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Hung TH, Chen VCH, Chuang YC, Hsu YH, Wu WC, Tsai YH, McIntyre RS, Weng JC. Investigating the effect of hypertension on vascular cognitive impairment by using the resting-state functional connectome. Sci Rep 2024; 14:4580. [PMID: 38403657 PMCID: PMC10894879 DOI: 10.1038/s41598-024-54996-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
Hypertension (HTN) affects over 1.2 billion individuals worldwide and is defined as systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. Hypertension is also considered a high risk factor for cerebrovascular diseases, which may lead to vascular cognitive impairment (VCI). VCI is associated with executive dysfunction and is also a transitional stage between hypertension and vascular dementia. Hence, it is essential to establish a reliable approach to diagnosing the severity of VCI. In 28 HTN (51-83 yrs; 18 males, 10 females) and 28 healthy controls (HC) (51-75 yrs; 7 males, 21 females), we investigated which regions demonstrate alterations in the resting-state functional connectome due to vascular cognitive impairment in HTN by using the amplitude of the low-frequency fluctuations (ALFF), regional homogeneity (ReHo), graph theoretical analysis (GTA), and network-based statistic (NBS) methods. In the group comparison between ALFF/ReHo, HTN showed reduced spontaneous activity in the regions corresponding to vascular or metabolic dysfunction and enhanced brain activity, mainly in the primary somatosensory cortex and prefrontal areas. We also observed cognitive dysfunction in HTN, such as executive function, processing speed, and memory. Both the GTA and NBS analyses indicated that the HTN demonstrated complex local segregation, worse global integration, and weak functional connectivity. Our findings show that resting-state functional connectivity was altered, particularly in the frontal and parietal regions, by hypertensive individuals with potential vascular cognitive impairment.
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Affiliation(s)
- Tai-Hsin Hung
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Chen Chuang
- Institute of Medical Device and Imaging, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Wen-Chau Wu
- Institute of Medical Device and Imaging, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan.
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 33302, Taiwan.
- Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan.
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Chen VCH, Chuang W, Tsai YH, McIntyre RS, Weng JC. Longitudinal assessment of chemotherapy-induced brain connectivity changes in cerebral white matter and its correlation with cognitive functioning using the GQI. Front Neurol 2024; 15:1332984. [PMID: 38385045 PMCID: PMC10879440 DOI: 10.3389/fneur.2024.1332984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Objective Breast cancer was the most prevalent type of cancer and had the highest incidence rate among women worldwide. The wide use of adjuvant chemotherapy might have a detrimental effect on the human brain and result in chemotherapy-related cognitive impairment (CICI) among breast cancer patients. Furthermore, prior to chemotherapy, patients reported cancer-related cognitive impairment (CRCI), which might be due to physiological factors or mood symptoms. The present longitudinal study aimed to investigate microstructural and macroscale white matter alterations by generalized q-sampling imaging (GQI). Methods The participants were categorized into a pre-chemotherapy group (BB) if they were diagnosed with primary breast cancer and an age-matched noncancer control group (HC). Some participants returned for follow-up assessment. In the present follow up study, 28 matched pairs of BB/BBF (follow up after chemotherapy) individuals and 28 matched pairs of HC/HCF (follow up) individuals were included. We then used GQI and graph theoretical analysis (GTA) to detect microstructural alterations in the whole brain. In addition, we evaluated the relationship between longitudinal changes in GQI indices and neuropsychological tests as well as psychiatric comorbidity. Findings The results showed that disruption of white matter integrity occurred in the default mode network (DMN) of patients after chemotherapy, such as in the corpus callosum (CC) and middle frontal gyrus (MFG). Furthermore, weaker connections between brain regions and lower segregation ability were observed in the post-chemotherapy group. Significant correlations were observed between neuropsychological tests and white matter tracts of the CC, MFG, posterior limb of the internal capsule (PLIC) and superior longitudinal fasciculus (SLF). Conclusion The results provided evidence of white matter alterations in breast cancer patients, and they may serve as potential imaging markers of cognitive changes. In the future, the study may be beneficial to create and evaluate strategies designed to maintain or improve cognitive function in breast cancer patients undergoing chemotherapy.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei Chuang
- Department of Medical Imaging and Radiological Sciences, and Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Roger S. McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medical Imaging and Radiological Sciences, and Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
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Tsai YT, Fang KH, Tsai MH, Lai CH, Ko CA, Tsai MS, Chang GH, Liao CT, Kang CJ, Hsu CM, Huang EI, Lee YC, Tsai YH, Luan CW. Prognostic utility of preoperative platelet-to-albumin ratio in surgically treated oral cavity cancer patients. Head Neck 2024; 46:386-397. [PMID: 38071495 DOI: 10.1002/hed.27592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/10/2023] [Accepted: 11/24/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study aimed to explore the prognostic utility of the preoperative platelet-to-albumin ratio (PAR) among patients with oral cavity squamous cell carcinoma (OSCC). METHODS We retrospectively reviewed of 355 patients with surgically-treated OSCC between 2008 and 2017. The optimal PAR cutoff for patient stratification was determined through X-tile analysis. Prognostic variables for disease-free survival (DFS) and overall survival (OS) were identified using Cox proportional hazards models. We developed a PAR-based nomogram to predict personalized OS. RESULTS We determined the optimal PAR cutoff to be 7.45. A PAR of ≥7.45 was an independent negative prognostic factor for DFS and OS (hazard ratio = 1.748 and 2.386; p = 0.005 and p < 0.001, respectively). The developed nomogram demonstrates the practical utility of PAR and accurately predicts personalized OS. CONCLUSIONS The preoperative PAR is a promising and cost-effective prognostic biomarker for patients with surgically-treated OSCC; the PAR-based nanogram accurately predicts OS for such patients.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ku-Hao Fang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Hsien Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chia-Hsuan Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chien-An Ko
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ethan I Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Wei Luan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Lo Sheng Sanatorium and Hospital Ministry of Health and Welfare, Taoyuan, Taiwan
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Chen VCH, Wu YF, Tsai YH, Weng JC. Association of Longitudinal Changes in Cerebral Microstructure with Cognitive Functioning in Breast Cancer Survivors after Adjuvant Chemotherapy. J Clin Med 2024; 13:668. [PMID: 38337362 PMCID: PMC10856189 DOI: 10.3390/jcm13030668] [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: 11/23/2023] [Revised: 12/28/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Adjuvant chemotherapy for breast cancer might impact cognitive function and brain structure. Methods: In this study, we investigated the cerebral microstructural changes in breast cancer survivors after adjuvant chemotherapy and the correlation with cognitive function with both cross-sectional and longitudinal study designs. All participants underwent structural MRI. In total, we recruited 67 prechemotherapy patients (BB), 67 postchemotherapy patients (BA), and 77 healthy controls (BH). For the follow-up study, 28 participants in the BH and 28 in the BB groups returned for imaging and assessment (BHF, BBF). Voxel-based morphometry analysis was performed to evaluate differences in brain volume; vertex-based shape analysis was used to assess the shape alterations of subcortical regions. Moreover, multiple regression was applied to assess the association between the changes in neuropsychological assessment and brain volume. Results: The results showed brain volume reduction in the temporal and parietal gyrus in BB and BA patients. Among each group, we also found significant shape alterations in the caudate and thalamus. Volume reductions in the temporal regions and shape changes in the caudate and hippocampus were also observed in patients from time point 1 to time point 2 (postchemotherapy). An association between brain volume and cognitive performance was also found in the limbic system. Conclusions: Based on our findings, we can provide a better understanding of the cerebral structural changes in breast cancer survivors, establish a subsequent prediction model, and serve as a reference for subsequent treatment.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Yi-Fang Wu
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan 333, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan 333, Taiwan
- Department of Artificial Intelligence, Chang Gung University, Taoyuan 333, Taiwan
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Huang YC, Lee JD, Lin LC, Weng HH, Yang JT, Tsai YH, Chen CH. Exploring the relationship between lesion morphology and pathogenesis in acute small subcortical infarction. Cerebrovasc Dis 2023:000535936. [PMID: 38128486 DOI: 10.1159/000535936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Acute small subcortical infarctions (SSIs) result from occlusions of small penetrating arteries, and the underlying pathological factors can have different clinical implications. The objective of this study was to assess the clinical relevance of acute SSIs based on their sizes and morphologies. Methods This retrospective case-control study analyzed clinical and imaging data of stroke patients with acute SSIs in penetrating artery territories who underwent MRI within 5 days of stroke onset, registered between 2016 and 2020. We categorized these patients into three groups based on size and morphology: diameter < 20mm, diameter ≧ 20mm, and separated lesions. We then evaluated their clinical characteristics and outcomes. Results We analyzed 726 stroke patients with SSIs, among whom 573 had a diameter <20mm, 99 had a diameter ≥20mm, and 54 had separated lesions. The patients had a median age of 70 years and a median National Institutes of Health Stroke Scale (NIHSS) score of 4 on arrival. Patients who experienced early neurological deterioration (END) had a significantly lower chance of good functional outcomes (27.3% vs. 64.4%, p<0.001). Patients with a diameter ≧20mm had the most severe NIHSS on arrival and at day 3, the highest rate of END, and the lowest rate of good outcome at 3 months. The incidence of cardioembolism did not differ between patients with diameters of ≥20mm and <20mm. However, multiple logistic regression analysis revealed that separated lesions were more likely to be associated with cardioembolic stroke (adjusted odds ratio [aOR], 7.6; 95% confidence interval [CI], 2.0-28.5) and parent artery stenosis >50% (aOR, 3.8; 95% CI, 2.1-7.0) than a diameter of <20mm. Moreover, SSIs with a diameter of ≥20mm was found to be associated with an increased risk of END compared to that with a diameter of <20mm (aOR, 2.9; 95% CI, 1.7-5.2). Conclusion Our study suggests that the sizes and morphologies of acute SSIs may indicate different underlying pathologies and be linked to diverse clinical outcomes. Our findings also challenge the current imaging criteria for embolic stroke of undetermined source, as we did not find a link between large subcortical infarction and cardioembolic stroke.
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Chen CH, Lee AT, Yang JT, Tsai YH, Lin LC, Huang YC. An observational study on salivary conductivity for fluid status assessment and clinical relevance in acute ischemic stroke during intravenous fluid hydration. Sci Rep 2023; 13:22460. [PMID: 38105313 PMCID: PMC10725879 DOI: 10.1038/s41598-023-49957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023] Open
Abstract
The body fluid status in acute stroke is a crucial determinant in early stroke recovery but a real-time method to monitor body fluid status is not available. This study aims to evaluate the relationship between salivary conductivity and body fluid status during the period of intravenous fluid hydration. Between June 2020 to August 2022, patients presenting with clinical signs of stroke at the emergency department were enrolled. Salivary conductivities were measured before and 3 h after intravenous hydration. Patients were considered responsive if their salivary conductivities at 3 h decreased by more than 20% compared to their baseline values. Stroke severity was assessed using the National Institutes of Health Stroke Scale, and early neurological improvement was defined as a decrease of ≥ 2 points within 72 h of admission. Among 108 recruited patients, there were 35 of stroke mimics, 6 of transient ischemic attack and 67 of acute ischemic stroke. Salivary conductivity was significantly decreased after hydration in all patients (9008 versus 8118 µs/cm, p = 0.030). Among patients with acute ischemic stroke, the responsive group, showed a higher rate of early neurological improvement within 3 days compared to the non-responsive group (37% versus 10%, p = 0.009). In a multivariate logistic regression model, a decrease in salivary conductivity of 20% or more was found to be an independent factor associated with early neurological improvement (odds ratio 5.42, 95% confidence interval 1.31-22.5, p = 0.020). Real-time salivary conductivity might be a potential indicator of hydration status of the patient with acute ischemic stroke.
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Affiliation(s)
- Chun-Hao Chen
- Department of Orthopedic, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - An-Ting Lee
- Department of Anesthesiology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi Branch, No. 6 West Chia-Pu Road, Putz, Chiayi County, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Wang TC, Tsai YH, Yang JT, Lin MS, Lin YC, Huang TJ, Chen MY. The prevalence of chronic dehydration and associated with cardiometabolic risks among agriculture and aquaculture workers. Front Public Health 2023; 11:1183557. [PMID: 37744492 PMCID: PMC10516687 DOI: 10.3389/fpubh.2023.1183557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Background Chronic dehydration is associated with complications and mortality in acute ischemic stroke patients. Prior literature indicates that farmers and fishery workers are commonly affected by cardiometabolic diseases and there is a need for early prevention of stroke. This study explores the prevalence of dehydration and the association of cardiometabolic risk profiles in agricultural and aquaculture workers. Methods We conducted a community-based, cross-sectional study of agriculture and aquaculture workers in Yunlin County of Taiwan between August 1 and December 31, 2021. Data on demographic characteristics and health-related lifestyles were collected through one-on-one interviews using a questionnaire. The threshold for dehydration is defined as serum osmolality ≥295 mOsm/kg, and physiological biomarkers were collected from a collaborating hospital. Multivariable logistic regression analyses adjusted for demographic characteristics were performed to investigate the association between dehydration levels, cardiometabolic risks, and health-related behaviors. Results A total of 962 Taiwanese agriculture and aquaculture workers who were predominantly women (65%) with a mean age of 64 years (SD = 13.8) were enrolled. The findings showed a high prevalence of dehydration (36%), metabolic syndrome (44.5%), abnormal waist circumference (64.4%), and abnormal blood pressure (68.5%). Multivariate logistic regression demonstrated that dehydration was significantly associated with metabolic syndrome (p < 0.001), 10-year stroke risk prediction (p < 0.001), and an unhealthy lifestyle (p < 0.001). Conclusion The prevalence of chronic dehydration was higher in Taiwanese agriculture and aquaculture workers, which was significantly associated with cardiometabolic risks and unhealthy lifestyles.
