Jui-sheng Hsu | Kaohsiung Medical University Hospital (original) (raw)
Papers by Jui-sheng Hsu
Medicina
Interstitial pneumonia with autoimmune features (IPAF) is a new disease entity proposed in 2015. ... more Interstitial pneumonia with autoimmune features (IPAF) is a new disease entity proposed in 2015. Numerous questions regarding IPAF require clarification, including diagnostic criteria, standard managements for stable disease and exacerbation, and prognosis. We report a case of a 67-year-old Asian woman who presented with progressive dyspnea. Chest computed tomography (CT) scans revealed nonspecific interstitial pneumonia. Serologic testing indicated positive anti-Jo-1 without presence of extrathoracic manifestations. An IPAF diagnosis was made after a multidisciplinary discussion. The patient experienced a severe exacerbation requiring mechanical ventilation, and she was successfully salvaged with methylprednisolone pulse therapy and single-dose cyclophosphamide. During the one-year follow-up, she reported bilateral leg muscle weakness with noticeably elevated serum creatine kinase, suggesting polymyositis. The development of malignancy was also noted 15 months after the initial pre...
Kaohsiung Journal of Medical Sciences, Nov 17, 2022
European journal of clinical nutrition, Jan 4, 2018
The aim of the study was to evaluate the relationship between Geriatric Nutrition Risk Index (GNR... more The aim of the study was to evaluate the relationship between Geriatric Nutrition Risk Index (GNRI) and low muscle mass (LMM) in elderly people. A cross-sectional study was carried out in Chinese PLA General Hospital with 3240 participants who underwent a health check-up examination between February 2016 and February 2017. Linear regression and logistic regression were used to examine the relationship between GNRI and LMM. The mean age of the participants in the study was 64.6 years. The mean appendicular skeletal muscle mass index (ASMI) was 8.92 ± 0.93 kg/m in men and 7.62 ± 0.73 kg/m in women. The incidences of LMM were 7.9% in men and 3.7% in women. Linear regression demonstrated that GNRIs were positively correlated with ASMIs in both men and women (β = 0.055 for men and 0.039 for women, all P < 0.001). The cut-off point of the GNRI in elderly people for LMM was 104.0 in men and 107.0 in women and were identified by Classification and Regression Trees (CART). Logistic regres...
Acta neurologica Taiwanica, Jan 15, 2017
The purpose of this study was to compare brain metabolite concentration ratios determined by LCMo... more The purpose of this study was to compare brain metabolite concentration ratios determined by LCModel and Spectroscopy Analysis by General Electric (SAGE) quantitative methods to elucidate the advantages and disadvantages of each method. A total of 10 healthy volunteers and 10 patients with mild cognitive impairment (MCI) were recruited in this study. A point-resolved spectroscopy (PRESS) sequence was used to obtain the brain magnetic resonance spectroscopy (MRS) spectra of the volunteers and patients, as well as the General Electric (GE) MRS-HD-sphere phantom. The brain metabolite concentration ratios were estimated based on the peak area obtained from both LCModel and SAGE software. Three brain regions were sampled for each volunteer or patient, and 20 replicates were acquired at different times for the phantom analysis. The metabolite ratios of the GE phantom were estimated to be myo-inositol (mI)/creatine (Cr): 0.70 ± 0.01, choline (Cho)/Cr: 0.37 ± 0.00, N-acetylaspartate (NAA)/C...
The Kaohsiung Journal of Medical Sciences, 2021
F IGURE 1 Images and pathological studies of the focal autoimmune pancreatitis in a 45-year-old m... more F IGURE 1 Images and pathological studies of the focal autoimmune pancreatitis in a 45-year-old man. (A) Coronal contrast-enhanced computed tomography (CT) shows swelling pancreatic head (arrowheads) with dilatation of the upstream bile duct (arrows). (B) Axial T1-weighted magnetic resonance (MR) image shows a relatively hypointense lesion (arrowheads) in the pancreatic head. (C) Homogeneous enhancement (arrowheads) of the lesion is seen on delayed enhanced phase. (D) The lesion is seen as hyperintense area on diffusion-weighted images (DWI) (arrowheads) and hypointense area on apparent diffusion coefficient (ADC) map (E, arrowheads). (F) Coronal magnetic resonance cholangiopancreatography (MRCP) shows long segment stenosis of the main pancreatic duct (arrowheads) and dilatation of the bile duct (arrow). (G) Resected specimen shows a mass at the pancreatic head. (H) Photomicrograph (hematoxylin–eosin [H-E] stain; original magnification, ×100) shows intense lymphoplasmacytic infiltra...
