostics (Basel) 2022; 12:diagnostics12051066. [PMID: 35626222 PMCID: PMC9139956 DOI: 10.3390/diagnostics12051066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 12/10/2022] Open
Abstract
The management of peptic ulcer bleeding is clinically challenging. For decades, the Forrest classification has been used for risk stratification for nonvariceal ulcer bleeding. The perception and interpretation of the Forrest classification vary among different endoscopists. The relationship between the bleeder and ulcer images and the different stages of the Forrest classification has not been studied yet. Endoscopic still images of 276 patients with peptic ulcer bleeding for the past 3 years were retrieved and reviewed. The intra-rater agreement and inter-rater agreement were compared. The obtained endoscopic images were manually drawn to delineate the extent of the ulcer and bleeding area. The areas of the region of interest were compared between the different stages of the Forrest classification. A total of 276 images were first classified by two experienced tutor endoscopists. The images were reviewed by six other endoscopists. A good intra-rater correlation was observed (0.92–0.98). A good inter-rater correlation was observed among the different levels of experience (0.639–0.859). The correlation was higher among tutor and junior endoscopists than among experienced endoscopists. Low-risk Forrest IIC and III lesions show distinct patterns compared to high-risk Forrest I, IIA, or IIB lesions. We found good agreement of the Forrest classification among different endoscopists in a single institution. This is the first study to quantitively analyze the obtained and explain the distinct patterns of bleeding ulcers from endoscopy images.
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Affiliation(s)
- Hsu-Heng Yen
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500209, Taiwan; (H.-H.Y.); (T.-L.W.); (S.-P.H.); (Y.-Y.C.)
- General Education Center, Chienkuo Technology University, Changhua 500020, Taiwan
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan 320314, Taiwan; (P.-Y.W.); (M.-F.C.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 400, Taiwan
| | - Ping-Yu Wu
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan 320314, Taiwan; (P.-Y.W.); (M.-F.C.)
| | - Tung-Lung Wu
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500209, Taiwan; (H.-H.Y.); (T.-L.W.); (S.-P.H.); (Y.-Y.C.)
| | - Siou-Ping Huang
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500209, Taiwan; (H.-H.Y.); (T.-L.W.); (S.-P.H.); (Y.-Y.C.)
| | - Yang-Yuan Chen
- Department of Internal Medicine, Division of Gastroenterology, Changhua Christian Hospital, Changhua 500209, Taiwan; (H.-H.Y.); (T.-L.W.); (S.-P.H.); (Y.-Y.C.)
| | - Mei-Fen Chen
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan 320314, Taiwan; (P.-Y.W.); (M.-F.C.)
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan 320314, Taiwan; (W.-C.L.); (C.-L.T.)
| | - Wen-Chen Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan 320314, Taiwan; (W.-C.L.); (C.-L.T.)
| | - Cheng-Lun Tsai
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan 320314, Taiwan; (W.-C.L.); (C.-L.T.)
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan 320314, Taiwan
| | - Kang-Ping Lin
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan 320314, Taiwan; (P.-Y.W.); (M.-F.C.)
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan 320314, Taiwan; (W.-C.L.); (C.-L.T.)
- Correspondence:
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Yen HH, Wu PY, Su PY, Yang CW, Chen YY, Chen MF, Lin WC, Tsai CL, Lin KP. Performance Comparison of the Deep Learning and the Human Endoscopist for Bleeding Peptic Ulcer Disease. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00608-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Purpose
Management of peptic ulcer bleeding is clinically challenging. Accurate characterization of the bleeding during endoscopy is key for endoscopic therapy. This study aimed to assess whether a deep learning model can aid in the classification of bleeding peptic ulcer disease.
Methods
Endoscopic still images of patients (n = 1694) with peptic ulcer bleeding for the last 5 years were retrieved and reviewed. Overall, 2289 images were collected for deep learning model training, and 449 images were validated for the performance test. Two expert endoscopists classified the images into different classes based on their appearance. Four deep learning models, including Mobile Net V2, VGG16, Inception V4, and ResNet50, were proposed and pre-trained by ImageNet with the established convolutional neural network algorithm. A comparison of the endoscopists and trained deep learning model was performed to evaluate the model’s performance on a dataset of 449 testing images.
Results
The results first presented the performance comparisons of four deep learning models. The Mobile Net V2 presented the optimal performance of the proposal models. The Mobile Net V2 was chosen for further comparing the performance with the diagnostic results obtained by one senior and one novice endoscopists. The sensitivity and specificity were acceptable for the prediction of “normal” lesions in both 3-class and 4-class classifications. For the 3-class category, the sensitivity and specificity were 94.83% and 92.36%, respectively. For the 4-class category, the sensitivity and specificity were 95.40% and 92.70%, respectively. The interobserver agreement of the testing dataset of the model was moderate to substantial with the senior endoscopist. The accuracy of the determination of endoscopic therapy required and high-risk endoscopic therapy of the deep learning model was higher than that of the novice endoscopist.
Conclusions
In this study, the deep learning model performed better than inexperienced endoscopists. Further improvement of the model may aid in clinical decision-making during clinical practice, especially for trainee endoscopist.
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Wu HK, Chang MY, Cheng HM, Hsu PC, Lo LC, Chen LC, Lin KP, Chang HH. Low central blood pressure and sympathetic activity predispose for the development of intradialytic hypotension. Medicine (Baltimore) 2021; 100:e25299. [PMID: 33832099 PMCID: PMC8036036 DOI: 10.1097/md.0000000000025299] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/04/2021] [Indexed: 01/05/2023] Open
Abstract
Intradialytic hypotension (IDH) may lead to a poor life quality and was associated with cardiovascular mortality in patients under hemodialysis. This study investigated the autonomic nerve and cardiovascular function in the IDH episodes.In this case-control study, 70 end stage renal disease patients (198 visits) were recruited. Pulse wave analysis and heart rate variability were evaluated before hemodialysis. Two definitions of IDH were confirmed by medical records. IDH-f indicated a drop of systolic blood pressure or mean arterial pressure, accompanied with symptoms; IDH-n indicated a low nadir systolic pressure during the hemodialysis. All parameters were evaluated for the possible predisposing factors under each definition.A total of 24 IDH-f and 37 IDH-n were noted in 177 visits. For both definitions, central pulse pressure seemed to be a consistent predisposing factor. Furthermore, lower sympathetic activity (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.35-0.87), lower pulse pressure (OR 0.95; 95% CI 0.92-0.98), and higher augmentation index (OR 17.36; 95% CI 1.48-204.10) were the possible predisposing factors for IDH-f. On the contrary, lower mean arterial pressure (OR 0.87; 95% CI 0.78-0.98) was identified as the possible factor for IDH-n.It was suggested that the lower central pulse pressure and sympathetic activity might be involved in the development of IDH.
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Affiliation(s)
- Han-Kuei Wu
- School of Post-Baccalaureate Chinese Medicine, China Medical University
- Department of Traditional Chinese Medicine, Kuang Tien General Hospital, Taichung
- Department of Chinese Medicine, China Medical University Hospital Taipei Branch, Taipei
| | - Ming-Yang Chang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University, Taoyuan
| | - Hao-Min Cheng
- Center for Evidence-based Medicine, Taipei Veterans General Hospital
- Faculty of Medicine, and Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei
| | - Po-Chi Hsu
- Department of Chinese Medicine, China Medical University Hospital Taipei Branch, Taipei
- School of Chinese Medicine, China Medical University
- Department of Chinese Medicine, China Medical University Hospital, Taichung
| | - Lun-Chien Lo
- School of Chinese Medicine, China Medical University
- Department of Chinese Medicine, China Medical University Hospital, Taichung
| | - Li-Chuan Chen
- Division of Translational Medicine, Department of Biomedical Sciences and Engineering, National Central University, Taoyuan
| | - Kang-Ping Lin
- Department of Electrical Engineering
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan
| | - Hen-Hong Chang
- Department of Chinese Medicine, China Medical University Hospital, Taichung
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, and Traditional Chinese Medicine Research Center, China Medical University, Taichung, Taiwan
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Feng YJ, Lin KP, Tsai CL, Wei HW. Influence of gap distance between bone and plate on structural stiffness and parallel interfragmental movement in far-cortical locking technique - a biomechanical study. Comput Methods Biomech Biomed Engin 2021; 24:1206-1211. [PMID: 33410708 DOI: 10.1080/10255842.2020.1870964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sufficient interfragmental movement is the key to successful fracture healing in the theory of secondary bone healing. The far-cortical locking technique enables both stiffness reduction and parallel motion for ideal callus formation and fracture healing, but the influence of plate-bone gap on the performance of far-cortical locking technique remains unclear. The current study conducted a series of finite element analyses with mechanical validation to clarify this issue. Plate-bone gaps were assigned by 1, 2, 3, and 4 mm in a simulated mid-shaft fracture model fixed with locking plate and six semi-rigid locking screws. Axial compressive load to 500 N was applied to the fixation structure to evaluate the structural stiffness, pattern of interfragmental movement (parallel motion), and stresses on the screws. Results revealed the increased plate-bone gaps reduced the structural in order (315.3, 288.8, 264.9, and 243.4 N/mm). Tilting angles for determining parallel interfragmental movement (1.58°-1.85°) and stresses on semi-rigid screws for evaluating implant safety were not severely altered. Greater stresses were found on the screws adjacent to the fracture site in all simulated models. The current study suggested that 1 mm gap between the locking plate and the bone shall be ideal in view of parallel motion achieved balanced callus formation in far-cortical locking technique. Issue of reducing structural stiffness with limited plate-bone gap distance should be further investigated.
