Simple but Organized Neurology Residency Training Improves the Quality of Acute Stroke Care: From the Outset to Long-Term Effect

Yu-Ming Chang,Chun-Min Wang,Po-Yu Lin,Pi-Shan Sung,Sheng-Hsiang Lin,Chih-Hung Chen 대한뇌졸중학회 2021 Journal of stroke Vol.23 No.2

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Research and Development of RFIC Technology in Smart Temperature Information Material

Chang, Chih-Yuan,Hung, San-Shan,Chang, Yu-Chueh,Peng, Yu-Fang Korea Institute of Construction Engineering and Ma 2011 Journal of construction engineering and project ma Vol.1 No.1

Conservation of energy and fuel is the trend in smart building design. Radio Frequency Integrated Circuit (RFIC) technology is often used in temperature sensing and signal transmission to manage indoor temperature, but it is rarely applied to the shell of the building. Heat retention and poor insulation in building shells are the largest causes of high energy consumption by indoor air conditioning. Through combining RFIC technology with temperature sensors, this study will develop smart temperature information material that can be embedded in concrete. In addition to accurately evaluating the effectiveness of shell insulation material, the already-designed Building Physiology Information System can monitor long-term temperature changes, leading to smarter building health management.

Clinical Features and Computed Tomography Characteristics of Non-Klebsiella pneumoniae Liver Abscesses in Elderly (>65 Years) and Nonelderly Patients

Chih-Weim Hsiang,Wei-Chou Chang,Chang-Hsien Liu,Hsiu-Lung Fan,Kai-Hsiung Ko,Chih-Yung Yu,Hong-Hau Wang,Wen-I Liao,Hsian-He Hsu 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.2

Purpose: To compare the clinical and computed tomography (CT) appearances of liver abscesses caused by non-Klebsiella pneumoniae bacterial pathogens in elderly and nonelderly patients. Materials and Methods: Eighty patients with confirmed non-Klebsiella pneumoniae liver abscesses (non-KPLAs) were enrolled and dividedinto two age groups: elderly (age ≥65 years, n=42) and nonelderly (age <65 years, n=38). Diagnosis of non-KPLA was established by pus and/or blood culture. We compared clinical presentations, outcomes, and CT characteristics of the two groups, and performed multivariate analysis for significant variables and receiver-operating-characteristic analysis to determine the cutoff value of abscess diameter for predicting non-KPLA. Results: Elderly patients with non-KPLA were associatedwith a longer hospital stay (p<0.01). Regarding etiology, biliary sources had a strong association in the elderly group (p<0.01), and chronic liver diseases were relatedto the nonelderly group (p<0.01). Non-KPLAs (52.5%) tended to show a large, multiloculated appearance in the elderly group and were associated with bile duct dilatation (p<0.01), compared with the nonelderly group. The abscess diameter (cutoff value, 5.2 cm; area under the curve, 0.78) between the two groups was predicted. In multivariate analysis, underlying biliary tract disease [odds ratio (OR), 3.58, p<0.05], abscess diameter (OR, 2.40, p<0.05), and multiloculated abscess (OR, 1.19, p<0.01) independently predicted elderly patients with non-KPLA. Conclusion:In the elderly patients with non-KPLA, a large, multiloculated abscess with a diameter greater than 5.2 cm was the predominant imaging feature.

Using Multidetector-Row CT for the Diagnosis of Afferent Loop Syndrome Following Gastroenterostomy Reconstruction

Yu-Hsiu Juan,Wei-Chou Chang,Chih-Yung Yu,Hsian-He Hsu,Guo-Shu Huang,De-Chuan Chan,Chang-Hsien Liu,Ho-Jui Tung 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.4

Purpose: To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions. Materials and Methods: From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple’s operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy. Results: The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT. Conclusion: Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.

