Unrecognized History of Transient Atrial Fibrillation at the Time of Discharge from an Index Stroke Hospitalization Is Associated with Increased Recurrent Stroke Risk

Chia-Yu Hsu,Daniel E. Singer,Hooman Kamel,Yi-Ling Wu,Pei-Chun Chen,Jiann-Der Lee,Meng Lee,Bruce Ovbiagele 대한뇌졸중학회 2019 Journal of stroke Vol.21 No.2

Background and Purpose Preceding episodes of paroxysmal atrial fibrillation (AF) among stroke patients can be easily overlooked in routine clinical practice. We aim to determine whether an unrecognized history of paroxysmal AF is associated with an increased risk of recurrent stroke. Methods We retrospectively identified all adult patients hospitalized with a primary diagnosis of ischemic stroke who had no AF diagnosis on their discharge records, using the Taiwan National Health Insurance Research Database between January 2001 and December 2012. Patients were categorized into two groups: unrecognized AF history and no AF. Patients with unrecognized AF history were defined as having documented AF preceding the index ischemic stroke hospitalization, but not recording at the index ischemic stroke. Primary endpoint was recurrent stroke within 1 year after the index stroke. Results Among 203,489 hospitalized ischemic stroke patients without AF diagnosed at discharge, 6,731 patients (3.3%) had an unrecognized history of prior transient AF. Patients with an unrecognized AF history, comparing to those without AF, had higher adjusted risk of all recurrent stroke ([original cohort: hazard ratio (HR), 1.41; 95% confidence interval [CI], 1.30 to 1.53], [matched cohort: HR, 1.51; 95% CI, 1.37 to 1.68]) and recurrent ischemic stroke ([original cohort: HR, 1.42; 95% CI, 1.30 to 1.55], [matched cohort: HR, 1.56; 95% CI, 1.40 to 1.74]) during the 1-year follow-up period. Conclusions Unrecognized history of AF among patients discharged after an index ischemic stroke hospitalization is associated with higher recurrent stroke risk. Careful history review to uncover a paroxysmal AF history is important for ischemic stroke patients.

Folic Acid in Stroke Prevention in Countries without Mandatory Folic Acid Food Fortification: A Meta-Analysis of Randomized Controlled Trials

Chia-Yu Hsu,Shao-Wen Chiu,Keun-Sik Hong,Jeffrey L. Saver,Yi-Ling Wu,Jiann-Der Lee,Meng Lee,Bruce Ovbiagele 대한뇌졸중학회 2018 Journal of stroke Vol.20 No.1

Background and Purpose Additional folic acid (FA) treatment appears to have a neutral effect on reducing vascular risk in countries that mandate FA fortification of food (e.g., USA and Canada). However, it is uncertain whether FA therapy reduces stroke risk in countries without FA food fortification. The purpose of this study was to comprehensively evaluate the efficacy of FA therapy on stroke prevention in countries without FA food fortification. Methods PubMed, EMBASE, and clinicaltrials.gov from January 1966 to August 2016 were searched to identify relevant studies. Relative risk (RR) with 95% confidence interval (CI) was used as a measure of the association between FA supplementation and risk of stroke, after pooling data across trials in a random-effects model. Results The search identified 13 randomized controlled trials (RCTs) involving treatment with FA that had enrolled 65,812 participants, all of which stroke was reported as an outcome measure. After all 13 RCTs were pooled, FA therapy versus control was associated with a lower risk of any future stroke (RR, 0.85; 95% CI, 0.77 to 0.95). FA alone or combination of FA and minimal cyanocobalamin (≤0.05 mg/day) was associated with a lower risk of future stroke (RR, 0.75; 95% CI, 0.66 to 0.86) whereas combination of FA and cyanocobalamin (≥0.4 mg/day) was not associated with a lower risk of future stroke (RR, 0.95; 95% CI, 0.86 to 1.05). Conclusions FA supplement reduced stroke in countries without mandatory FA food fortification. The benefit was found mostly in patients receiving FA alone or combination of FA and minimal cyanocobalamin.

