Taipei Medical University Clinical Research Database: a collaborative hospital EHR database aligned with international common data standards.

OBJECTIVE: The objective of this paper is to provide a comprehensive overview of the development and features of the Taipei Medical University Clinical Research Database (TMUCRD), a repository of real-world data (RWD) derived from electronic health records (EHRs) and other sources. METHODS: TMUCRD was developed by integrating EHRs from three affiliated hospitals, including Taipei Medical University Hospital, Wan-Fang Hospital and Shuang-Ho Hospital. The data cover over 15 years and include diverse patient care information. The database was converted to the Observational Medical Outcomes Partnership Common Data Model (OMOP CDM) for standardisation. RESULTS: TMUCRD comprises 89 tables (eg, 29 tables for each hospital and 2 linked tables), including demographics, diagnoses, medications, procedures and measurements, among others. It encompasses data from more than 4.15 million patients with various medical records, spanning from the year 2004 to 2021. The dataset offers insights into disease prevalence, medication usage, laboratory tests and patient characteristics. DISCUSSION: TMUCRD stands out due to its unique advantages, including diverse data types, comprehensive patient information, linked mortality and cancer registry data, regular updates and a swift application process. Its compatibility with the OMOP CDM enhances its usability and interoperability. CONCLUSION: TMUCRD serves as a valuable resource for researchers and scholars interested in leveraging RWD for clinical research. Its availability and integration of diverse healthcare data contribute to a collaborative and data-driven approach to advancing medical knowledge and practice.

The Effect of Social Robots on Depression and Loneliness for Older Residents in Long-Term Care Facilities: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVES: Depression and loneliness are challenges facing older residents living in long-term care facilities. Social robots might be a solution as nonpharmacologic interventions. The purpose of this study was to explore the effects of concrete forms of social robots on depression and loneliness in older residents in long-term care facilities by a systematic review and meta-analysis of randomized controlled trials. DESIGN: This is a systematic review and meta-analysis. SETTING AND PARTICIPANTS: Older residents in long-term care facilities. METHODS: Six electronic databases of PubMed, Embase, Scopus, Web of Science, MEDLINE, and CINAHL plus were searched in August 2023. Random effect models of meta-analyses, subgroup analyses, and meta-regressions were performed for statistical analyses. RESULTS: After evaluation, 8 studies were selected for both qualitative and quantitative synthesis. Social robot interventions had significant positive effects on decreasing depression and loneliness with large effect sizes. Group-based robot activities had a better effect on improving depression than individual-based robot activities. Longer durations of interventions produced significantly more improvement in depression. CONCLUSION AND IMPLICATION: Social robots with physical manifestation provide the opportunity for older adults' social engagement and interactions with robots and others. Social robot interventions are recommended for older residents in long-term care facilities to promote psychosocial well-being in daily care routines.

Correction: A novel Multi-Level Refined (MLR) knowledge graph design and chatbot system for healthcare applications.

[This corrects the article DOI: 10.1371/journal.pone.0296939.].

Clinical experience in intracranial stenting of Wingspan stent system under local anesthesia.

Objective: The use of endovascular treatments for symptomatic intracranial atherosclerosis disease (ICAD) remains contentious due to high periprocedural complications. Many centers resort to general anesthesia for airway protection and optimal periprocedural conditions; however, this approach lacks real-time monitoring of patients' neurological status during procedures. In this study, we employed intracranial stenting with the Wingspan system under local anesthesia to address this challenge. Methods: We conducted a retrospective study of 45 consecutive ICAD patients who underwent intracranial stenting with the Wingspan system at our hospital from August 2013 to May 2021. These stenting procedures were performed under local anesthesia in a hybrid operation room. Neurological assessments were conducted during the procedure. The patients with periprocedural complications were analyzed for the risk factors. Results: The study included 45 ICAD patients (median age 62 years; 35 male and 10 female individuals). Among them, 30 patients had anterior circulation ICAD, and 15 had posterior circulation ICAD. The periprocedural complication rate was 8.9% (4/45), with an overall mortality rate of 2.2% (1/45). Notably, no procedure-related perforation complications were found, and all ischemic complications occurred in the perforating bearing artery, specifically in patients with stents placed in the middle cerebral artery or basilar artery, while no complications were observed in the non-perforating bearing artery of the internal carotid artery and vertebral artery (p = 0.04). Conclusion: Our study demonstrates the safety and efficacy of the Wingspan stent system when performed on selected patients under local anesthesia. This approach seems to reduce procedural-related morbidity and be a safe intervention. In addition, it is crucial for surgeons to be aware that patients with perforator-bearing artery stenosis may be at a higher risk of complications.