The purpose of this study was to determine whether the reverse abdominal breathing or music inter... more The purpose of this study was to determine whether the reverse abdominal breathing or music intervention before and during mammography decreases the subjective reports of pain and anxiety during screening mammography. A total of 150 subjects were enrolled in this study: 50 subjects in the reverse abdominal breathing group (52.88 ± 6.67 years old), 50 in the music group (50.42 ± 5.54 years old), and 50 in the control group (51.52 ± 5.17 years old). The measures included State Trait Anxiety Inventory (STAI) questionnaire and 11-point numeric rating scale (NRS) of anxiety and pain. Results showed the NRS score during mammography (NRSduring) of the anxiety was lower than the NRS score before mammography (NRSbefore) of the anxiety in both reverse abdominal breathing (p=0.001) and music intervention groups (p=0.02). No significant difference was found between NRSduring and NRSbefore in anxiety in the control group (p=0.90). No significant differences were found in the NRSduring of pain am...
The study investigated the usage of the new designed foot supports assisted to take the radiograp... more The study investigated the usage of the new designed foot supports assisted to take the radiography of foot in cooperative and uncooperative subjects with traumatic history. 149 subjects for AP and medial oblique projections of foot were enrolled in this study. The subjects were divided into four groups: (1) 50 cooperative subjects (37.32±16.73 years old) with conventional procedure; (2) 33 cooperative subjects with foot supports (34.67±8.34 years old); (3) 50 uncooperative subjects with Supports (42.48±19.08 years old) and (4) 16 uncooperative subjects with modified procedure (50.06±22.3 years old). The convenience of operation and the imaging quality of radiography were rated as a five-point scale. Our results showed that the convenience of operation with foot supports was superior to that with modified procedure in uncooperative subjects (4.88±0.39 vs. 3.06±1.24, P ＞ 0.001). No statistically significant difference was found in the convenience of operation either between cooperati...
European Journal of Radiology, 2020
To examine the potential cost-savings of stereotactic vacuum-assisted biopsy (SVAB) over open sur... more To examine the potential cost-savings of stereotactic vacuum-assisted biopsy (SVAB) over open surgical biopsy (OSB) in diagnosis of nonpalpable lesions on mammography and to estimate the cost-saving effect on lesions at different levels of malignant probability. Methods: This retrospective study was approved by our Institutional Review Board. We retrospectively reviewed 276 (33.8 %) SVAB and 541 (66.2 %) OSB medical records at a medical center. Direct costs included patients' self-paid and national health insurance claim charges. Indirect costs were calculated using sick days, average salary, and age-adjusted employment rate. One-way and two-way sensitivity analyses were conducted. Lesion classification was determined by the assessment categories of Breast Imaging Reporting and Data System (BI-RADS), 4th or 5th editions. Results: SVAB decreased the direct cost by 90.3(10.190.3 (10.1 %) per diagnosis. The indirect cost was decreased by 90.3(10.1560.2 (96.0 %). Overall, SVAB saved 43.9 % of resource utilization for each biopsy. Taking the cost of the subsequent malignant surgery into account, from the healthcare providers' perspective, SVAB was cost-effective if a lesion had less than 19 % likelihood of malignancy. From the societal perspective, SVAB reduced productivity loss for all the lesions. Based on the positive predictive value of the BI-RADS categories, SVAB was more suitable for the lesions of category 4A and category 3, resulting in greater savings in both medical and societal resources. Conclusions: SVAB is a cost-effective diagnostic option for nonpalpable breast lesions. The cost-saving effect is greater for the lesions of category 4A and category 3.
Children
Eisenmenger syndrome (ES) refers to congenital heart diseases (CHD) with reversal flow associated... more Eisenmenger syndrome (ES) refers to congenital heart diseases (CHD) with reversal flow associated with increased pulmonary pressure and irreversible pulmonary vascular remodeling. Previous reports showed limited therapeutic strategies in ES. In this study, 5 ES patients (2 males and 3 females), who had been followed regularly at our institution from 2010 to 2019, were retrospectively reviewed. We adopted an add-on combination of sildenafil, bosentan, and iloprost and collected the clinical characteristics and outcomes as well as findings of echocardiography, computed tomography, pulmonary perfusion-ventilation scans, positron emission tomography, and biomarkers. The age of diagnosis in these ES patients ranged from 23 to 54 years (38.2 ± 11.1 years; mean ± standard deviation), and they were followed for 7 to 17 years. Their mean pulmonary arterial pressure and pulmonary vascular resistance index were 56.4 ± 11.3 mmHg and 24.7 ± 8.5 WU.m2, respectively. Intrapulmonary arterial thromb...
Applied Sciences, 2021
Sarcopenia is prevalent in postmenopausal women but is inconclusive in total thyroidectomy and un... more Sarcopenia is prevalent in postmenopausal women but is inconclusive in total thyroidectomy and under levothyroxine replacement. We aim to analyze the determinants of sarcopenia and investigate the early detection of sarcopenia in this group. Fifty postmenopausal women with total thyroidectomy were measured for body composition via Dual-energy X-ray Absorptiometry (DXA) and Appendicular Skeletal Muscle mass divided by the height square (ASM/ht2). Handgrip strength and gait speed and Geriatric Nutritional Risk Index (GNRI) were calculated. Eight determinants associated with sarcopenia include GNRI (β, 0.042; 95% confidence interval (CI), 0.021 to 0.064), femoral neck BMD (β, 0.989; 95% CI, 0.049 to 1.929), TSH (β, 0.192; 95% CI, 0.027 to 0.357), and thyroglobulin Ab (0.657; 95% CI, 0.210 to 1.103) for ASM/height2; menopausal years (β, −3.112; 95% CI, −5.661 to −0.563) and ASM/height2 (β, 2.669; 95% CI, 1.073 to 4.265) for handgrip strength; and GNRI (β, 0.062; 95% CI, 0.019 to 0.105),...
