Experiences of Implementing Rooming-in Practice for First-Time Mothers in a Postpartum Care Center.

Introduction: Practices promoted by the Baby-Friendly Hospital Initiative have become a part of the current mainstream postpartum infant care. However, adherence to rooming-in practice by health-care facilities is lower than that of other steps under this initiative. Objective: The aim of this study was to investigate the experiences in implementing the rooming-in policy among first-time mothers at a postpartum center. Methods: The present study is a qualitative research conducted using the descriptive phenomenological method. This study was performed at a postpartum care center in Southern Taiwan between August 2018 and December 2018. Semi-structured interviews were conducted with 20 postpartum mothers during their postpartum care center stay. Results: Based on interview data, this study identified three main themes about implementing full-time rooming-in experiences: (a) against the rule of taking plenty of rest during the postpartum period, (b) negative experiences and myths regarding implementing rooming-in experience, and (c) postpartum care centers service content affect first-time mothers' willingness to implement rooming-in. Conclusions: In postpartum care centers, first-time mothers' willingness to implement full-time rooming-in significantly decreases due to the effects of the "doing-the-month" culture, postpartum physical recovery status, stress of the rooming-in experience, myths regarding rooming-in practice, trusting professional neonate care services more than own care, and attitude toward payment for services.

The early predictive value of frailty for health-related quality of life among elderly patients with cancer receiving curative chemotherapy.

Changes in health-related quality of life (HRQOL) among elderly patients with cancer before and after receiving curative treatment, such as chemotherapy, have always been an important consideration in physician-patient treatment decision-making. Although frailty assessment can help predict the effects of chemotherapy, there is a lack of relevant literature on its effectiveness in predicting post-chemotherapy HRQOL. Therefore, this study investigated the early predictive value of pre-chemotherapy frailty assessment for post-chemotherapy HRQOL among elderly patients with cancer receiving curative chemotherapy. From September 2016 to November 2018, this study enrolled elderly patients with cancer aged ≥ 65 years (N = 178), who were expected to receive chemotherapy at three hospitals in Taiwan. The mean age of patients was 71.70 years (SD = 5.46 years) and half of them were female (n = 96, 53.9%). A comprehensive geriatric assessment was performed to measure frailty in 178 participants one week before receiving chemotherapy (T0). Further, the HRQOL of the elderly patients with cancer was assessed again, four weeks after chemotherapy (T1). After controlling for demographic variables, this study evaluated the predictive value of frailty for HRQOL using a hierarchical regression analysis. A total of 103 (57.9%) participants met the frailty criteria. The results showed that 31.1%-56.7% of the variance in the seven domains of HRQOL could be explained by demographic variables and the presence or absence of frailty. This suggests that the presence or absence of frailty is an important predictor of the illness burden domain (ß = 9.5; p < .05) of HRQOL. Frailty affects the illness burden domain of HRQOL in elderly patients with cancer. Finally, the administration of frailty assessments before treatment is recommended as a reference for patient treatment decision-making.

Critical Thinking Disposition and Influencing Factors Among New Graduate Nurses.

BACKGROUND: Critical thinking disposition is important to facilitate professional judgment for novice nurses. The goals of this study were to describe critical thinking disposition among newly graduated nurses and to examine the factors that impact the development of critical thinking disposition. METHOD: This study employed a cross-sectional research design. RESULTS: The mean critical thinking score was 244.11 (SD = 44.70), with the highest mean scores earned on the inquisitiveness subscale (M = 38.46, SD = 7.10). The lowest subscale scores were for systematicity (M = 34.81, SD = 5.54), truth seeking (M = 33.12, SD = 6.42), and self-confidence (M = 29.26, SD = 6.90). Critical thinking dispositions were significantly associated with teaching strategies during the educational period, problem-based learning courses, and length of exposure to problem-based learning. CONCLUSION: Findings provide information to understand the disposition toward critical thinking in novice nurses and can serve as a reference in efforts to improve novice nurses' critical thinking skills. [J Contin Educ Nurs. 2023;54(5):233-240.].

Effect of Acupressure on Fatigue in Hemodialysis Patients: A Single-Blinded Randomized Controlled Trial.