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Affiliation(s)
- Yong-Jian Feng
- Cangzhou Central Hospital, Hebei, People's Republic of China
| | - Kang-Ping Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan.,Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Cheng-Lung Tsai
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan.,Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Hung-Wen Wei
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan.,Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
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Yang BH, Lin KP, Chen MF, Weng JH, Kao PF, Lin WC, Liu RS. Automatic Striatal ROI Delineation for Semi-quantitative Analysis of 99mTc-TRODAT-1 Brain SPECT Imaging. J Med Biol Eng 2020. [DOI: 10.1007/s40846-020-00530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lin CC, Lin KP, Huang CC, Chen WC, Wei HW, Tsai CL, Lin KJ. Partially threaded headless screw may benefit adequate interfragmentary compression and reduced driving torque for small bone fixation. J Orthop Surg (Hong Kong) 2019; 26:2309499018760130. [PMID: 29486668 DOI: 10.1177/2309499018760130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 12/13/2022] Open
Abstract
Headless compression screws (HCSs) are commonly used to fixate small bones and articular fractures. Understanding the biomechanical efficacy of different HCS designs can help surgeons make proper interfragmentary compression when a specific implant is chosen. HCSs with three different central shaft designs (unthreaded, fully threaded, and partially threaded) were studied: the Herbert-Whipple, Mini-Acutrak 2, and headless reduction (HLR). Polyurethane foam blocks were machined with a simulated fracture gap of 0.5 mm and set onto a custom-made jig to simultaneously measure compression force and driving torque during screw insertion. The maximal achievable compression forces and driving torques recorded were 47.4 ± 0.9 N and 145.11 ± 1.65 N mm for the HLR, 50.98 ± 1.29 N and 152.62 ± 2.83 N mm for the Mini-Acutrak 2, and 19.33 ± 1.0 N and 33.4 ± 2.2 N mm for the Herbert-Whipple. Overall, the compression force of the Mini-Acutrak 2 and HLR increased with the torque. Unlike the other screws, the Herbert-Whipple's driving torque increased while the compression force decreased after peak compression force was achieved. The partially threaded shaft design (HLR) demonstrated equivalent biomechanical advantage with the Mini-Acutrak 2 in interfragmentary compression. The HCSs with cone-shaped proximal ends (HLR and Mini-Acutrak 2) maintained their compression force during over-fastening, whereas the unthreaded central shaft of the Herbert-Whipple screw caused it to lose compression force.
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Affiliation(s)
- Chen-Chiang Lin
- 1 Department of Orthopedics, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Kang-Ping Lin
- 2 Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan.,3 Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Chuan-Ching Huang
- 1 Department of Orthopedics, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Wen-Chuan Chen
- 2 Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Hung-Wen Wei
- 4 Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Lun Tsai
- 5 Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Kun-Jhih Lin
- 2 Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan
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Chen MF, Tsai CL, Chen YH, Wu CN, Chou C, Chien CH, Tu PW, Kao T, Lin KP. Comparative Study of Regulations of Devices for Aesthetic Purposes: US, European Union, China, and Taiwan. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yang JCS, Lin KP, Wei HW, Chen WC, Chiang CC, Chang MC, Tsai CL, Lin KJ. Importance of a moderate plate-to-bone distance for the functioning of the far cortical locking system. Med Eng Phys 2019; 56:48-53. [PMID: 29685856 DOI: 10.1016/j.medengphy.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 08/04/2017] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 11/17/2022]
Abstract
The far cortical locking (FCL) system, a novel bridge-plating technique, aims to deliver controlled and symmetric interfragmentary motion for a potential uniform callus distribution. However, clinical data for the practical use of this system are limited. The current study investigated the biomechanical effect of a locking plate/far cortical locking construct on a simulated comminuted diaphyseal fracture of the synthetic bones at different distance between the plate and the bone. Biomechanical in vitro experiments were performed using composite sawbones as bone models. A 10-mm osteotomy gap was created and bridged with FCL constructs to determine the construct stiffness, strength, and interfragmentary movement under axial compression, which comprised one of three methods: locking plates applied flush to bone, at 2 mm, or at 4 mm from the bone. The plate applied flush to the bone exhibited higher stiffness than those at 2 mm and 4 mm plate elevation. A homogeneous interfragmentary motion at the near and far cortices was observed for the plate at 2 mm, whereas a relatively large movement was observed at the far cortex for the plate applied at 4 mm. A plate-to-bone distance of 2 mm had the advantages of reducing axial stiffness and providing nearly parallel interfragmentary motion. The plate flush to the bone prohibits the dynamic function of the far cortical locking mechanism, and the 4-mm offset was too unstable for fracture healing.
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Affiliation(s)
- Jesse Chieh-Szu Yang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kang-Ping Lin
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan; Technology Translation Center for Medical Device, Chung Yuan Christian University, No. 200, Chung-Pei Rd., Chung Li District, Taoyuan 32023, Taiwan
| | - Hung-Wen Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; Technology Translation Center for Medical Device, Chung Yuan Christian University, No. 200, Chung-Pei Rd., Chung Li District, Taoyuan 32023, Taiwan
| | - Wen-Chuan Chen
- Technology Translation Center for Medical Device, Chung Yuan Christian University, No. 200, Chung-Pei Rd., Chung Li District, Taoyuan 32023, Taiwan
| | - Chao-Ching Chiang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Chau Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Lun Tsai
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan ; Technology Translation Center for Medical Device, Chung Yuan Christian University, No. 200, Chung-Pei Rd., Chung Li District, Taoyuan 32023, Taiwan
| | - Kun-Jhih Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, No. 200, Chung-Pei Rd., Chung Li District, Taoyuan 32023, Taiwan .
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Chen MF, Tsai CL, Chen YH, Huang YW, Wu CN, Chou C, Chien CH, Tu PW, Kao T, Lin KP. Web-Based Experience Sharing Platform on Medical Device Incidents for Clinical Engineers in Hospitals. J Med Biol Eng 2018; 38:835-844. [PMID: 30220902 PMCID: PMC6132694 DOI: 10.1007/s40846-018-0441-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/16/2018] [Indexed: 11/30/2022]
Abstract
The aim of this study was to establish a web-based platform for exchanging medical device management and maintenance experiences to enhance the professional competency of clinical engineers (CEs), which ensures the quality of medical devices and increases patients' satisfaction with medical services. Medical devices play an essential role in diagnosis and disease management. CEs are responsible for providing functional medical devices that contribute worthwhile functions to a medical service to improve patients' health and safety. The purpose of the platform is to facilitate collection and sharing of medical device incidents experiences to improve CEs' capability. To provide useful and practical information for CEs, an event review committee, composed of experts with more than 20 years of clinical engineering experience who were recruited as reviewers, was established under the platform. Cases submitted to the platform were required to have comprehensive descriptions of the device and events. Each case was evaluated by at least two reviewers based on five evaluation indices: (1) severity, (2) breadth, (3) frequency, (4) insidiousness, and (5) correctness. After being reviewed, each final report was published on the platform to be shared with the event submitters and other members. The results show that 116 staffs from 32 different hospitals, registered to join this platform. From January 2015 to December 2016, 70 events were submitted with 56 reports. This study also assessed the platform's benefits for CEs. A total of 93 respondents completed a questionnaire survey: 93% of the CEs agreed that the information from the platform helped them do their job. The web-based platform has high value as an experience-sharing interface for medical devices. The CEs obtained extremely useful information from the platform for medical device management and their daily duties. This study provided an online training model with systematic methods to improve the quality and effectiveness of medical device management.
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Affiliation(s)
- Mei-Fen Chen
- 1Electrical Engineering Department, Chung Yuan Christian University, 200 Chung Pei Road, Chung Li District, Taoyuan City, 32023 Taiwan, ROC
| | - Cheng-Lun Tsai
- 2Biomedical Engineering Department, Chung Yuan Christian University, Taoyuan City, Taiwan, ROC
| | - Yung-Hsin Chen
- 3Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan City, Taiwan, ROC
| | - Yu-Wen Huang
- 4Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Cheng-Ning Wu
- 4Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ching Chou
- 4Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chia-Hung Chien
- 4Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Pei-Weng Tu
- 4Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Tsair Kao
- 3Technology Translation Center for Medical Device, Chung Yuan Christian University, Taoyuan City, Taiwan, ROC
| | - Kang-Ping Lin
- 1Electrical Engineering Department, Chung Yuan Christian University, 200 Chung Pei Road, Chung Li District, Taoyuan City, 32023 Taiwan, ROC
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Chu CH, Chen YY, Lin KP, Chen WC, Lee PY. Anatomic Locking Plate for Displaced Intraarticular Calcaneal Fracture: Design and Application. J Foot Ankle Surg 2018; 56:1165-1169. [PMID: 28888405 DOI: 10.1053/j.jfas.2017.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/18/2015] [Indexed: 02/03/2023]
Abstract
Calcaneal fracture can lead to long-term disability and have a considerable economic effect. Most calcaneal fractures are intraarticular fractures involving the posterior facet of the subtalar joint. Treating displaced intraarticular calcaneal fractures is complicated because of the lack of an optimal treatment option. Internal fixation typically involves screw-and-plate implants, which can be unfavorable owing to the lack of an anatomic design and the intraoperative bending required for the plate to contour to the irregular surface of the calcaneus. We assessed the outcomes of 30 patients treated using innovative, anatomically designed calcaneal locking plates and the perceived advantages for surgeons. Postoperative computed tomography images of the affected feet were obtained, and the functional performance was recorded. The mean average Böhler angle had increased significantly from 16.8° ± 14.9° to 28.5° ± 9.4° (p < .001). The mean average maximal fracture gap and maximal step-off in the posterior facet of the subtalar joint in the coronal computed tomography images also decreased significantly from 2.8 ± 3.7 mm to 0.8 ± 1.3 mm (p < .01) and from 3.3 ± 2.8 mm to 0.8 ± 1.2 mm (p < .001), respectively. The mean average American Orthopaedic Foot and Ankle Ankle-Hindfoot scale score was 93.9 ± 7.1 at the final follow-up visit. In addition, the surgical time was reduced because bending the plate was not required and the quality of reduction could be assessed easily by examining the gap between the cortex and the plate. The results were promising, revealing that the anatomic locking plate can be used effectively in the treatment of displaced intraarticular calcaneal fractures using simple reduction techniques with a potentially shortened operating time.