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Affiliation(s)
- Ta-Chin Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shyang Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Yu-Chih Lin
- Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Tung-Jung Huang
- Department of Family Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan
- School of Nursing, Chang Gung University, Taoyuan, Taiwan
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Ho KW, Fang KH, Lu CH, Hsu CM, Lai CH, Liao CT, Kang CJ, Tsai YH, Tsai MS, Huang EI, Chang GH, Ko CA, Tsai MH, Tsai YT. Prognostic Utility of Neck Lymph Node-to-Primary Tumor Standardized Uptake Value Ratio in Oral Cavity Cancer. Biomedicines 2023; 11:1954. [PMID: 37509593 PMCID: PMC10376942 DOI: 10.3390/biomedicines11071954] [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: 06/02/2023] [Revised: 07/08/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
We investigated the prognostic utility of preoperative neck lymph node-to-primary tumor maximum standardized uptake value ratios (NTRs) in oral cavity squamous cell carcinoma (OSCC). We retrospectively reviewed the medical records of 141 consecutive patients who were diagnosed as having OSCC and had received fluorodeoxyglucose-positron emission tomography within 2 weeks prior to radical surgery between 2009 and 2018. To determine the optimal NTR cutoff, receiver operating characteristic analysis for overall survival (OS) was executed. The NTR's prognostic value for disease-free survival (DFS) and OS were determined through Cox proportional hazards analysis and the Kaplan-Meier method. We determined the median (range) follow-up duration to be 35.2 (2.1-122.4) months. The optimal NTR cutoff was 0.273, and patients with a higher NTR (≥0.273) exhibited significantly worse DFS and OS (p = 0.010 and 0.003, respectively). A higher NTR (≥0.273) predicted poorer DFS (hazard ratio: 2.696, p = 0.008) and OS (hazard ratio: 4.865, p = 0.003) in multivariable analysis. We created a nomogram on the basis of the NTR, and it could accurately predict OS (concordance index: 0.774). Preoperative NTRs may be a useful prognostic biomarker for DFS and OS in patients with OSCC who have undergone surgery. NTR-based nomograms may also be helpful prognostic tools in clinical trials.
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Affiliation(s)
- Kuo-Wei Ho
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
| | - Ku-Hao Fang
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Chang-Hsien Lu
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Cheng-Ming Hsu
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Chia-Hsuan Lai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Chun-Ta Liao
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Ming-Shao Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Ethan I Huang
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Geng-He Chang
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Chien-An Ko
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
| | - Ming-Hsien Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan
| | - Yao-Te Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
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Lin CW, Tsai YH, Peng YS, Yang JT, Lu YP, Chen MY, Tung CW. A Novel Salivary Sensor with Integrated Au Electrodes and Conductivity Meters for Screening of Diabetes. Biosensors (Basel) 2023; 13:702. [PMID: 37504101 PMCID: PMC10377178 DOI: 10.3390/bios13070702] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
The rise in diabetes cases is a growing concern due to the aging of populations. This not only places a strain on healthcare systems but also creates serious public health problems. Traditional blood tests are currently used to check blood sugar levels, but they are invasive and can discourage patients from regularly monitoring their levels. We recently developed nano-sensing probes that integrate Au microelectrodes and conductivity meters, requiring only 50 μL of saliva for measurement. The usage of the co-planar design of coating-free Au electrodes makes the measurement more stable, precise, and easier. This study found a positive correlation between the participant's fasting blood sugar levels and salivary conductivity. We observed a diabetes prevalence of 11.6% among 395 adults under 65 years in this study, using the glycated hemoglobin > 6.5% definition. This study found significantly higher salivary conductivity in the diabetes group, and also a clear trend of increasing diabetes as conductivity levels rose. The prediction model, using salivary conductivity, age, and body mass index, performed well in diagnosing diabetes, with a ROC curve area of 0.75. The study participants were further divided into low and high groups based on salivary conductivity using the Youden index with a cutoff value of 5.987 ms/cm. Individuals with higher salivary conductivity had a 3.82 times greater risk of diabetes than those with lower levels, as determined by the odds ratio calculation. In conclusion, this portable sensing device for salivary conductivity has the potential to be a screening tool for detecting diabetes.
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Affiliation(s)
- Chen-Wei Lin
- Department of Medical Education, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yun-Shing Peng
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Jen-Tsung Yang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yen-Pei Lu
- National Applied Research Laboratories, Taiwan Instrument Research Institute, Hsinchu 30261, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Chun-Wu Tung
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Chang Gung Medical Education Research Centre, Taoyuan 33302, Taiwan
- Department of Biochemical Science and Technology, National Chiayi University, Chiayi 61363, Taiwan
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10
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Chen VCH, Chuang W, Chen CW, Tsai YH, McIntyre RS, Weng JC. Detecting microstructural alterations of cerebral white matter associated with breast cancer and chemotherapy revealed by generalized q-sampling MRI. Front Psychiatry 2023; 14:1161246. [PMID: 37363171 PMCID: PMC10289548 DOI: 10.3389/fpsyt.2023.1161246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Previous studies have discussed the impact of chemotherapy on the brain microstructure. There is no evidence of the impact regarding cancer-related psychiatric comorbidity on cancer survivors. We aimed to evaluate the impact of both chemotherapy and mental health problem on brain microstructural alterations and consequent cognitive dysfunction in breast cancer survivors. Methods In this cross-sectional study conducted in a tertiary center, data from 125 female breast cancer survivors who had not received chemotherapy (BB = 65; 49.86 ± 8.23 years) and had received chemotherapy (BA = 60; 49.82 ± 7.89 years) as well as from 71 age-matched healthy controls (47.18 ± 8.08 years) was collected. Chemotherapeutic agents used were docetaxel and epirubicin. We used neuropsychological testing and questionnaire to evaluate psychiatric comorbidity, cognitive dysfunction as well as generalized sampling imaging (GQI) and graph theoretical analysis (GTA) to detect microstructural alterations in the brain. Findings Cross-comparison between groups revealed that neurotoxicity caused by chemotherapy and cancer-related psychiatric comorbidity may affect the corpus callosum and middle frontal gyrus. In addition, GQI indices were correlated with the testing scores of cognitive function, quality of life, anxiety, and depression. Furthermore, weaker connections between brain regions and lower segregated ability were found in the post-treatment group. Conclusion This study suggests that chemotherapy and cancer-related mental health problem both play an important role in the development of white matter alterations and cognitive dysfunction.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei Chuang
- Department of Medical Imaging and Radiological Sciences, Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Wei Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Roger S. McIntyre
- Mood Disorder Psychopharmacology Unit, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medical Imaging and Radiological Sciences, Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan
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11
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Luan CW, Kuo LT, Wang YT, Liao CT, Kang CJ, Lee YC, Chen KY, Lai CH, Tsai YH, Huang EI, Tsai MS, Hsu CM, Chang GH, Tsai YT. Utility of modified Glasgow prognostic score for head and neck squamous cell carcinoma: Systematic review and meta-analysis. Head Neck 2023. [PMID: 37161915 DOI: 10.1002/hed.27397] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/30/2023] [Indexed: 05/11/2023] Open
Abstract
Whether the modified Glasgow prognostic score (mGPS) is useful for patients with head and neck squamous cell carcinoma (HNSCC) remains controversial. An electronic database search on EMBASE, PubMed, and the Cochrane Library from inception to 30 June 2022 was performed for study selection and data extraction. The associations between the mGPS and survival outcomes were evaluated using a random-effects meta-analysis and expressed as pooled hazard ratios (HRs) and 95% CIs. We included 11 studies involving a total of 2017 patients with HNSCC. A higher mGPS was associated with poorer progression-free survival (HR = 2.39, 95% CI 1.69-3.38), overall survival (HR = 2.40, 95% CI 1.94-2.98), disease-specific survival (HR = 2.57, 95% CI 1.71-3.88), and disease-free survival (HR = 2.67, 95% CI 1.51-4.73, all p ≤ 0.001) in HNSCC. The mGPS can function as a valid prognostic biomarker for patients diagnosed as having HNSCC.
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Affiliation(s)
- Chih-Wei Luan
- Department of Otorhinolaryngology - Head and Neck Surgery, LO-Sheng Hospital Ministry of Health and Welfare-Home, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Lunghwa University of Science and Technology, Taoyuan, Taiwan
| | - Liang-Tseng Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yun-Ting Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Ta Liao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Yin Chen
- School of Dentistry, National Yang Ming University, Hsinchu, Taiwan
| | - Chia-Hsuan Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ethan I Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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12
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Tsai YT, Lai CH, Chang GH, Hsu CM, Tsai MS, Liao CT, Kang CJ, Tsai YH, Lee YC, Huang EI, Tsai MH, Fang KH. A Nomogram Incorporating Neutrophil-to-Lymphocyte Ratio and Squamous Cell Carcinoma Antigen Predicts the Prognosis of Oral Cancers. Cancers (Basel) 2023; 15:cancers15092492. [PMID: 37173956 PMCID: PMC10177202 DOI: 10.3390/cancers15092492] [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: 03/27/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
We introduced a novel squamous cell carcinoma inflammatory index (SCI) and explored its prognostic utility for individuals with operable oral cavity squamous cell carcinomas (OSCCs). We retrospectively analyzed data from 288 patients who were given a diagnosis of primary OSCC from January 2008 to December 2017. The SCI value was derived by multiplying the serum squamous cell carcinoma antigen and neutrophil-to-lymphocyte ratio values. We appraised the associations of the SCI with survival outcomes by performing Cox proportional hazards and Kaplan-Meier analyses. We constructed a nomogram for survival predictions by incorporating independent prognostic factors in a multivariable analysis. By executing a receiver operating characteristic curve analysis, we identified the SCI cutoff to be 3.45, and 188 and 100 patients had SCI values of <3.45 and ≥3.45, respectively. The patients with a high SCI (≥3.45) were associated with worse disease-free survival and overall survival than those with a low SCI (<3.45). An elevated preoperative SCI (≥3.45) predicted adverse overall survival (hazard ratio [HR] = 2.378; p < 0.002) and disease-free survival (HR = 2.219; p < 0.001). The SCI-based nomogram accurately predicted overall survival (concordance index: 0.779). Our findings indicate that SCI is a valuable biomarker that is highly associated with patient survival outcomes in OSCC.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 60040, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
| | - Chia-Hsuan Lai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi 60040, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 60040, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 60040, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 60040, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
| | - Chun-Ta Liao
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 60040, Taiwan
| | - Yi-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Ethan I Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 60040, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
| | - Ming-Hsien Tsai
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan
| | - Ku-Hao Fang
- College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
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13
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Wang YT, Kuo LT, Lai CH, Tsai YH, Lee YC, Hsu CM, Liao CT, Kang CJ, Huang EI, Tsai MS, Chang GH, Tsai YT. Low Pretreatment Albumin-to-Globulin Ratios Predict Poor Survival Outcomes in Patients with Head and Neck Cancer: A Systematic Review and Meta-analysis. J Cancer 2023; 14:281-289. [PMID: 36741261 PMCID: PMC9891875 DOI: 10.7150/jca.80955] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/25/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Studies have indicated that a low albumin-to-globulin ratio (AGR) before treatment is linked to poor prognosis of many cancers, but the prognostic impact of AGR remains controversial in head and neck cancer (HNC). This meta-analysis examined the prognostic value of AGR in HNC. Methods: We systematically searched the Embase, PubMed, and Cochrane library for relevant articles from inception to July 22, 2022. Studies conducted from 2000 to 2022 exploring the prognostic value of AGR in HNC were retrieved. We employed a random-effects model and calculated pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) to examine the associations of AGR with survival outcome. Results: Our analysis included nine studies involving 3211 patients with HNC. The pooled results revealed significant associations between low pretreatment AGRs and poor disease-free survival (HR = 1.97, 95% CI 1.58-2.45, p < 0.001), distant metastasis-free survival (HR = 1.64, 95% CI 1.25-2.16, p < 0.001), overall survival (HR = 2.18, 95% CI 1.65-2.88, p < 0.001), T3-T4 status (OR = 2.22, 95% CI 1.43-3.44, p < 0.001), stage III-IV disease (OR = 2.62, 95% CI 1.62-4.23, p < 0.001), and lymph node metastasis (OR = 1.95, 95% CI 1.29-2.82, p = 0.001) in patients with HNC. Conclusion: AGR can serve as a prognostic biomarker in managing HNC, and a low pretreatment AGR is strongly associated with adverse survival outcomes and advanced cancer status. Additional large-scale prospective trials must be conducted to assess the validity of our findings.