Management of Hyperacute Stroke during the Coronavirus Disease of 2019 Pandemic: The Modified Code Stroke in a Medical Center in Taiwan

Po-Yu Lin,Yu-Ming Chang,Chih-Yuan Huang,Chih-Hao Lin,Ming-Tsung Chuang,Po-Lin Chen,Pi-Shan Sung,Chih-Hung Chen 대한뇌졸중학회 2020 Journal of stroke Vol.22 No.2

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Feline mammary carcinoma-derived extracellular vesicle promotes liver metastasis via sphingosine kinase-1-mediated premetastatic niche formation

Yi-Chih Chang,Hao-Ping Liu,Hsiao-Li Chuang,Jiunn-Wang Liao,Pei-Ling Kao,Hsun-Lung Chan,Ter-Hsin Chen,Yu-Chih Wang 한국실험동물학회 2023 Laboratory Animal Research Vol.39 No.4

Background: Feline mammary carcinoma (FMC) is one of the most prevalent malignancies of female cats. FMC is highly metastatic and thus leads to poor disease outcomes. Among all metastases, liver metastasis occurs in about 25% of FMC patients. However, the mechanism underlying hepatic metastasis of FMC remains largely uncharacterized. Results: Herein, we demonstrate that FMC-derived extracellular vesicles (FMC-EVs) promotes the liver metastasis of FMC by activating hepatic stellate cells (HSCs) to prime a hepatic premetastatic niche (PMN). Moreover, we provide evidence that sphingosine kinase 1 (SK1) delivered by FMC-EV was pivotal for the activation of HSC and the formation of hepatic PMN. Depletion of SK1 impaired cargo sorting in FMC-EV and the EV-potentiated HSC activation, and abolished hepatic colonization of FMC cells. Conclusions: Taken together, our findings uncover a previously uncharacterized mechanism underlying liver-metastasis of FMC and provide new insights into prognosis and treatment of this feline malignancy.

The feasibility of detecting endometrial and ovarian cancer using DNA methylation biomarkers in cervical scrapings

Cheng-Chang Chang,Hui-Chen Wang,Yu-Ping Liao,Yu-Chih Chen,Yu-Chun Weng,Mu-Hsien Yu,Hung-Cheng Lai 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.1

Objective: We hypothesized that DNA methylation of development-related genes may occur in endometrial cancer (EC)/ovarian cancer (OC) and may be detected in cervical scrapings. Methods: We tested methylation status by quantitative methylation-specific polymerase chain reaction for 14 genes in DNA pools of endometrial and OC tissues. Tissues of EC/normal endometrium, OC/normal ovary, were verified in training set using cervical scrapings of 10 EC/10 OC patients and 10 controls, and further validated in the testing set using independent cervical scrapings in 30 EC/30 OC patients and 30 controls. We generated cutoff values of methylation index (M-index) from cervical scrapings to distinguish between cancer patients and control. Sensitivity/specificity of DNA methylation biomarkers in detecting EC and OC was calculated. Results: Of 14 genes, 4 (PTGDR, HS3ST2, POU4F3, MAGI2) showed hypermethylation in EC and OC tissues, and were verified in training set. POU4F3 and MAGI2 exhibited hypermethylation in training set were validated in independent cases. The mean M-index of POU4F3 is 78.28 in EC and 20.36 in OC, which are higher than that in controls (6.59; p<0.001 and p=0.100, respectively), and that of MAGI2 is 246.0 in EC and 12.2 in OC, which is significantly higher that than in controls (2.85; p<0.001 and p=0.480, respectively). Sensitivity and specificity of POU4F3/MAGI2 were 83%–90% and 69%–75% for detection of EC, and 61% and 62%–69% for the detection of OC. Conclusion: The findings demonstrate the potential of EC/OC detection through testing for DNA methylation in cervical scrapings.