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Affiliation(s)
- Chia-Hung Chu
- Orthopedic Surgeon, Department of Orthopedic Surgery, Show-Chwan Memorial Hospital, Changhua City, Taiwan, Republic of China
| | - Yan-Yu Chen
- Orthopedic Surgeon, Department of Orthopedic Surgery, Show-Chwan Memorial Hospital, Changhua City, Taiwan, Republic of China.
| | - Kang-Ping Lin
- Researcher, Holistic Medical Device R&D Center, Chung-Yuan Christian University, Taoyuan, Taiwan, Republic of China
| | - Wen-Chuan Chen
- Researcher, Holistic Medical Device R&D Center, Chung-Yuan Christian University, Taoyuan, Taiwan, Republic of China
| | - Pei-Yuan Lee
- Orthopedic Surgeon, Department of Orthopedic Surgery, Show-Chwan Memorial Hospital, Changhua City, Taiwan, Republic of China
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Lee PY, Lin KJ, Wei HW, Hu JJ, Chen WC, Tsai CL, Lin KP. Biomechanical effect of different femoral neck blade position on the fixation of intertrochanteric fracture: a finite element analysis. ACTA ACUST UNITED AC 2017; 61:331-6. [PMID: 26351785 DOI: 10.1515/bmt-2015-0091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/05/2015] [Indexed: 11/15/2022]
Abstract
Medial migration or cutout of the neck helical blade has commonly occurred in the treatment of trochanteric fracture of the femur. The position of the helical blade within the femoral head is one of the influencing factors that cause the blade to perforate the intact joint surface; however, the ideal placement of the helical blade is not currently known. A finite element model of a femur/nail construct was utilized to analyze five possible blade positions in the femoral head. Normal strain at the fracture surface, the minimum principal strain in the cancellous bone, and the von Mises stress in the implant itself were calculated and compared between different blade positions. The results showed that a large area of normal compressive strain at the fracture surface was observed in the inferior and posterior blade positions. The volume of cancellous bone strained to yielding in the femoral head and neck was lower for the inferior and posterior positions, whereas it was the highest for the superior position. The inferior and posterior positions had lower von Mises stress in the implant itself. The inferior and posterior positions may be the ideal position for the intramedullary nail with a helical neck blade.
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Huang SC, Wu LC, Lin WC, Lin KP, Liu RS. Adaptive Weighted Nonlinear Least Squares Method for Fluorodeoxyglucose Positron Emission Tomography Quantification. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lin CC, Lin KJ, Chen WC, Wei HW, Lin KP, Tsai CL. Larger screw diameter may not guarantee greater pullout strength for headless screws – a biomechanical study. ACTA ACUST UNITED AC 2017; 62:257-261. [DOI: 10.1515/bmt-2016-0090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/11/2016] [Indexed: 12/13/2022]
Abstract
AbstractHeadless compression screws (HCSs) are commonly utilized devices for small bone fracture fixation. The Mini-Acutrak 2 and headless reduction (HLR) screws are the newer version types, in which both have fully threaded and variable pitch design. Specifically, the HLR is characterized by two thread runouts to facilitate implantation. With the thread runouts, the holding strength of the screw may be compromised. To the best of our knowledge, no study has examined the pullout force of the global sizes of a HCS. We sought to determine the pullout strength of the HLR and compare the strength of this screw with that of the Mini-Acutrak 2. Synthetic bone blocks with simulated transverse fractures were used to conduct the tests. Four commonly used sizes of the HLR were examined, and one Mini-Acutrak 2 was employed for comparison. Five screws of each size were tested. The pullout force of all screws that were tested in this study ranged from 45.23 to 233.22 N. The results revealed that the pullout force increased as the screw diameter increased. Interestingly, we found that one small screw outperformed the Mini-Acutrak 2, which has a larger diameter. This study provided extensive knowledge regarding the pullout strength of fully threaded HCSs of different sizes. An unexpected finding is that a small screw has higher holding power than a large one because of its increased number of threads. Therefore, we suggest that the thread number should be a critical consideration for the design of size distribution of HCSs.
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Fu TC, Lin WC, Wang JS, Wang CH, Chang CT, Tsai CL, Lee YS, Lin KP. Detection of exercise periodic breathing using thermal flowmeter in patients with heart failure. Med Biol Eng Comput 2016; 55:1189-1198. [PMID: 27744563 DOI: 10.1007/s11517-016-1581-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/03/2016] [Accepted: 09/26/2016] [Indexed: 02/04/2023]
Abstract
Exercise periodic breathing (EPB) is associated with exercise intolerance and poor prognosis in patients with heart failure (HF). However, EPB detection during cardiopulmonary exercise test (CPET) is difficult. The present study investigated the use of a wireless monitoring device to record the EPB during CPET and proposed quantization parameter estimates for the EPB. A total of 445 patients with HF were enrolled and underwent exercise tests. The ventilation data from the wearable device were compared with the data obtained during the CPET and were analyzed based on professional opinion and on 2 automated programs (decision tree [DT] and oscillatory pattern methods). The measurement accuracy was greater with the DT method (89 %) than with the oscillatory pattern method (75 %). The cutoffs for EPB recognition using the DT method were (1) an intercept of the regression line passing through the minute ventilation rate vs. the time curve during the recovery phase ≥64.63, and (2) an oscillatory phase duration to total exercise time ratio ≥0.5828. The wearable device was suitable for the assessment of EPB in patients with HF, and our new automated analysis system using the DT method effectively identified the EPB pattern.
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Affiliation(s)
- Tieh-Cheng Fu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Chen Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Tao-Yuan, Taiwan
| | - Jong-Shyan Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan.,Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical College, Chang Gung University, Tao-Yuan, Taiwan
| | - Chao-Hung Wang
- Heart Failure Center, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chun-Tien Chang
- Computer and Communication Center, National Tsing Hua University, Hsinchu, Taiwan
| | - Cheng-Lun Tsai
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Tao-Yuan, Taiwan.,Department of Biomedical Engineering, Chung Yuan Christian University, Tao-Yuan, Taiwan
| | - Yun-Shien Lee
- Department of Biotechnology, Ming-Chuan University, Kwei-Shan, Tao-Yuan, Taiwan
| | - Kang-Ping Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Tao-Yuan, Taiwan. .,Department of Electrical Engineering, Chung Yuan Christian University, 200 Chung Pei Road, Chung Li, Tao-Yuan, 32023, Taiwan.
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Huang TL, Chen WC, Lin KJ, Tsai CL, Lin KP, Wei HW. Conceptual finite element study for comparison among superior, anterior, and spiral clavicle plate fixations for midshaft clavicle fracture. Med Eng Phys 2016; 38:1070-5. [DOI: 10.1016/j.medengphy.2016.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/06/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
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Abstract
Bajiaolian ( Dysosma pleianthum), one species in the Mayapple family, has been widely used as a general remedy and for the treatment of snake bite, weakness, condyloma accuminata, lymphadenopathy and tumours in China for thousands of years. However, the textbooks of traditional Chinese medicine mention little about the toxicity of Bajiaolian. Within 1 year, the authors saw five people who manifested nausea, vomiting, diarrhoea, abdominal pain, thrombocytopenia, leucopenia, abnormal liver function tests, sensory ataxia, altered consciousness and persistant peripheral tingling or numbness after drinking infusions made with Bajiaolian. The herb was recommended by either traditional Chinese medical doctors or herbal pharmacies for postpartum recovery and treatment of a neck mass, hepatoma, lumbago and dysmenorrhoea. Podophyllotoxin is one of the main ingredients of the Bajiaolian root. The clinical manifestations observed in our patients were consistent with podophyllum intoxication. Podophyllotoxin intoxication usually results from the accidental ingestion or topical application of podophyllum resin. However, these cases of Bajiaolian intoxication were iatrogenic and results from 'therapeutic doses' of Bajiaolian cited in the textbooks of traditional Chinese medicine.