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Affiliation(s)
- Yun-Ting Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Tseng Kuo
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Hsuan Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Chan Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ethan I. Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,✉ Corresponding author: Yao-Te Tsai, MD, Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. Address: No.6, W. Sec., Jiapu Rd., Puzih City, Chiayi County 613, Taiwan. E-mail: ; Tel: +886 975014653
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14
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Lee YL, Lee JD, Weng HH, Wang AN, Tsai YH. Association of Aortic Arch Calcification with Acute Ischemic Stroke Subtypes and Endovascular Thrombectomy Outcomes. J Vasc Interv Radiol 2023; 34:865-870. [PMID: 36603769 DOI: 10.1016/j.jvir.2022.12.471] [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] [Received: 07/03/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To analyze the aortic arch calcification (AAC) on computed tomography (CT) scans, with the goal of predicting the subtypes of patients with ischemic stroke and endovascular thrombectomy (EVT) outcomes. MATERIALS AND METHODS Automated analysis was used to quantify AAC on CT scans. From January 2020 to March 2021, 119 patients diagnosed with ischemic stroke were analyzed, and the feasibility of EVT was assessed; 43 underwent the procedure. RESULTS AAC was present in 117 (98.3%) of 119 patients. There was a significant difference (P <.001) in AAC severity among all patients with ischemic stroke according to the Trial of ORG 10172 in Acute Stroke Treatment classification. In patients who underwent EVT, AAC severity was significantly related to the thrombolysis in cerebral infarction grade, thrombectomy procedure time, and modified Rankin scale at discharge (P =.002, P =.035 and P =.015, respectively). Multivariate logistic regression analysis also showed that severe AAC (volume, ≥1,000 mm3) (adjusted odds ratio [OR], 12.1; adjusted 95% confidence interval [CI]), 2.1-36.4; P =.001) and intracranial atherosclerotic disease (adjusted OR, 9.5; adjusted 95% CI, 2.3-33.7; P =.001) were both independently associated with poor thrombolysis reperfusion rate. CONCLUSIONS A high proportion of patients with ischemic stroke have AAC, the severity of which is a potential imaging marker of ischemic stroke subtypes and the outcome of EVT.
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Affiliation(s)
- Yu-Li Lee
- Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang-Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - An-Ni Wang
- Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang-Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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15
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Hsu LM, Yang JT, Wen X, Liang X, Lin LC, Huang YC, Tsai YH. Human thirst behavior requires transformation of sensory inputs by intrinsic brain networks. BMC Biol 2022; 20:255. [PMID: 36357909 PMCID: PMC9650886 DOI: 10.1186/s12915-022-01446-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background To survive and thrive, many animals, including humans, have evolved goal-directed behaviors that can respond to specific physiological needs. An example is thirst, where the physiological need to maintain water balance drives the behavioral basic instinct to drink. Determining the neural basis of such behaviors, including thirst response, can provide insights into the way brain-wide systems transform sensory inputs into behavioral outputs. However, the neural basis underlying this spontaneous behavior remains unclear. Here, we provide a model of the neural basis of human thirst behavior. Results We used fMRI, coupled with functional connectivity analysis and serial-multiple mediation analysis, we found that the physiological need for water is first detected by the median preoptic nucleus (MnPO), which then regulates the intention of drinking via serial large-scale spontaneous thought-related intrinsic network interactions that include the default mode network, salience network, and frontal-parietal control network. Conclusions Our study demonstrates that the transformation in humans of sensory inputs for a single physiological need, such as to maintain water balance, requires large-scale intrinsic brain networks to transform this input into a spontaneous human behavioral response. Supplementary Information The online version contains supplementary material available at 10.1186/s12915-022-01446-5.
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16
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Chen CH, Lee M, Weng HH, Lee JD, Yang JT, Tsai YH, Huang YC. Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke. Front Neurol 2022; 13:952462. [PMID: 36176550 PMCID: PMC9513827 DOI: 10.3389/fneur.2022.952462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/25/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeThe early identification of cardioembolic stroke is critical for the early initiation of anticoagulant treatment. However, it can be challenging to identify the major cardiac source, particularly since the predominant source, paroxysmal atrial fibrillation (AF), may not be present at the time of stroke. In this study, we aimed to evaluate imaging predictors for unrecognized AF in patients with acute ischemic stroke.MethodsWe performed a cross-sectional analysis of data and magnetic resonance imaging (MRI) scans from two prospective cohorts of patients who underwent serial 12-lead electrocardiography and 24-h Holter monitoring to detect unrecognized AF. The imaging patterns in diffusion-weighted imaging and imaging characteristics were assessed and classified. A logistic regression model was used to identify predictive factors for newly detected AF in patients with acute ischemic stroke.ResultsA total of 734 patients were recruited for analysis, with a median age of 72 (interquartile range: 65–79) years and a median National Institutes of Health Stroke Scale score of 4 (interquartile range: 2–6). Of these patients, 64 (8.7%) had newly detected AF during the follow-up period. Stepwise multivariate logistic regression revealed that age ≥75 years [adjusted odds ratio (aOR) 5.66, 95% confidence interval (CI) 2.98–10.75], receiving recombinant tissue plasminogen activator treatment (aOR 4.36, 95% CI 1.65–11.54), congestive heart failure (aOR 6.73, 95% CI 1.85–24.48), early hemorrhage in MRI (aOR 3.62, 95% CI 1.52–8.61), single cortical infarct (aOR 6.49, 95% CI 2.35–17.92), and territorial infarcts (aOR 3.54, 95% CI 1.06–11.75) were associated with newly detected AF. The C-statistic of the prediction model for newly detected AF was 0.764.ConclusionInitial MRI at the time of stroke may be useful to predict which patients have cardioembolic stroke caused by unrecognized AF. Further studies are warranted to verify these findings and their application to high-risk patients.
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Affiliation(s)
- Chao-Hui Chen
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
- *Correspondence: Yen-Chu Huang
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17
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Huang SY, Hsu CM, Yang YH, Tsai YH, Tsai MS, Chang GH, Liu CY, Lee YC, Huang EI, Tsai YT. Elevated risk of acute epiglottitis in patients with chronic obstructive pulmonary disease: A nationwide cohort study. PLoS One 2022; 17:e0273437. [PMID: 35984835 PMCID: PMC9390908 DOI: 10.1371/journal.pone.0273437] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
In individuals with epiglottitis, chronic obstructive pulmonary disease (COPD) is a common comorbidity; however, the impact of COPD under such circumstances is not well documented. Therefore, we performed this population-based study to determine whether, in adults, COPD is a risk factor for epiglottitis.
Methods
In this retrospective matched-cohort study, data obtained from the Taiwan National Health Insurance Research Database were analyzed. We identified all patients newly diagnosed as having COPD in 2000–2011 and performed frequency matching and propensity-score matching for every patient with COPD individually to another patient without a COPD diagnosis. We used epiglottitis occurrence as the study endpoint, and we investigated the hazard ratio of epiglottitis by using the Cox proportional hazards model after adjustment for potential confounders.
Results
In the frequency matching, the cumulative epiglottitis incidence was significantly higher (p = 0.005) in the COPD cohort. According to the adjusted Cox proportional hazard model, COPD exhibited a significant association with elevated epiglottitis incidence (adjusted hazard ratio: 1.76; 95% confidence interval: 1.15–2.70, p = 0.009). Similar trend was observed in the propensity-score matching analysis (adjusted hazard ratio: 1.50; 95% confidence interval: 0.99–2.29, p = 0.057). Our subgroup analysis revealed COPD to be an epiglottitis risk factor in male patients and those aged 40–64 years.
Conclusions
This is the first nationwide matched-cohort research to examine the association of COPD with epiglottitis. Our results revealed that COPD may be a potential risk factor for epiglottitis; thus, clinicians should be mindful of the potential increased risk of epiglottitis following COPD.
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Affiliation(s)
- Shu-Yi Huang
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ethan I. Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
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18
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Wang CH, Chao K, Chen PT, Yeh KY, Chen YC, Chen YL, Yang SW, Wu TH, Chang PH, Young CK, Tsan DL, Tsai MH, Hsieh CY, Chen WC, Tsai YH, Hsu CM, Chang JWC, Yu WC, Shen BN. PEP503 (NBTXR3), a radioenhancer, in combination with concurrent chemoradiation (CCRT) in locally advanced or recurrent head and neck squamous cell carcinoma (HNSCC): Dose-finding of a phase 1b/2 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18041 Background: PEP503 (aka NBTXR3), a novel radioenhancer composed of functionalized hafnium oxide nanoparticles, is designed for intratumoral injection to increase radiation energy deposition within solid tumors and subsequent tumor cell killing, without increasing toxicity to surrounding healthy tissue. PEP503 nanoparticles plus RT has been tested in elderly HNSCC patients and has demonstrated a good safety profile. The phase 1b part of the study aimed to test the feasibility and the recommended phase 2 dose (RP2D) of PEP503 intratumoral injection when added with low-dose (LD) weekly cisplatin-containing chemoradiation (CCRT) in HNSCC. Methods: Patients who had T3-4 locally advanced HNSCC suitable for CCRT were eligible. An intratumoral single injection of PEP503 was performed 24 to 72 hours before the start of CCRT: consisting of IMRT (70̃72 Gy, 2-2.12 Gy/fraction) and weekly cisplatin (low dose, 40 mg/m2) concurrently during IMRT. Traditional 3+3 design was planned for dose escalation and 5 levels of PEP503 were planned, including 5%, 10%, 15%, 22%, and 33% of the baseline GTV by MRI. PEP503 Intra-tumor dispersion was anayzed by CT-scan. Results: Twelve (12) patients (male/female: 11/1; oral cavity/oropharynx: 11/1) were enrolled, with 3, 6, and 3 patients at 5%, 10%, and 15% PEP503 dose levels, respectively, in combination with LD cisplatin CCRT. DLTs were observed in one patient at 10% dose level which were G3 ALT and G3 AST increased. Common G3 AEs observed across dose levels were stomatitis (50.0%), WBC decreased (33.3%), decreased appetite (16.7%), neutrophil count decreased (16.7%), and leukopenia (16.7%), and only one G4 AE (hyponatraemia) was observed. CT images demonstrated PEP503 within the tumor contour after injection throughout the CCRT period. Hafnium, for all patients, was either not detected or below the Lower Limit of Quantification (LLOQ) in the circulation 60 minutes after PEP503 intratumoral injection, and not found in urine. DCR was achieved in 100% of patients with responding patients for an ORR of 58.3%. No subjects received salvage surgery after study treatment. Study was terminated early before MTD and RP2D could be determined. Conclusions: Adding PEP503, a radioenhancer, via a single intratumoral injection to weekly cisplatin-containing CCRT was feasible and safe for patients with locally advanced or recurrent LA-HNSCC. RP2D was not reached due to study early termination. Clinical trial information: NCT02901483.
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Affiliation(s)
- Cheng-Hsu Wang
- Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Keelung, Taiwan
| | | | | | - Kun-Yun Yeh
- Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | | | - Shih-Wei Yang
- Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tsung-Han Wu
- Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Pei-Hung Chang
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung, Taiwan
| | | | - Din-Li Tsan
- Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ming-Hsui Tsai
- Cancer Center, China Medical University Hospital, Taichung, Taiwan
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19
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Tsai YH, Yan YJ, Li YS, Chang CH, Haung CC, Chen TC, Lin SG, Ou-Yang M. Development and verification of the coaxial heterogeneous hyperspectral imaging system. Rev Sci Instrum 2022; 93:063105. [PMID: 35778029 DOI: 10.1063/5.0088474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
A hyperspectral imaging system (HIS) is a helpful tool that acquires spatial and spectral information from a target. This study developed a coaxial heterogeneous HIS (CHHIS) to collect spectral images with wavelengths ranging from 400 to 1700 nm. In this system, a visible (VIS) spectrometer and a short-wave infrared (SWIR) spectrometer are combined with a coaxial optical path to share the same field of view. This structure reduces the complexity of spatial registration and maintains the scanning duration of two spectrometers as that of a single spectrometer. The spectrometers are also replaceable for extending the detecting spectral range of the system. The calibration methodologies, including spatial correction, spectral calibration, and reflectance calibration, were developed for this system. The signal-to-noise ratio of VIS and SWIR spectrometers in the CHHIS was up to 40 and 60 dB when the exposure time of the VIS and SWIR imaging sensors was 1000 and 10 ms, respectively. When the target distance was at 600 mm, the spatial error of VIS and SWIR images in the scanning direction was less than 1 pixel; these results proved that the system was stable.
