Transforaminal Endoscopic Lumbar Discectomy for L5–S1 Disc Herniation With High Iliac Crest: Technical Note and Preliminary Series

Kuo-Tai Chen,Sung-Tai Wei,Chun Tseng,Su-Wei Ou,Li-Wei Sun,Chien-Min Chen 대한척추신경외과학회 2020 Neurospine Vol.17 No.sup.

With the trend of minimally invasive spine surgery, full-endoscopic lumbar discectomy (FELD) has evolved with the advancement of the optics and instruments. Regarding the techniques, the transforaminal and interlaminar approach remain the major accesses in FELD. Transforaminal endoscopic lumbar discectomy (TELD) is an effective and safe treatment for herniation of the lumbar disc. More and more evidence supports the TELD in enhancing recovery and decreasing surgical complications. However, the learning curve of TELD remains steep, especially at the L5–S1 level. The iliac crest height is an essential factor in the operability of TELD at the L5–S1 level. In the situation of the high iliac crest, TELD is technically challenging even for an experienced surgeon. Therefore, the authors report their techniques of TELD with foraminoplasty step-by-step and the preliminary results in this report.

Current Indications for Spinal Endoscopic Surgery and Potential for Future Expansion

Kuo-Tai Chen,김진성,Abel Po-Hao Huang,Martin Hsiu-Chu Lin,Chien-Min Chen 대한척추신경외과학회 2023 Neurospine Vol.20 No.1

Endoscopic spine surgery (ESS) has evolved as a safe, effective, and efficient alternative for minimally invasive spine surgery (MISS). The innovation of full-endoscopic systems makes definitive decompression surgery through different approaches feasible. The approach can be determined according to the location of the target lesion or the surgeon's preference. During the past 2 decades, ESS has expanded its indications from lumbar to cervical spines. Except for decompression, endoscopy-assisted fusion surgery is also developing. However, ESS is still evolving and has a steep learning curve. The revolution of technologies and ESS techniques will enable surgeons to treat various spinal diseases more practically. In recent years, the application of the computer-assisted navigation system and augmented reality have reformed imaging quality and interpretation. The endoscopic rhizotomy techniques have opened a new way for MISS of chronic low back pain. This review introduces the current indications of ESS and its potential future expansion.

Prequalification of VDSL2 copper customers for G.fast services with artificial intelligence technology

Pang-Chen Liu,Shun-Kai Yang,Lung-Chin Huang,Huai-Eu Tseng,Fei-Hua Kuo,Tai-Chueh Shih 한국통신학회 2020 한국통신학회 APNOMS Vol.2020 No.09

In recent years, due to customers have higher requirements for 4K/8K video and high-speed internet, telecom operators have begun to deploy FTTH network , but found that it is generally difficult to deploy fiber to the home, so G.fast technology has been favored by most telecom operators around the world and have begun to actively deploy. For the most widely deploy VDSL2 line with maximum rate that can only provide 100M internet service, a intelligent and accurate G.fast 300M high speed service prequalification technology, is a major research topic for telecom operators to promote 300M high-speed internet service. This paper proposes to use AI machine learning to estimate the G.fast line rate by using VDSL2 line attenuation to meet the real-site provision needs of telecommunications operators.

The energy band alignment at the interface between mechanically exfoliated few-layer NiPS3 nanosheets and ZnO

Cheng-Tai Kuo,Karuppannan Balamurugan,Hung Wei Shiu,Hyun Ju Park,Soobin Sinn,Michael Neumann,한문섭,장영준,Chia-Hao Chen,Hyeong-Do Kim,박제근,Tae Won Noh 한국물리학회 2016 Current Applied Physics Vol.16 No.3

We have studied the electronic structure and interfacial properties of mechanically exfoliated few-layer NiPS3 van der Waals crystals on ZnO/Nb:SrTiO3 substrates using scanning photoelectron microscopy and spectroscopy. The conducting ZnO layer enhances the visibility of few-layer NiPS3 on Nb:SrTiO3 and prevents charging effects in photoemission. We experimentally determined a type-II band alignment at the NiPS3/ZnO interface. The valence band offset (VBO) of few-layer NiPS3/ZnO is 2.8 ± 0.09 eV, and the conduction band offset is 1.0 ± 0.09 eV. Moreover, we found an increase of ~0.3 eV in VBO as decreasing NiPS3 thickness, suggesting electronic coupling or charge transfer at the NiPS3/ZnO interface.