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Affiliation(s)
- W F Kao
- Department of Emergency Medicine, Veterans General Hospital, Taipei, Taiwan
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Zhang YK, Wei HW, Lin KP, Chen WC, Tsai CL, Lin KJ. Biomechanical effect of the configuration of screw hole style on locking plate fixation in proximal humerus fracture with a simulated gap: A finite element analysis. Injury 2016; 47:1191-5. [PMID: 26975793 DOI: 10.1016/j.injury.2016.02.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 07/13/2015] [Revised: 01/24/2016] [Accepted: 02/29/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Locking plate fixation for proximal humeral fractures is a commonly used device. Recently, plate breakages were continuously reported that the implants all have a mixture of holes allowing placement of both locking and non-locking screws (so-called combi plates). In commercialized proximal humeral plates, there still are two screw hole styles included "locking and dynamic holes separated" and "locking hole only" configurations. It is important to understand the biomechanical effect of different screw hole style on the stress distribution in bone plate. METHODS Finite element method was employed to conduct a computational investigation. Three proximal humeral plate models with different screw hole configurations were reconstructed depended upon an identical commercialized implant. A three-dimensional model of a humerus was created using process of thresholding based on the grayscale values of the CT scanning of an intact humerus. A "virtual" subcapital osteotomy was performed. Simulations were performed under an increasing axial load. The von Mises stresses around the screw holes of the plate shaft, the construct stiffness and the directional displacement within the fracture gap were calculated for comparison. RESULTS The mean value of the peak von Mises stresses around the screw holes in the plate shaft was the highest for combi hole design while it was smallest for the locking and dynamic holes separated design. The stiffness of the plate-bone construct was 15% higher in the locking screw only design (132.6N/mm) compared with the combi design (115.0N/mm), and it was 4% higher than the combi design for the locking and dynamic holes separated design (119.5N/mm). The displacement within the fracture gap was greatest in the combi hole design, whereas it was smallest for the locking hole only design. CONCLUSIONS The computed results provide a possible explanation for the breakages of combi plates revealed in clinical reports. The locking and dynamic holes separated design may be a better configuration to reduce the risk of plate fracture.
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Affiliation(s)
- Ya-Kui Zhang
- Department of Orthopaedics Tongzhou Luhe Teaching Hospital, Capital Medical University, Beijing, China
| | - Hung-Wen Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; Translation Technology Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Kang-Ping Lin
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan; Translation Technology Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Wen-Chuan Chen
- Translation Technology Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Cheng-Lun Tsai
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan; Translation Technology Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Kun-Jhih Lin
- Department of Electrical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan; Translation Technology Center for Medical Device, Chung Yuan Christian University, Taoyuan, Taiwan.
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Yu B, Chen WC, Lee PY, Lin KP, Lin KJ, Tsai CL, Wei HW. Biomechanical comparison of conventional and anatomical calcaneal plates for the treatment of intraarticular calcaneal fractures - a finite element study. Comput Methods Biomech Biomed Engin 2016; 19:1363-70. [PMID: 26813403 DOI: 10.1080/10255842.2016.1142534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Initial stability is essential for open reduction internal fixation of intraarticular calcaneal fractures. Geometrical feature of a calcaneal plate is influential to its endurance under physiological load. It is unclear if conventional and pre-contoured anatomical calcaneal plates may exhibit differently in biomechanical perspective. A Sanders' Type II-B intraarticular calcaneal fracture model was reconstructed to evaluate the effectiveness of calcaneal plates using finite element methods. Incremental vertical joint loads up to 450 N were exerted on the subtalar joint to evaluate the stability and safety of the calcaneal plates and bony structure. Results revealed that the anatomical calcaneal plate model had greater average structural stiffness (585.7 N/mm) and lower von Mises stress on the plate (774.5 MPa) compared to those observed in the conventional calcaneal plate model (stiffness: 430.9 N/mm; stress on plate: 867.1 MPa). Although both maximal compressive and maximal tensile stress and strain were lower in the anatomical calcaneal plate group, greater loads on fixation screws were found (average 172.7 MPa compared to 82.18 MPa in the conventional calcaneal plate). It was noted that high magnitude stress concentrations would occur where the bone plate bridges the fracture line on the lateral side of the calcaneus bone. Sufficient fixation strength at the posterolateral calcaneus bone is important for maintaining subtalar joint load after reduction and fixation of a Sanders' Type II-B calcaneal fracture. In addition, geometrical design of a calcaneal plate should worth considering for the mechanical safety in practical usage.
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Affiliation(s)
- Bin Yu
- a Department of Orthopedics and Traumatology , Nanfang Hospital, Southern Medical University , GuangZhou , China
| | - Wen-Chuan Chen
- b Technology Translation Center for Medical Device , Chung Yuan Christian University , Taoyuan , Taiwan
| | - Pei-Yuan Lee
- c Department of Orthopaedic Surgery , Show Chwan Memorial Hospital , Changhua City , Taiwan
| | - Kang-Ping Lin
- b Technology Translation Center for Medical Device , Chung Yuan Christian University , Taoyuan , Taiwan.,d Department of Electrical Engineering , Chung Yuan Christian University , Taoyuan , Taiwan
| | - Kun-Jhih Lin
- b Technology Translation Center for Medical Device , Chung Yuan Christian University , Taoyuan , Taiwan
| | - Cheng-Lun Tsai
- b Technology Translation Center for Medical Device , Chung Yuan Christian University , Taoyuan , Taiwan.,e Department of Biomedical Engineering , Chung Yuan Christian University , Taoyuan , Taiwan
| | - Hung-Wen Wei
- b Technology Translation Center for Medical Device , Chung Yuan Christian University , Taoyuan , Taiwan.,f Department of Physical Therapy and Assistive Technology , National Yang-Ming University , Taipei , Taiwan
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Abstract
Biomedical Engineers (BME) play an important role in medical and healthcare society. Well educational programs are important to support the healthcare systems including hospitals, long term care organizations, manufacture industries of medical devices/instrumentations/systems, and sales/services companies of medical devices/instrumentations/system. In past 30 more years, biomedical engineering society has accumulated thousands people hold a biomedical engineering degree, and work as a biomedical engineer in Taiwan. Most of BME students can be trained in biomedical engineering departments with at least one of specialties in bioelectronics, bio-information, biomaterials or biomechanics. Students are required to have internship trainings in related institutions out of campus for 320 hours before graduating. Almost all the biomedical engineering departments are certified by IEET (Institute of Engineering Education Taiwan), and met the IEET requirement in which required mathematics and fundamental engineering courses. For BMEs after graduation, Taiwanese Society of Biomedical Engineering (TSBME) provides many continue-learning programs and certificates for all members who expect to hold the certification as a professional credit in his working place. In current status, many engineering departments in university are continuously asked to provide joint programs with BME department to train much better quality students. BME is one of growing fields in Taiwan.
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Lin YH, Lin KP, Huang SM, Lu HT, Lin TH, Huang TC. Left ventricle segmentation in dynamic cardiac CT using random walks method. J Xray Sci Technol 2015; 23:25-31. [PMID: 25567404 DOI: 10.3233/xst-140467] [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] [Indexed: 06/04/2023]
Abstract
PURPOSE Segmentation of the left ventricle (LV) in cardiac CT (CCT) images is difficult due to the intensity heterogeneity arising from accumulation of contrast agent in papillary muscle and trabeculae carneae. In this study, we demonstrated the random walks method for LV segmentation in CCT through cardiac phases. METHODS 63 CCT data sets from 7 patients with 9 cardiac phases were included in this study. All cardiac CT examinations were performed with GE 64-detector CT scanner with ECG gating. In each patient, 60-80 ml iohexol was injected at a flow rate of 5 ml/sec followed by 60 ml normal saline solution. Random walks (RW) based on probability of labels was used for LV segmentation. The LV delineations generated by the experienced physician (MD), conventional image-based method (IB), and RW were compared. RESULTS In general the contours segment the LV closely by RW and MD, but the discrepancies in papillary muscle and trabeculae carneae were observed while using the IB method. CONCLUSION We showed the RW method potentially improved LV segmentation as compared to the volume by conventional IB method. In this study, we demonstrated the clinical feasibility of LV volume segmentation using random walks algorithm.
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Affiliation(s)
- Yang-Hsien Lin
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taiwan Department of Diagnostic Radiology, Peng Hu Hospital, Ministry of Health and Welfare, Taiwan
| | - Kang-Ping Lin
- Department of Electrical Engineering, Chun Yuan Christian University, Taiwan
| | - Shih-Min Huang
- Department of Radiology, China Medical University Hospital, Taiwan
| | - Hui-Ting Lu
- Department of Diagnostic Radiology, Peng Hu Hospital, Ministry of Health and Welfare, Taiwan
| | - Tien-Hsiang Lin
- Department of Diagnostic Radiology, Peng Hu Hospital, Ministry of Health and Welfare, Taiwan
| | - Tzung-Chi Huang
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taiwan Department of Biomedical Informatics, Asia University, Taiwan
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Hsieh YJ, Hwu L, Chen YC, Ke CC, Chen FD, Wang HE, Lin KP, Yeh HH, Chang CW, Liu RS. P21-driven multifusion gene system for evaluating the efficacy of histone deacetylase inhibitors by in vivo molecular imaging and for transcription targeting therapy of cancer mediated by histone deacetylase inhibitor. J Nucl Med 2014; 55:678-85. [PMID: 24639460 DOI: 10.2967/jnumed.113.126573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Overexpressed histone deacetylase (HDAC) activity has been linked with tumor initiation and progression that prompt the development of histone deacetylase inhibitors (HDACIs) as anticancer agents. HDACI was reported to be able to activate p21 promoter through the SP1 binding sites in the proximal region of p21(WAF1/CIP1) promoter. In this study, we established a p21(WAF1/CIP1) promoter-driven triple-fused reporter gene system (p21-3H) to evaluate the efficacy of HDACI and the ganciclovir (GCV)-mediated anticancer effect contributed by HDACI-induced and p21-driven truncated herpes simplex virus-1 thymidine kinase sr39 mutant (ttksr39) in vitro and in vivo. METHODS The p21-3H construct was generated and stably or transiently transfected into H1299 cell lines. These cells were treated with trichostatin A or vorinostat (suberoylanilide hydroxamic acid [SAHA]) to evaluate the activation of p21 promoter-driven reporter gene expression by in vitro confocal fluorescence microscopy, luciferase assay, 2'-fluoro-2'-deoxyarabinofuranosyl-5-ethyluracil ((3)H-FEAU) cellular uptake, in vivo bioluminescence imaging, and 9-(4-(18)F-fluoro-3-hydroxymethylbutyl) guanine ((18)F-FHBG) small-animal PET imaging. The therapeutic efficacy on p21-3H-expressing tumor xenografts was assessed by daily administration with SAHA (100 mg/kg intraperitoneally) or GCV (20 mg/kg) for 9 d, followed by tumor volume measurement. RESULTS On treatment with trichostatin A or SAHA, H1299 cells carrying p21-3H showed a significant increase of luciferase activity, cellular uptake of (3)H-FEAU (Moravek), and DsRed expression. In vivo tumor xenografts carrying p21-3H also showed increased luciferase activity by luminescent imaging and enhanced accumulation of (18)F-FHBG by small-animal PET imaging. Furthermore, when cells transfected with p21-3H or p21/PstI-3H (which lacks p53-binding sites) were treated, the increase of luciferase activity was similar in both groups, indicating that HDACI-induced p21 promoter activation is independent of p53. Both in vitro and in vivo results showed improved therapeutic effect by combined treatment of GCV and HDACI. CONCLUSION We have established an HDACI-inducible, p21-driven reporter system that has the potential for evaluating the anticancer effect of HDACIs on cancer cells by multiple molecular imaging modalities. Furthermore, ttksr39 in a p21-3H reporter construct provides a potential combination with thymidine kinase-mediated gene therapy to optimize the therapeutic benefit of HDACI.