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Affiliation(s)
- Y H Tsai
- Institute of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Y J Yan
- Institute of Electrical and Control Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Y S Li
- Institute of Electrical and Control Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - C H Chang
- Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - C C Haung
- Department of Tropical Fruit Trees (Fengshan Tropical Horticultural Experiment Branch), Taiwan Agricultural Research Institute, Kaohsiung 30010, Taiwan
| | - T C Chen
- Department of Aerospace and Systems Engineering, Feng Chia University, Taichung 30010, Taiwan
| | - S G Lin
- Department of Communication, Navigation and Control Engineering, National Taiwan Ocean University, Keelung, Taiwan
| | - M Ou-Yang
- Institute of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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20
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Huang YC, Chang CH, Tsai YH, Weng HH, Lin LC, Lee JD. PCSK9 inhibition in patients with acute stroke and symptomatic intracranial atherosclerosis: protocol for a prospective, randomised, open-label, blinded end-point trial with vessel-wall MR imaging. BMJ Open 2022; 12:e060068. [PMID: 35487727 PMCID: PMC9058777 DOI: 10.1136/bmjopen-2021-060068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Dual antiplatelet therapy and high-intensity statins are the mainstay treatment in patients with acute stage, symptomatic intracranial atherosclerotic stenosis (ICAS). Alirocumab is a monoclonal antibody that can inhibit proprotein convertase subtilisin-kexin type 9 and effectively lower low-density lipoprotein cholesterol levels with less side effects than statins. We hypothesise that alirocumab treatment in addition to statin therapy could stabilise intracranial plaque and reduce arterial stenosis. METHODS AND ANALYSIS In this prospective, randomised, open-label, blinded end-point study, we will use high-resolution vessel-wall MRI to evaluate the efficacy and safety of alirocumab in patients who had an acute ischaemic stroke from ICAS. We will recruit 66 patients who had an acute ischaemic stroke within 7 days of symptom onset, who had symptomatic intracranial artery stenosis (>30%) at the middle cerebral artery, basilar artery or intracranial internal carotid artery. Among them, 22 patients will be randomised to the intervention group to receive treatment with 75 mg alirocumab subcutaneously every 2 weeks for a total of 26 weeks, while those in the control group will not. All patients in both groups will receive antiplatelet agents and high-intensity statins, including 20 mg rosuvastatin or 40-80 mg atorvastatin or at the maximum tolerated dose. All of them will undergo MRI at recruitment and after 26 weeks. The primary outcomes are changes in intracranial atherosclerotic plaques in the MRI before and after 6 months treatment. This trial is being conducted at Chang Gung Memorial Hospital at Chiayi, Taiwan. ETHICS AND DISSEMINATION This trial has been approved by the Institutional Review Board of Chang Gung Memorial Hospital (approval no. 202 002 482A3). Written informed consent will be obtained from all research participants. Study results will be published as peer-reviewed articles. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, Identifier: NCT05001984; Pre-results.
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Affiliation(s)
- Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi County, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hao Chang
- College of Nursing and Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi County, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi County, Taiwan
- College of Nursing, Chang Gung University of Science and Technology, Chiayi County, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi County, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi County, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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21
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Lin CW, Tsai YH, Lu YP, Yang JT, Chen MY, Huang TJ, Weng RC, Tung CW. Application of a Novel Biosensor for Salivary Conductivity in Detecting Chronic Kidney Disease. Biosensors (Basel) 2022; 12:bios12030178. [PMID: 35323448 PMCID: PMC8946539 DOI: 10.3390/bios12030178] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 06/12/2023]
Abstract
The prevalence of chronic kidney disease (CKD) is increasing, and it brings an enormous healthcare burden. The traditional measurement of kidney function needs invasive blood tests, which hinders the early detection and causes low awareness of CKD. We recently designed a device with miniaturized coplanar biosensing probes for measuring salivary conductivity at an extremely low volume (50 μL). Our preliminary data discovered that the salivary conductivity was significantly higher in the CKD patients. This cross-sectional study aims to validate the relationship between salivary conductivity and kidney function, represented by the estimated glomerular filtration rate (eGFR). We enrolled 214 adult participants with a mean age of 63.96 ± 13.53 years, of whom 33.2% were male. The prevalence rate of CKD, defined as eGFR < 60 mL/min/1.73 m2, is 11.2% in our study. By multivariate linear regression analyses, we found that salivary conductivity was positively related to age and fasting glucose but negatively associated with eGFR. We further divided subjects into low, medium, and high groups according to the tertials of salivary conductivity levels. There was a significant trend for an increment of CKD patients from low to high salivary conductivity groups (4.2% vs. 12.5% vs. 16.9%, p for trend: 0.016). The receiver operating characteristic (ROC) curves disclosed an excellent performance by using salivary conductivity combined with age, gender, and body weight to diagnose CKD (AUC equal to 0.8). The adjusted odds ratio of CKD is 2.66 (95% CI, 1.10−6.46) in subjects with high salivary conductivity levels. Overall, salivary conductivity can serve as a good surrogate marker of kidney function; this real-time, non-invasive, and easy-to-use portable biosensing device may be a reliable tool for screening CKD.
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Affiliation(s)
- Chen-Wei Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Medical Education, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-T.Y.); (T.-J.H.)
| | - Yen-Pei Lu
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu 30261, Taiwan; (Y.-P.L.); (R.-C.W.)
| | - Jen-Tsung Yang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-T.Y.); (T.-J.H.)
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan;
| | - Tung-Jung Huang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (J.-T.Y.); (T.-J.H.)
- Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin 63862, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Rui-Cian Weng
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Hsinchu 30261, Taiwan; (Y.-P.L.); (R.-C.W.)
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 106319, Taiwan
| | - Chun-Wu Tung
- Department of Medical Education, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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22
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Huang YC, Lee JD, Weng HH, Lin LC, Tsai YH, Yang JT. Statin and dual antiplatelet therapy for the prevention of early neurological deterioration and recurrent stroke in branch atheromatous disease: a protocol for a prospective single-arm study using a historical control for comparison. BMJ Open 2021; 11:e054381. [PMID: 34836908 PMCID: PMC8628334 DOI: 10.1136/bmjopen-2021-054381] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Branch atheromatous disease (BAD) contributes to small-vessel occlusion in cases of occlusion or stenosis of large calibre penetrating arteries, and it is associated with a higher possibility of early neurological deterioration (END) and recurrent stroke in acute ischaemic stroke. As the pathology of BAD is due to atherosclerosis, we postulate that early intensive medical treatment with dual antiplatelet therapy (DAPT) and high-intensity statins may prevent END and recurrent stroke in acute small subcortical infarction caused by BAD. METHODS AND ANALYSIS In this prospective, single-centre, open-label, non-randomised, single-arm study using a historical control, we will compare early DAPT and high-intensity statin treatment with a historical control group of patients with BAD who were treated with single antiplatelet therapy without high-intensity statin treatment. Patients will be eligible for enrolment if they are admitted for acute ischaemic stroke within 24 hours, have a National Institutes of Health Stroke Scale (NIHSS) score of 1-8 and are diagnosed with BAD by MRI. Patients will take aspirin, clopidogrel and high-intensity statins (atorvastatin or rosuvastatin) within 24 hours of stroke onset, followed by aspirin or clopidogrel alone from day 22. The primary endpoint is the percentage of patients who develop END within 7 days of stroke onset (defined as an increase in the NIHSS score ≥2 points) and recurrent stroke within 30 days. The total sample sizes will be 138 for the intervention group and 277 for the control group. A historical control group will be drawn from previous prospective observation studies. ETHICS AND DISSEMINATION The protocol of this study has been approved by the Institutional Review Board of Chang Gung Memorial Hospital (202001386A3). All participants will have to sign and date an informed consent form. The findings arising from this study will be disseminated in peer-reviewed journals and academic conferences. TRIAL REGISTRATION NUMBER NCT04824911.
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Affiliation(s)
- Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Radiology, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
| | - Jen-Tsung Yang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan
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23
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Chen VCH, Kao CJ, Tsai YH, Cheok MT, McIntyre RS, Weng JC. Assessment of Disrupted Brain Structural Connectome in Depressive Patients With Suicidal Ideation Using Generalized Q-Sampling MRI. Front Hum Neurosci 2021; 15:711731. [PMID: 34512298 PMCID: PMC8430248 DOI: 10.3389/fnhum.2021.711731] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Suicide is one of the leading causes of mortality worldwide. Various factors could lead to suicidal ideation (SI), while depression is the predominant cause among all mental disorders. Studies have shown that alterations in brain structures and networks may be highly associated with suicidality. This study investigated both neurological structural variations and network alterations in depressed patients with suicidal ideation by using generalized q-sampling imaging (GQI) and Graph Theoretical Analysis (GTA). This study recruited 155 participants and divided them into three groups: 44 depressed patients with suicidal ideation (SI+; 20 males and 24 females with mean age = 42, SD = 12), 56 depressed patients without suicidal ideation (Depressed; 24 males and 32 females with mean age = 45, SD = 11) and 55 healthy controls (HC; nine males and 46 females with mean age = 39, SD = 11). Both the generalized fractional anisotropy (GFA) and normalized quantitative anisotropy (NQA) values were evaluated in a voxel-based statistical analysis by GQI. We analyzed different topological parameters in the graph theoretical analysis and the subnetwork interconnections in the Network-based Statistical (NBS) analysis. In the voxel-based statistical analysis, both the GFA and NQA values in the SI+ group were generally lower than those in the Depressed and HC groups in the corpus callosum and cingulate gyrus. Furthermore, we found that the SI+ group demonstrated higher global integration and lower local segregation among the three groups of participants. In the network-based statistical analysis, we discovered that the SI+ group had stronger connections of subnetworks in the frontal lobe than the HC group. We found significant structural differences in depressed patients with suicidal ideation compared to depressed patients without suicidal ideation and healthy controls and we also found several network alterations among these groups of participants, which indicated that white matter integrity and network alterations are associated with patients with depression as well as suicidal ideation.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Ju Kao
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Man Teng Cheok
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan.,Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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24
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Shen CY, Tsai YH, Chen VCH, Chou MC, McIntyre RS, Weng JC. Comparison of functional dorsal attention network alterations in breast cancer survivors before and after chemotherapy. Medicine (Baltimore) 2021; 100:e27018. [PMID: 34414995 PMCID: PMC8376308 DOI: 10.1097/md.0000000000027018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Breast cancer is the leading type of cancer among women worldwide, and a high number of breast cancer patients are suffering from psychological and cognitive disorders. This cross-sectional study used resting-state functional magnetic resonance imaging (rs-fMRI) and clinical neuropsychological tests to evaluate the possible underlying mechanisms.We enrolled 32 breast cancer patients without chemotherapy (BC), 32 breast cancer patients within 6 to 12 months after the completion of chemotherapy (BC_CTx) and 46 healthy controls. Participants underwent neuropsychological tests and rs-fMRI with mean fractional amplitude of low-frequency fluctuation and mean regional homogeneity analyses. Between groups whole-brain voxel-wise rs-fMRI comparisons were calculated using two-sample t test. rs-fMRI and neuropsychological tests correlation analyses were calculated using multiple regression. Age and years of education were used as covariates. A false discovery rate-corrected P-value of less than .05 was considered statistically significant.We found significantly alteration of mean fractional amplitude of low-frequency fluctuation and mean regional homogeneity in the frontoparietal lobe and occipital lobe in the BC group compared with the other 2 groups, indicating alteration of functional dorsal attention network (DAN). Furthermore, we found the DAN alteration was correlated with neuropsychological impairment.The majority of potential underlying mechanisms of DAN alteration in BC patients may due to insufficient frontoparietal lobe neural activity to drive DAN and may be related to the effects of neuropsychological distress. Further longitudinal studies with comprehensive images and neuropsychological tests correlations are recommended.
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Affiliation(s)
- Chao-Yu Shen
- Institute of Medicine and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Chih Chou
- Institute of Medicine and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Roger S. McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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25
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Kao CH, Lee MH, Yang JT, Tsai YH, Lin MHC. Percutaneous Radiofrequency Rhizotomy Is Equally Effective for Trigeminal Neuralgia Patients with or without Neurovascular Compression. Pain Med 2021; 23:807-814. [PMID: 34264315 DOI: 10.1093/pm/pnab221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) can be a factor of treatment outcome especially in microvascular decompression and stereotactic radiosurgery. No such effect has been reported in percutaneous radiofrequency rhizotomy (RF). This study is to investigate if NVC affects the efficacy of RF in patients with TN. METHODS We retrospectively reviewed patients with TN who received RF in our institution. Pre-treatment MRI was performed in every patient, and the presence of NVC was reviewed independently by two physicians. The patients were followed up at least for a year after the treatment. Pain severity was assessed with numerical rating scale (NRS). RESULTS Sixty-two patients were included in the study. All the patients had single-sided lesion, and 35 patients had NVC. There was no significant difference between these two groups of patients in terms of gender distribution, age, and pre-treatment pain severity. Comparable pain severity improvement was found in one-year follow-up between these two groups (NRS 7.93 ± 0.492 without compression vs. 7.57 ± 0.451 with compression, p = 0.600). No significant difference in post-treatment pain severity at one year between these two patient groups (NRS 1.37 ± 0.466 without compression vs. 1.66 ± 0.458 with compression, p = 0.667) was found. CONCLUSIONS For patients with TN treated by RF, the presence of NVC or not is not likely to affect the one-year pain control rate.