A Hybrid Dynamic Stabilization and Fusion System in Multilevel Lumbar Spondylosis

Li-Yu Fay,Chih-Chang Chang,Hsuan-Kan Chang,Tsung-Hsi Tu,Tzu-Yun Tsai,Ching-Lan Wu,Wen-Cheng Huang,Jau-Ching Wu,Henrich Cheng 대한척추신경외과학회 2018 Neurospine Vol.15 No.3

Objective: The Dynesys-Transition-Optima (DTO) hybrid system was designed to achieve arthrodesis and stabilization in patients with lumbar degeneration. Satisfactory outcomes were demonstrated previously. However, no study has evaluated the effects of using the DTO system in patients with lumbar spondylolisthesis or stenosis. Methods: This retrospective study included 35 consecutive patients with multilevel lumbar degeneration with or without spondylolisthesis who underwent surgery using the DTO system. Imaging studies included pre- and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain. Results: Thirty patients (85.7%) with a mean age of 61.9 years completed the follow-up, with a mean duration of 35.1 months. There were 21 patients in the spondylolisthesis group and 9 in the stenosis group. The spondylolisthesis group had worse functional scores than the stenosis group preoperatively. After DTO surgery, all patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, ODI, and JOA scores (p<0.05). There were no significant differences in clinical outcomes between the 2 groups. At a 2-year follow-up, lumbar alignment was well maintained in both groups (p=0.116). There were no significant differences in lumbar alignment between the 2 groups. Conclusion: During a follow-up period of over 2 years, both patients with spondylolisthesis and those with stenosis showed improvements and similar disability and pain scores after surgery using the DTO system. Lumbar alignment was also well maintained.

AN EXPLORATIVE STUDY OF INNOVATIVE ENTREPRENEURSHIP IN A HOSPITALITY STARTUP CONTEXT

Jeou-Shyan Horng,Chang-Yen Tsai,Chih-Hsing Liu,Sheng-Fang Chou,Da-Chian Hu,Shang-Yu 글로벌지식마케팅경영학회 2018 Global Marketing Conference Vol.2018 No.07