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Affiliation(s)
- Ya-Ju Hsieh
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
We study anomaly detection in a context that considers user trajectories as input and tries to identify anomalies for users following normal routes such as taking public transportation from the workplace to home or vice versa. Trajectories are modeled as a discrete-time series of axis-parallel constraints ("boxes") in the 2-D space. The anomaly can be estimated by considering two trajectories, where one trajectory is the current movement pattern and the other is a weighted trajectory collected from N norms. The proposed system was implemented and evaluated with eight individuals with cognitive impairments. The experimental results showed that recall was 95.0% and precision was 90.9% on average without false alarm suppression. False alarms and false negatives dropped when axis rotation was applied. The precision with axis rotation was 97.6% and the recall was 98.8%. The average time used for sending locations, running anomaly detection, and issuing warnings was in the range of 15.1-22.7 s. Our findings suggest that the ability to adapt anomaly detection devices for appropriate timing of self-alerts will be particularly important.
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Lin WC, Lin TJ, Tsai CL, Lin KP. An improved method for velocity estimation of red blood cell in microcirculation. Annu Int Conf IEEE Eng Med Biol Soc 2014; 2014:214-217. [PMID: 25569935 DOI: 10.1109/embc.2014.6943567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper presents a coarse-to-fine combined method for dealing with large displacement situations caused by low speed of frame rate in microscopic video sequences. Motion image estimation method utilizes the modified block matching method based on image warping to perform a wide range of changes in the amount of search comparison, and then using the optical flow method to fine adjustment pixel by pixel, to complete the overall precision of the estimation. In the evaluation experiment, we have compared both current optical flow and proposed method by testing them with simulated vessel images, the results of the estimation is quite accurate.
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Lin YH, Huang YH, Lin KP, Liu JC, Huang TC. Ventricular hemodynamics using cardiac computed tomography and optical flow method. J Xray Sci Technol 2014; 22:129-136. [PMID: 24463391 DOI: 10.3233/xst-130414] [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] [Indexed: 06/03/2023]
Abstract
Ventricular hemodynamics plays an important role in assessing cardiac function in clinical practice. The aim of this study was to determine the ventricular hemodynamics based on contrast movement in the left ventricle (LV) between the phases in a cardiac cycle recorded using an electrocardiography (ECG) with cardiac computed tomography (CT) and optical flow method. Cardiac CT data were acquired at 120 kV and 280 mA with a 350 ms gantry rotation, which covered one cardiac cycle, on the 640-slice CT scanner with ECG for a selected patient without heart disease. Ventricular hemodynamics (mm/phase) were calculated using the optical flow method based on contrast changes with ECG phases in anterior-posterior, lateral and superior-inferior directions. Local hemodynamic information of the LV with color coating was presented. The visualization of the functional information made the hemodynamic observation easy.
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Affiliation(s)
- Yang-Hsien Lin
- Department of Diagnostic Radiology, Peng Hu Hospital, Ministry of Health and Welfare, Taiwan Department of Biomedical Imaging and Radiological Science, China Medical University, Taiwan
| | - Yung-Hui Huang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Taiwan
| | - Kang-Ping Lin
- Department of Electrical Engineering, Chung Yuan Christian University, Taiwan
| | - Juhn-Cherng Liu
- Department of Radiology, China Medical University Hospital, Taiwan
| | - Tzung-Chi Huang
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taiwan Department of Biomedical Informatics, Asia University, Taiwan
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Lin YD, Chien YH, Wang SF, Tsai CL, Chang HH, Lin KP. IMPLEMENTATION OF MULTIPLE-CHANNEL CAPACITIVE ECG MEASUREMENT BASED ON CONDUCTIVE FABRIC. Biomed Eng Appl Basis Commun 2013. [DOI: 10.4015/s101623721350052x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Capacitive electrocardiogram (cECG) measurement is an attractive approach for long-term health monitoring. However, there is little literature available for the implementation of multiple-channel cECG system in standard limb leads. The circuit diagram for such a system is also rarely available in literature. This paper presents a multiple-channel limb-lead cECG system that utilized conductive fabrics as the capacitive sensors. The design criteria and the corresponding circuit diagram are described in detail. The proposed system also incorporates the capacitive driven-body (CDB) circuit to reduce the common-mode power-line interference (PLI). The presented system is verified to be stable by theoretic analysis and long-term experiments. The signals acquired by the presented system are competitive with those by commercially available electrocardiogram (ECG) machines. The feasible size and distance to the subject for the sensor made by conductive fabric have also been evaluated by a series of tests. From the test results, the sensor is suggested to be of greater than 60 cm2 in area and not more than 3 mm in distance for cECG measurement.
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Affiliation(s)
- Yue-Der Lin
- Department of Automatic Control Engineering, Feng Chia University, Taichung 40724, Taiwan
- Master's Program of Biomedical Informatics and Biomedical Engineering, Feng Chia University, Taichung 40724, Taiwan
| | - Ya-Hsuech Chien
- Ph.D. Program in Electrical and Communications, Engineering, Feng Chia University, Taichung 40724, Taiwan
| | - Shih-Fan Wang
- Master's Program of Biomedical Informatics and Biomedical Engineering, Feng Chia University, Taichung 40724, Taiwan
| | - Cheng-Lun Tsai
- Department of Biomedical Engineering, Chung Yuan Christian University, Chung-Li 32023, Taiwan
| | - Hen-Hong Chang
- Institute of Traditional Chinese Medicine, Chang Gung University, Tao-Yuan 333, Taiwan
| | - Kang-Ping Lin
- Department of Electrical Engineering, Chung Yuan Christian University, Chung-Li 32023, Taiwan
- Holistic Medical Device Development Center, Chung Yuan Christian University, Chung-Li 32023, Taiwan
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Lin YD, Ho HY, Tsai CC, Wang SF, Lin KP, Chang HH. SIMULTANEOUS HEARTBEAT AND RESPIRATION MONITORING USING PPG AND RIIV ON A SMARTPHONE DEVICE. Biomed Eng Appl Basis Commun 2013. [DOI: 10.4015/s1016237213500415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Photoplethysmography (PPG) is a technique based on photonics related to the volumetric changes in blood vessels during circulation. PPG has been widely applied in monitoring respiration, hypervolemia and other circulatory diseases. The smartphone becomes more popular nowadays. As the smartphone is usually equipped with light-emitting diode (LED) and camera, the imaging function in smartphone is proposed for PPG signal detection. An algorithm termed as the autoregressive (AR) decomposition is presented to extract the respiratory rate and pulse rate of the subject buried in the PPG measurement. The extracted information is verified by those derived from commercial equipments and the derived results agree well. The proposed algorithm is not complex and can be implemented in a smartphone as an application program. For its convenience in usage, the proposed strategy may be potential in telemedicine, preventive medicine and home care usage.