Objectives: The objective of this study was to investigate the effect of acupressure on fatigue severity, sleep quality, and psychological status in patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) treatment. Design: A single-blinded parallel-group randomized controlled trial. Settings/Location: A medical center in central Java, Indonesia. Subjects: One hundred and six patients who had been receiving HD for at least 3 months were enrolled in this study and randomly assigned to two groups. Interventions: The experimental group received acupressure at K1, ST36, and SP6 acupoints. In contrast, the control group received sham acupressure at 1 cun from these three acupoints. Subjects received acupressure thrice per week for 4 weeks, and pressure on each acupoint was applied for 3 min bilaterally. Outcome measures: The primary outcome was fatigue severity, while sleep quality and psychological status (depression/anxiety) were evaluated as secondary outcomes. Outcomes were assessed using the Brief Fatigue Inventory, Pittsburgh Sleep Quality Index, and Hospital Anxiety and Depression Scale. Results: Acupressure induced a significant medium to large effect on improvement in fatigue (b = -1.71, confidence interval [95% CI]: -1.90 to -1.51, ΔR2 = 0.744), sleep quality (b = -5.81, 95% CI: -6.80 to -4.81, ΔR2 = 0.525), and anxiety (Estimate = -3.213, 95% CI: -4.238 to -2.188, pseudo R2 = 0.292)/depression (Estimate = -3.378, 95% CI: -4.432 to -2.325, pseudo R2 = 0.268) in experimental group patients compared to controls. No adverse events of acupressure were reported during the study process. Conclusions: Acupressure significantly and independently improved fatigue, depression/anxiety, and sleep quality in ESRD patients receiving HD. Clinical Trial Registration: NCT05571007.

Use of Transcutaneous Electrical Nerve Stimulation to Alleviate Thirst After Surgery: A Randomized Controlled Trial.

PURPOSE: This prospective study investigated the preventive effect of transcutaneous electrical nerve stimulation (TENS) for postoperative thirst. DESIGN: This experimental study was conducted with the CONSORT checklist. METHODS: A total of 105 surgical patients who received general anesthesia were recruited from a medical center. Each patient was randomly assigned to the experimental group (n = 53; 20 min of TENS) or the control group (n = 52; routine care). In each group, oral moisture wetness was measured at 1 min, 20 min, and 50 min post-surgery. Descriptive and inferential statistics (Chi-square test, t test, one-way ANOVA, and generalized estimating equation (GEE) regression analysis) were performed to assess the proposed relationships. FINDINGS: The two groups showed similar characteristics at baseline. The oral moisture wetness was significantly higher in the experimental group than the control group at each post-surgery assessment time (all P < .001). The GEE results showed that patients in the experimental group reported more oral moisture wetness than patients in the control group. CONCLUSIONS: This study demonstrated that TENS can reduce thirst reported by patients after general anesthesia. Thus, this method may have clinical applications for managing postoperative thirst.

Developing the "Healthcare CEO App" for patients with type 1 diabetes transitioning from adolescence to young adulthood: A mixed-methods study.

AIM: To develop and test a mobile application that supports the disease self-management of adolescents with type 1 diabetes during their transition to early adulthood. DESIGN: A sequential mixed-methods design was employed. METHODS: The application content was designed according to previously identified care needs and expectations, followed by application development on the Android operating system. From the outpatient clinic of the Department of Paediatric Endocrinology and Metabolism at a medical centre in northern Taiwan, 35 individuals aged between 16-25 years participated in application testing. RESULTS: The overall median score of the QUIS was 4-5, most of the 25% quartile was 4-5, and all of the 75% quartile was 5, indicating adequate user interaction satisfaction.

A Comparative Study of Stone Re-Treatment after Lithotripsy.

The high recurrence rate has always been a problem associated with urolithiasis. This study aimed to explore the effectiveness of single interventions, combined therapies, and surgical and nonsurgical interventions. Herein, three lithotripsy procedures­extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopic lithotripsy (URSL)­were assessed and a retrospective cohort was selected in order to further analyze the association with several risk factors. Firstly, a population-based cohort from the Taiwan National Health Insurance Research Database (NHIRD) from 1997 to 2010 was selected. In this study, 350 lithotripsy patients who underwent re-treatment were followed up for at least six years to compare re-treatment rates, with 1400 patients without any lithotripsy treatment being used as the comparison cohort. A Cox proportional hazards regression model was applied. Our results indicate that the risk of repeat urolithiasis treatment was 1.71-fold higher in patients that received lithotripsy when compared to patients that were not treated with lithotripsy (hazard ratio (HR) 1.71; 95% confidence interval (CI) = 1.427−2.048; p < 0.001). Furthermore, a high percentage of repeated treatment was observed in the ESWL group (HR 1.60; 95% CI = 1.292−1.978; p < 0.001). Similarly, the PCNL group was also independently associated with a high chance of repeated treatment (HR 2.32; 95% CI = 1.616−3.329; p < 0.001). Furthermore, age, season, level of care, and Charlson comorbidities index (CCI) should always be taken into consideration as effect factors that are highly correlated with repeated treatment rates.