Efficient Channel Assignment Scheme Based on Finite Projective Plane Theory

( Chi-chung Chen ),( Ing-jiunn Su ),( Chien-hsing Liao ),( Tai-kuo Woo ) 한국인터넷정보학회 2016 KSII Transactions on Internet and Information Syst Vol.10 No.2

This paper proposes a novel channel assignment scheme that is based on finite projective plane (FPP) theory. The proposed scheme involves using a Markov chain model to allocate N channels to N users through intermixed channel group arrangements, particularly when channel resources are idle because of inefficient use. The intermixed FPP-based channel group arrangements successfully related Markov chain modeling to punch through ratio formulations proposed in this study, ensuring fair resource use among users. The simulation results for the proposed FPP scheme clearly revealed that the defined throughput increased, particularly under light traffic load conditions. Nevertheless, if the proposed scheme is combined with successive interference cancellation techniques, considerably higher throughput is predicted, even under heavy traffic load conditions.

Navigation-Assisted Full-Endoscopic Radiofrequency Rhizotomy Versus Fluoroscopy-Guided Cooled Radiofrequency Ablation for Sacroiliac Joint Pain Treatment: Comparative Study

Chien-Min Chen,Jae Hwan Lee,Meng-Yin Yang,Shang-Wun Jhang,Kai-Sheng Chang,Su-Wei Ou,Li-Wei Sun,Kuo-Tai Chen 대한척추신경외과학회 2023 Neurospine Vol.20 No.1

Objective: Sacroiliac joint (SIJ) pain is a common cause of chronic low back pain. Full-endoscopic rhizotomy of lateral branches of dorsal rami innervating SIJ is a potential option for patients’ refractory to medical treatment. The full-endoscopic rhizotomy is sometimes challenging under fluoroscopic guidance. This study is to evaluate the effectiveness of the navigation-assisted full-endoscopic rhizotomy for SIJ pain. Methods: The study was a retrospective match-paired study that enrolled consecutive patients undergoing navigation-assisted full-endoscopic rhizotomy for SIJ pain. The patient demographics, clinical outcomes, and operative parameters of endoscopic rhizotomy were compared with conventional cooled radiofrequency ablation (RFA) treatment. Results: The study enrolled 72 patients, including 36 patients in the endoscopic group. Thirty-six patients in the cooled RFA group were matched by age as the control. The follow-up time was at least 1 year. Patient characteristics were similar between the groups. The navigation-assisted endoscopic rhizotomy operation time was significantly longer than the cooled RFA. The visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) significantly decreased after each treatment. However, the between-group comparison revealed that the VAS and ODI of the patients after endoscopic rhizotomy were significantly lower than those after the cooled RFA group. There were no postoperative complications in the study. Conclusion: Navigation-assisted full-endoscopic rhizotomy is an alternative to SIJ pain treatment. Integrating intraoperative navigation can ensure accurate full-endoscopic rhizotomy to provide better durability of pain relief than the cooled RFA.