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Affiliation(s)
- Yue-Der Lin
- Department of Automatic Control Engineering, Feng Chia University, Taichung 40724, Taiwan
- Master's Program of Biomedical Informatics & Biomedical Engineering, Feng Chia University, Taichung 40724, Taiwan
| | - Hu-Ying Ho
- Department of Electrical Engineering, Chung Yuan Christian University, Chung Li City, Taiwan
| | - Ching-Che Tsai
- Holistic Medical Device Research & Development Center, Chung Yuan Christian University, Chung Li City, Taiwan
| | - Shih-Fan Wang
- Master's Program of Biomedical Informatics & Biomedical Engineering, Feng Chia University, Taichung 40724, Taiwan
| | - Kang-Ping Lin
- Department of Electrical Engineering, Chung Yuan Christian University, Chung Li City, Taiwan
- Holistic Medical Device Research & Development Center, Chung Yuan Christian University, Chung Li City, Taiwan
| | - Hen-Hong Chang
- Institute of Traditional Chinese Medicine, Chang-Gung University, Taiwan
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Hsieh YJ, Chen FD, Ke CC, Wang HE, Huang CJ, Hou MF, Lin KP, Gelovani JG, Liu RS. The EIIAPA chimeric promoter for tumor specific gene therapy of hepatoma. Mol Imaging Biol 2012; 14:452-61. [PMID: 21796480 DOI: 10.1007/s11307-011-0509-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/27/2023]
Abstract
PURPOSE For targeted imaging and therapy of hepatocellular carcinoma (HCC), we established a chimeric promoter (EIIAPA) containing alpha-fetoprotein (AFP) promoter and hepatitis B virus enhancer II (EIIA) to control downstream expression of reporter and therapeutic genes. PROCEDURES We combined AFP promoter and EIIA to establish a chimeric EIIAPA promoter, then developed a bi-cistronic plasmid vector containing HSV1-tk and luciferase genes controlled by EIIAPA to stably transfect HCC cells. The selective transcriptional activity of EIIAPA was assayed by bioluminescence imaging (BLI) and the function of EIIAPA was determined by in vivo microPET and BLI. RESULTS The luciferase expression driven by EIIAPA was higher than that driven by AFP promoter in HCC cell lines. EIIAPA-tk induced cytotoxicity was observed only in HepG2 cells. Accumulation of ¹³¹I-FIAU and bioluminescent signal were detected on HepG2 tumors but not in parental tumors. The HepG2 tumors derived from lentiviral-transduced EIIAPA-tk expressing cells accumulated ¹²⁴I-FIAU whereas the ARO tumors did not. The transfected HepG2 tumors expressed adequate EIIAPA-controlled HSV1-TK and the tumor regressed after ganciclovir treatment. CONCLUSION The chimeric EIIAPA is a potential candidate promoter for targeted imaging and gene therapy of HCC.
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Affiliation(s)
- Ya-Ju Hsieh
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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Wu CC, Lin WC, Zhang G, Chang CW, Liu RS, Lin KP, Huang TC. Accuracy evaluation of RBC velocity measurement in nail-fold capillaries. Microvasc Res 2011; 81:252-60. [PMID: 21255589 DOI: 10.1016/j.mvr.2011.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 01/11/2011] [Indexed: 11/17/2022]
Abstract
Cutaneous red blood cell velocity in vivo can be measured by using capillaroscopy with image processing techniques. However, unlike simulated blood flow images, there is no standard to determine the accuracy of the techniques for computing blood flow velocities. In this paper, we quantitatively evaluated the accuracy of previously proposed optical flow method for measuring red blood cell velocity in nail-fold capillaries. Blood flow images of subjects under normal and occlusion-release conditions were examined by a capillaroscope. To obtain velocity values, the images were further analyzed by using optical flow, cross-correlation and visual inspection methods, respectively. Visual inspection method was taken as the golden standard to determine the accuracy of blood flow velocity measurement using optical flow and cross-correlation techniques. Results showed that optical flow estimation provided superior accuracy to cross-correlation when assessing real blood flow velocity in nail-fold capillaries. Optical flow estimation is able to measure red blood cell velocity with a high accuracy of 91% and 86% when the observed velocity is less than 0.5mm/s under normal and occlusion-release conditions, respectively. In addition, optical flow method showed good agreement with visual inspection in determining blood flow velocity in both normal and occlusion-release conditions when the high-velocity zone is excluded.
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Affiliation(s)
- Chih-Chieh Wu
- Instrument Technology Research Center, National Applied Research Laboratories, Hsinchu, Taiwan
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Lin WC, Wu CC, Zhang G, Wu TH, Lin YH, Huang TC, Liu RS, Lin KP. An approach to automatic blood vessel image registration of microcirculation for blood flow analysis on nude mice. Comput Methods Biomech Biomed Engin 2010; 14:319-30. [PMID: 21082459 DOI: 10.1080/10255842.2010.497489] [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: 10/18/2022]
Abstract
Image registration is often a required and a time-consuming step in blood flow analysis of large microscopic video sequences in vivo. In order to obtain stable images for blood flow analysis, frame-to-frame image matching as a preprocessing step is a solution to the problem of movement during image acquisition. In this paper, microscopic system analysis without fluorescent labelling is performed to provide precise and continuous quantitative data of blood flow rate in individual microvessels of nude mice. The performance properties of several matching metrics are evaluated through simulated image registrations. An automatic image registration programme based on Powell's optimisation search method with low calculation redundancy was implemented. The matching method by variance of ratio is computationally efficient and improves the registration robustness and accuracy in practical application of microcirculation registration. The presented registration method shows acceptable results in close requisition to analyse red blood cell velocities, confirming the scientific potential of the system in blood flow analysis.
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Affiliation(s)
- Wen-Chen Lin
- Department of Electrical Engineering, Chung Yuan Christian University, Chungli, Taiwan
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Zhang GG, Huang TC, Forster KM, Lin KP, Stevens C, Harris E, Guerrero T. Dose mapping: validation in 4D dosimetry with measurements and application in radiotherapy follow-up evaluation. Comput Methods Programs Biomed 2008; 90:25-37. [PMID: 18178288 DOI: 10.1016/j.cmpb.2007.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Revised: 11/05/2007] [Accepted: 11/15/2007] [Indexed: 05/25/2023]
Abstract
The purpose of this paper is to validate a dose mapping program using optical flow method (OFM), and to demonstrate application of the program in radiotherapy follow-up evaluation. For the purpose of validation, the deformation matrices between four-dimensional (4D) CT data of different simulated respiration phases of a phantom were calculated using OFM. The matrices were then used to map doses of all phases to a single-phase image, and summed in equal time weighting. The calculated dose should closely represent the dose delivered to the moving phantom if the deformation matrices are accurately calculated. The measured point doses agreed with the OFM calculations better than 2% at isocenters, and dose distributions better than 1mm for the 50% isodose line. To demonstrate proof-of-concept for the use of deformable image registration in dose mapping for treatment evaluation, the treatment-planning CT was registered with the post-treatment CT image from the positron emission tomography (PET)/CT resulting in a deformation matrix. The dose distribution from the treatment plan was then mapped onto the restaging PET/CT using the deformation matrix. Two cases in which patients had thoracic malignancies are presented. Each patient had CT-based treatment planning for radiotherapy and restaging fluorodeoxy glucose (FDG)-PET/CT imaging 4-6 weeks after completion of treatments. Areas of pneumonitis and recurrence were identified radiographically on both PET and CT restaging images. Local dose and standard uptake values for pneumonitis and recurrence were studied as a demonstration of this method. By comparing the deformable mapped dose to measurement, the treatment evaluation method which is introduced in this manuscript proved to be accurate. It thus provides a more accurate analysis than other rigid or linear dose-image registration when used in studying treatment outcome versus dose.
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Affiliation(s)
- Geoffrey G Zhang
- H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida, Radiation Oncology, Tampa, FL 33612, United States.
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Zhang G, Huang TC, Guerrero T, Lin KP, Stevens C, Starkschall G, Forster K. Use of three-dimensional (3D) optical flow method in mapping 3D anatomic structure and tumor contours across four-dimensional computed tomography data. J Appl Clin Med Phys 2008; 9:59-69. [PMID: 18449166 PMCID: PMC5721534 DOI: 10.1120/jacmp.v9i1.2738] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 01/11/2008] [Accepted: 12/04/2007] [Indexed: 11/23/2022] Open
Abstract
A three‐dimensional (3D) optical flow program that includes a multi‐resolution feature has been developed and applied to 3D anatomic structure and gross tumor volume (GTV) contour mapping for four‐dimensional computed tomography (4D CT) data. The present study includes contour mapping for actual CT data sets from 3 patients and also for a thoracic phantom in which the displacement for each voxel was known. Of the CT data sets for the actual patients, one set was used to map lung and GTV contours over all respiration phases, and the other two were studied using only the end inspiration and end expiration phases, in which the displacements between phases were the largest. Including the residual motion in the 4D CT data and motion from table shaking, the optical flow calculation agrees with the known displacement to within 1 mm. Excluding errors not introduced by the optical flow algorithm, agreement for a displacement magnitude of 24 mm can be within 0.1 mm. The mapped contours in 4D CT images of lungs, liver, esophagus, GTV, and other structures for actual patients were acceptable to clinicians. The 3D optical flow program is a good tool for contour mapping of anatomic structure and tumor volume across 4D CT scans. PACS numbers: 87.55.D‐, 87.59.bd
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Affiliation(s)
- Geoffrey Zhang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Tzung-Chi Huang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Thomas Guerrero
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Craig Stevens
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - George Starkschall
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ken Forster
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
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Liu DS, Chang WH, Wong AMK, Chen SC, Lin KP, Lai CH. Development of a biofeedback tilt-table for investigating orthostatic syncope in patients with spinal cord injury. Med Biol Eng Comput 2007; 45:1223-8. [DOI: 10.1007/s11517-007-0272-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 10/04/2007] [Indexed: 12/21/2022]
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Lee YC, Chang MH, Lin KP, Soong BW. Gene symbol: MPZ. Disease: Charcot-Marie-Tooth disease type 1B. Hum Genet 2005; 118:547-8. [PMID: 16521307] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Y C Lee
- Section of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan 00407 (ROC)
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Abstract
The purpose of this work was to develop and validate an automated method for intrathoracic tumour motion estimation from breath-hold computed tomography (BH CT) imaging using the three-dimensional optical flow method (3D OFM). A modified 3D OFM algorithm provided 3D displacement vectors for each voxel which were used to map tumour voxels on expiration BH CT onto inspiration BH CT images. A thoracic phantom and simulated expiration/inspiration BH CT pairs were used for validation. The 3D OFM was applied to the measured inspiration and expiration BH CT images from one lung cancer and one oesophageal cancer patient. The resulting displacements were plotted in histogram format and analysed to provide insight regarding the tumour motion. The phantom tumour displacement was measured as 1.20 and 2.40 cm with full-width at tenth maximum (FWTM) for the distribution of displacement estimates of 0.008 and 0.006 cm, respectively. The maximum error of any single voxel's motion estimate was 1.1 mm along the z-dimension or approximately one-third of the z-dimension voxel size. The simulated BH CT pairs revealed an rms error of less than 0.25 mm. The displacement of the oesophageal tumours was nonuniform and up to 1.4 cm, this was a new finding. A lung tumour maximum displacement of 2.4 cm was found in the case evaluated. In conclusion, 3D OFM provided an accurate estimation of intrathoracic tumour motion, with estimated errors less than the voxel dimension in a simulated motion phantom study. Surprisingly, oesophageal tumour motion was large and nonuniform, with greatest motion occurring at the gastro-oesophageal junction.