Risk Factors Associated with Passengers with Imported Dengue Fever at International Airports in Taiwan.

Dengue fever (DF) is a mosquito-borne disease prevalent in the tropics (e.g., sub-Saharan Africa, Asia, and Central and South America) and a common cause of febrile illness in travelers. The high incidence of imported DF in Taiwan has led to a domestic outbreak. This study explored the risk factors associated with individuals given diagnoses of imported DF at international airports in Taiwan. The results may serve as a reference for DF prevention. In this retrospective study, data from the symptom notification system database of the Taiwan Centers for Disease Control (TCDC) were used. These data concerned travelers who returned to Taiwan from DF-endemic areas with suspected DF symptoms. The epidemiological characteristics of the cases were analyzed, and 28 variables related to DF infection were included in the multivariate logistic regression analysis. In 2018-2019, there were 8656 cases (451 positive and 8205 negative cases). The results revealed DF symptoms and a 16-30-day stay in endemic areas to be independent risk factors and the presence of three respiratory symptoms and <10 days of short-term travel to be protective factors. These results may enable the accurate assessment of symptoms in travelers with DF as well as the risk factors associated with imported DF, lowering the risk of indigenous DF outbreaks caused by imported DF.

Rooming-In and Breastfeeding Duration in First-Time Mothers in a Modern Postpartum Care Center.

Uncertainty concerning the associations between rooming-in and breastfeeding duration remains at postpartum care centers. This cross-sectional study investigated the associations between the rooming-in policy and continual exclusive breastfeeding among first-time mothers at a postpartum center. Of the 160 participants, only 12.5% (n = 20) implemented full rooming-in. At 3-month follow-up, 85% (n = 17) of those individuals were exclusively breastfeeding. At the same time point, no participant practicing partial rooming-in (n = 140) was exclusively breastfeeding. The generalized estimating equation analysis indicated that full (24 h) rooming-in was statistically associated with continual exclusive breastfeeding 1 month postpartum (odds ratio (OR) = 0.90, p < 0.001) and 3 months postpartum (OR = 0.73, p < 0.001). Significant factors associated with a first-time mother's willingness to practice full rooming-in included vaginal delivery, a prenatal decision to practice breastfeeding, and undergoing prenatal classes on both rooming-in and breastfeeding. Success with continual exclusive breastfeeding in the postpartum period is dependent on full rooming-in. The findings serve as a reference for promoting exclusive breastfeeding for the first 6 months, as recommended by the World Health Organization.

Malignant testicular tumors in children: A single institution's 12-year experience.

Testicular neoplasms are not commonly found in children and are a formidable threat if treated inappropriately. However, there is no consensus regarding its management. This study aimed to create a holistic picture of the interprofessional team in the management of malignant testicular tumors. Seventeen patients had mixed germ cell tumors, 15 had pure yolk sac tumors, 2 had immature teratomas, 2 had teratocarcinomas, and 1 had a sex cord stromal tumor. Five lesions were diagnosed as nongerm cell tumors: 2 embryonal rhabdomyosarcomas, 2 lymphomas, and 1 acute myeloid leukemia. At initial presentation, retroperitoneal (n = 2), bone marrow (n =1), and mediastinal (n = 1) metastases were identified in 4 (10%) patients. The operative interventions performed included radical inguinal orchiectomy (n = 5), scrotal orchiectomy (n = 31), and testicular biopsy or testis-sparing enucleation of the tumor (n = 6). Postoperatively, 18 patients received either adjuvant chemotherapy (n = 14) or chemoradiation (n = 5). Five patients with mixed germ cell tumors (n = 2), group IV paratesticular rhabdomyosarcoma (n = 2), and acute myeloid leukemia with myeloid sarcoma (n =1) died of disease progression. Thirty-six patients remained alive and disease-free at the last visit. Malignant testicular tumors in children deserve proper diagnostic support from a therapeutic perspective. Any concern or suspicion of a testicular tumor warrants an inguinal approach to avoid scrotal violation.

Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques.

Coronary computed tomography angiography (CCTA) is a widely used imaging modality for diagnosing coronary artery disease (CAD) but is limited by a high false positive rate when evaluating coronary arteries with stents and heavy calcifications. Virtual intravascular endoscopy (VIE) images generated from CCTA can be used to qualitatively assess the vascular lumen and might be helpful for overcoming this challenge. In this study, one hundred subjects with coronary stents underwent both CCTA and invasive coronary angiography (ICA). A total of 902 vessel segments were analyzed using CCTA and VIE. The vessel segments were first analyzed on CCTA alone. Then, using VIE, the segments were classified qualitatively as either negative or positive for in-stent restenosis (ISR) or CAD. These results were compared, using ICA as the reference, to determine the added diagnostic value of VIE. Of the 902 analyzed vessel segments, CCTA/VIE had sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (shown in %) of 93.9/90.2, 96.2/98.2, 96.0/97.7, 70.0/83.1, and 99.4/99.0, respectively, in diagnosing ISR or CAD, with significantly improved specificity (p = 0.025), accuracy (p = 0.046), and positive predictive value (p = 0.047). VIE can be a helpful addition to CCTA when evaluating coronary arteries.