Platelet-Derived Growth Factor Receptor-α Subunit Targeting Suppresses Metastasis in Advanced Thyroid Cancer In Vitro and In Vivo

( Ching-ling Lin ),( Ming-lin Tsai ),( Yu-hsin Chen ),( Wei-ni Liu ),( Chun-yu Lin ),( Kai-wen Hsu ),( Chien-yu Huang ),( Yu-jia Chang ),( Po-li Wei ),( Shu-huey Chen ),( Li-chi Huang ),( Chia-hwa Lee 한국응용약물학회 2021 Biomolecules & Therapeutics(구 응용약물학회지) Vol.29 No.5

Thyroid cancer is the most common endocrine malignancy. Patients with well-differentiated thyroid cancers, such as papillary and follicular cancers, have a favorable prognosis. However, poorly differentiated thyroid cancers, such as medullary, squamous and anaplastic advanced thyroid cancers, are very aggressive and insensitive to radioiodine treatment. Thus, novel therapies that attenuate metastasis are urgently needed. We found that both PDGFC and PDGFRA are predominantly expressed in thyroid cancers and that the survival rate is significantly lower in patients with high PDGFRA expression. This finding indicates the important role of PDGF/PDGFR signaling in thyroid cancer development. Next, we established a SW579 squamous thyroid cancer cell line with 95.6% PDGFRA gene insertion and deletions (indels) through CRISPR/Cas9. Protein and invasion analysis showed a dramatic loss in EMT marker expression and metastatic ability. Furthermore, xenograft tumors derived from PDGFRA geneedited SW579 cells exhibited a minor decrease in tumor growth. However, distant lung metastasis was completely abolished upon PDGFRA gene editing, implying that PDGFRA could be an effective target to inhibit distant metastasis in advanced thyroid cancers. To translate this finding to the clinic, we used the most relevant multikinase inhibitor, imatinib, to inhibit PDGFRA signaling. The results showed that imatinib significantly suppressed cell growth, induced cell cycle arrest and cell death in SW579 cells. Our developed noninvasive apoptosis detection sensor (NIADS) indicated that imatinib induced cell apoptosis through caspase-3 activation. In conclusion, we believe that developing a specific and selective targeted therapy for PDGFRA would effectively suppress PDGFRA-mediated cancer aggressiveness in advanced thyroid cancers.

Evaluation of a rotating packed bed equipped with blade packings for methanol and 1-butanol removal

Chia-Chang Lin,Yu-Chiao Lin,Shu-Ching Chen,Ling-Jung Hsu 한국공업화학회 2010 Journal of Industrial and Engineering Chemistry Vol.16 No.6

Absorption removal of methanol and 1-butanol from gaseous streams with water was investigated in the RPB equipped with blade packings. The removal efficiency (E) of methanol and 1-butanol was found to increase with the RPB speed and the liquid flow rate but decrease with the gas flow rate. Also, the overall volumetric gas-side mass transfer coefficient (KGa) for methanol and 1-butanol absorption was observed to increase with the RPB speed, the gas flow rate, and the liquid flow rate. According to the obtained dependence of KGa on the gas and liquid flow rates, the mass transfer in methanol and 1-butanol absorption was observed to be controlled primarily by the gas-side mass transfer. Furthermore, the height of a transfer unit (HTU) for methanol and 1-butanol absorption decreased with the RPB speed and the liquid flow rate but increased with the gas flow rate. The obtained results demonstrated that mass transfer efficiency of the RPB equipped with blade packing was comparable to that of a hollow fiber absorber. Consequently, the RPB equipped with blade packings has a great potential in the removal of alkanols from the exhausted gases. 2010 The Korean Society of Industrial and Engineering Chemistry. Published by Elsevier B.V. All rights reserved.

