BACKGROUND The treatment of acute respiratory distress syndrome(ARDS)complicated by sepsis syndrome(SS)remains challenging.AIM To investigate whether combined adipose-derived mesenchymal-stem-cells(ADMSCs)-derived exo...BACKGROUND The treatment of acute respiratory distress syndrome(ARDS)complicated by sepsis syndrome(SS)remains challenging.AIM To investigate whether combined adipose-derived mesenchymal-stem-cells(ADMSCs)-derived exosome(EXAD)and exogenous mitochondria(mitoEx)protect the lung from ARDS complicated by SS.METHODS In vitro study,including L2 cells treated with lipopolysaccharide(LPS)and in vivo study including male-adult-SD rats categorized into groups 1(sham-operated-control),2(ARDS-SS),3(ARDS-SS+EXAD),4(ARDS-SS+mitoEx),and 5(ARDS-SS+EXAD+mitoEx),were included in the present study.RESULTS In vitro study showed an abundance of mitoEx found in recipient-L2 cells,resulting in significantly higher mitochondrial-cytochrome-C,adenosine triphosphate and relative mitochondrial DNA levels(P<0.001).The protein levels of inflammation[interleukin(IL)-1β/tumor necrosis factor(TNF)-α/nuclear factor-κB/toll-like receptor(TLR)-4/matrix-metalloproteinase(MMP)-9/oxidative-stress(NOX-1/NOX-2)/apoptosis(cleaved-caspase3/cleaved-poly(ADP-ribose)polymerase)]were significantly attenuated in lipopolysaccharide(LPS)-treated L2 cells with EXAD treatment than without EXAD treatment,whereas the protein expressions of cellular junctions[occluding/β-catenin/zonula occludens(ZO)-1/E-cadherin]exhibited an opposite pattern of inflam-mation(all P<0.001).Animals were euthanized by 72 h post-48 h-ARDS induction,and lung tissues were harvested.By 72 h,flow cytometric analysis of bronchoalveolar lavage fluid demonstrated that the levels of inflam-matory cells(Ly6G+/CD14+/CD68+/CD11b/c+/myeloperoxidase+)and albumin were lowest in group 1,highest in group 2,and significantly higher in groups 3 and 4 than in group 5(all P<0.0001),whereas arterial oxygen-saturation(SaO2%)displayed an opposite pattern of albumin among the groups.Histopathological findings of lung injury/fibrosis area and inflammatory/DNA-damaged markers(CD68+/γ-H2AX)displayed an identical pattern of SaO2%among the groups(all P<0.0001).The protein expressions of inflammatory(TLR-4/MMP-9/IL-1β/TNF-α)/oxidative stress(NOX-1/NOX-2/p22phox/oxidized protein)/mitochondrial-damaged(cytosolic-cytochrome-C/dynamin-related protein 1)/autophagic(beclin-1/Atg-5/ratio of LC3B-II/LC3B-I)biomarkers exhibited a similar manner,whereas antioxidants[nuclear respiratory factor(Nrf)-1/Nrf-2]/cellular junctions(ZO-1/E-cadherin)/mitochondrial electron transport chain(complex I-V)exhibited an opposite manner of albumin among the groups(all P<0.0001).CONCLUSION Combined EXAD-mitoEx therapy was better than merely one for protecting the lung against ARDS-SS induced injury.展开更多
Artificial intelligence(AI)is defined as the digital computer or computer-controlled robot's ability to mimic intelligent conduct and crucial thinking commonly associated with intelligent beings.The application of...Artificial intelligence(AI)is defined as the digital computer or computer-controlled robot's ability to mimic intelligent conduct and crucial thinking commonly associated with intelligent beings.The application of AI technology and machine learning in medicine have allowed medical practitioners to provide patients with better quality of services;and current advancements have led to a dramatic change in the healthcare system.However,many efficient applications are still in their initial stages,which need further evaluations to improve and develop these applications.Clinicians must recognize and acclimate themselves with the developments in AI technology to improve their delivery of healthcare services;but for this to be possible,a significant revision of medical education is needed to provide future leaders with the required competencies.This article reviews the potential and limitations of AI in healthcare,as well as the current medical application trends including healthcare administration,clinical decision assistance,patient health monitoring,healthcare resource allocation,medical research,and public health policy development.Also,future possibilities for further clinical and scientific practice were also summarized.展开更多
BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have diff...BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have different conclusions.AIM To explore the medium-term effect of postoperative HRQoL in such patients.METHODS This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups.HRQoL was assessed during the preoperative period and 3,6,and 12 mo postoperative using a modified version of the 36-Item Short Form(SF-36)Health Survey questionnaire,emphasizing eight specific items.RESULTS This cohort randomly assigned 541 patients to receive LR(n=296)or OR(n=245)surgical procedures.More episodes of postoperative urinary tract infection(P<0.001),wound infection(P<0.001),and pneumonia(P=0.048)were encountered in the OR group.The results demonstrated that the LR group subjectively gained mildly better general health(P=0.045),moderately better physical activity(P=0.006),and significantly better social function recovery(P=0.0001)3 mo postoperatively.Only the aspect of social function recovery was claimed at 6 mo,with a significant advantage in the LR group(P=0.001).No clinical difference was found in HRQoL during the 12 mo.CONCLUSION Our results demonstrated that LR resulted in better outcomes,including intra-operative blood loss,surgery-related complications,course of recovery,and especially some health domains of HRQoL at least within 6 mo postoperatively.Patients should undergo LR if there is no contraindication.展开更多
Purpose:The aim of the study was to investigate the actual benefits of the electronic official document online submission and approval system and the satisfaction of hospital staff in a medical center in southern Taiw...Purpose:The aim of the study was to investigate the actual benefits of the electronic official document online submission and approval system and the satisfaction of hospital staff in a medical center in southern Taiwan,and to find out whether there are any differences between medical institutions and general government personnel.Methods:A cross-sectional study was conducted to investigate satisfactory outcome with questionnaires.The subjects were administrators,healthcare professionals and medical personnel of a medical center in the southern part of Taiwan who had signed electronic documents online.A total of 395 questionnaires were sent out,147 of which were valid,and the rate of collecting data survey was 37%.We analyzed with SPSS version 20.Results:The official document approval system was mainly used by administrative units and contractors,accounting for more than 50%of users.Besides,the frequency of use was at least more than once a week.As for the user’s perception of operating system,most people thought that it is easier to choose the format of official document and to set up the duty agent on leave,but in the part of the signing and approval process setting or modifying,it was considered more difficult,accounting for 38.1%.In terms of perceptual usefulness,the average value was 3.81,which showed that the user agreed that the system has met the needs of daily official documents.When some users of service area encountered problems with their use,the clerical staff were able to provide services immediately and have the professional ability to resolve problems,in order to agree to the majority,accounting for 53.7%.In addition,nearly 60%of users rated the official document system positively,with an average of 3.84 satisfaction,which was higher than the certified value of 3,conforming to the standards for satisfaction with the use of official documents.In addition,the role authorization,perceptual easy-to-use and service area were significant(p<0.05).The perceptual usefulness of Subordinate units was also significant(p=0.016).The frequency of use,perceptual easy-to-use,perceptual usefulness,service area and satisfaction were significantly different(p<0.05).The correlation coefficient between perceptual usefulness and user satisfaction was 0.833,indicating that there was a high correlation.The daily usage frequency of contractors was higher than supervisors.However,supervisors had the highest frequency of use every quarter(p=0.135).There was no significant difference between contractors and supervisors in the frequency of use.Conclusion:It is suggested that education and training on the operation of the electronic official document on-line submission and approval system should be conducted,which can enhance the education and training of supervisors and medical personnel.Continually,invite supervisors and medical personnel to provide advices on the official document system as a reference for future improvements of the system.展开更多
Background:Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years.This study aimed to validate the use of the artificial neural network(ANN)model to predict the 5?year mortalit...Background:Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years.This study aimed to validate the use of the artificial neural network(ANN)model to predict the 5?year mortality of breast cancer patients after surgery and compare predictive accuracy between the ANN model,multiple logistic regression(MLR)model,and Cox regression model.Methods:This study compared the MLR,Cox,and ANN models based on clinical data of 3632 breast cancer patients who underwent surgery between 1996 and 2010.An estimation dataset was used to train the model,and a validation dataset was used to evaluate model performance.The sensitivity analysis was also used to assess the relative signifi?cance of input variables in the prediction