The arboreal snail genus Amphidromus Albers, 1850 (Eupulmonata, Camaenidae) of Southeast Asia: 1. Molecular systematics of some Vietnamese species and related species from Cambodia, Indonesia, and Laos.

This paper reassesses the taxonomy and systematics of 11 arboreal snail species in the genus Amphidromus from Vietnam, Cambodia, Indonesia and Laos (A.bozhii Wang, 2019, A.buelowi Fruhstorfer, 1905, A.costifer Smith, 1893, A.haematostoma Möllendorff, 1898, A.ingens Möllendorff, 1900, A.madelineae Thach, 2020, A.metabletus Möllendorff, 1900, A.pankowskianus Thach, 2020, A.placostylus Möllendorff, 1900, A.roseolabiatus Fulton, 1896, and A.thachi Huber, 2015). The taxonomic validity of each species is supported by a phylogenetic analysis of mitochondrial COI and 16S rRNA gene fragments from 17 ingroup taxa. Amphidromusbuelowi was found to comprise two populations from two distant localities, one from Mount Singgalang, West Sumatra, Indonesia and the other from southern Vietnam. The samples from southern Vietnam were previously described as A.asper Haas, 1934 and A.franzhuberi Thach, 2016, but they are now treated as junior synonyms of A.buelowi in this study. In addition, two species from Vietnam are described as new to science, viz. A.asperoides Jirapatrasilp & Lee, sp. nov. and A.ingensoides Jirapatrasilp & Lee, sp. nov., each of which is conchologically comparable to A.buelowi and A.ingens, respectively.

Personalised prediction of maintenance dialysis initiation in patients with chronic kidney disease stages 3-5: a multicentre study using the machine learning approach.

BACKGROUND: Optimal timing for initiating maintenance dialysis in patients with chronic kidney disease (CKD) stages 3-5 is challenging. This study aimed to develop and validate a machine learning (ML) model for early personalised prediction of maintenance dialysis initiation within 1-year and 3-year timeframes among patients with CKD stages 3-5. METHODS: Retrospective electronic health record data from the Taipei Medical University clinical research database were used. Newly diagnosed patients with CKD stages 3-5 between 2008 and 2017 were identified. The observation period spanned from the diagnosis of CKD stages 3-5 until the maintenance dialysis initiation or a maximum follow-up of 3 years. Predictive models were developed using patient demographics, comorbidities, laboratory data and medications. The dataset was divided into training and testing sets to ensure robust model performance. Model evaluation metrics, including area under the curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value and F1 score, were employed. RESULTS: A total of 6123 and 5279 patients were included for 1 year and 3 years of the model development. The artificial neural network demonstrated better performance in predicting maintenance dialysis initiation within 1 year and 3 years, with AUC values of 0.96 and 0.92, respectively. Important features such as baseline estimated glomerular filtration rate and albuminuria significantly contributed to the predictive model. CONCLUSION: This study demonstrates the efficacy of an ML approach in developing a highly predictive model for estimating the timing of maintenance dialysis initiation in patients with CKD stages 3-5. These findings have important implications for personalised treatment strategies, enabling improved clinical decision-making and potentially enhancing patient outcomes.

Incidence and risk factors of heterotopic ossification after cervical Baguera C disc arthroplasty.

OBJECTIVE: This retrospective study was designed to evaluate the incidence and predisposing factors of heterotopic ossification (HO) after cervical disc arthroplasty (CDA) with a specific implant at 1 and 2 levels, and to investigate the biomechanical effects related to HO. The study goal was to identify ways to reduce the likelihood of HO formation after surgery. METHODS: The study included patients who underwent only 1- or 2-level CDA with the Baguera C disc between November 2014 and December 2021 at a single medical center. All patients were operated on by the same neurosurgeon. The surgical indication included 1-level or 2-level disc herniation between C3 and C7 with radiculopathy, myelopathy, or both, with minimal spondylosis. The various factors were assessed by evaluating plain radiographs and cervical CT scans. The presence of HO was evaluated at different intervals postsurgery, and HO severity was graded using the McAfee classification. RESULTS: Of 107 patients who underwent CDA, 47 (43.9%) had HO at 63 of 171 levels (36.8%). Most cases with HO were grade 1, and no grade 4 was observed. Statistically significant risk factors for HO were the length of endplate coverage ratio and inferior anterior residual exposed endplate (AREE); sex, age, implant height and width, shell angle, and pre- and postoperative functional spinal unit (FSU) angle were not significant. More AREE and greater kyphotic postoperative FSU angle in the flexion position were significant factors differentiating HO grades 0 and 1 from grades 2 and 3. Furthermore, the non-HO group showed a trend of higher range of motion at any postoperative time compared to the HO group, especially at 1 month after surgery. CONCLUSIONS: The HO incidence after CDA was correlated with the residual length of endplate coverage and inferior AREE. Additionally, the AREE and kyphotic postoperative FSU angle in the flexion position were associated with HO grade progression. Patients with HO also showed a trend of lower range of motion at 1 month after surgery. Using an adequately sized implant and encouraging neck motion may help prevent HO development and progression.