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Affiliation(s)
- Chih-Hao Kao
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Ming-Hsueh Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan 33302, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
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Chang SW, Tsai YH, Hsu CM, Huang EI, Chang GH, Tsai MS, Tsai YT. Masticatory muscle index for indicating skeletal muscle mass in patients with head and neck cancer. PLoS One 2021; 16:e0251455. [PMID: 33970954 PMCID: PMC8109770 DOI: 10.1371/journal.pone.0251455] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background A typical assessment for sarcopenia involves the use of abdominal computed tomography (CT) for calculating the skeletal muscle index (SMI) at the level of the third lumbar vertebra (L3). However, abdominal CT is not regularly performed on patients with head and neck cancer (HNC). We investigated whether masticatory SMI (M-SMI) measurements based on head and neck CT scans can be used to conduct sarcopenia assessments by evaluating whether M-SMI is correlated with L3-SMI. Methods Abdominal and head and neck CT images of patients with trauma (n = 50) and HNC (n = 52) were analyzed retrospectively. Both manual delineation and threshold selection methods were used to measure cross-sectional areas of masticatory muscles and those of muscles at the L3 level on CT images. Muscle cross-sectional areas were normalized to height squared to calculate SMI, and a multivariate linear regression model was established to evaluate the correlation between the M-SMI and L3-SMI. Receiver operating characteristic curve analysis was used to assess the ability of the M-SMI to identify sarcopenia, and Cox logistic regression was used to identify predictors of sarcopenia. Results Patients with HNC had significantly lower M-SMI and L3-SMI than did patients with trauma (p = 0.011 and 0.03, respectively). M-SMI and L3-SMI were strongly correlated (r = 0.901, p < 0.001); in the multivariate model that included sex, the correlation was stronger (r = 0.913, p < 0.001). The associations of sarcopenia with a lower M-SMI (p < 0.001), male sex (p = 0.028), and advanced age (p = 0.011) were significant, and multivariate logistic analysis demonstrated that an M-SMI of <5.5 was an independent predictor of sarcopenia (hazard ratio = 5.37, p < 0.001). Conclusions M-SMI assessment in routine head and neck CT scans is feasible and can be an alternative for detecting sarcopenia in patients with HNC.
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Affiliation(s)
- Sheng-Wei Chang
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ethan I. Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
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Chen VCH, Kao CJ, Tsai YH, McIntyre RS, Weng JC. Mapping Brain Microstructure and Network Alterations in Depressive Patients with Suicide Attempts Using Generalized Q-Sampling MRI. J Pers Med 2021; 11:jpm11030174. [PMID: 33802354 PMCID: PMC7998726 DOI: 10.3390/jpm11030174] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Depressive disorder is one of the leading causes of disability worldwide, with a high prevalence and chronic course. Depressive disorder carries an increased risk of suicide. Alterations in brain structure and networks may play an important role in suicidality among depressed patients. Diffusion magnetic resonance imaging (MRI) is a noninvasive method to map white-matter fiber orientations and provide quantitative parameters. This study investigated the neurological structural differences and network alterations in depressed patients with suicide attempts by using generalized q-sampling imaging (GQI). Our study recruited 155 participants and assigned them into three groups: 44 depressed patients with a history of suicide attempts (SA), 56 depressed patients without a history of suicide attempts (D) and 55 healthy controls (HC). We used the GQI to analyze the generalized fractional anisotropy (GFA) and normalized quantitative anisotropy (NQA) values in voxel-based statistical analysis, topological parameters in graph theoretical analysis and subnetwork connectivity in network-based statistical analysis. GFA indicates the measurement of neural anisotropy and represents white-matter integrity; NQA indicates the amount of anisotropic spins that diffuse along fiber orientations and represents white-matter compactness. In the voxel-based statistical analysis, we found lower GFA and NQA values in the SA group than in the D and HC groups and lower GFA and NQA values in the D group than in the HC group. In the graph theoretical analysis, the SA group demonstrated higher local segregation and lower global integration among the three groups. In the network-based statistical analysis, the SA group showed stronger subnetwork connections in the frontal and parietal lobes, and the D group showed stronger subnetwork connections in the parietal lobe than the HC group. Alternations were found in the structural differences and network measurements in healthy controls and depressed patients with and without a history of suicide attempt.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (V.C.-H.C.); (Y.-H.T.)
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Chun-Ju Kao
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, No. 259, Wenhua 1st Rd., Taoyuan 33302, Taiwan;
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (V.C.-H.C.); (Y.-H.T.)
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Roger S. McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, ON M5S, Canada;
- Institute of Medical Science, University of Toronto, Toronto, ON M5S, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON M5S, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, No. 259, Wenhua 1st Rd., Taoyuan 33302, Taiwan;
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-3-2118800 (ext. 5394)
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Chen VCH, Wong FT, Tsai YH, Cheok MT, Chang YPE, McIntyre RS, Weng JC. Convolutional Neural Network-Based Deep Learning Model for Predicting Differential Suicidality in Depressive Patients Using Brain Generalized q-Sampling Imaging. J Clin Psychiatry 2021; 82. [PMID: 33988925 DOI: 10.4088/jcp.19m13225] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide is a priority health problem. Suicide assessment depends on imperfect clinician assessment with minimal ability to predict the risk of suicide. Machine learning/deep learning provides an opportunity to detect an individual at risk of suicide to a greater extent than clinician assessment. The present study aimed to use deep learning of structural magnetic resonance imaging (MRI) to create an algorithm for detecting suicidal ideation and suicidal attempts. METHODS We recruited 4 groups comprising a total of 186 participants: 33 depressive patients with suicide attempt (SA), 41 depressive patients with suicidal ideation (SI), 54 depressive patients without suicidal thoughts (DP), and 58 healthy controls (HCs). The confirmation of depressive disorder, SA and SI was based on psychiatrists' diagnosis and Mini-International Neuropsychiatric Interview (MINI) interviews. In the generalized q-sampling imaging (GQI) dataset, indices of generalized fractional anisotropy (GFA), the isotropic value of the orientation distribution function (ISO), and normalized quantitative anisotropy (NQA) were separately trained in convolutional neural network (CNN)-based deep learning and DenseNet models. RESULTS From the results of 5-fold cross-validation, the best accuracies of the CNN classifier for predicting SA, SI, and DP against HCs were 0.916, 0.792, and 0.589, respectively. In SA-ISO, DenseNet outperformed the simple CNNs with a best accuracy from 5-fold cross-validation of 0.937. In SA-NQA, the best accuracy was 0.915. CONCLUSIONS The results showed that a deep learning method based on structural MRI can effectively detect individuals at different levels of suicide risk, from depression to suicidal ideation and attempted suicide. Further studies from different populations, larger sample sizes, and prospective follow-up studies are warranted to confirm the utility of deep learning methods for suicide prevention and intervention.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Fu-Te Wong
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Man Teng Cheok
- Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Peng Eve Chang
- Department of Counseling and Clinical Psychology, Columbia University, New York City, New York
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Medical Imaging and Radiological Sciences, Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan.,Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Corresponding author: Jun-Cheng Weng, PhD, Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan Dist., Taoyuan City 33302, Taiwan
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Chang SW, Hsu CM, Tsai YH, Chang GH, Tsai MS, Huang EI, Tsai YT. Prognostic Value of Third Cervical Vertebra Skeletal Muscle Index in Oral Cavity Cancer: A Retrospective Study. Laryngoscope 2021; 131:E2257-E2265. [PMID: 33433021 DOI: 10.1002/lary.29390] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/23/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS To assess the prognostic utility of third cervical vertebra skeletal muscle index (C3 SMI) measured from preoperative head and neck computed tomography (CT) in patients with oral cavity squamous cell carcinoma (OSCC). STUDY DESIGN Retrospective study. METHODS We retrospectively reviewed the medical records of 125 patients who underwent primary curative surgery for OSCC between 2009 and 2017. Their preoperative C3 SMI was calculated by adjusting the C3 cross-sectional area delineated on head and neck CT by body height squared. A Cox proportional hazard model was employed to identify prognostic factors, and a novel nomogram based on C3 SMI was built for individualized survival prediction. RESULTS In Kaplan-Meier analysis, high C3 SMI was significantly associated with higher 5-year disease-free survival (DFS) and overall survival (OS) than low C3 SMI. In multivariate analysis, low C3 SMI was an independent risk factor for poor DFS and OS (hazard ratio [HR]: 2.197; 95% confidence interval [CI], 1.170-4.512, P = .032 and HR: 2.143; 95% CI, 1.232-3.728, P = .007, respectively). The concordance-index (C-index) of the nomogram based on C3 SMI was 0.814 for OS, higher than that of the nomogram based on tumor-node-metastasis staging alone (C-index = 0.731). CONCLUSIONS C3 SMI might serve as a novel prognosticator in OSCC patients undergoing curative surgery, and the nomogram based on C3 SMI might provide good prognostic discrimination ability for individualized survival prediction. LEVEL OF EVIDENCE IV Laryngoscope, 131:E2257-E2265, 2021.
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Affiliation(s)
- Sheng-Wei Chang
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ming Hsu
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shao Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ethan I Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Chen VCH, Chou YS, Tsai YH, Huang YC, McIntyre RS, Weng JC. Resting-State Functional Connectivity and Brain Network Abnormalities in Depressive Patients with Suicidal Ideation. Brain Topogr 2021; 34:234-244. [PMID: 33420533 DOI: 10.1007/s10548-020-00817-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
Our study aimed to investigate whether changes in brain function measured with functional magnetic resonance imaging (fMRI) can be detected among individuals with depressive disorders and suicidal ideation. The association between depression severity and brain images is also discussed. Our study recruited 111 participants in three groups: 35 depressive patients with suicidal ideation (SI), 32 depressive patients without suicidal ideation (NS), and 44 healthy controls (HCs). All participants were scanned using 3T MRI to obtain resting-state functional images, and functional connectivity (FC), amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and graph theoretical analysis (GTA) were performed. We found functional activity differences, such as the hippocampus and thalamus, in the SI group compared with the NS group. We also concluded lower activity in the thalamus and cuneus regions were related to suicidal ideation. We also found several functional connectivity of the brain areas, such as hippocampus, cuneus, and frontal regions, in the SI group correlated with Hamilton Depression Rating Scale (HAM-D) and Hospital Anxiety and Depression Scale (HADS). A graph theoretical analysis (GTA) and network-based statistical (NBS) analysis revealed different topological organization and slightly better local segregation of the brain network in healthy participants compared with those in depressive patients with suicidal ideation. We suggest that brain functional connectivity may be affected in depressive patients with suicidal ideation.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Syuan Chou
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,Department of Medical Imaging and Radiological Sciences, and Bachelor Program in Artificial Intelligence, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 33302, Taiwan. .,Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Kao CC, Chen CW, Tseng YH, Tsai YH, Wang SC, Huang YK. Non-contrast-enhanced magnetic resonance imaging: Objective figures in differentiation between acute and chronic deep venous thrombosis in the lower extremities. Phlebology 2020; 35:777-783. [PMID: 32635819 DOI: 10.1177/0268355520939375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/13/2023]
Abstract
BACKGROUND Deep vein thrombosis is a severe health problem. Treatment options may differ between acute and chronic deep vein thrombosis. Thus, distinguishing acute from chronic deep vein thrombosis is essential for patients with deep vein thrombosis.Triggered angiography non-contrast enhanced is an innovative magnetic resonance imaging protocol that may provide objective evidence in differentiating acute from chronic deep vein thrombosis. METHOD We prospectively collected information on consecutive patients who had been evaluated through triggered angiography non-contrast enhanced magnetic resonance imaging for venous pathology in their lower extremities at a vascular wound care center in a tertiary hospital between April 2017 and January 2020. Patients included were divided into two groups with the onset time cutoff point of 21 days. All were undergone non-contrast-enhanced magnetic resonance imaging evaluation. Non-contrast-enhanced magnetic resonance imaging images were evaluated by a radiologist, and lower extremity venous thrombosis, collateral-vein development, and subcutaneous honeycombing were emphasized. Cohen's kappa coefficient was used to measure interrater agreement between the development of collateral veins, subcutaneous honeycombing, and symptom onset over 21 days. RESULTS Interrater agreement analysis revealed that the development of collateral veins was substantially correlated with the onset of symptoms over 21 days (Table 1). Additionally, the development of subcutaneous honeycombing detected through triggered angiography non-contrast enhanced magnetic resonance imaging also substantially agreed with the onset of symptoms over 21 days (Table 2). CONCLUSION The diagnostic power of triggered angiography non-contrast enhanced magnetic resonance imaging in deep vein thrombosis is rival to current gold standard, color Doppler sonography. Triggered angiography non-contrast enhanced magnetic resonance imaging provides objective information on onset timing in patients with deep vein thrombosis that could differentiate acute from chronic deep vein thrombosis and provides guidance for treatment planning.