model.Results:The ANN model significantly outperformed the MLR and Cox models in predicting 5?year mortality,with higher overall performance indices.The results indicated that the 5?year postoperative mortality of breast cancer patients was significantly associated with age,Charlson comorbidity index(CCI),chemotherapy,radiotherapy,hormone therapy,and breast cancer surgery volumes of hospital and surgeon(all P<0.05).Breast cancer surgery volume of surgeon was the most influential(sensitive)variable affecting 5?year mortality,followed by breast cancer surgery volume of hospital,age,and CCI.Conclusions:Compared with the conventional MLR and Cox models,the ANN model was more accurate in predict?ing 5?year mortality of breast cancer patients who underwent surgery.The mortality predictors identified in this study can also be used to educate candidates for breast cancer surgery with respect to the course of recovery and health outcomes.展开更多
文摘BACKGROUND The treatment of acute respiratory distress syndrome(ARDS)complicated by sepsis syndrome(SS)remains challenging.AIM To investigate whether combined adipose-derived mesenchymal-stem-cells(ADMSCs)-derived exosome(EXAD)and exogenous mitochondria(mitoEx)protect the lung from ARDS complicated by SS.METHODS In vitro study,including L2 cells treated with lipopolysaccharide(LPS)and in vivo study including male-adult-SD rats categorized into groups 1(sham-operated-control),2(ARDS-SS),3(ARDS-SS+EXAD),4(ARDS-SS+mitoEx),and 5(ARDS-SS+EXAD+mitoEx),were included in the present study.RESULTS In vitro study showed an abundance of mitoEx found in recipient-L2 cells,resulting in significantly higher mitochondrial-cytochrome-C,adenosine triphosphate and relative mitochondrial DNA levels(P<0.001).The protein levels of inflammation[interleukin(IL)-1β/tumor necrosis factor(TNF)-α/nuclear factor-κB/toll-like receptor(TLR)-4/matrix-metalloproteinase(MMP)-9/oxidative-stress(NOX-1/NOX-2)/apoptosis(cleaved-caspase3/cleaved-poly(ADP-ribose)polymerase)]were significantly attenuated in lipopolysaccharide(LPS)-treated L2 cells with EXAD treatment than without EXAD treatment,whereas the protein expressions of cellular junctions[occluding/β-catenin/zonula occludens(ZO)-1/E-cadherin]exhibited an opposite pattern of inflam-mation(all P<0.001).Animals were euthanized by 72 h post-48 h-ARDS induction,and lung tissues were harvested.By 72 h,flow cytometric analysis of bronchoalveolar lavage fluid demonstrated that the levels of inflam-matory cells(Ly6G+/CD14+/CD68+/CD11b/c+/myeloperoxidase+)and albumin were lowest in group 1,highest in group 2,and significantly higher in groups 3 and 4 than in group 5(all P<0.0001),whereas arterial oxygen-saturation(SaO2%)displayed an opposite pattern of albumin among the groups.Histopathological findings of lung injury/fibrosis area and inflammatory/DNA-damaged markers(CD68+/γ-H2AX)displayed an identical pattern of SaO2%among the groups(all P<0.0001).The protein expressions of inflammatory(TLR-4/MMP-9/IL-1β/TNF-α)/oxidative stress(NOX-1/NOX-2/p22phox/oxidized protein)/mitochondrial-damaged(cytosolic-cytochrome-C/dynamin-related protein 1)/autophagic(beclin-1/Atg-5/ratio of LC3B-II/LC3B-I)biomarkers exhibited a similar manner,whereas antioxidants[nuclear respiratory factor(Nrf)-1/Nrf-2]/cellular junctions(ZO-1/E-cadherin)/mitochondrial electron transport chain(complex I-V)exhibited an opposite manner of albumin among the groups(all P<0.0001).CONCLUSION Combined EXAD-mitoEx therapy was better than merely one for protecting the lung against ARDS-SS induced injury.
文摘Artificial intelligence(AI)is defined as the digital computer or computer-controlled robot's ability to mimic intelligent conduct and crucial thinking commonly associated with intelligent beings.The application of AI technology and machine learning in medicine have allowed medical practitioners to provide patients with better quality of services;and current advancements have led to a dramatic change in the healthcare system.However,many efficient applications are still in their initial stages,which need further evaluations to improve and develop these applications.Clinicians must recognize and acclimate themselves with the developments in AI technology to improve their delivery of healthcare services;but for this to be possible,a significant revision of medical education is needed to provide future leaders with the required competencies.This article reviews the potential and limitations of AI in healthcare,as well as the current medical application trends including healthcare administration,clinical decision assistance,patient health monitoring,healthcare resource allocation,medical research,and public health policy development.Also,future possibilities for further clinical and scientific practice were also summarized.
基金Supported by The Research Foundation of E-Da Cancer Hospital and E-Da Hospital,Kaohsiung,Taiwan,No.EDCHI111002 and NCKUEDA11110.