Metaplastic carcinoma is a rare form of breast carcinoma. Herein we reported a breast cancer pati... more Metaplastic carcinoma is a rare form of breast carcinoma. Herein we reported a breast cancer patient with metaplastic carcinoma which mimicked infiltrating ductal carcinoma in the initial pathological diagnosis. She received modified radical mastectomy, adjuvant chemotherapy and radiotherapy to the chest wall and loco-regional lymphatic area. Eight months after radiotherapy, a 3 x 2 cm hard mass over the right upper margin of incision was noted. The pathology revealed metaplastic carcinoma. Sequentially multi-organ metastases to the bones, lung and brain developed. The survival period was only 26 months from the diagnosis of breast cancer. The pathology pictures and literature of metaplastic breast carcinoma were reviewed and discussed.
Mediastinal hemangiomas are rare benign tumors of vascular origin. Here we report two cases of me... more Mediastinal hemangiomas are rare benign tumors of vascular origin. Here we report two cases of mediastinal hemangiomas with different image features. The first case is a 58-year-old man who had a large solitary hemangioma in the posterior mediastinum with well-defined capsule and small punctate calcification. The second case was a 57-year-old female with two hemangiomas in the anterior and middle mediastinum separately. Although mediastinal hemangiomas are rare tumors with various image features, we should keep this tumor in mind as one of the differential diagnoses, especially when the lesions show well-defined margins, peripheral enhancement, presence of phleboliths and dilated drainage veins.
The Kaohsiung Journal of Medical Sciences, 2020
Proper bone age assessment is crucial for the clinical diagnosis and evaluation of treatment resp... more Proper bone age assessment is crucial for the clinical diagnosis and evaluation of treatment responses. We investigated the applicability of Greulich and Pyle (GP), and Tanner and Whitehouse 3 (TW3) methods for children in modern Taiwan, using computer-aided diagnosis. Hand and wrist radiographs were obtained from 611 children (3-17 years) who came to our emergency department due to trauma. Ages 0 to 2 years old were excluded because of a limited number of cases. Skeletal maturation was assessed using the BoneXpert (version 2.5.4.1 automated software), which determines GP and TW3 bone age. The two scoring systems were evaluated for comparing the chronological ages in each subgroup. In boys, mean GP bone age vs mean chronological ages were delayed for ages 3 to 11 and advanced for age 12 to 17. In girls, mean GP bone age vs mean chronological ages was delayed for ages 4 to 8 and 17, and advanced for ages 3 and 9 to 17. In boys, the mean TW3 bone ages vs mean chronological ages were delayed for ages 5 to 10 except age 8, and advanced for ages 3 to 4, 8, and 11 to 15. In girls, the mean TW3 bone ages vs mean chronological ages were delayed for ages 4 to 12, and advanced for ages 3 and 13 to 14. By using the BoneXpert automatic software, we established bone age reference standards for children in Taiwan. Clinical application of GP and TW3 scoring methods can be adjusted according to our results to better assess bone age.
The Kaohsiung Journal of Medical Sciences, 2019
Stereotactic vacuum-assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpa... more Stereotactic vacuum-assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpable lesions detected by mammography. Considering the diagnostic effectiveness, a direct comparison of SVAB and open surgical biopsy (OSB) is lacking. We performed a retrospective review of 276 (33.8%) SVAB and 541 (66.2%) OSB to compare the diagnostic accuracy and the total number of procedures the patients underwent. The negative predictive values of OSB and SVAB were 99.77% and 99.61%, and their false-negative rates were 0.96% and 4.76%, respectively. SVAB, as the first-line biopsy method, obviated 92.3% of operations. All malignancies diagnosed using SVAB could be treated with single therapeutic surgery. By contrast, 48% of malignancies of OSB group received two operations. Breast Imaging Reporting and Data System (BI-RADS) category used at the study correlated well with the percentage of malignancy and can thus be used to predict biopsy results. Our study concluded that SVAB is reliable for diagnosing nonpalpable breast lesions and is the better biopsy method for categories 3 and 4A lesions, which reduces the benign surgery rate. For lesions with a higher likelihood of malignancy, BI-RADS 4B, 4C and 5, SVAB has an advantage over OSB, which lowers the total number of operations for malignancy treatment.
Obesity Research & Clinical Practice, 2017
Both O & SFA and control groups exhibited activation of the insula and caudate during error proce... more Both O & SFA and control groups exhibited activation of the insula and caudate during error processing. The activation over the left insula, precuneus, and bilateral putamen were higher in the subjects with O & SFA than for those in the control group. Conclusion: Our results support the fact that the fronto-striatal network is involved in response inhibition, and the caudate and insula contributes to error processing. Furthermore, women with O & SFA have impaired rolandic operculum when processing response inhibition and have greater insular and putamen activation in maintain their error processing function.