Risk Factors for Cervical Disc Arthroplasty Subsidence with Bryan Disc-A Retrospective Observational Analysis.

Background: Cervical disc arthroplasty (CDA) is currently used instead of fusion to preserve cervical spine motion. Cervical implant subsidence is a potential complication after CDA. Methods: Radiological measurements were recorded via patient anteroposterior and lateral radiographs in the neutral position. Subsidence was defined as a decrease of 3 mm or more in functional spinal unit height (FSUH) from which was measured on a post-operative (OP) radiograph. Results: This study included 104 patients who underwent 153 CDA levels with the Bryan Disc. Approximately one-quarter of the implants (22.9%) showed subsidence. Binary logistic regression analysis indicated that pre-OP mean disc height (DH) was identified as an independent risk factor for subsidence in multivariate analysis (0.151, 95% Confidence Interval 0-0.073, p = 0.018). Receiver operating characteristic curve analysis (area under the curve = 0.852, sensitivity 84.7%, specificity 77.1%) revealed a cut-off value of 4.48 mm for pre-OP Mean-DH in the risk for implant subsidence. Conclusions: In this study, the subsidence rate significantly increased when the implants were oversized beyond a pre-OP Mean-DH of approximately >4 mm. Moreover, the implant subsidence incidence was higher than that reported in previous studies. This is possibly due to endplate over-preparation or disc space over-distraction during placement at the same height as the Bryan Disc (8.5 mm).

A novel Multi-Level Refined (MLR) knowledge graph design and chatbot system for healthcare applications.

Imagine having a knowledge graph that can extract medical health knowledge related to patient diagnosis solutions and treatments from thousands of research papers, distilled using machine learning techniques in healthcare applications. Medical doctors can quickly determine treatments and medications for urgent patients, while researchers can discover innovative treatments for existing and unknown diseases. This would be incredible! Our approach serves as an all-in-one solution, enabling users to employ a unified design methodology for creating their own knowledge graphs. Our rigorous validation process involves multiple stages of refinement, ensuring that the resulting answers are of the utmost professionalism and solidity, surpassing the capabilities of other solutions. However, building a high-quality knowledge graph from scratch, with complete triplets consisting of subject entities, relations, and object entities, is a complex and important task that requires a systematic approach. To address this, we have developed a comprehensive design flow for knowledge graph development and a high-quality entities database. We also developed knowledge distillation schemes that allow you to input a keyword (entity) and display all related entities and relations. Our proprietary methodology, multiple levels refinement (MLR), is a novel approach to constructing knowledge graphs and refining entities level-by-level. This ensures the generation of high-quality triplets and a readable knowledge graph through keyword searching. We have generated multiple knowledge graphs and developed a scheme to find the corresponding inputs and outputs of entity linking. Entities with multiple inputs and outputs are referred to as joints, and we have created a joint-version knowledge graph based on this. Additionally, we developed an interactive knowledge graph, providing a user-friendly environment for medical professionals to explore entities related to existing or unknown treatments/diseases. Finally, we have advanced knowledge distillation techniques.

Speech Emotion Recognition Applied to Real-World Medical Consultation.

Since 2020, the COVID-19 epidemic has changed our lives in healthcare behaviors. Forced to wear masks influenced doctor-patient interaction perceptions truly, thus, to build a satisfying relationship is not just empathize with facial expressions. The voice becomes more important for the sake of conquering the burden of masks. Hence, verbal and non-verbal communication will be crucial criteria for doctor-patient interaction during medical consultations and other conversations. In these years, speech emotion recognition has been a popular research domain. In spite of abundant work conducted, nonverbal emotion recognition in medical scenarios is still required to reveal. In this study, we investigate YAMNet transfer learning on Chinese Mandarin speech corpus NTHU-NTUA Chinese Interactive Emotion Corpus (NNIME) and use real-world dermatology clinic recording to test the generalization capability. The results showed that the accuracy validated on NNIME data was 0.59 for activation prediction and 0.57 for valence. Furthermore, the validation accuracy on the doctor-patient dataset was 0.24 for activation and 0.58 for valence, respectively.