Introduction Due to fierce competition in the marketplace, globalization and an explosion of technology in recent years, innovation and differentiation are considered as a necessity for every company (Tajeddini & Trueman, 2008a). At the same time, to achieve market success and sustain a competitive advantage, businesses need to exploit new opportunities, develop new products and/or services and markets (Berthon, McHulbert, & Pitt, 2004) as well as place customer orientation at the heart of the firm’s competitiveness (Deshpande, Farley, & Webster, 1993). Hospitality entrepreneurship is a pivotal factor in the development and growth of many national economies (Hospitality Standards Institute, 2012), and in Taiwan, a significant proportion of hospitality businesses are small owner-operated outlets (). Therefore, understanding the nature of, and challenges faced by hospitality entrepreneurs is an important issue for researchers, as well as current and future entrepreneurs, financial institutions, local authorities, and government. This article reports on an exploratory study of qualitative data collected through open-ended questions, understanding of the many factors influencing entrepreneurs to start their businesses. Literature As noted by Middleton (2001), small businesses form a seedbed for the entrepreneurial and enterprise culture on which much of the profit and employment prospects of big businesses ultimately depend. This observation clearly indicates the difference between small business owners and entrepreneurs. But although support for this viewpoint in the literature is universal, some researchers do not draw such a fine line between the two terms when discussing related issues; also, studies of small business firms are usually found in the entrepreneurship literature, where sometimes the two terms are used interchangeably. The existing entrepreneurship literature shows that several critical factors influence the birth and growth of start-up firms. These factors include both macro-level environmental and micro-level, or personal level, forces. Studies focusing on the former often examine the influence of politics, culture, society, economics, competition, and demographics on a person’s decision to start or grow a new business in a specific setting; this in turn can take place at different levels, such as the company, city, region, or nation (Jogartnam, 2002; Ramos-Rodriguez et al., 2012). Studies on the latter investigate the influence of personal characteristics, such as subculture, social factors (e.g., role, status, reference group), personal factors (e.g., age, gender, education, life cycle, personality, self-perception, lifestyles, values), and psychological factors (e.g., motives, beliefs, attitudes, perceptions, learning, risk-taking propensity, etc. (Littunen, 2000; Ramos-Rodriguez et al., 2012). This study adopted Chen and Elston’s (2013) entrepreneurial activity model for classifying and modeling these factors affecting firm start-ups and growth. Fig. 1 captures this process and highlights the critical factors influencing the entrepreneurial process and their various relationships. In this model, the macro-environment mix influences not only a person’s personal characteristics but also this person’s entrepreneurial process. These personal characteristics in turn also influence the entrepreneurial process. The research methodology was conducted with qualitative research method. Firstly, we interviewed the experts with regard to this industry, and then used content analysis for the interview records. After the in-depth interviews, a grounded theory was adopted to analyze the interview data with repeated coding and reading, and then innovative entrepreneurship were coded into fundamental categories with diverse descriptions (Corbin & Strauss, 1990). These descriptions represent the idea and meaning squeeze from the transcripts of interview. As for the research reliability, we read the biographies of participants and collect relative information such as their provided books, documents and reports from the news. To guarantee the validity of this study, we also improve the research content with researchers’ interview and reflection notes. Those notes were observation on innovative entrepreneurship process in this study. Therefore, these systematic methods could conclude a theory for a specific phenomenon (Hsieh & Shannon, 2005). Results The results of our qualitative analysis demonstrated the opinions of experts with regard to innovative entrepreneurship in hotel industry. Based on Chen and Elston’s (2013) entrepreneurial activity model, the characteristics of each concept were grounded with four dimensions: (1) Macro-environment mix (2) Personal characteristics (3) Entrepreneurial Proces (4) Major entrepreneurial outcome. The experts’ critical viewpoints are also presented by typical quotations. (1) Macro-environment mix ●? Shifting Market “Now the entire consumer market is shifting, everyone booking via the internet.”(sample 1) “When you book a hotel or a flight, people like the price competition. So you may have to spend a lot of time.” (sample 9) ●? The old technology “We are still using the technology more than a decade ago. Taiwan is still running the hotel in a very traditional way. It is when I open a hotel , I am looking for some people, and then ... I think I will make money. In fact, a lot of know how they do not know.”(sample 1) ●? Price competition “We think the outbound market has entered the Red Sea. The inbound market has not been fully developed and has potential for development. Therefore, we would not like to see the inbound market enter the price competition.” (sample 6) ●? Want Taiwan to be seen “Taiwan's B & B are really world-class highlights in tourism industry.”(DEAR BNB) ●? Make up the industrial gap “We think Taiwan needs a brand new high-quality hotel and lodging platform and we did it.” (sample 3) “I think what we do is very traditional! Just fill the gap by using the resources we have integrated with the method we want.” (sample 4) (2) Personal characteristics ●? Personal interest “I like traveling, I like going abroad, I like to fly.”(sample 8) “This is my hobby, I also like to interact with people.” (sample 4) ●? Doing what I want to do “I just want to do what I want to do.”(sample 8) “I like the Internet and marketing but don’t like to do engineer. “(sample 7) ●? Apply own expertise “Using my own technology and see the market demand gap, hoping to help Taiwan's lodging industry can be transformed, technology upgrades, do not have to monopolize by the traditional manufacturers.” (sample 1) “I study hospitality and work for a year in Taipei Evergreen Hotel, and later went to Vancouver to study hotel management. To start a new venture also an ultimate goal of our depasample 6ent, so I think it must be done.” (sample 2) ●? Personal life experience “I think creation needs inspiration, inspiration comes from life experience. Entrepreneurship will not have nothing, what you have to do today, it must have some relationship with your past life experience.” (sample 3) (3) Entrepreneurial Process ●? Self-finaning “I did not find someone or looking for funds.” (sample 4) “I have a deposit of 20 years, our funds are wholly-owned. We do not borrow money from banks nor fundraising or venture capital.” (sample 5) ●? Related connections “Originally, my good friend who knew about the lodging industry. You are ready, and then meet the right people, and then a good time point enter into the right market.” (sample 1) “When talent comes in, they will recommend people who have such abilities and values. Therefore, we have not publicly recruited R & D people.” (sample 4) ●? Try and error “In the beginning, we don’t seriously think about our business model. Through more case, we revise our business model.”(sample 6) “After my trip, I wanted to start a business. At that time, I did not have many ideas, so I did a lot of work to find directions.” (sample 7) ●? Find the right shareholder “Shareholders are important. When finding shareholders, his resources and skills are very important. I want more than his money.” (sample 2) ●? Play a consultant role “We are selling our ideas, as well as selling our resources, experience so a bit like a consultant's role.” (sample 7) (4) Major entrepreneurial outcome ●? Change the industry ecology “We have successfully changed some of the airline's mind, we have changed the hotel's promotional model and have changed an ecological.”(sample 8) ” The core of entrepreneurship is to re-establish an ecosystem.(sample 5) ●? Tourism industry knowledge education and personnel training of think tanks “We want to make domain knowledge, know-how in tourism industry can be extracted, shared, and can be taught textbook.” (smaple 6) ●? Package Form a network and provide a unique package “In addition to the network, we hope to the forming some unique service package.” (sample 5) “Our three companies are different areas and require different skills. In the future, we would integrate them.” (sample 7) Discussion and conclusions This study examined the innovative entrepreneurship with start up in the hotel industry. Using content analysis method to access the research conclusions, the four key components of entrepreneurial activity: Macro-environment mix, personal characteristics, entrepreneurial process and major entrepreneurial outcome (Chen and Elston, 2013) were adopted to set up a theoretical framework. The results of our research were provided through a systematic approach to interpret and summarize experts’ professional opinions. These data were collected by in-depth and semi-structured interviews which give participants opportunities to express their opinions based on their experience in innovative entrepreneurship of hospitality. Meanwhile, the concepts of experts’ comprehensions were written into different characteristics with logical explanations. Most important of all, our research contributes to the entrepreneurship literature. Though some previous studies have discussed Chen and Elston’s (2013) entrepreneurial activity model, none of them tried to integrate this perspective with start up company in hotel industry. Therefore, the results of this study filled the gap between theory and practice, and provide a distinct example for future innovative entrepreneurship research in hospitality. To sum up, as most previous research focus on theoretical or practical perspective to interpret entrepreneurship, the result of this research further contribute the development of innovative entrepreneurship especially in start up. These findings offered essential framework and required knowledge of strategies for current and future trends in this field.