Hints from a Female Patient with Breast Cancer Who Later Presented with Cowden Syndrome

Wen-Chung Wang,Tai-Cheng Hou,Chen-Yun Kuo,Yen-Chein Lai 한국유방암학회 2020 Journal of breast cancer Vol.23 No.4

A 51-year-old woman presented with metachronous tumor development in bilateral breasts, thyroid, and endometrium. Additional signs and symptoms fulfilled the National Comprehensive Cancer Network criteria for Cowden syndrome. Immunohistochemistry showed loss of PTEN expression in all tumors. Single nucleotide variants, 647 germline variants (including one each in PTEN and MSH3), and 21 somatic mutations within exons were detected in all tumors after whole-exome sequencing. There were 0, 11, and 46 specific somatic mutations in bilateral breasts, thyroid, and endometrial cancers, respectively. Although PTEN mutation is key to the development of Cowden syndrome, DNA repair dysfunction might be the initial driver of mutations. Fewer mutations were required to induce initial bilateral breast carcinomas, with subsequent thyroid and endometrial carcinomas requiring more mutations for induction. When genetic screening is unavailable, breast cancer patients with clinical manifestations of Cowden syndrome must be carefully assessed for secondary malignancies, such as thyroid and endometrial carcinomas.

Sofosbuvir/Ledipasvir in the Treatment of Chronic Hepatitis C - A Subgroup Analysis from A Nationwide Real-World HCV Registry Program (TACR) in Taiwan

( Ming-Lung Yu ),( Chi-Yi Chen ),( Kuo-Chih Tseng ),( Ching-Chu Lo ),( Pin-Nan Cheng ),( Cheng-Yuan Peng ),( Ming-Jong Bair ),( Chih-Lang Lin ),( Chi-Ming Tai ),( Chi-Chieh Yang ),( Chih-Wen Lin ),( C 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: TASL HCV Registry (TACR) is a nationwide registry program organized and supervised by Taiwan Association for the Study of the Liver (TASL), which aims to setup the database and biobank of patients with chronic hepatitis C (CHC) in Taiwan. The present study aimed to evaluate the treatment outcome of sofosbuvir (SOF)/ledipasvir (LDV) in Taiwanese CHC patients in TACR. Methods: By May 2020, 19 tertiary hospitals, 23 community hospitals and one primary care clinic join the TACR program. The baseline characteristics, prior liver and non-liver related medical history, DAA regimens, laboratory results, treatment course and outcome were recorded. The primary objective was sustained virological response, defined as undetectable HCV RNA 3 months after end-of-treatment (SVR12). Results: A total of 4742 SOF/LDV+ ribavirin treated CHC patients with available SVR12 data from 39 sites were enrolled in the current analysis. The mean age was 61.3 years, and female accounted for 54.8% of the population. The dominant viral genotypes were GT1b (52.6%) and GT2 (35.6%). 1354 (28.6%) patients had liver cirrhosis, including 156 (3.3%) with liver decompensation, 552 (11.6%) had preexisting hepatocellular carcinoma (HCC) before DAAs treatment and 413 (8.7%) had hepatitis B virus dual infections. The overall SVR12 rate was 98.5%, with 98.5%, 98.2%, 99.7% and 98.6% in treatment- naïve non-cirrhotics, treatment-naïve cirrhotics, treatment- experienced non-cirrhotics and treatment-experienced cirrhotics patients, respectively. While patients were stratified by HCV genotype, the SVR12 was 98.5%, 98.4% and 98.5% among those with GT1, GT2 and GT6 infection, respectively. The strongest factor independent associated with treatment failure was DAA adherence < 60% (odds ratio [OR]/95% confidence intervals [CI]: 125.4/25.7-612.4, P<0.0001), followed by active HCC (OR/CI: 6.20/2.57-14.97, P<0.0001), HIV co-infection (OR/CI: 3.01/1.14-7.92, P=0.026), and male gender (OR/ CI: 1.85/1.09-3.13, P=0.023). The eGFR decreased significantly at the end of treatment (EOT) (89.3 ml/min/1.73㎡ vs. 93.2 ml/min/1.73㎡, P< 0.001) and remained stable 3 months after EOT (89.3 ml/min/1.73㎡). However, the decreased eGFR was observed only in patients whose baseline eGFR > 90 ml/ min/1.73㎡. Instead, patients with chronic kidney diseases whose pretreatment eGFR < 60 ml/min/1.73㎡ had improved eGFR after SOF/LDV. Conclusions: SOF/LDV is highly effective in treating CHC patients in real-world setting of Taiwan. The satisfactory result could be explicitly generalized to patients with different viral genotypes and liver disease severities.