Facial Mimicry and Doctor-Patient Satisfaction: The Feasibility of Artificial Empathy in a Clinical Video Data.

Good nonverbal communication between doctor and patient is essential for achieving a successful and therapeutic doctor-patient relationship. Increasing evidence has shown that nonverbal communication mimicry, particularly facial mimicry, where one mirrors another's facial expressions, is linked to empathy and emotion recognition. Empathy is also the key driver of patient satisfaction. This study explores how facial expressions and facial mimicry influence doctor-patient satisfaction during a clinical encounter. We used a facial emotion recognition-based artificial empathy model to analyze 315 recorded clinical video data of doctors and patients in a dermatology outpatient clinic. The results show a significant negative correlation between patients' emotions of sadness and neutral and doctor satisfaction, but no correlation between the duration of doctors mimicking patient emotions and patient satisfaction. These findings provide valuable insights into the future design of systems that can further enhance clinician awareness to maintain communication skills in the search for better doctor-patient satisfaction.

Coding-complete genomic sequence of bovine viral diarrhea virus isolated from a calf in Taiwan.

The coding-complete genomic sequence of a Taiwanese bovine viral diarrhea virus (BVDV) was sequenced. Phylogenetic analysis suggested that the Taiwanese isolate belonged to the 1b clade. This study will advance the understanding of BVDV genotypes in Southeast Asia and promote future studies on BVDV epidemiology in Taiwan.

Crowdsource authoring as a tool for enhancing the quality of competency assessments in healthcare professions.

The current Objective Structured Clinical Examination (OSCE) is complex, costly, and difficult to provide high-quality assessments. This pilot study employed a focus group and debugging stage to test the Crowdsource Authoring Assessment Tool (CAAT) for the creation and sharing of assessment tools used in editing and customizing, to match specific users' needs, and to provide higher-quality checklists. Competency assessment international experts (n = 50) were asked to 1) participate in and experience the CAAT system when editing their own checklist, 2) edit a urinary catheterization checklist using CAAT, and 3) complete a Technology Acceptance Model (TAM) questionnaire consisting of 14 items to evaluate its four domains. The study occurred between October 2018 and May 2019. The median time for developing a new checklist using the CAAT was 65.76 minutes whereas the traditional method required 167.90 minutes. The CAAT system enabled quicker checklist creation and editing regardless of the experience and native language of participants. Participants also expressed the CAAT enhanced checklist development with 96% of them willing to recommend this tool to others. The use of a crowdsource authoring tool as revealed by this study has efficiently reduced the time to almost a third it would take when using the traditional method. In addition, it allows collaborations to partake on a simple platform which also promotes contributions in checklist creation, editing, and rating.

Complete coding sequence of Tembusu virus isolated from geese in Taiwan in 2020.

We reported the complete coding sequence of a Tembusu virus (TMUV) isolated from sick geese in Taiwan in 2020. The nucleotide sequence of the 20120008 isolate was most closely related to the strain TP1906 isolated from mosquitoes in Taiwan and clustered within a subgroup of Cluster 4 of the Tembusu virus.

Feasibility and workflow analysis of IV-DSA-based augmented reality-guided brain arteriovenous malformation resection in a hybrid operating room: i-Flow tailored method.

Augmented reality (AR) has emerged as a promising technology in various medical fields.1 2 In the context of brain arteriovenous malformation (bAVM) surgery, AR offers the potential to enhance surgical visualization and improve procedural accuracy.3 4 5 6 This report aims to explore the application of digital subtraction angiography (DSA) from an IV contrast injection (IV-DSA) in AR-guided resection of bAVMs in a neurosurgical hybrid operating room.The workflow of IV-DSA-based AR-guided surgery for the resection of bAVMs consists of four main components: (1) acquiring source images through i-Flow tailored or multiphase scans (Siemens, Germany); (2) labelling targets in the workstation using Smartbrush software (Brainlab, Westchester, Illinois, USA); (3) using the Brainlab Curve navigation system; and (4) merging microscopic AR fusion using Zeiss Kinevo (AG, Germany). In video 1 we show the entire workflow and introduce i-Flow tailored IV-DSA data acquisition in the hybrid operating room. In summary, IV-DSA-based augmented reality is an innovative technique for bAVM surgery.neurintsurg;jnis-2023-020797v1/V1F1V1Video 1-i-flow tailored iv-DSA.