Psilocybin for End-of-Life Anxiety Symptoms: A Systematic Review and Meta-Analysis

Chia-Ling Yu,Fu-Chi Yang,Szu-Nian Yang,Ping-Tao Tseng,Brendon Stubbs,Ta-Chuan Yeh,Chih-Wei Hsu,Dian-Jeng Li,Chih-Sung Liang 대한신경정신의학회 2021 PSYCHIATRY INVESTIGATION Vol.18 No.10

Objective To systematically examine the effectiveness and tolerability of psilocybin for treating end-of-life anxiety symptoms. Methods The Medline, Embase, CENTRAL, and PsycINFO databases were searched up to November 25, 2020. We enrolled clinical trials investigating psilocybin for treating end-of-life anxiety symptoms. Meta-analysis was conducted using random-effects model. Results Overall, five studies were included, revealing that psilocybin was superior to the placebo in treating state anxiety at 1 day (Hedges’ g, -0.70; 95% confidence interval, -1.01 to -0.39) and 2 weeks (-1.03; -1.47 to -0.60) after treatment. Psilocybin was more effective than placebo in treating trait anxiety at 1 day (-0.71; -1.15 to -0.26), 2 weeks (-1.08; -1.80 to -0.36), and 6 months (-0.84; -1.37 to -0.30) after treatment. Psilocybin was associated with transient elevation in systolic (19.00; 13.58-24.41 mm Hg) and diastolic (8.66; 5.18-12.15 mm Hg) blood pressure compared with placebo. The differences between psilocybin and placebo groups with regard to allcause discontinuation, serious adverse events, and heart rates were nonsignificant. Conclusion Psilocybin-assisted therapy could ameliorate end-of-life anxiety symptoms without serious adverse events. Because of the small sample sizes of the included studies and high heterogeneity on long-term outcomes, future randomized controlled trials with large sample sizes are needed.

IPv6 DoS Attacks Detection Using Machine Learning Enhanced IDS in SDN/NFV Environment

Chia-Wei Tseng,Li-Fan Wu,Shih-Chun Hsu,Sheng Wang Yu 한국통신학회 2020 한국통신학회 APNOMS Vol.2020 No.09

The rapid growth of IPv6 traffic makes security issues become more important. This paper proposes an IPv6 network security system that integrates signature-based Intrusion Detection Systems (IDS) and machine learning classification technologies to improve the accuracy of IPv6 denial-of-service (DoS) attacks detection. In addition, this paper has also enhanced IPv6 network security defense capabilities through software-defined networking (SDN) and network function virtualization (NFV) technologies. The experimental results prove that the detection and defense mechanisms proposed in this paper can effectively strengthen IPv6 network security.

Delay of Surgery for Spinal Metastasis due to the COVID-19 Outbreak Affected Patient Outcomes

Chia-Jung Hsieh,Chun-Yu Wu,Yen-Heng Lin,Yu-Cheng Huang,Wen-Chi Yang,Tom Wei-Wu Chen,Wei-Li Ma,Wei-Hsin Lin,Feng-Ming Hsu,Furen Xiao,Shih-Hung Yang,Dar-Ming Lai,Chang-Mu Chen,Shin-Yi Chao,Fon-Yih Tsuan 대한척추신경외과학회 2023 Neurospine Vol.20 No.4

Objective: The present study is to analyze the effects of the coronavirus disease 2019 (COVID 2019) outbreak and the subsequent lockdown on the outcomes of spinal metastasis patients. Methods: The study was a retrospective analysis of data from a prospective cohort study. All patients underwent surgical intervention for spinal metastases between January 2019 and December 2021 and had at least 3 months of postoperative follow-up. The primary outcome was overall mortality during the 4 different stages (pre-COVID-19 era, COVID-19 pandemic except in Taiwan, national lockdown, lifting of the lockdown). The secondary outcomes were the oncological severity scores, medical/surgical accessibility, and patient functional outcome during the 4 periods as well as survival/mortality. Results: A total of 233 patients were included. The overall mortality rate was 41.20%. During the Taiwan lockdown, more patients received palliative surgery than other surgical methods, and no total en bloc spondylectomy was performed. The time from surgeon visit to operation was approximately doubled after the COVID-19 outbreak in Taiwan (75.97, 86.63, 168.79, and 166.91 hours in the 4 periods, respectively). The estimated survival probability was highest after the national lockdown was lifted and lowest during the lockdown. In the multivariate analysis, increased risk of mortality was observed with delay of surgery, with emergency surgery having a higher risk with delays above 33 hours, urgent surgery (below 59 and above 111 hours), and elective surgery (above 332 hours). Conclusion: The COVID-19 pandemic and related policies have altered daily clinical practice and negatively impacted the survival of patients with spinal metastases.