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Affiliation(s)
- Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan.,Institute of Medicine, Chung Shan Medical University, Taichung
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Chiayi and Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, College of Medicine, Taoyuan
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Lian ME, Tsai YH, Li IG, Hong YH, Chang SL, Tsai HY. Occupational radiation dose to the eye lens of physicians from departments of interventional radiology. RADIAT MEAS 2020. [DOI: 10.1016/j.radmeas.2020.106276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Huang YK, Tseng YH, Lin CH, Tsai YH, Hsu YC, Wang SC, Chen CW. Evaluation of venous pathology of the lower extremities with triggered angiography non-contrast-enhanced magnetic resonance imaging. BMC Med Imaging 2019; 19:96. [PMID: 31847822 PMCID: PMC6918566 DOI: 10.1186/s12880-019-0395-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 06/09/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background To explore the diagnostic performance of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) for the evaluation of venous pathology of the lower extremity. Methods This was a single-centre prospective cohort study of 25 patients with suspected venous disease in the lower extremities. Each patient received Doppler ultrasonography (for venous evaluation) before the scheduled TRANCE-MRI (for venous and arterial evaluations) on a 1.5 T MR scanner (Philips Ingenia, Philips Healthcare, Best, the Netherlands), followed by lymphography and computed tomography angiography that were arranged according to the diagnostic indications. Results The sensitivity, specificity and accuracy of TRANCE-MRI were 85.7%, 88/9 and 88%, respectively. The inter-rater agreement for deep vein thrombosis (DVT) of the thigh between the ultrasonography and TRANCE-MRI results was substantial agreement (Cohen’s kappa κ, 0.72). In ultrasonography-negative cases, TRANCE-MRI detected four additional cases (16%, 4/25) of DVT; three cases (12%, 3/25) of venous compression caused by pelvic lymphadenopathy, hip prosthesis or knee joint effusion; one case (4%, 1/25) of vena cava anomaly; two cases (8%, 2/25) of occult peripheral artery disease (PAD); and one case (4%, 1/25) of an occluded bypass graft. Conclusion TRANCE-MRI can be used as an alternative and objective tool for assessing lower extremity diseases, especially suspected venous pathology. Compared with ultrasonography, TRANCE-MRI plays a better role in assessing varicose veins of the lower extremities and deep veins of the pelvis and abdomen. However, false-positive results may occur in the left common iliac vein of elderly patients. Finally, occult PAD rarely occurs in patients with suspected lower extremity venous disease. Therefore, we recommend performing the TRANCE-MRV protocol instead of the full protocol (MRV + MRA) in the clinical setting in patients with venous scenarios.
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Affiliation(s)
- Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Wound Center and Plastic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Wound Center and Plastic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hung Lin
- Wound Center and Plastic Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi and Taoyuan, Taiwan
| | - Yin-Chen Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi and Taoyuan, Taiwan
| | - Shih-Chung Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi and Taoyuan, Taiwan.,Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Chien-Wei Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi and Taoyuan, Taiwan. .,Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Weng JC, Chou YS, Tsai YH, Lee CT, Hsieh MH, Chen VCH. Connectome Analysis of Brain Functional Network Alterations in Depressive Patients with Suicidal Attempt. J Clin Med 2019; 8:jcm8111966. [PMID: 31739450 PMCID: PMC6912611 DOI: 10.3390/jcm8111966] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022] Open
Abstract
Our study aimed to clarify the neuroimaging correlates of suicide attempt by comparing differences in functional magnetic resonance imaging (fMRI) among depressed suicide attempters, depressed patients without suicide attempt history, and healthy controls through comprehensive and novel fMRI analyses and methods in the same study population. The association between depression severity and aspects of the brain imaging was also discussed. Our study recruited 109 participants who were assigned to three groups: 33 depressed patients with suicide attempt (SA), 32 depressed patients without suicide attempt (NS), and 44 healthy controls (HC). All participants were scanned using a 3 T MRI imaging system to obtain resting-state functional images. In seed-based correlation analysis, we found altered functional connectivity in some brain regions of the SA compared with the NS or HC, especially in the hippocampus and thalamus. In the voxel-based analysis, our results showed differential activation and regional homogeneity of the temporal lobe and several brain regions in the SA compared with the NS and HC. We also found that some brain areas correlated with the Hamilton Depression Rating Scale (HAM-D), anxiety, and depression scores, especially in the frontal and temporal lobes. Graph theoretical analysis (GTA) and network-based statistical (NBS) analyses revealed different topological organization as well as slightly better global integration and worse local segregation of the brain network (i.e., more like a random network) in depressed participants compared with healthy participants. We concluded that the brain function of major depressive disorders with and without suicide attempts changed compared with healthy participants.
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Affiliation(s)
- Jun-Cheng Weng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan 33302, Taiwan;
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yu-Syuan Chou
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Chun-Te Lee
- Department of Psychiatry, School of Medicine, Chung Shan Medical University and Hospital, Taichung 40201, Taiwan; (C.-T.L.); (M.-H.H.)
| | - Ming-Hong Hsieh
- Department of Psychiatry, School of Medicine, Chung Shan Medical University and Hospital, Taichung 40201, Taiwan; (C.-T.L.); (M.-H.H.)
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Correspondence: ; Tel.: +886-5-3621000 (ext. 2315)
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Tsai YH, Liang X, Yang JT, Hsu LM. Modular organization of brain resting state networks in patients with classical trigeminal neuralgia. Neuroimage Clin 2019; 24:102027. [PMID: 31677586 PMCID: PMC6978210 DOI: 10.1016/j.nicl.2019.102027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/22/2019] [Accepted: 10/02/2019] [Indexed: 01/03/2023]
Abstract
Sensorimotor network and default mode network activities were lower in trigeminal neuralgia patients and increased after surgery. Higher communication between the default mode network module and other modules before surgery was associated with better treatment response. Subcortical modules was associated with pain duration. A lower connection between the default mode network and subcortical modules was associated with a better treatment response and the thalamus and midcingulate cortex were the major connectors within the subcortical module.
Background The modular organization of brain networks in trigeminal neuralgia patients has remained largely unknown. We aimed to analyze the brain modules and intermodule connectivity in patients with trigeminal neuralgia before and after percutaneous radiofrequency rhizotomy treatment to identify specific modules that may be associated with the development and brain plasticity of trigeminal neuralgia and to test the ability of modularity analysis to be a predictive imaging biomarker for the treatment effect in patients with trigeminal neuralgia. Methods A total of 25 patients with right trigeminal neuralgia and 20 matched healthy subjects were included. Blood-oxygen-level dependent resting state fMRI was used to analyze the brain modular organization. Results Whole brain modularity analysis identified seven modules. The metric of intermodule connectivity, participation coefficient, of the sensorimotor network and default mode network modules were significantly lower in patients and increased after surgery. The participation coefficient of the subcortical modules was associated with the pain duration. Higher communication between the default mode network module and other modules before surgery was associated with a better treatment response. Furthermore, the subcortical module was a significant contributor to the participation coefficient relationship of the default mode network module with the treatment response, and the bilateral midcingulate cortex and thalamus were major connectors in the subcortical module. Conclusions These findings have important implications regarding the global brain modular responses to chronic neuropathic pain and it may be feasible to use the modularity analysis as part of a risk stratification to predict the treatment response.
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Affiliation(s)
- Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Xia Liang
- Laboratory for Space Environment and Physical Sciences, Harbin Institute of Technology, Harbin 150001, China
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan; Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Li-Ming Hsu
- Department of Radiology and BRIC, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Wang HL, Hsu WY, Lee MH, Weng HH, Chang SW, Yang JT, Tsai YH. Automatic Machine-Learning-Based Outcome Prediction in Patients With Primary Intracerebral Hemorrhage. Front Neurol 2019; 10:910. [PMID: 31496988 PMCID: PMC6713018 DOI: 10.3389/fneur.2019.00910] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 06/01/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022] Open
Abstract
Background: A predictive model can provide physicians, relatives, and patients the accurate information regarding the severity of disease and its predicted outcome. In this study, we used an automated machine-learning-based approach to construct a prognostic model to predict the functional outcome in patients with primary intracerebral hemorrhage (ICH). Methods: We retrospectively collected data on demographic characteristics, laboratory studies and imaging findings of 333 patients with primary ICH. The functional outcomes at the 1st and 6th months after ICH were defined by the modified Rankin scale. All of the attributes were used for preprocessing and for automatic model selection with Automatic Waikato Environment for Knowledge Analysis. Confusion matrix and areas under the receiver operating characteristic curves (AUC) were used to test the predictive performance. Results: Among the models tested, the random forest provided the best predictive performance for functional outcome. The overall accuracy for predicting the 1st month outcome was 83.1%, with 77.4% sensitivity and 86.9% specificity, and the AUC was 0.899. The overall accuracy for predicting the 6th month outcome was 83.9%, with 72.5% sensitivity and 90.6% specificity, and the AUC was 0.917. Conclusions: Using an automatic machine learning technique to predict functional outcome after ICH is feasible, and the random forest model provides the best predictive performance across all tested models. This prediction model may provide information regarding functional outcome for clinicians that will help provide appropriate medical care for patients and information for their caregivers.
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Affiliation(s)
- Hsueh-Lin Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Yen Hsu
- Department of Information Management, National Chung Cheng University, Chiayi, Taiwan
| | - Ming-Hsueh Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Sheng-Wei Chang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Lin CH, Liu CH, Wang AYC, Wu YM, Chen CC, Tsai YH, Chang TY, Huang KL, Wu HC, Lee TH, Chang YJ, Lin CM, Cheng CK, Chang CH. Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patients Receiving Thrombectomy: Standard or Low Dose Therapy? Curr Neurovasc Res 2019; 15:204-210. [PMID: 30014803 DOI: 10.2174/1567202615666180717113526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/07/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND We compared the clinical outcomes of low and standard dose recombinant tissue Plasminogen Activator (rtPA) treatment in Acute Ischemic Stroke (AIS) patients receiving Endovascular Mechanical Thrombectomy (EVT). METHODS Between April 01, 2015 and September 30, 2017, all AIS patients admitted to the Linkou and Chiayi Chang Gung Memorial Hospital were retrospectively reviewed. Patients with large vessel occlusions, who underwent bridging therapy with rtPA and EVT, were further enrolled. The enrolled patients were categorized into low (0.6-0.7 mg/kg; LD) or standard dose (0.9 mg/kg; SD) group based on the dose of rtPA they received. Baseline characteristics, reperfusion status, and clinical outcomes were compared between the two groups. RESULTS Forty-two patients were enrolled in the final analyses, including 13 in the LD and 29 in the SD group. In all groups analyzed, the frequencies of moderate to severe and severe stroke at discharge were significantly decreased compared to those at stroke onset (p < 0.01). Compared to the SD group, patients of the LD group had a similar rate of mortality (LD vs. SD; 0% vs. 3.4%, p = 1.00), and comparable frequencies of functional independence at 3 months after stroke onset (LD vs. SD; 33.3% vs. 44.8%, p = 0.50). The rates of symptomatic intracerebral hemorrhage were also similar between the two groups (LD vs. SD; 0% vs. 6.9%, p =1.00). CONCLUSIONS Compared to standard dose treatment, low dose rtPA may have similar clinical efficacy and safety outcomes in AIS patients receiving bridging therapy.
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Affiliation(s)
- Chun-Hsien Lin
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Hung Liu
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Medical Education, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Alvin Yi-Chou Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurosurgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ming Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Chang Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurosurgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ting-Yu Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Lun Huang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Chuan Wu
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeu-Jhy Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
| | - Chuan-Min Lin
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Kuang Cheng
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
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Lee YL, Chen ST, Yang JT, Weng HH, Wang HL, Tsai YH. Diffusivity parameters of diffusion tensor imaging and apparent diffusion coefficient as imaging markers for predicting the treatment response of patients with trigeminal neuralgia. J Neurosurg 2019; 132:1993-1999. [PMID: 31100729 DOI: 10.3171/2019.2.jns183008] [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] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/19/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is facial pain that is usually caused by neurovascular compression syndrome and is characterized by suddenly intense and paroxysmal pain. Radiofrequency lesioning (RFL) is one of the major treatments for TN, but the treatment response for RFL is sometimes inconsistent, and the recurrence of TN is not uncommon. This study aimed to estimate the outcome predictors of TN treated with RFL by using the parameters of diffusion tensor imaging (DTI). METHODS Fifty-one patients with TN who were treated with RFL were enrolled in the study. MRI was performed in all patients within 1 week before surgery. The visual analog scale was used to evaluate symptom severity at three time points: before, 1 week after, and 3 months after RFL. The involved cisternal segment of the trigeminal nerves was manually selected, and the histograms of each of the diffusivity metrics-including the apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD)-were measured. The differences in the means, as well as the kurtosis and skewness of each of the diffusivity metrics between the nonrecurrent and recurrent groups, were then analyzed using the Mann-Whitney U-test. RESULTS There were significantly lower kurtosis values (a broader peak of the distributional curves) for both FA and ADC in the recurrent group (p = 0.0004 and 0.015, respectively), compared to the nonrecurrent group. The kurtoses of AD and RD, as well as the mean and skewness of all other diffusivity metrics, did not show significant differences between the two groups. CONCLUSIONS The pretreatment diffusivity metrics of DTI and ADC may be feasible imaging biomarkers for predicting the outcome of TN after RFL. A clarification of the kurtosis value of FA and ADC is helpful for determining the prognosis of patients after RFL.