BMC Pharmacology and Toxicology, 2017
Background: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) such as gefit... more Background: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) such as gefitinib can provide better efficacy and prolonged progression free survival (PFS) than cytotoxic chemotherapy for metastatic lung non-squamous cell carcinoma harboring susceptible EGFR mutations when used as first-line therapy. Cytotoxic chemotherapy is regarded as being the standard therapy to overcome acquired resistance to an initial EGFR TKI. However, there is currently no consensus on how best to treat patients who develop resistance to both an initial EGFR TKI and chemotherapy. Methods: We enrolled stage IV lung adenocarcinoma patients with an EGFR mutation and who had developed acquired resistance to gefitinib and cytotoxic chemotherapy from two university-affiliated hospitals in Taiwan from June 2011 to December 2014. Basic demographic data, included Eastern Cooperative Oncology Group (ECOG) performance status were collected, and the response rate, progression-free survival (PFS) and overall survival (OS) were analyzed. Result: Two hundred and nine patients with mutated EGFR and who took gefitinib as the first-line therapy were identified in the study period, of whom 86 received second-line cytotoxic chemotherapy, and 60 who received third-line therapy were eligible for this study. The patients who received cytotoxic chemotherapy had a significantly higher disease control rate than those who received erlotinib (73% vs. 46%, p = 0.0363), however there were no significant differences in PFS (2.9 months vs. 3.1 months, p = 0.9049) and OS (8.9 months vs. 7.9 months, p = 0.4956). Platinum-or pemetrexed-based chemotherapy provided similar PFS and OS as others did. The only significant poor prognostic factors for OS were old age (≥65 years) (HR = 5.97 [2.65-13.44], p < 0.0001) and poor performance status (ECOG ≥2) (HR = 5.84 [2.61-13.09], p < 0.0001).
AJR. American journal of roentgenology, 2016
The purpose of this study is to evaluate the diagnostic performance of split-bolus portal venous ... more The purpose of this study is to evaluate the diagnostic performance of split-bolus portal venous phase dual-energy CT (DECT) urography in patients with hematuria. True unenhanced and split-bolus portal venous phase contrast-enhanced weighted-average images were obtained in 171 patients with hematuria. Virtual unenhanced and iodine-overlay images were reconstructed from contrast-enhanced 80-kVp and tin-filtered 140-kVp scans. Images were independently reviewed by two radiologists who were blinded to the final diagnoses in two separate reading sessions: virtual unenhanced and iodine-overlay images (single phase) in the first session and true unenhanced and contrast-enhanced weighted-average images (dual phase) in the second session (mean ± SD, 52 ± 8 days later). Sensitivity, specificity, and accuracy of mass detection were calculated from the data of both reading sessions. The number of calculi detected on virtual unenhanced images was compared with the number detected on true unenha...
OncoTargets and Therapy, 2016
Background: Increased evidences show that epidermal growth factor receptor (EGFR)-tyrosine kinase... more Background: Increased evidences show that epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors such as gefitinib could prolong progression-free survival (PFS) compared with cytotoxic chemotherapy for metastatic lung nonsquamous cell carcinoma harboring susceptible EGFR mutation, and gefitinib was served as the first-line therapy. However, acquired resistance is inevitable, but the salvage therapies are still unclear. Patients and methods: We designed a retrospective study of the salvage therapy and enrolled patients with stage IV lung adenocarcinoma who had mutated EGFR and developed an acquired resistance to the first-line gefitinib in two university-affiliated hospitals in Taiwan during June 2011 to December 2014. Age, sex, smoking history, EGFR gene mutation, performance statuses, response rate, PFS2 (the PFS in salvage therapy), and overall survival (OS2, the OS in salvage therapy) were recorded. Results: Two hundred and nine patients with mutated EGFR and who took gefitinib as firstline therapy were identified in the period, and a total of 98 patients who had been treated with salvage therapy with cytotoxic chemotherapy or erlotinib were eligible for this study. The overall response rate of second salvage therapy is 13%, and none of them received erlotinib. Patients who received chemotherapy had a trend for better PFS2 than those who received erlotinib (4.3 months vs 3.0 months, P=0.1417) but not in OS. Furthermore, patients who received platinum-based doublet had a trend for better PFS2 and a significantly better OS2 than those who received chemotherapy without platinum (PFS2: 4.9 months vs 2.6 months, P=0.0584; OS2: 16.1 months vs 6.7 months, P=0.0007). Analyses of the patients receiving platinum-based doublet showed that patients receiving pemetrexed had a significantly better PFS2 (6.4 months vs 4.1 months, P=0.0083) and a trend for better OS2 than those without pemetrexed treatment. Conclusion: Pemetrexed-based platinum chemotherapy may be the most optimal therapy in acquired resistance to gefitinib. Further prospective randomized controlled study is needed urgently.