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Affiliation(s)
- Thomas Guerrero
- Division of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
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Peng CW, Chen JJJ, Lin CCK, Poon PWF, Liang CK, Lin KP. High frequency block of selected axons using an implantable microstimulator. J Neurosci Methods 2004; 134:81-90. [PMID: 15102506 DOI: 10.1016/j.jneumeth.2003.11.005] [Citation(s) in RCA: 19] [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] [Subscribe] [Scholar Register] [Received: 05/28/2003] [Revised: 11/13/2003] [Accepted: 11/18/2003] [Indexed: 11/29/2022]
Abstract
Currently, the majority of neural stimulation studies are limited to acute animal experiments due to lack of suitable implantable microstimulation devices. As an initial step to observe the long-term effects of neural stimulation, a system consisting of an external wireless controller and an implantable dual-channel microcontroller-based microstimulator for tripolar high frequency blocking was developed. The system is not only small in size, and thus suitable for short-term implantation, but also has sufficient current output parameter ranges to meet the demand for high frequency blocking experiments. Using this implantable microstimulator, a series of experiments were conducted on New Zealand rabbit's tibial nerve, including frequency and amplitude selection in driving stimulus and blocking effect tests, which were designed to assess the feasibility and efficiency of the device via torque measurements. Our results showed that the implantable microstimulator system gave a satisfactory performance and could be utilized to achieve selective stimulation and blocking on various sizes of nerve fibers. Our implantable microstimulation system is not only a novel tool for neuromuscular control studies but could also provide a basis for developing various types of sophisticated neural prostheses.
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Affiliation(s)
- Chih-Wei Peng
- Institute of Biomedical Engineering, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan
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Abstract
OBJECTIVES We can assess brain function by measuring the cortical relay time (CRT) of long latency reflex (LLR) of hand muscle. We would study if measurement of CRT of LLR can explore the brain involvement of adrenomyeloneuropathy (AMN). METHODS Two AMN patients were included in the study. Both of them had spastic gait and mild sensory deficits but normal mental function. The LLRs were provoked at the first dorsal interosseous muscle by electrical stimulation of the middle finger. We measured the latency of LLR and its CRT. RESULTS Delayed LLR and prolonged CRT were noted in AMN patients, even though the magnetic resonance imaging of brain did not show any significant abnormalities. CONCLUSIONS Measuring CRT of LLR reveals brain involvement of AMN patients, and it is an adjunct in the assessment of brain function though without specific anatomic diagnosis.
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Affiliation(s)
- K K Liao
- Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan.
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Tsai DC, Lin PK, Lin KP, Kao KP, Liu JH. Optic neuropathy in a patient with chronic inflammatory demyelinating polyneuropathy. Eye (Lond) 2000; 14:911-2. [PMID: 11584858 DOI: 10.1038/eye.2000.252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Yu HY, Wu ZA, Su MS, Yen DJ, Luk HR, Chao YC, Liao KK, Lin KP, Yu SM, Liu HC. Problem-based, small-group tutorial learning in clinical neurology for second-year medical students. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:598-604. [PMID: 10969445] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Problem-based learning (PBL) in small-group tutorials has been a trend in medical education. Chinese students are known to be reserved and passive; thus, they may not be adaptable to PBL. Neuroanatomy, important to clinical neurology, is difficult to learn. We incorporated clinical neurology with PBL, complementary to the traditional neuroanatomy curriculum, to evaluate the feasibility of PBL for Chinese students in Taiwan. METHODS Forty-two second-year medical students and seven tutors participated in the clinical neurology PBL small-group tutorials. Twelve case reports were discussed weekly beginning in February, 1999. Each case was designed to meet the progressive curriculum of the neuroanatomy course. The tutors evaluated the students by the degree of their preparation, participation, key-point comprehension and interaction. All tutors and students filled out questionnaires at the end of each session. RESULTS The majority of the students and tutors agreed that the case materials were clearly written. Ninety percent of the students agreed that the case materials matched the traditional content of neuroanatomy. Eighty-five percent of students and 71% of tutors were satisfied and found the class rewarding. Ninety-one percent of students and 74% of tutors were in favor of PBL being continued. CONCLUSIONS This preliminary PBL, small-group tutorial learning in clinical neurology showed satisfactory results and was, indeed, complementary to a traditional neuroanatomy course. The students, as early as during the second year of their medical school education, were able to learn through the PBL. More integration of basic and clinical sciences by PBL may be considered in future curricula designs.
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Affiliation(s)
- H Y Yu
- Neurological Institute, Taipei Veterans General Hospital, Taiwan, ROC
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Abstract
High spatial resolution results in very large digital mammogram file sizes. For telemammography, and picture archiving and communication systems, the large file issue introduces technical difficulties in image transmission, storage, and display. We propose extracting the breast region from the mammogram to reduce the image file size. The challenge is on how to faithfully extract breast regions from digital mammograms generated from different types of acquisition systems that contain various imaged compositions. We report an algorithm to automatically identify the orientation of breast region and extract the breast region from mammograms. Breast regions extracted from full-field digital mammograms reduce file sizes by three to five folds.
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Affiliation(s)
- S L Lou
- Laboratory for Radiological Informatics, Department of Radiology, University of California, San Francisco, 530 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
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Huang CC, Wang ST, Chang YC, Lin KP, Wu PL. Measurement of the urinary lactate:creatinine ratio for the early identification of newborn infants at risk for hypoxic-ischemic encephalopathy. N Engl J Med 1999; 341:328-35. [PMID: 10423467 DOI: 10.1056/nejm199907293410504] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [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: 11/19/2022]
Abstract
BACKGROUND Newborn infants with perinatal asphyxia are prone to the development of hypoxic-ischemic encephalopathy. There are no reliable methods for identifying infants at risk for this disorder. METHODS We measured the ratio of lactate to creatinine in urine by proton nuclear magnetic resonance spectroscopy within 6 hours and again 48 to 72 hours after birth in 58 normal infants and 40 infants with asphyxia. The results were correlated with the subsequent presence or absence of hypoxic-ischemic encephalopathy. RESULTS Hypoxic-ischemic encephalopathy did not develop in any of the normal newborns but did develop in 16 of the 40 newborns with asphyxia. Within six hours after birth, the mean (+/-SD) ratio of urinary lactate to creatinine was 16.75+/-27.38 in the infants who subsequently had hypoxic-ischemic encephalopathy, as compared with 0.09+/-0.02 in the normal infants (P<0.001) and 0.19+/-0.12 in the infants with asphyxia in whom hypoxic-ischemic encephalopathy did not develop (P<0.001). A ratio of 0.64 or higher within six hours after birth had a sensitivity of 94 percent and a specificity of 100 percent for predicting the development of hypoxic-ischemic encephalopathy. The sensitivity and specificity of measurements obtained 48 to 72 hours after birth were much lower. The mean ratio of urinary lactate to creatinine was significantly higher in the infants who had adverse outcomes at one year (25.36+/-32.02) than in the infants with favorable outcomes (0.63+/-1.50) (P<0.001). CONCLUSIONS Measurement of the urinary lactate: creatinine ratio soon after birth may help identify infants at high risk for hypoxic-ischemic encephalopathy.
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Affiliation(s)
- C C Huang
- Department of Pediatrics, National Cheng Kung University Medical Center, Tainan, Taiwan
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Pong WF, Lin KP, Chang YK, Tsai MH, Hsieh HH, Pieh JY, Tseng PK, Lee JF, Hsu LS. Electronic structure of Ni3Al and Ni3Ga alloys. J Synchrotron Radiat 1999; 6:731-733. [PMID: 15263440 DOI: 10.1107/s0909049598016203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/1998] [Accepted: 12/01/1998] [Indexed: 05/24/2023]
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Chen JT, Chen CC, Lin KP, Wang SJ, Wu ZA, Liao KK. Botulism: heart rate variation, sympathetic skin responses, and plasma norepinephrine. Can J Neurol Sci 1999; 26:123-6. [PMID: 10352872] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Botulism may involve the autonomic nervous system. METHODS We assessed the autonomic function of 6 botulism patients with heart rate variations, sympathetic skin responses, and plasma norepinephrine. RESULTS Two weeks after onset, all the patients had absent sympathetic skin response in the palm and sole. Compared with controls, the heart rate variation of botulism patients was significantly decreased at rest (3.1 +/- 1.2% vs. 20.9 +/- 2.0%, p = 0.0018) and during deep breathing (4.3 +/- 2.3% vs. 29.7 +/- 2.6%, p = 0.0018). The botulism patients had significantly lower plasma norepinephrine levels (supine 29.2 +/- 10.1 pg/ml vs. 257.5 +/- 65.8 pg/ml, p = 0.0018; standing 40.3 +/- 13.1 pg/ml vs. 498.5 +/- 85.6 pg/ml, p = 0.0018). The heart rate variation and sympathetic skin response was greatly improved 6 months after onset. CONCLUSIONS Heart rate variation, absence of sympathetic skin response, and low plasma norepinephrine are all manifestations of autonomic dysfunction in botulism patients.