Advances in surgical treatment for atlantoaxial instability focusing on rheumatoid arthritis: Analysis of a series of 67 patients.

AIM: An estimated 88% of rheumatoid arthritis (RA) patients experience various degrees of cervical spine involvement. The excessive movement of the atlantoaxial joint, which connects the occiput to the upper cervical spine, results in atlantoaxial instability (AAI). AAI stabilization is usually achieved by C1 lateral mass-to-C2 pedicle screw-rod fixation (LC1-PC2 fixation), which is technically challenging in RA patients who often show destructive changes in anatomical structures. This study aimed to analyze the clinical results and operative experiences of C1-C2 surgery, with emphasis on the advancement of image-guided surgery and augmented reality (AR) assisted navigation. METHODS: We presented our two decades of experience in the surgical management of AAI from April 2004 to November 2022. RESULTS: We have performed surgery on 67 patients with AAI, including 21 traumatic odontoid fractures, 20 degenerative osteoarthritis, 11 inflammatory diseases of RA, 5 congenital anomalies of the os odontoideum, 2 unknown etiologies, 2 movement disorders, 2 previous implant failures, 2 osteomyelitis, 1 ankylosing spondylitis, and 1 tumor. Beginning in 2007, we performed LC1-PC2 fixation under C-arm fluoroscopy. As part of the progress in spinal surgery, since 2011 we used surgical navigation from presurgical planning to intraoperative navigation, using the preoperative computed tomography (CT) -based image-guided BrainLab navigation system. In 2021, we began using intraoperative CT scan and microscope-based AR navigation. CONCLUSION: The technical complexities of C1-C2 surgery can be mitigated by CT-based image-guided surgery and microscope-based AR navigation, to improve accuracy in screw placement and overall clinical outcomes, particularly in RA patients with AAI.

Multi-Level Resistive Al/Ga2O3/ITO Switching Devices with Interlayers of Graphene Oxide for Neuromorphic Computing.

Recently, resistive random access memory (RRAM) has been an outstanding candidate among various emerging nonvolatile memories for high-density storage and in-memory computing applications. However, traditional RRAM, which accommodates two states depending on applied voltage, cannot meet the high density requirement in the era of big data. Many research groups have demonstrated that RRAM possesses the potential for multi-level cells, which would overcome demands related to mass storage. Among numerous semiconductor materials, gallium oxide (a fourth-generation semiconductor material) is applied in the fields of optoelectronics, high-power resistive switching devices, and so on, due to its excellent transparent material properties and wide bandgap. In this study, we successfully demonstrate that Al/graphene oxide (GO)/Ga2O3/ITO RRAM has the potential to achieve two-bit storage. Compared to its single-layer counterpart, the bilayer structure has excellent electrical properties and stable reliability. The endurance characteristics could be enhanced above 100 switching cycles with an ON/OFF ratio of over 103. Moreover, the filament models are also described in this thesis to clarify the transport mechanisms.

The residual exposed endplate ratio is predictive of posterior heterotopic ossification after cervical Bryan disc arthroplasty.

OBJECTIVES: Heterotopic ossification (HO), a major cause of dysfunction after disc arthroplasty (CDA). The aim of this study was to determine the cut value of the residual exposed endplate (REE) ratio and to predict the development of posterior HO after Bryan CDA. METHODS: This retrospective study investigated the relationship between the REE ratio and posterior HO formation after Bryan CDA. Consecutive adult patients who underwent 1- or 2-level Bryan CDA by a single neurosurgeon between 2006 and 2016 with at least two years follow-up were included. Postoperative radiographic analysis and measurement were performed to obtain the REE ratio and the HO grade. RESULTS: Of 249 patients with 384 surgical levels who underwent Bryan CDA during the study period, 114 (45.8 %) received 1-level CDA and 135 (54.2 %) received 2-level CDA. Lateral radiographs showed that 169 implants (44 %) had posterior HOs in all grades after two years or more of follow up and 14 implants (3.64 %) had severe HO (McAfee grades 3 and 4). In 329 implants (85.7 %), a comparison of radiographs to CT examination of HO grading showed a substantial relationship. Using area under the curve (AUC) analysis, a REE ratio >9 %, with 65.1 % sensitivity and 86.5 % specificity, was the cut point for posterior HO formation. CONCLUSIONS: REE is highly correlated with the development of postoperative posterior HO after Bryan CDA, regardless of the level of implantation. An undersized implant causing a REE ratio >9 % is a predictor of postoperative posterior HO formation after cervical Bryan CDA.