The Mediating Effect of Spiritual Well-Being and Quality of Life for Persons with Parkinson's Disease in Northern Taiwan.

BACKGROUND: Parkinson's disease (PD), a degenerative disease with irreversible motor dysfunction, impacts patients' quality of life (QoL). Spirituality can provide a sense of hope and meaning when individuals are faced with adverse life events, such as a diagnosis of PD. However, few studies have examined the relationship between spiritual well-being and QoL for persons with PD. OBJECTIVE: To explore the relationships between the disease characteristics, spirituality and QoL for persons with PD, and verify the mediating effects of spirituality on the relationship. METHODS: This cross-sectional study recruited patients with PD (n = 110) by convenience sampling from a neurological clinic in northern Taiwan. Variables were measured using the Spirituality Index of Well-Being Chinese version (SIWB-C) and the 39-item Parkinson's disease Quality of Life Questionnaire Chinese version (PDQ-39-C) self-report questionnaires. Descriptive analysis and linear hierarchical regression were conducted to examine the studied variables and explore the mediating effect of spiritual wellbeing. RESULTS: Those whose scores were significantly better in PDQ-39 were younger, employed, with shorter disease duration and less severe condition with better functioning on their early stages and lower LEDD; additionally, those who had better quality of life also experienced better spiritual wellbeing than the counterparts. The regression model demonstrated spiritual self-efficacy had mediating effects between disease characteristics and QoL, explaining 69.8%of the variance (adjusted R2 = 65.3%). CONCLUSION: The results can be the references for future strategies and interventions, focusing on increasing spiritual self-efficacy and reducing the impact of disease severity to improve QoL for persons with PD.

Comparable Outcomes Between Adolescent/Young Adults and Children With Acute Myeloid Leukemia Following Allogeneic Hematopoietic Cell Transplantation: A Single-Center Experience.

BACKGROUND: The cytogenetics of acute myeloid leukemia (AML) increases exponentially with age. Adolescent and young adult (AYA) patients have specific psychosocial and other challenges, influencing their ability to access appropriate treatment. Therefore, in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for AML, inferior outcomes would be observed in AYA patients compared to children. METHODS: We defined the age range of AYA patients as 15 to 29 years. Sixty-three patients who underwent allo-HSCT from 1998 to 2020 at Chang Gung Children Hospital were enrolled in this study. Overall survival was the time duration from HSCT to death from any cause. Disease-free survival was the time duration from HSCT to the last follow-up or first event (failure to achieve complete remission, relapse, secondary malignancy, or death from any cause). RESULTS: Thirty-seven (59%) patients were <15 years of age during allo-HSCT, and 26 (41%) were 15 to 29 years of age. The median age during allo-HSCT was 6.3 years for those <15 years of age compared with 15.7 years for AYA patients. The median follow-up period was 2.2 years after hematopoietic stem cell transplantation for patients <15 years old and 3.8 years after hematopoietic stem cell transplantation for AYA patients. Univariate analysis revealed no significant difference in the 5-year overall survival or disease-free survival among all patients. CONCLUSIONS: Several distinct AML subtypes could be amenable to treatment deintensification and targeted therapies. Furthermore, we found that children and AYA patients who underwent allo-HSCT for AML had similar survival.

[A Preliminary Study to Investigate Frailty in Advanced Lung Cancer Patients Before Receiving Immunotherapy].

BACKGROUND: Most advanced lung cancer patients have already received many types of treatment before starting immunotherapy. Compared with advanced lung cancer patients under first-line treatment, those receiving immunotherapy are vulnerable to many health problems and increased frailty. PURPOSE: This study was designed to investigate frailty in advanced lung cancer patients before starting immunotherapy. METHODS: A total of 52 pre-immunotherapy patients completed the survey. Frailty status was determined using the Fried standard and survey questionnaires included the Barthel Index, Center for Epidemiologic Studies Depression Scale, the Chinese version of scales of international physical activities questionnaire (short version). In addition, the handgrip and 4.6-meter walk speed of the participants were measured. RESULTS: The ratio of frailty was 17.3%, with comorbidities (p = .023), body mass index (p = .004), Eastern Cooperative Oncology Group Status (p < .001), activities of daily living status (p < .001), albumin (p = .042), and C-reactive protein (p = .048) all associated with frailty. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: In this study, weight loss and low physical activity were the main symptoms of frailty in patients with advanced lung cancer. Therefore, healthcare workers should assess the nutrition and physical activity status of patients before initiating immunotherapy. We suggest that clinical care workers provide frailty care to patients before administering immunotherapy.