文摘BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have different conclusions.AIM To explore the medium-term effect of postoperative HRQoL in such patients.METHODS This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups.HRQoL was assessed during the preoperative period and 3,6,and 12 mo postoperative using a modified version of the 36-Item Short Form(SF-36)Health Survey questionnaire,emphasizing eight specific items.RESULTS This cohort randomly assigned 541 patients to receive LR(n=296)or OR(n=245)surgical procedures.More episodes of postoperative urinary tract infection(P<0.001),wound infection(P<0.001),and pneumonia(P=0.048)were encountered in the OR group.The results demonstrated that the LR group subjectively gained mildly better general health(P=0.045),moderately better physical activity(P=0.006),and significantly better social function recovery(P=0.0001)3 mo postoperatively.Only the aspect of social function recovery was claimed at 6 mo,with a significant advantage in the LR group(P=0.001).No clinical difference was found in HRQoL during the 12 mo.CONCLUSION Our results demonstrated that LR resulted in better outcomes,including intra-operative blood loss,surgery-related complications,course of recovery,and especially some health domains of HRQoL at least within 6 mo postoperatively.Patients should undergo LR if there is no contraindication.
文摘Purpose:The aim of the study was to investigate the actual benefits of the electronic official document online submission and approval system and the satisfaction of hospital staff in a medical center in southern Taiwan,and to find out whether there are any differences between medical institutions and general government personnel.Methods:A cross-sectional study was conducted to investigate satisfactory outcome with questionnaires.The subjects were administrators,healthcare professionals and medical personnel of a medical center in the southern part of Taiwan who had signed electronic documents online.A total of 395 questionnaires were sent out,147 of which were valid,and the rate of collecting data survey was 37%.We analyzed with SPSS version 20.Results:The official document approval system was mainly used by administrative units and contractors,accounting for more than 50%of users.Besides,the frequency of use was at least more than once a week.As for the user’s perception of operating system,most people thought that it is easier to choose the format of official document and to set up the duty agent on leave,but in the part of the signing and approval process setting or modifying,it was considered more difficult,accounting for 38.1%.In terms of perceptual usefulness,the average value was 3.81,which showed that the user agreed that the system has met the needs of daily official documents.When some users of service area encountered problems with their use,the clerical staff were able to provide services immediately and have the professional ability to resolve problems,in order to agree to the majority,accounting for 53.7%.In addition,nearly 60%of users rated the official document system positively,with an average of 3.84 satisfaction,which was higher than the certified value of 3,conforming to the standards for satisfaction with the use of official documents.In addition,the role authorization,perceptual easy-to-use and service area were significant(p<0.05).The perceptual usefulness of Subordinate units was also significant(p=0.016).The frequency of use,perceptual easy-to-use,perceptual usefulness,service area and satisfaction were significantly different(p<0.05).The correlation coefficient between perceptual usefulness and user satisfaction was 0.833,indicating that there was a high correlation.The daily usage frequency of contractors was higher than supervisors.However,supervisors had the highest frequency of use every quarter(p=0.135).There was no significant difference between contractors and supervisors in the frequency of use.Conclusion:It is suggested that education and training on the operation of the electronic official document on-line submission and approval system should be conducted,which can enhance the education and training of supervisors and medical personnel.Continually,invite supervisors and medical personnel to provide advices on the official document system as a reference for future improvements of the system.
基金supported by funding from“the Ministry of Science and Technology”in Taiwan,China(MOST 102-2314-B-037-043)
文摘Background:Few studies of breast cancer surgery outcomes have used longitudinal data for more than 2 years.This study aimed to validate the use of the artificial neural network(ANN)model to predict the 5?year mortality of breast cancer patients after surgery and compare predictive accuracy between the ANN model,multiple logistic regression(MLR)model,and Cox regression model.Methods:This study compared the MLR,Cox,and ANN models based on clinical data of 3632 breast cancer patients who underwent surgery between 1996 and 2010.An estimation dataset was used to train the model,and a validation dataset was used to evaluate model performance.The sensitivity analysis was also used to assess the relative signifi?cance of input variables in the prediction model.Results:The ANN model significantly outperformed the MLR and Cox models in predicting 5?year mortality,with higher overall performance indices.The results indicated that the 5?year postoperative mortality of breast cancer patients was significantly associated with age,Charlson comorbidity index(CCI),chemotherapy,radiotherapy,hormone therapy,and breast cancer surgery volumes of hospital and surgeon(all P<0.05).Breast cancer surgery volume of surgeon was the most influential(sensitive)variable affecting 5?year mortality,followed by breast cancer surgery volume of hospital,age,and CCI.Conclusions:Compared with the conventional MLR and Cox models,the ANN model was more accurate in predict?ing 5?year mortality of breast cancer patients who underwent surgery.The mortality predictors identified in this study can also be used to educate candidates for breast cancer surgery with respect to the course of recovery and health outcomes.