Exendin-4 improves resistance to Listeria monocytogenes infection in diabetic db/db mice

Hsien Yueh Liu,Chih-Yao Chung,Wen-Chin Yang,Chih-Lung Liang,Chi-Young Wang,Chih-Yu Chang,Cicero Lee-Tian Chang 대한수의학회 2012 Journal of Veterinary Science Vol.13 No.3

The incidence of diabetes mellitus is increasing among companion animals. This disease has similar characteristics in both humans and animals. Diabetes is frequently identified as an independent risk factor for infections associated with increased mortality. In the present study, homozygous diabetic (db/db) mice were infected with Listeria (L.) monocytogenes and then treated with the anti-diabetic drug exendin-4, a glucagon-like peptide 1 analogue. In aged db/db mice, decreased CD11b+ macrophage populations with higher lipid content and lower phagocytic activity were observed. Exendin-4 lowered high lipid levels and enhanced phagocytosis in macrophages from db/db mice infected with L. monocytogenes. Exendin-4 also ameliorated obesity and hyperglycemia, and improved ex vivo bacteria clearance by macrophages in the animals. Liver histology examined during L. monocytogenes infection indicated that abscess formation was much milder in exendin-4-treated db/db mice than in the control animals. Moreover, mechanistic studies demonstrated that expression of ATP binding cassette transporter 1, a sterol transporter, was higher in macrophages isolated from the exendin-4-treated db/db mice. Overall, our results suggest that exendin-4 decreases the risk of infection in diabetic animals by modifying the interaction between intracellular lipids and phagocytic macrophages.