A Study of Nursing Preceptor's Need for the Curriculum of Faculty Development

Chia Hsien Su,Mei Chun Lai,Lin Nu Hsu,Chu Yu Chan 한국간호과학회 2011 한국간호과학회 학술대회 Vol.2011 No.10

WHO IS THE MORE INFLUENTIAL DECISION-MAKER? : SPA TRAVEL IN BALI AIMING AT TAIWANESE AND MAINLAND CHINESE COUPLE TOURISTS

Wen-Yu Chen,Chia-Yuan Hsu,Magdalena Samidjen 글로벌지식마케팅경영학회 2014 Global Marketing Conference Vol.2014 No.5

Spa tourism is part of wellness tourism, which has been prosperously booming over the past decade. In accordance to the aforesaid, the spa-tourism-oriented marketing strategy is exceedingly significant for businesses akin to hotel, resort and even governments which aim at appealing to more tourists. For the future success, spa tourism needs to appreciate the changing demands of the spa market while providing enough capacity to satisfy them (Henderson, 2004). The worldwide spa industry revenue is growing up from US 60 billion in 2007 to US 73 billion in 2012 (Global Spa & Wellness Summit, 2012). Spa market is one of the fastest growing leisure markets both on the supply and demand sides. Nevertheless, spa industry is utterly fragmented with each segment catering for different customer needs (Harmsworth, 2004). Bali is a popular tourist destination renown for its nature beauty, which attracts both domestic and international tourists. Over the years, it has been dubbed as “the morning of the world”, “the last paradise” and “island with a thousand temples”. According to Indonesian Central Bureau of Statistics (BPS, 2013), it was chosen as the most favorite tourist destination worldwide with a number of tourists totaled at 2,756,579. Among the foreign spa tourism patrons, Mainland Chinese tourists ranked the second while Taiwanese tourists being the fifth in ranking. CNN Travel (2012) reported that the Indonesian government estimated one million Mainland Chinese tourists would patronize the spa tourism in Bali by 2014. Regardless Mainland China and Taiwan are dual sovereignties which identically possess similar culture, there are still some aspects such as gender issue that distinguishes one from another. Furthermore, age, occupation, education, family structure, and life experience are some other aspects that differentiate Taiwanese and Mainland Chinese. In summation, the main objectives of this paper is threefold: (1) to compare the decision making process between Taiwanese and Chinese tourists, specifically, amid the wedded/unwedded couples; (2) to identify the most influential decision maker among the wedded-couple tourists/unwedded-couple tourists in Taiwan and Mainland China; (3) to assist travel agencies which aim at luring couple tourists to concoct the customized package tours. This research develops a quantitative survey for data collection, inference and the resulting data. The first part of questionnaire evaluates the influence regarding wedded / unwedded couples over how much influence each other have (problem recognition, information search, and a final decision) (Davis & Rigaux, 1974). The second part consists of fourteen sub-decisions: the destination (Bali), budget (how much money to spend), days (how much time to spend), accommodation (where to stay), and departure time (when to go) (Belch, Belch, & Ceresino, 1985; Szybillo & Sosanie, 1977); airline, restaurant, local transportation, shopping, travel agency, tour leader, tour guide, optional tour, and spa activities (Wang, Hsieh, & Huan, 2000; Heung & Chu, 2000) and the other kinds of activities (Jenkins, 1979) complete with five-point Likert scale, ranging from “no influence at all” to “all of the influence”. The third part provides some questions asking respondents regarding where they receive the information about Bali. The fourth part asking the respondents provide information such as frequency of visiting destination; how long have the couples been together and how the package tour was booked. Eventually, this questionnaire provides information related to socio-demographic variables, including gender, respondents’ age, occupation, monthly income, and the highest education level (Howard & Madrigal, 1990; Darley & Lim, 1986; Fodness, 1992). The ultimate version of the questionnaire items are refined through the purification process. Above all, this study invites three experts to examine the validity and reliability concerning the questionnaire. 350 valid questionnaires were collected (consists of 171 Taiwanese tourists and 179 Chinese tourists) which was adequate to questions only one spouse in summer period. There is merely one significant discrepancy exists between the wedded and unwedded couples in the decision-making stages, that is, “Information search” conducted under the joint decision making. The nature beauty and wellness services combined with evening entertainment are relatively satisfactory in Bali. During the check-in process, wellness tourists are supposed to be notified of all the spa-oriented services in the spa area. Overall, the satisfaction level of spa in Bali is exceedingly-high. With hindsight, customer service seems to be the greatest asset in Bali. The presented study is an unprecedented research focusing on the behavioral disparity between Taiwanese and Chinese spa tourists when it comes to decision-making stages. The results of this study unfurls the different decision making process between Taiwanese and Chinese couples; according to the research result, the unwedded couples possess more influence than the wedded couples in decision making stages. Moreover, the findings of this research do not entirely support earlier statement given by Tourism Queensland (2013), which mentioned considerable spa customers are female, married, and age approximately 34 to 52 year olds. According to our research, actually, men accounts for a quarter of spa users. The research result indicates the mini-tour is a niche business in the tourism industry that can both benefit Taiwan and Mainland China; mini-tour is a novel concept mentioned in a previous research, which focuses on seniors’ GPT (Wang et al., 2013). This study provides information concerning customer satisfaction level in Bali spa business and travel agency services. The sub-decisions regarding couple tourists are thoroughly researched. Therefore, this presented study can potentially bring benefits to all parties (spa prov