Effect of patient decision aids on choice between sugammadex and neostigmine in surgeries under general anesthesia: a multicenter randomized controlled trial

Wang Li-Kai,Lin Yao-Tsung,Chen Jui-Tai,Lan Winnie,Hung Kuo-Chuan,Chen Jen-Yin,Liu Kuei-Jung,Yen Yu-Chun,Chou Yun-Yun,Cherng Yih-Giun,Tam Ka-Wai 대한마취통증의학회 2023 Korean Journal of Anesthesiology Vol.76 No.4

Background: Shared decision making using patient decision aids (PtDAs) was established over a decade ago, but few studies have evaluated its efficacy in Asian countries. We therefore evaluated the application of PtDAs in a decision conflict between two muscle relaxant reversal agents, neostigmine and sugammadex, and sequentially analyzed the regional differences and operating room turnover rates.Methods: This multicenter, outcome-assessor-blind, randomized controlled trial included 3,132 surgical patients from two medical centers admitted between March 2020 and August 2020. The patients were randomly divided into the classical and PtDA groups for pre-anesthesia consultations. Their clinicodemographic characteristics were analyzed to identify variables influencing the choice of reversal agent. On the day of the pre-anesthesia consultation, the patients completed the four SURE scale (sure of myself, understand information, risk-benefit ratio, encouragement) screening items. The operating turnover rates were also evaluated using anesthesia records. Results: Compared with the classical group, the PtDA group felt more confident about receiving sufficient medical information (P < 0.001), felt better informed about the advantages and disadvantages of the medications (P < 0.001), exhibited a superior understanding of the benefits and risks of their options (P < 0.001), and felt surer about their choice (P < 0.001). Moreover, the PtDA group had a significantly greater tendency to choose sugammadex over neostigmine (P < 0.001). Conclusions: PtDA interventions in pre-anesthesia consultations provided surgical patients with clear knowledge and better support. PtDAs should be made available in other medical fields to enhance shared clinical decision-making.

The Natural Flavonoid Apigenin Suppresses Th1- and Th2-Related Chemokine Production by Human Monocyte THP-1 Cells Through Mitogen-Activated Protein Kinase Pathways

Ching-Hua Huang,Po-Lin Kuo,Ya-Ling Hsu,Tai-Tsung Chang,Hsing-I Tseng,Yu-Te Chu,Chang-Hung Kuo,Huan-Nan Chen,Chih-Hsing Hung 한국식품영양과학회 2010 Journal of medicinal food Vol.13 No.2

Dietary flavonoids have various biological functions, and there is increasing evidence that reduced prevalence and severity of allergic reactions are associated with the intake of flavonoids. Among natural flavonoids, apigenin is a potent anti-inflammatory agent. However, the mechanisms of apigenin's effect remain uncertain. Monocyte-derived chemokine (MDC) plays a pivotal role in recruiting T-helper (Th) 2 cells in the allergic inflammation process. In the late phase of allergic inflammation, the Th1 chemokine interferon-inducible protein 10 (IP-10) has also been found in elevated levels in the bronchial alveolar fluid of asthmatic children. We used human THP-1 monocyte cells, pretreated with or without apigenin, prior to lipopolysaccharide stimulation. By means of enzyme-linked immunosorbent assay, we found that apigenin inhibited production of both MDC and IP-10 by THP-1 cells and that the suppressive effect of apigenin was not reversed by the estrogen receptor antagonist ICI182780. The p65 phosphorylation of nuclear factor κB remained unaffected, but the phosphorylation of p38, c-Jun N-terminal kinase, and extracellular signal-regulated kinase mitogen-activated protein kinase pathways were all blocked. We found that inhibition of c-raf phosphorylation might be the target of apigenin's anti-inflammation property.