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Affiliation(s)
- Yu-Li Lee
- Departments of1Diagnostic Radiology and
| | | | - Jen-Tsung Yang
- 2Neurosurgery, Chang Gung Memorial Hospital, Chiayi branch, Chiayi; and
| | | | | | - Yuan-Hsiung Tsai
- Departments of1Diagnostic Radiology and.,3College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Huang YC, Tsai YH, Lee JD, Yang JT, Pan YT. A Novel Neuroimaging Model to Predict Early Neurological Deterioration After Acute Ischemic Stroke. Curr Neurovasc Res 2019; 15:129-137. [PMID: 29766805 PMCID: PMC6350204 DOI: 10.2174/1567202615666180516120022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/12/2018] [Accepted: 04/14/2018] [Indexed: 12/02/2022]
Abstract
Objective: In acute ischemic stroke, early neurological deterioration (END) may occur in up to one-third of patients. However, there is still no satisfying or comprehensive predictive model for all the stroke subtypes. We propose a practical model to predict END using magnetic resonance imaging (MRI). Method: Patients with anterior circulation infarct were recruited and they underwent an MRI within 24 hours of stroke onset. END was defined as an elevation of ≥2 points on the National Institute of Health Stroke Scale (NIHSS) within 72 hours of stroke onset. We examined the relationships of END to individual END models, including: A, infarct swelling; B, small subcortical infarct; C, mis-match; and D, recurrence. Results: There were 163 patients recruited and 43 (26.4%) of them had END. The END models A, B and C significantly predicted END respectively after adjusting for confounding factors (p=0.022, p=0.007 and p<0.001 respectively). In END model D, we examined all imaging predictors of Recur-rence Risk Estimator (RRE) individually and only the “multiple acute infarcts” pattern was signifi-cantly associated with END (p=0.032). When applying END models A, B, C and D, they success-fully predicted END (p<0.001; odds ratio: 17.5[95% confidence interval: 5.1–60.8]), with 93.0% sensitivity, 60.0% specificity, 45.5% positive predictive value and 96.0% negative predictive value. Conclusion: The results demonstrate that the proposed model could predict END in all stroke sub-types of anterior circulation infarction. It provides a practical model for clinical physicians to select high-risk patients for more aggressive treatment to prevent END.
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Affiliation(s)
- Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University, College of Medicine, Putz, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University, College of Medicine, Putz, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University, College of Medicine, Putz, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University, College of Medicine, Putz, Taiwan
| | - Yi-Ting Pan
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University, College of Medicine, Putz, Taiwan
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40
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Chen ST, Yang JT, Weng HH, Wang HL, Yeh MY, Tsai YH. Diffusion tensor imaging for assessment of microstructural changes associate with treatment outcome at one-year after radiofrequency Rhizotomy in trigeminal neuralgia. BMC Neurol 2019; 19:62. [PMID: 30979362 PMCID: PMC6460667 DOI: 10.1186/s12883-019-1295-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/15/2018] [Accepted: 04/02/2019] [Indexed: 01/03/2023] Open
Abstract
Background Trigeminal neuralgia (TN) is characterized by facial pain that may be sudden, intense, and recurrent. Neurosurgical interventions, such as radiofrequency rhizotomy, can relieve TN pain, but their mechanisms and effects are unknown. The aim of the present study was to investigate the microstructural tissue changes of the trigeminal nerve (TGN) in patients with TN after they underwent radiofrequency rhizotomy. Methods Thirty-seven patients with TN were recruited, and diffusion tensor imaging was obtained before and two weeks after radiofrequency rhizotomy. By manually selecting the cisternal segment of the TGN, we measured the volume of the TGN, fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD). The TGN volume and mean value of the DTI metrics of the post-rhizotomy lesion side were compared with those of the normal side and those of the pre-rhizotomy lesion side, and they were correlated to the post-rhizotomy visual analogue scale (VAS) pain scores after a one-year follow-up. Results The alterations before and after rhizotomy showed a significantly increased TGN volume and FA, and a decreased ADC, AD, and RD. The post-rhizotomy lesion side showed a significantly decreased TGN volume, FA, and AD compared with the normal side; however, no significant difference in the ADC and RD were found between the groups. The TGN volume was significantly higher in the non-responders than in the responders (P = 0.016). Conclusion Our results may reflect that the effects of radiofrequency rhizotomy in TN patients include axonal damage with perineural edema and that prolonged swelling associated with recurrence might be predicted by MRI images. Further studies are necessary to understand how DTI metrics can quantitatively represent the pathophysiology of TN and to examine the application of DTI in the treatment of TN.
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Affiliation(s)
- Shu-Tian Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, No.6 Chia-Pu Rd. West Sec., Chiayi County, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, No.6 Chia-Pu Rd. West Sec., Chiayi County, Taiwan
| | - Hsueh-Lin Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, No.6 Chia-Pu Rd. West Sec., Chiayi County, Taiwan
| | - Mei-Yu Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, No.6 Chia-Pu Rd. West Sec., Chiayi County, Taiwan.
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Ho CY, Chen BC, Tsai YH, Chiou YJ, Wen MY, Wong RH. Nanoscale Removal of Picosecond Laser Ablation for Polymer. J Nanosci Nanotechnol 2018; 18:7281-7285. [PMID: 29954574 DOI: 10.1166/jnn.2018.15480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper analytically investigates the picosecond laser ablation of polymer. Laser-pulsed ablation is a well-established tool for polymer. However the ablation mechanism of laser processing for polymer has not been thoroughly understood yet. This study utilized a thermal transport model to analyze the relationship between the ablation rate and laser fluences. This model considered the energy balance at the decomposition interface as the ablation mechanisms and is applied to predict the laser-ablated depth of Acrylonitrile Butadiene Styrene/PolyVinyl Chloride (ABS/PVC). The calculated variation of the ablation rate with the logarithm of the laser fluence agrees with the measured data. The effects of material properties and processing parameters on the ablation depth per pulse are discussed for picosecond laser processing of ABS/PVC.
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Tsai YH, Yang JL, Lee IN, Yang JT, Lin LC, Huang YC, Yeh MY, Weng HH, Su CH. Effects of Dehydration on Brain Perfusion and Infarct Core After Acute Middle Cerebral Artery Occlusion in Rats: Evidence From High-Field Magnetic Resonance Imaging. Front Neurol 2018; 9:786. [PMID: 30294297 PMCID: PMC6158308 DOI: 10.3389/fneur.2018.00786] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Dehydration is common among ischemic stroke patients and is associated with early neurological deterioration and poor outcome. This study aimed to test the hypothesis that dehydration status is associated with decreased cerebral perfusion and aggravation of ischemic brain injury. Methods: Diffusion-weighted imaging and arterial spin labeling perfusion MR imaging were performed on rats with middle cerebral artery occlusion (MCAO) by using a 9.4T MR imaging scanner to measure the volume of infarction and relative cerebral blood flow (rCBF) after infarction. Twenty-five rats were assigned to either a dehydration group or normal hydration group, and dehydration status was achieved by water deprivation for 48 h prior to MCAO. Results: The volume of the infarction was significantly larger for the dehydration group at the 4th h after MCAO (p = 0.040). The progression in the infarct volume between the 1st and 4th h was also larger in the dehydration group (p = 0.021). The average rCBF values of the contralateral normal hemispheres at the 1st and the 4th h were significantly lower in the dehydration group (p = 0.027 and 0.040, respectively). Conclusions: Our findings suggested that dehydration status is associated with the progression of infarct volume and decreases in cerebral blood flow during the acute stage of ischemic stroke. This preliminary study provided an imaging clue that more intensive hydration therapies and reperfusion strategies are necessary for the management of acute ischemic stroke patients with dehydration status.
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Affiliation(s)
- Yuan-Hsiung Tsai
- Departments of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jenq-Lin Yang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - I-Neng Lee
- Department of Medical Research, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Yu Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Hsu-Huei Weng
- Departments of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hao Su
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Tsai YH, Lee M, Lin LC, Chang SW, Weng HH, Yang JT, Huang YC, Lee MH. Association of Chronic Kidney Disease With Small Vessel Disease in Patients With Hypertensive Intracerebral Hemorrhage. Front Neurol 2018; 9:284. [PMID: 29780349 PMCID: PMC5946026 DOI: 10.3389/fneur.2018.00284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/16/2017] [Accepted: 04/11/2018] [Indexed: 01/22/2023] Open
Abstract
Background Chronic kidney disease (CKD) has been closely associated with hypertension and stroke. Although studies have reported the relationship between CKD and cerebral small vessel disease (SVD), the link between CKD, hypertension, and SVD is uncertain. The aim of this study was to investigate the association between CKD and SVD in patients with strictly hypertensive intracerebral hemorrhage (ICH). Methods 142 patients with acute hypertensive ICH were enrolled in this study. Magnetic resonance imaging was performed to assess imaging markers for SVD. Patients were categorized into three CKD groups based on the degree of kidney dysfunction [glomerular filtration rate (GFR) in milliliters per minute per 1.73 m2]: normal kidney function (GFR ≥ 90), mild kidney disease (60 ≤ GFR < 90), and moderate to severe kidney disease (GFR < 60). Results The prevalence rate of mild and moderate to severe CKD was 50 and 14.8%, respectively. The stage of CKD was associated with history of chronic hypertension (p = 0.046) as well as the prevalence rate of overall and deep cerebral microbleed (CMB) (p = 0.001 and p = 0.002, respectively). The stage of CKD was a significant risk factor for deep white matter hyperintensity (WMH) (OR 1.848; 95% CI 1.022–3.343, p = 0.042), overall CMB (OR 2.628; 95% CI 1.462–4.724, p = 0.001), lobar CMB (OR 2.106; 95% CI 1.119–3.963, p = 0.021), and deep CMB (OR 2.237; 95% CI 1.263–3.960, p = 0.006), even after adjustment for confounders. Conclusion In patients with hypertensive ICH, the prevalence of CKD is high even at the early stage of renal function impairment and is associated with the prevalence of CMB and deep WMH. These results reinforce the notion of a link between hypertensive vasculopathy, renal function impairment, and cerebral SVD.