Medicina
Interstitial pneumonia with autoimmune features (IPAF) is a new disease entity proposed in 2015. ... more Interstitial pneumonia with autoimmune features (IPAF) is a new disease entity proposed in 2015. Numerous questions regarding IPAF require clarification, including diagnostic criteria, standard managements for stable disease and exacerbation, and prognosis. We report a case of a 67-year-old Asian woman who presented with progressive dyspnea. Chest computed tomography (CT) scans revealed nonspecific interstitial pneumonia. Serologic testing indicated positive anti-Jo-1 without presence of extrathoracic manifestations. An IPAF diagnosis was made after a multidisciplinary discussion. The patient experienced a severe exacerbation requiring mechanical ventilation, and she was successfully salvaged with methylprednisolone pulse therapy and single-dose cyclophosphamide. During the one-year follow-up, she reported bilateral leg muscle weakness with noticeably elevated serum creatine kinase, suggesting polymyositis. The development of malignancy was also noted 15 months after the initial pre...
Kaohsiung Journal of Medical Sciences, Nov 17, 2022
European journal of clinical nutrition, Jan 4, 2018
The aim of the study was to evaluate the relationship between Geriatric Nutrition Risk Index (GNR... more The aim of the study was to evaluate the relationship between Geriatric Nutrition Risk Index (GNRI) and low muscle mass (LMM) in elderly people. A cross-sectional study was carried out in Chinese PLA General Hospital with 3240 participants who underwent a health check-up examination between February 2016 and February 2017. Linear regression and logistic regression were used to examine the relationship between GNRI and LMM. The mean age of the participants in the study was 64.6 years. The mean appendicular skeletal muscle mass index (ASMI) was 8.92 ± 0.93 kg/m in men and 7.62 ± 0.73 kg/m in women. The incidences of LMM were 7.9% in men and 3.7% in women. Linear regression demonstrated that GNRIs were positively correlated with ASMIs in both men and women (β = 0.055 for men and 0.039 for women, all P < 0.001). The cut-off point of the GNRI in elderly people for LMM was 104.0 in men and 107.0 in women and were identified by Classification and Regression Trees (CART). Logistic regres...
Acta neurologica Taiwanica, Jan 15, 2017
The purpose of this study was to compare brain metabolite concentration ratios determined by LCMo... more The purpose of this study was to compare brain metabolite concentration ratios determined by LCModel and Spectroscopy Analysis by General Electric (SAGE) quantitative methods to elucidate the advantages and disadvantages of each method. A total of 10 healthy volunteers and 10 patients with mild cognitive impairment (MCI) were recruited in this study. A point-resolved spectroscopy (PRESS) sequence was used to obtain the brain magnetic resonance spectroscopy (MRS) spectra of the volunteers and patients, as well as the General Electric (GE) MRS-HD-sphere phantom. The brain metabolite concentration ratios were estimated based on the peak area obtained from both LCModel and SAGE software. Three brain regions were sampled for each volunteer or patient, and 20 replicates were acquired at different times for the phantom analysis. The metabolite ratios of the GE phantom were estimated to be myo-inositol (mI)/creatine (Cr): 0.70 ± 0.01, choline (Cho)/Cr: 0.37 ± 0.00, N-acetylaspartate (NAA)/C...
The Kaohsiung Journal of Medical Sciences, 2021
F IGURE 1 Images and pathological studies of the focal autoimmune pancreatitis in a 45-year-old m... more F IGURE 1 Images and pathological studies of the focal autoimmune pancreatitis in a 45-year-old man. (A) Coronal contrast-enhanced computed tomography (CT) shows swelling pancreatic head (arrowheads) with dilatation of the upstream bile duct (arrows). (B) Axial T1-weighted magnetic resonance (MR) image shows a relatively hypointense lesion (arrowheads) in the pancreatic head. (C) Homogeneous enhancement (arrowheads) of the lesion is seen on delayed enhanced phase. (D) The lesion is seen as hyperintense area on diffusion-weighted images (DWI) (arrowheads) and hypointense area on apparent diffusion coefficient (ADC) map (E, arrowheads). (F) Coronal magnetic resonance cholangiopancreatography (MRCP) shows long segment stenosis of the main pancreatic duct (arrowheads) and dilatation of the bile duct (arrow). (G) Resected specimen shows a mass at the pancreatic head. (H) Photomicrograph (hematoxylin–eosin [H-E] stain; original magnification, ×100) shows intense lymphoplasmacytic infiltra...
The purpose of this study was to determine whether the reverse abdominal breathing or music inter... more The purpose of this study was to determine whether the reverse abdominal breathing or music intervention before and during mammography decreases the subjective reports of pain and anxiety during screening mammography. A total of 150 subjects were enrolled in this study: 50 subjects in the reverse abdominal breathing group (52.88 ± 6.67 years old), 50 in the music group (50.42 ± 5.54 years old), and 50 in the control group (51.52 ± 5.17 years old). The measures included State Trait Anxiety Inventory (STAI) questionnaire and 11-point numeric rating scale (NRS) of anxiety and pain. Results showed the NRS score during mammography (NRSduring) of the anxiety was lower than the NRS score before mammography (NRSbefore) of the anxiety in both reverse abdominal breathing (p=0.001) and music intervention groups (p=0.02). No significant difference was found between NRSduring and NRSbefore in anxiety in the control group (p=0.90). No significant differences were found in the NRSduring of pain am...