WHO IS THE MORE INFLUENTIAL DECISION-MAKER? SPA TRAVEL IN BALI AIMING AT TAIWANESE AND MAINLAND CHINESE COUPLE TOURISTS

Wen-Yu Chen,Chia-Yuan Hsu,Magdalena Samidjen 글로벌지식마케팅경영학회 2014 Global Marketing Conference Vol.2014 No.7

Spa tourism is part of wellness tourism, which has been prosperously booming over the past decade. In accordance to the aforesaid, the spa-tourism-oriented marketing strategy is exceedingly significant for businesses akin to hotel, resort and even governments which aim at appealing to more tourists. For the future success, spa tourism needs to appreciate the changing demands of the spa market while providing enough capacity to satisfy them (Henderson, 2004). The worldwide spa industry revenue is growing up from US 60 billion in 2007 to US 73 billion in 2012 (Global Spa & Wellness Summit, 2012). Spa market is one of the fastest growing leisure markets both on the supply and demand sides. Nevertheless, spa industry is utterly fragmented with each segment catering for different customer needs (Harmsworth, 2004). Bali is a popular tourist destination renown for its nature beauty, which attracts both domestic and international tourists. Over the years, it has been dubbed as “the morning of the world”, “the last paradise” and “island with a thousand temples”. According to Indonesian Central Bureau of Statistics (BPS, 2013), it was chosen as the most favorite tourist destination worldwide with a number of tourists totaled at 2,756,579. Among the foreign spa tourism patrons, Mainland Chinese tourists ranked the second while Taiwanese tourists being the fifth in ranking. CNN Travel (2012) reported that the Indonesian government estimated one million Mainland Chinese tourists would patronize the spa tourism in Bali by 2014. Regardless Mainland China and Taiwan are dual sovereignties which identically possess similar culture, there are still some aspects such as gender issue that distinguishes one from another. Furthermore, age, occupation, education, family structure, and life experience are some other aspects that differentiate Taiwanese and Mainland Chinese. In summation, the main objectives of this paper is threefold: (1) to compare the decision making process between Taiwanese and Chinese tourists, specifically, amid the wedded/unwedded couples; (2) to identify the most influential decision maker among the wedded-couple tourists/unwedded-couple tourists in Taiwan and Mainland China; (3) to assist travel agencies which aim at luring couple tourists to concoct the customized package tours. This research develops a quantitative survey for data collection, inference and the resulting data. The first part of questionnaire evaluates the influence regarding wedded / unwedded couples over how much influence each other have (problem recognition, information search, and a final decision) (Davis & Rigaux, 1974). The second part consists of fourteen sub-decisions: the destination (Bali), budget (how much money to spend), days (how much time to spend), accommodation (where to stay), and departure time (when to go) (Belch, Belch, & Ceresino, 1985; Szybillo & Sosanie, 1977); airline, restaurant, local transportation, shopping, travel agency, tour leader, tour guide, optional tour, and spa activities (Wang, Hsieh, & Huan, 2000; Heung & Chu, 2000) and the other kinds of activities (Jenkins, 1979) complete with five-point Likert scale, ranging from “no influence at all” to “all of the influence”. The third part provides some questions asking respondents regarding where they receive the information about Bali. The fourth part asking the respondents provide information such as frequency of visiting destination; how long have the couples been together and how the package tour was booked. Eventually, this questionnaire provides information related to socio-demographic variables, including gender, respondents’ age, occupation, monthly income, and the highest education level (Howard & Madrigal, 1990; Darley & Lim, 1986; Fodness, 1992). The ultimate version of the questionnaire items are refined through the purification process. Above all, this study invites three experts to examine the validity and reliability concerning the questionnaire. 