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Affiliation(s)
- Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Meng Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Leng-Chieh Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Sheng-Wei Chang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Tsung Yang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Chu Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Hsueh Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Tsai YH, Yuan R, Patel D, Chandrasekaran S, Weng HH, Yang JT, Lin CP, Biswal BB. Altered structure and functional connection in patients with classical trigeminal neuralgia. Hum Brain Mapp 2018. [PMID: 29105886 DOI: 10.1002/hbm.v39.210.1002/hbm.23696] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Classical trigeminal neuralgia (TN) is a specific type of neuropathic orofacial pain of which the plasticity of brain structure and connectivity have remained largely unknown. A total of 62 TN patients were included and referred to MRI scans. Voxel-based morphometry was used to analyze the change of gray matter volume. Resting-state functional imaging was used to analyze the connectivity between brain regions. The results showed gray matter volume reduction in components of the prefrontal cortex, precentral gyrus, cerebellar tonsil, thalamus, hypothalamus, and nucleus accumbens among right TN patient and in the inferior frontal gyrus, precentral gyrus, cerebellum, thalamus, ventral striatum, and putamen among left TN patients. The connections between the right superior frontal gyrus and right middle frontal gyrus were lower in right TN patients. The connection between the left precentral gyrus and the left superior frontal gyrus was lower while the connection between bilateral thalamus was higher in left TN patients. The changes of volume in bilateral thalamus of right TN patients and left ventral striatum of left TN patients, and the connectivity between bilateral thalamus of left TN patients were moderately correlated with pain duration. These findings suggest that brain regions such as the thalamus may not only be involved in processing of pain stimuli but also be important for the development of TN. The left hemisphere may be dominant in processing and modulation of TN pain signal. Chronification of TN induces volume changes in brain regions which are associated with emotional or cognitive modulation of pain. Hum Brain Mapp 39:609-621, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Rui Yuan
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, New Jersey
| | - Dharni Patel
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, New Jersey
| | - Subhashini Chandrasekaran
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, New Jersey
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, New Jersey
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Tsai YH, Yuan R, Patel D, Chandrasekaran S, Weng HH, Yang JT, Lin CP, Biswal BB. Altered structure and functional connection in patients with classical trigeminal neuralgia. Hum Brain Mapp 2017; 39:609-621. [PMID: 29105886 DOI: 10.1002/hbm.23696] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 04/12/2016] [Revised: 06/10/2017] [Accepted: 06/13/2017] [Indexed: 12/26/2022] Open
Abstract
Classical trigeminal neuralgia (TN) is a specific type of neuropathic orofacial pain of which the plasticity of brain structure and connectivity have remained largely unknown. A total of 62 TN patients were included and referred to MRI scans. Voxel-based morphometry was used to analyze the change of gray matter volume. Resting-state functional imaging was used to analyze the connectivity between brain regions. The results showed gray matter volume reduction in components of the prefrontal cortex, precentral gyrus, cerebellar tonsil, thalamus, hypothalamus, and nucleus accumbens among right TN patient and in the inferior frontal gyrus, precentral gyrus, cerebellum, thalamus, ventral striatum, and putamen among left TN patients. The connections between the right superior frontal gyrus and right middle frontal gyrus were lower in right TN patients. The connection between the left precentral gyrus and the left superior frontal gyrus was lower while the connection between bilateral thalamus was higher in left TN patients. The changes of volume in bilateral thalamus of right TN patients and left ventral striatum of left TN patients, and the connectivity between bilateral thalamus of left TN patients were moderately correlated with pain duration. These findings suggest that brain regions such as the thalamus may not only be involved in processing of pain stimuli but also be important for the development of TN. The left hemisphere may be dominant in processing and modulation of TN pain signal. Chronification of TN induces volume changes in brain regions which are associated with emotional or cognitive modulation of pain. Hum Brain Mapp 39:609-621, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Rui Yuan
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, New Jersey
| | - Dharni Patel
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, New Jersey
| | - Subhashini Chandrasekaran
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, New Jersey
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, University Heights, Newark, New Jersey
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Cheng CY, Hsu CY, Tsai YH, Lin KL, Huang CE, Fan YH, Chin SC, Huang YC. Novel Anterior Brainstem Magnetic Resonance Imaging Findings in Non-Small Cell Lung Cancer with Leptomeningeal Carcinomatosis. Front Neurol 2017; 8:579. [PMID: 29163342 PMCID: PMC5671500 DOI: 10.3389/fneur.2017.00579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 06/06/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Leptomeningeal carcinomatosis (LC) is found in around 4% of patients with non-small cell lung cancer (NSCLC). The most common radiological finding of LC is diffuse leptomeningeal enhancement on contrast-enhanced brain magnetic resonance imaging (MRI). Herein, we report a novel brain MRI finding-non-enhanced, band-like, symmetric restricted diffusion along the anterior surface of the brainstem-of LC in four patients with NSCLC. We also identified three additional cases with similar MRI findings in a literature review. We hypothesized that the restricted diffusion along the anterior brainstem was caused by malignant cells concentrating in the cistern around the brainstem and infiltrating into the circumferential perforating arteries along the anterior brainstem surface, which then resulted in microinfarctions.
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Affiliation(s)
- Chun-Yu Cheng
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yu Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuang-Lin Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatric Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Cih-En Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Hong Fan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Chest, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shy-Chyi Chin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yen-Chu Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Lin CH, Tsai YH, Lee JD, Weng HH, Yang JT, Lin LC, Lin YH, Wu CY, Huang YC, Hsu HL, Lee M, Hsu CY, Pan YT, Huang YC. Magnetic Resonance Perfusion Imaging Provides a Significant Tool for the Identification of Cardioembolic Stroke. Curr Neurovasc Res 2017; 13:271-276. [PMID: 27586679 PMCID: PMC5068491 DOI: 10.2174/1567202613666160901143040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/06/2016] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
Despite advances in imaging techniques and detailed examinations to determine the etiology of a stroke, the cause still remains undetermined in about one fourth of all ischemic strokes. The aim of this prospective study was to determine whether perfusion magnetic resonance imaging (MRI) can differentiate cardioembolic stroke from large artery atherosclerosis (LAA). We recruited 17 cardioembolic stroke and 22 LAA stroke patients, who were classified according to the Trial of Org 10172 in Acute Stroke Treatment and underwent perfusion MRI within 24 hours after the onset of stroke. The patients with cardioembolic stroke had more severe initial stroke severity and larger volumes of initial and final infarct compared to those with LAA stroke. Receiver operating characteristic curve analysis showed that the ratio of time to maximum of the residual curve (Tmax) volume for a 2-, 3-, 4- or 5-s lag over Tmax volume for a 8s lag all had excellent area under the curve values (> 0.9) to predict cardioembolic stroke. After adjusting for initial National Institute of Health Stroke Scale scores, a threshold of 3.73 for (Tmax > 4s volume)/(Tmax > 8s volume) had the highest odds ratio to predict cardioembolic stroke (p=0.012; odds ratio: 58.5; 95% confident interval: 2.5-1391.1), with 87.5% sensitivity and 94.4% specificity. In conclusion, perfusion MRI could be a reliable tool to identify cardioembolic stroke with its lower collateral. This is important as it could be used to reveal the exact mechanism and provide supportive evidence to classify a stroke.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital, 6 West Chia-Pu Road, Putz City, Chiayi County, Taiwan.
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Weng HH, Noll KR, Johnson JM, Prabhu SS, Tsai YH, Chang SW, Huang YC, Lee JD, Yang JT, Yang CT, Tsai YH, Yang CY, Hazle JD, Schomer DF, Liu HL. Accuracy of Presurgical Functional MR Imaging for Language Mapping of Brain Tumors: A Systematic Review and Meta-Analysis. Radiology 2017; 286:512-523. [PMID: 28980887 DOI: 10.1148/radiol.2017162971] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To compare functional magnetic resonance (MR) imaging for language mapping (hereafter, language functional MR imaging) with direct cortical stimulation (DCS) in patients with brain tumors and to assess factors associated with its accuracy. Materials and Methods PubMed/MEDLINE and related databases were searched for research articles published between January 2000 and September 2016. Findings were pooled by using bivariate random-effects and hierarchic summary receiver operating characteristic curve models. Meta-regression and subgroup analyses were performed to evaluate whether publication year, functional MR imaging paradigm, magnetic field strength, statistical threshold, and analysis software affected classification accuracy. Results Ten articles with a total of 214 patients were included in the analysis. On a per-patient basis, the pooled sensitivity and specificity of functional MR imaging was 44% (95% confidence interval [CI]: 14%, 78%) and 80% (95% CI: 54%, 93%), respectively. On a per-tag basis (ie, each DCS stimulation site or "tag" was considered a separate data point across all patients), the pooled sensitivity and specificity were 67% (95% CI: 51%, 80%) and 55% (95% CI: 25%, 82%), respectively. The per-tag analysis showed significantly higher sensitivity for studies with shorter functional MR imaging session times (P = .03) and relaxed statistical threshold (P = .05). Significantly higher specificity was found when expressive language task (P = .02), longer functional MR imaging session times (P < .01), visual presentation of stimuli (P = .04), and stringent statistical threshold (P = .01) were used. Conclusion Results of this study showed moderate accuracy of language functional MR imaging when compared with intraoperative DCS, and the included studies displayed significant methodologic heterogeneity. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Hsu-Huei Weng
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Kyle R Noll
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jason M Johnson
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Sujit S Prabhu
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Yuan-Hsiung Tsai
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Sheng-Wei Chang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Yen-Chu Huang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jiann-Der Lee
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Jen-Tsung Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Cheng-Ta Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Ying-Huang Tsai
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Chun-Yuh Yang
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - John D Hazle
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Donald F Schomer
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
| | - Ho-Ling Liu
- From the Departments of Diagnostic Radiology (H.H.W., Yuan-Hsiung Tsai, S.W.C.), Neurology (Y.C.H., J.D.L.), and Neurosurgery (J.T.Y.), Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan (H.H.W.); Department of Psychology, National Chung Cheng University, Chiayi, Taiwan (H.H.W.); Department of Imaging Physics (H.H.W., J.D.H., H.L.L.), Department of Diagnostic Radiology (J.M.J., D.F.S.), Division of Diagnostic Imaging, Department of Neuro-Oncology, Section of Neuropsychology, Division of Cancer Medicine (K.R.N.), Department of Neurosurgery, Division of Surgery (S.S.P.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Division of Pulmonary and Critical Care Medicine of Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.T.Y.); Department of Respiratory Care, College of Medicine (C.T.Y.), Department of Respiratory Therapy (Ying-Huang Tsai), Chang Gung University, Taoyuan, Taiwan; Division of Pulmonary and Critical Care Medicine and Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan (Ying-Huang Tsai); and Faculty of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan (C.Y.Y.)
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Lin CJ, Tsai YY, Hsiao KY, Tsai YH, Lee MH, Huang YC, Lee M, Yang JT, Hsiao CT, Lin LC. Urine-Specific Gravity-Based Hydration Prevents Stroke in Evolution in Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26:1885-1891. [PMID: 28739345 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/21/2017] [Revised: 06/06/2017] [Accepted: 06/28/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Early neurological deterioration after ischemic stroke (stroke-in-evolution [SIE]) is associated with poorer outcomes. Previous studies have demonstrated a link between hydration status and the development of SIE. In this study, we tested the hypothesis that rehydration therapy, administered on the basis of urine-specific gravity (USG) findings, might reduce the development of SIE. METHODS We conducted a single-arm prospective study of patients with acute ischemic stroke with historical controls. For the study group, a USG higher than 1.010 was taken as an indication for rehydration. Control group patients were rehydrated without referring to USG. An increase in National Institutes of Health Stroke Scale (NIHSS) score of 4 or higher within 3 days was defined as having SIE. RESULTS A total of 445 patients were analyzed, 167 in the study group and 278 in the control group. The proportion of patients who developed SIE was numerically, but not significantly, lower in the study group (5.9%; 10 of 167) compared with the control group (11.5%; 32 of 278). Among patients with a USG higher than 1.010 at admission, the SIE rate was significantly reduced in the study group compared with the control group (6.1% versus 16.0%; P = .021), while the rate of SIE was similar in those with a USG of 1.010 or lower at admission. Multivariate logistic regression analysis confirmed that USG-based hydration was an independent factor associated with reducing SIE. CONCLUSIONS USG might be a convenient and useful method for guiding fluid therapy in patients with acute ischemic stroke. USG-based hydration reduced the incidence of SIE among patients with a USG higher than 1.010 at admission.
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Affiliation(s)
- Chung-Jen Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Yen-Yun Tsai
- Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Kuang-Yu Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Hsueh Lee
- Department of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yen-Chu Huang
- Department of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng Lee
- Department of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Nursing and Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
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50
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Wu FF, Hung YC, Tsai YH, Yang JT, Lee TH, Liow CW, Lee JD, Lin CJ, Peng TI, Lin LC. The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator. BMC Cardiovasc Disord 2017; 17:154. [PMID: 28610565 PMCID: PMC5470225 DOI: 10.1186/s12872-017-0590-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background Many studies have determined that dehydration is an independent predictor of outcome after ischemic stroke (IS); however, none have determined if the use of thrombolytic therapy modifies the negative impact of poor hydration. To inform the stroke registry established at our institution, we conducted a retrospective study to determine if dehydration remains a negative prognostic factor after IS patients treated with tissue plasminogen activator (tPA). Methods Between 2007 and 2012, we recruited 382 subjects; 346 had data available and were divided into 2 groups on the basis of their blood urea nitrogen/creatinine (BUN/Cr) ratio. Dehydrated subjects had a BUN/Cr ratio ≥ 15; hydrated subjects had a BUN/Cr < 15. The primary outcome was impairment at discharge as graded by the Barthel Index (BI) and the modified Rankin Scale (mRS). Results The dehydration group had a greater mean age; more women; lower mean levels of hemoglobin, triglycerides, and sodium; and higher mean potassium and glucose levels. A favorable outcome as assessed by the mRS (≤2) was significantly less frequent among dehydrated subjects, but a favorable outcome by the BI (≥60) was not. Logistic regression and multivariate models confirmed that dehydration is an independent predictor of poor outcome by both the mRS and the BI; however, it was not predictive when patients were stratified by Trial of Org 10,172 in Acute Stroke Treatment subtype. Conclusions Our findings indicate that use of thrombolytic therapy does not eliminate the need to closely monitor hydration status in patients with IS.
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Affiliation(s)
- Fei-Fan Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC
| | - Yen-Chu Hung
- Department of Neurology, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Y H Tsai
- Department of Diagnostic Radiology, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Liow
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jen Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC
| | - Tsung-I Peng
- Department of Neurology, Keelung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Keelung, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC. .,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.
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