The study investigated the usage of the new designed foot supports assisted to take the radiograp... more The study investigated the usage of the new designed foot supports assisted to take the radiography of foot in cooperative and uncooperative subjects with traumatic history. 149 subjects for AP and medial oblique projections of foot were enrolled in this study. The subjects were divided into four groups: (1) 50 cooperative subjects (37.32±16.73 years old) with conventional procedure; (2) 33 cooperative subjects with foot supports (34.67±8.34 years old); (3) 50 uncooperative subjects with Supports (42.48±19.08 years old) and (4) 16 uncooperative subjects with modified procedure (50.06±22.3 years old). The convenience of operation and the imaging quality of radiography were rated as a five-point scale. Our results showed that the convenience of operation with foot supports was superior to that with modified procedure in uncooperative subjects (4.88±0.39 vs. 3.06±1.24, P ＞ 0.001). No statistically significant difference was found in the convenience of operation either between cooperati...
European Journal of Radiology, 2020
To examine the potential cost-savings of stereotactic vacuum-assisted biopsy (SVAB) over open sur... more To examine the potential cost-savings of stereotactic vacuum-assisted biopsy (SVAB) over open surgical biopsy (OSB) in diagnosis of nonpalpable lesions on mammography and to estimate the cost-saving effect on lesions at different levels of malignant probability. Methods: This retrospective study was approved by our Institutional Review Board. We retrospectively reviewed 276 (33.8 %) SVAB and 541 (66.2 %) OSB medical records at a medical center. Direct costs included patients' self-paid and national health insurance claim charges. Indirect costs were calculated using sick days, average salary, and age-adjusted employment rate. One-way and two-way sensitivity analyses were conducted. Lesion classification was determined by the assessment categories of Breast Imaging Reporting and Data System (BI-RADS), 4th or 5th editions. Results: SVAB decreased the direct cost by 90.3(10.190.3 (10.1 %) per diagnosis. The indirect cost was decreased by 90.3(10.1560.2 (96.0 %). Overall, SVAB saved 43.9 % of resource utilization for each biopsy. Taking the cost of the subsequent malignant surgery into account, from the healthcare providers' perspective, SVAB was cost-effective if a lesion had less than 19 % likelihood of malignancy. From the societal perspective, SVAB reduced productivity loss for all the lesions. Based on the positive predictive value of the BI-RADS categories, SVAB was more suitable for the lesions of category 4A and category 3, resulting in greater savings in both medical and societal resources. Conclusions: SVAB is a cost-effective diagnostic option for nonpalpable breast lesions. The cost-saving effect is greater for the lesions of category 4A and category 3.
Children
Eisenmenger syndrome (ES) refers to congenital heart diseases (CHD) with reversal flow associated... more Eisenmenger syndrome (ES) refers to congenital heart diseases (CHD) with reversal flow associated with increased pulmonary pressure and irreversible pulmonary vascular remodeling. Previous reports showed limited therapeutic strategies in ES. In this study, 5 ES patients (2 males and 3 females), who had been followed regularly at our institution from 2010 to 2019, were retrospectively reviewed. We adopted an add-on combination of sildenafil, bosentan, and iloprost and collected the clinical characteristics and outcomes as well as findings of echocardiography, computed tomography, pulmonary perfusion-ventilation scans, positron emission tomography, and biomarkers. The age of diagnosis in these ES patients ranged from 23 to 54 years (38.2 ± 11.1 years; mean ± standard deviation), and they were followed for 7 to 17 years. Their mean pulmonary arterial pressure and pulmonary vascular resistance index were 56.4 ± 11.3 mmHg and 24.7 ± 8.5 WU.m2, respectively. Intrapulmonary arterial thromb...
Applied Sciences, 2021
Sarcopenia is prevalent in postmenopausal women but is inconclusive in total thyroidectomy and un... more Sarcopenia is prevalent in postmenopausal women but is inconclusive in total thyroidectomy and under levothyroxine replacement. We aim to analyze the determinants of sarcopenia and investigate the early detection of sarcopenia in this group. Fifty postmenopausal women with total thyroidectomy were measured for body composition via Dual-energy X-ray Absorptiometry (DXA) and Appendicular Skeletal Muscle mass divided by the height square (ASM/ht2). Handgrip strength and gait speed and Geriatric Nutritional Risk Index (GNRI) were calculated. Eight determinants associated with sarcopenia include GNRI (β, 0.042; 95% confidence interval (CI), 0.021 to 0.064), femoral neck BMD (β, 0.989; 95% CI, 0.049 to 1.929), TSH (β, 0.192; 95% CI, 0.027 to 0.357), and thyroglobulin Ab (0.657; 95% CI, 0.210 to 1.103) for ASM/height2; menopausal years (β, −3.112; 95% CI, −5.661 to −0.563) and ASM/height2 (β, 2.669; 95% CI, 1.073 to 4.265) for handgrip strength; and GNRI (β, 0.062; 95% CI, 0.019 to 0.105),...