350 valid questionnaires were collected (consists of 171 Taiwanese tourists and 179 Chinese tourists) which was adequate to questions only one spouse in summer period. There is merely one significant discrepancy exists between the wedded and unwedded couples in the decision-making stages, that is, “Information search” conducted under the joint decision making. The nature beauty and wellness services combined with evening entertainment are relatively satisfactory in Bali. During the check-in process, wellness tourists are supposed to be notified of all the spa-oriented services in the spa area. Overall, the satisfaction level of spa in Bali is exceedingly-high. With hindsight, customer service seems to be the greatest asset in Bali. The presented study is an unprecedented research focusing on the behavioral disparity between Taiwanese and Chinese spa tourists when it comes to decision-making stages. The results of this study unfurls the different decision making process between Taiwanese and Chinese couples; according to the research result, the unwedded couples possess more influence than the wedded couples in decision making stages. Moreover, the findings of this research do not entirely support earlier statement given by Tourism Queensland (2013), which mentioned considerable spa customers are female, married, and age approximately 34 to 52 year olds. According to our research, actually, men accounts for a quarter of spa users. The research result indicates the mini-tour is a niche business in the tourism industry that can both benefit Taiwan and Mainland China; mini-tour is a novel concept mentioned in a previous research, which focuses on seniors’ GPT (Wang et al., 2013). This study provides information concerning customer satisfaction level in Bali spa business and travel agency services. The sub-decisions regarding couple tourists are thoroughly researched. Therefore, this presented study can potentially bring benefits to all parties (spa providers, travel agencies, and spa goers); simultaneously, it contributes greatly to the theory of “decision-making”. In conclusion, there are three management implications. First, wedded women, who are the crucial patrons in the spa industry, have more influence in the spa travel decision-making. Therefore, the marketing planners shall regard women as significant decision makers. Nevertheless, unwedded couples are more influential in spa travel when comparing to wedded couples, hence, spa providers shall make spa facilities more enjoyable, romantic, and rivate. Second, sub-decisions are regarded relatively pivotal when it comes to couple tourists. The findings shed some light on several factors of “sub-decision,” which are considered crucial by couple tourists when buying spa package tour. Third, Indonesian government deems Taiwan and Mainland China markets as tremendously paramount, especially when it comes to spa travel to Bali (CNN, 2012). As far as travel agencies are concerned, they need to create more appealing mini-package tours based on customer demographic. For spa providers, in order to efficiently maximize their revenue, they shall improve spa quality and the affiliated facilities and services.