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Affiliation(s)
- J T Chen
- Department of Neurology, Veterans General Hospital-Taipei, Taiwan, R.O.C
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Chang LB, Tsai CP, Liao KK, Kao KP, Yuan CL, Yen DJ, Lin KP. Use of botulinum toxin A in the treatment of hemifacial spasm and blepharospasm. Zhonghua Yi Xue Za Zhi (Taipei) 1999; 62:1-5. [PMID: 10063705] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Hemifacial spasm and blepharospasm are both dystonic disorders. They may seriously affect individuals' lifestyle and social activities. In 1990, the Food and Drug Administration of the USA approved botulinum toxin A as a therapeutic agent in the treatment of hemifacial spasm and blepharospasm. We present a therapeutic review of botulinum toxin A in 80 patients in Taiwan. METHODS Fifty-eight patients with hemifacial spasm and 22 with blepharospasm. Botulinum toxin A was prepared and injected into the facial and eyelid muscles. Patients were monitored every two weeks and classified into four groups (excellent, moderate, mild and no improvement) according to the clinical improvement scale. Complications were also recorded. RESULTS A total of 86.2% of hemifacial spasm patients and 81.8% of blepharospasm patients had excellent improvement on the spasm intensity scale, while 6.8% of hemifacial spasm and 9.0% of blepharospasm patients had moderate improvement. The complication rate was low and included transient mild facial weakness (5%), ptosis (3.8%), eyelid swelling and/or ecchymosis (3.8%), nausea/vomiting (2.5%) and transient severe facial weakness (1.3%). CONCLUSION Botulinum toxin A is an excellent therapeutic agent to improve spasm intensity and has a low complication rate.
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Affiliation(s)
- L B Chang
- Section of Neurology, Cardinal Tien Hospital, Taipei, Taiwan, ROC
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Lin KP, Tsai CP, Yamawaki M, Ariga T, Yu RK. Heterogeneity of antibody specificity in Taiwanese patients with polyneuropathy and IgM paraproteinemia. J Biomed Sci 1998; 5:441-5. [PMID: 9845848 DOI: 10.1007/bf02255933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
About half of the Caucasian patients with chronic polyneuropathy and IgM paraproteinemia show serum anti-myelin-associated glycoprotein (MAG) and anti-sulfoglucuronosyl glycosphingolipid (SGGLs) activities. These antibody activities have been demonstrated to react with a carbohydrate epitope known as the HNK-1 or sulfoglucuronic acid (SGA) epitope. However, in Asian populations the occurrence of serum anti-SGA activities has been reported to be relatively rare. We investigated 5 cases of chronic polyneuropathy with IgM paraproteinemia from Taiwan and found that 3 of them had high-titer serum anti-SGA (SGGL/MAG) antibody activities. The clinical symptoms of these 3 patients were consistent with sensory dominant polyneuropathy with a severer involvement of the lower limbs than of the upper limbs. Electromyography and nerve conduction studies revealed severe sensory nerve involvement (no response in 3 cases) and moderate slowing of motor conduction velocity (MCV) without conduction block. The decrease in MCV correlated well with anti-SGA antibody titer (less than 30 m/s with the titration of 1:12, 800, normal 55-60 m/s). Pathological findings showed active demyelinating polyneuropathy with myelin ovoid and myelinated fiber loss. Our data suggest that anti-SGGL antibody activities may not be very rare among Asian populations. Additionally, there seems an intriguing possibility that the titer of this antibody correlates with the severity of peripheral nerve involvement in patients of demyelinating polyneuropathy with IgM paraproteinemia.
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Affiliation(s)
- K P Lin
- Neurological Institute, Department of Neurology, Veterans' General Hospital, and Department of Neurology, National Yang Ming University, Faculty of Medicine, Taipei, Taiwan, ROC
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Liu YC, Wu ZA, Wang SJ, Shan DE, Lin KP. Transient syndrome of continuous muscle fiber activity associated with staphylococcal infection. Mov Disord 1998; 13:609-11. [PMID: 9613766 DOI: 10.1002/mds.870130343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Y C Liu
- Department of Neurology, Li-Shin Hospital, Ping-Chen, Tao-Yuan, Taiwan
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Soong BW, Lin KP. An electrophysiologic and pathologic study of peripheral nerves in individuals with Machado-Joseph disease. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61:181-187. [PMID: 9614775] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Machado-Joseph disease (MJD) is characterized by cerebellar ataxia, pyramidal signs, progressive external ophthalmoplegia, and variable degrees of bulging eyes and dystonia. Electrophysiologic and histologic alterations of the peripheral nervous system in patients with MJD have rarely been reported. METHODS The peripheral nerves of four patients with MJD who were identified by polymerase chain reaction were subjected to electrophysiologic testing and histologic study. Correlation analyses were made between clinical parameters and the electrophysiologic as well as histologic changes. RESULTS Electrophysiologic studies demonstrated a marked reduction of sensory action potential, as well as a decrease in the compound motor action potential. Light microscopy of the sural nerves revealed marked loss of myelinated fibers, and morphometry studies showed a loss of large myelinated fibers. The severity of these pathologic changes was not related to the duration of the disease. CONCLUSIONS In MJD, the peripheral nervous system was frequently affected. These findings were similar to those seen in Friedreich's ataxia, suggesting a loss of sensory and motor fibers probably following a lesion of the dorsal root ganglion and the anterior horns in the spinal cord.
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Affiliation(s)
- B W Soong
- Department of Neurology, National Yang-Ming University School of Medicine, Taiwan, ROC
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Abstract
Jugular venous cannulation is generally safer than subclavian cannulation. The traumatic complications associated with jugular vein hemodialysis catheters are rare. A jugular vein, therefore, has become the preferred site for hemodialysis catheter insertion. We describe the first case of brachial plexus compression attributable to delayed recognition of a right subclavian pseudoaneurysm as a complication of jugular venous cannulation of hemodialysis catheter. We advocate that any neck swelling, new bruit, and the symptoms of brachial plexopathy after jugular venous cannulation warrant an intensive investigation to exclude arterial injury. Because delayed diagnosis may lead to a worsened prognosis in patients with brachial plexus palsy, physicians should exercise vigilance to detect and manage early the potentially serious and fatal complications of subclavian artery pseudoaneurysm and brachial nerve injury.
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Affiliation(s)
- D C Tarng
- Department of Medicine, Veterans General Hospital-Taipei, Taiwan.
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Abstract
BACKGROUND Machado-Joseph disease (MJD) is a dominantly inherited cerebellar ataxia associated with spasticity, ophthalmoplegia and dystonia. There has been no report of electrophysiological or histological alterations of the peripheral nervous system in patients with MJD. METHODS Four patients with MJD were identified by polymerase chain reaction. The peripheral nerves of these patients were subjected to electrophysiological testing and histological study. Correlation analyses were made between various clinical parameters and the electrophysiological and histological changes. RESULTS Electrophysiological studies demonstrated a marked reduction of sensory action potential, acute denervation changes on needle EMG, as well as mild decrease in the compound motor action potential. Light microscopy of the sural nerves revealed clear loss of myelinated fibers, and morphometry studies showed a loss of large myelinated fibers. Moreover, the severity of these pathological changes was found to be related to the CAG repeat length in the MJD gene. CONCLUSION Our findings indicated that the peripheral nervous system was frequently affected in patients with MJD. These findings were similar to those seen in Friedreich's ataxia, suggesting a loss of sensory and motor fibers probably following a lesion of the dorsal root ganglion and the anterior horns in the spinal cord. Furthermore, the number of CAG repeats seems to have an inverse relationship to the extent of pathological changes of the peripheral nerves.
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Affiliation(s)
- B W Soong
- Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
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Li X, Feng D, Lin KP, Huang SC. Estimation of myocardial glucose utilisation with PET using the left ventricular time-activity curve as a non-invasive input function. Med Biol Eng Comput 1998; 36:112-7. [PMID: 9614758 DOI: 10.1007/bf02522867] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 02/07/2023]
Abstract
The validation study is described of a new modelling method that has been developed, using tracer kinetic modelling with positron emission tomography (PET) to achieve non-invasive measurement of myocardial metabolic rate of glucose (MMRGlc). Eight data sets obtained from dynamic cardiac PET 2-[18F]fluoro-2-deoxy-D-glucose (FDG) studies on human subjects are employed, and the estimation of MMRGlc using both the new and traditional methods is compared. The results from all eight human FDG studies are consistent with those from previous computer simulations. With the new method, the estimated mean of K (a parameter directly proportional to MMRGlc) increases by about 8%, and that of k 4 (the rate constant of FDG dephosphorylation) decreases by about 48%. The approach should be more suitable for use in dynamic cardiac PET studies when non-invasive means are used to obtain the plasma time-activity curve from left-ventricle PET images.
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Affiliation(s)
- X Li
- Department of Computer Science, University of Sydney, NSW, Australia
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