Metaplastic carcinoma is a rare form of breast carcinoma. Herein we reported a breast cancer pati... more Metaplastic carcinoma is a rare form of breast carcinoma. Herein we reported a breast cancer patient with metaplastic carcinoma which mimicked infiltrating ductal carcinoma in the initial pathological diagnosis. She received modified radical mastectomy, adjuvant chemotherapy and radiotherapy to the chest wall and loco-regional lymphatic area. Eight months after radiotherapy, a 3 x 2 cm hard mass over the right upper margin of incision was noted. The pathology revealed metaplastic carcinoma. Sequentially multi-organ metastases to the bones, lung and brain developed. The survival period was only 26 months from the diagnosis of breast cancer. The pathology pictures and literature of metaplastic breast carcinoma were reviewed and discussed.
Mediastinal hemangiomas are rare benign tumors of vascular origin. Here we report two cases of me... more Mediastinal hemangiomas are rare benign tumors of vascular origin. Here we report two cases of mediastinal hemangiomas with different image features. The first case is a 58-year-old man who had a large solitary hemangioma in the posterior mediastinum with well-defined capsule and small punctate calcification. The second case was a 57-year-old female with two hemangiomas in the anterior and middle mediastinum separately. Although mediastinal hemangiomas are rare tumors with various image features, we should keep this tumor in mind as one of the differential diagnoses, especially when the lesions show well-defined margins, peripheral enhancement, presence of phleboliths and dilated drainage veins.
The Kaohsiung Journal of Medical Sciences, 2020
Proper bone age assessment is crucial for the clinical diagnosis and evaluation of treatment resp... more Proper bone age assessment is crucial for the clinical diagnosis and evaluation of treatment responses. We investigated the applicability of Greulich and Pyle (GP), and Tanner and Whitehouse 3 (TW3) methods for children in modern Taiwan, using computer-aided diagnosis. Hand and wrist radiographs were obtained from 611 children (3-17 years) who came to our emergency department due to trauma. Ages 0 to 2 years old were excluded because of a limited number of cases. Skeletal maturation was assessed using the BoneXpert (version 2.5.4.1 automated software), which determines GP and TW3 bone age. The two scoring systems were evaluated for comparing the chronological ages in each subgroup. In boys, mean GP bone age vs mean chronological ages were delayed for ages 3 to 11 and advanced for age 12 to 17. In girls, mean GP bone age vs mean chronological ages was delayed for ages 4 to 8 and 17, and advanced for ages 3 and 9 to 17. In boys, the mean TW3 bone ages vs mean chronological ages were delayed for ages 5 to 10 except age 8, and advanced for ages 3 to 4, 8, and 11 to 15. In girls, the mean TW3 bone ages vs mean chronological ages were delayed for ages 4 to 12, and advanced for ages 3 and 13 to 14. By using the BoneXpert automatic software, we established bone age reference standards for children in Taiwan. Clinical application of GP and TW3 scoring methods can be adjusted according to our results to better assess bone age.
The Kaohsiung Journal of Medical Sciences, 2019
Stereotactic vacuum-assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpa... more Stereotactic vacuum-assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpable lesions detected by mammography. Considering the diagnostic effectiveness, a direct comparison of SVAB and open surgical biopsy (OSB) is lacking. We performed a retrospective review of 276 (33.8%) SVAB and 541 (66.2%) OSB to compare the diagnostic accuracy and the total number of procedures the patients underwent. The negative predictive values of OSB and SVAB were 99.77% and 99.61%, and their false-negative rates were 0.96% and 4.76%, respectively. SVAB, as the first-line biopsy method, obviated 92.3% of operations. All malignancies diagnosed using SVAB could be treated with single therapeutic surgery. By contrast, 48% of malignancies of OSB group received two operations. Breast Imaging Reporting and Data System (BI-RADS) category used at the study correlated well with the percentage of malignancy and can thus be used to predict biopsy results. Our study concluded that SVAB is reliable for diagnosing nonpalpable breast lesions and is the better biopsy method for categories 3 and 4A lesions, which reduces the benign surgery rate. For lesions with a higher likelihood of malignancy, BI-RADS 4B, 4C and 5, SVAB has an advantage over OSB, which lowers the total number of operations for malignancy treatment.
Obesity Research & Clinical Practice, 2017
Both O & SFA and control groups exhibited activation of the insula and caudate during error proce... more Both O & SFA and control groups exhibited activation of the insula and caudate during error processing. The activation over the left insula, precuneus, and bilateral putamen were higher in the subjects with O & SFA than for those in the control group. Conclusion: Our results support the fact that the fronto-striatal network is involved in response inhibition, and the caudate and insula contributes to error processing. Furthermore, women with O & SFA have impaired rolandic operculum when processing response inhibition and have greater insular and putamen activation in maintain their error processing function.
BMC Pharmacology and Toxicology, 2017
Background: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) such as gefit... more Background: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) such as gefitinib can provide better efficacy and prolonged progression free survival (PFS) than cytotoxic chemotherapy for metastatic lung non-squamous cell carcinoma harboring susceptible EGFR mutations when used as first-line therapy. Cytotoxic chemotherapy is regarded as being the standard therapy to overcome acquired resistance to an initial EGFR TKI. However, there is currently no consensus on how best to treat patients who develop resistance to both an initial EGFR TKI and chemotherapy. Methods: We enrolled stage IV lung adenocarcinoma patients with an EGFR mutation and who had developed acquired resistance to gefitinib and cytotoxic chemotherapy from two university-affiliated hospitals in Taiwan from June 2011 to December 2014. Basic demographic data, included Eastern Cooperative Oncology Group (ECOG) performance status were collected, and the response rate, progression-free survival (PFS) and overall survival (OS) were analyzed. Result: Two hundred and nine patients with mutated EGFR and who took gefitinib as the first-line therapy were identified in the study period, of whom 86 received second-line cytotoxic chemotherapy, and 60 who received third-line therapy were eligible for this study. The patients who received cytotoxic chemotherapy had a significantly higher disease control rate than those who received erlotinib (73% vs. 46%, p = 0.0363), however there were no significant differences in PFS (2.9 months vs. 3.1 months, p = 0.9049) and OS (8.9 months vs. 7.9 months, p = 0.4956). Platinum-or pemetrexed-based chemotherapy provided similar PFS and OS as others did. The only significant poor prognostic factors for OS were old age (≥65 years) (HR = 5.97 [2.65-13.44], p < 0.0001) and poor performance status (ECOG ≥2) (HR = 5.84 [2.61-13.09], p < 0.0001).
AJR. American journal of roentgenology, 2016
The purpose of this study is to evaluate the diagnostic performance of split-bolus portal venous ... more The purpose of this study is to evaluate the diagnostic performance of split-bolus portal venous phase dual-energy CT (DECT) urography in patients with hematuria. True unenhanced and split-bolus portal venous phase contrast-enhanced weighted-average images were obtained in 171 patients with hematuria. Virtual unenhanced and iodine-overlay images were reconstructed from contrast-enhanced 80-kVp and tin-filtered 140-kVp scans. Images were independently reviewed by two radiologists who were blinded to the final diagnoses in two separate reading sessions: virtual unenhanced and iodine-overlay images (single phase) in the first session and true unenhanced and contrast-enhanced weighted-average images (dual phase) in the second session (mean ± SD, 52 ± 8 days later). Sensitivity, specificity, and accuracy of mass detection were calculated from the data of both reading sessions. The number of calculi detected on virtual unenhanced images was compared with the number detected on true unenha...
OncoTargets and Therapy, 2016
Background: Increased evidences show that epidermal growth factor receptor (EGFR)-tyrosine kinase... more Background: Increased evidences show that epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors such as gefitinib could prolong progression-free survival (PFS) compared with cytotoxic chemotherapy for metastatic lung nonsquamous cell carcinoma harboring susceptible EGFR mutation, and gefitinib was served as the first-line therapy. However, acquired resistance is inevitable, but the salvage therapies are still unclear. Patients and methods: We designed a retrospective study of the salvage therapy and enrolled patients with stage IV lung adenocarcinoma who had mutated EGFR and developed an acquired resistance to the first-line gefitinib in two university-affiliated hospitals in Taiwan during June 2011 to December 2014. Age, sex, smoking history, EGFR gene mutation, performance statuses, response rate, PFS2 (the PFS in salvage therapy), and overall survival (OS2, the OS in salvage therapy) were recorded. Results: Two hundred and nine patients with mutated EGFR and who took gefitinib as firstline therapy were identified in the period, and a total of 98 patients who had been treated with salvage therapy with cytotoxic chemotherapy or erlotinib were eligible for this study. The overall response rate of second salvage therapy is 13%, and none of them received erlotinib. Patients who received chemotherapy had a trend for better PFS2 than those who received erlotinib (4.3 months vs 3.0 months, P=0.1417) but not in OS. Furthermore, patients who received platinum-based doublet had a trend for better PFS2 and a significantly better OS2 than those who received chemotherapy without platinum (PFS2: 4.9 months vs 2.6 months, P=0.0584; OS2: 16.1 months vs 6.7 months, P=0.0007). Analyses of the patients receiving platinum-based doublet showed that patients receiving pemetrexed had a significantly better PFS2 (6.4 months vs 4.1 months, P=0.0083) and a trend for better OS2 than those without pemetrexed treatment. Conclusion: Pemetrexed-based platinum chemotherapy may be the most optimal therapy in acquired resistance to gefitinib. Further prospective randomized controlled study is needed urgently.