Clinical spectrum and treatment outcome of retinoblastoma with Group D and E diseases: A single institution retrospective review.

The purpose of our study was to evaluate the ocular survival and event-free survival after multimodal therapy for group D and E of retinoblastoma (RB). Enucleation of group D and E is controversial as the risks of chemotherapy must be weighed against the potential for vision.A 10-year retrospective study from one center of 86 patients with advanced intraocular disease defined as International Classification Retinoblastoma (ICRB) group "D" or "E." Cases with visible extraocular extension at diagnosis were excluded. Ocular survival and patient survival were assessed. Indirect ophthalmoscopy at examination under anesthesia to visualize the tumor was used to evaluate clinical response.The median onset age in 86 patients with group D or E eye was 16 months (1-167 months). There were 29 (34%) bilateral cases. Leukocoria was the most common presentation sign (61%). Chemoreduction was primarily used in the treatment of intraocular RB. Selective ophthalmic arterial injection (SOAI) was applied as a component of multimodal therapy in 34 of the 86 cases. The globe preservation rate in patients with group D or E eyes was 19%. Using chemoreduction for advanced eyes, more eyes are being preserved which enables 70% 5-year ocular survival in patients with group D eyes.In triaging appropriate patients, multidisciplinary strategy can reduce tumor size with chemoreduction and consolidate the regressed tumor with local ophthalmic therapy to ensure globe salvage.

The Use of Artificial Intelligence in the Differentiation of Malignant and Benign Lung Nodules on Computed Tomograms Proven by Surgical Pathology.

The purpose of this work was to evaluate the performance of an existing commercially available artificial intelligence (AI) software system in differentiating malignant and benign lung nodules. The AI tool consisted of a vessel-suppression function and a deep-learning-based computer-aided-detection (VS-CAD) analyzer. Fifty patients (32 females, mean age 52 years) with 75 lung nodules (47 malignant and 28 benign) underwent low-dose computed tomography (LDCT) followed by surgical excision and the pathological analysis of their 75 nodules within a 3 month time frame. All 50 cases were then processed by the AI software to generate corresponding VS images and CAD outcomes. All 75 pathologically proven lung nodules were well delineated by vessel-suppressed images. Three (6.4%) of the 47 lung cancer cases, and 11 (39.3%) of the 28 benign nodules were ignored and not detected by the AI without showing a CAD analysis summary. The AI system/radiologists produced a sensitivity and specificity (shown in %) of 93.6/89.4 and 39.3/82.1 in distinguishing malignant from benign nodules, respectively. AI sensitivity was higher than that of radiologists, though not statistically significant (p = 0.712). Specificity obtained by the radiologists was significantly higher than that of the VS-CAD AI (p = 0.003). There was no significant difference between the malignant and benign lesions with respect to age, gender, pure ground-glass pattern, the diameter and location of the nodules, or nodules <6 vs. ≥6 mm. However, more part-solid nodules were proven to be malignant than benign (90.9% vs. 9.1%), and more solid nodules were proven to be benign than malignant (86.7% vs. 13.3%) with statistical significance (p = 0.001 and <0.001, respectively). A larger cohort and prospective study are required to validate the AI performance.

New Users of Herbal Medicine Containing Aristolochic Acids and the Risk of Dementia in the Elderly: A Nationwide, Population-Based Study in Taiwan.

BACKGROUND: Herbal medicine containing aristolochic acids (HMCAA) was used for inflammatory and infectious diseases. This study aimed to investigate the association between the usage of HMCAA and the risk of dementia. METHODS: A total of 199 new users of HMCAA were enrolled, along with 597 controls without the usage of HMCAA, at a ratio of 1:3 - matched by age, sex, and comorbidity, between 2000 and 2003 - from the National Health Research Institutes Database (NHRID) of Taiwan, which contains two million randomly sampled subjects, in this cohort study. We used Fine and Gray's survival analysis (competing with mortality) to compare the risk of developing dementia during a 15-year follow-up period (2000-2015). RESULTS: In general, HMCAA was not significantly associated with dementia (adjusted subdistribution hazard ratio [SHR] = 0.861, 95% confidence interval [CI] = 0.484-1.532, p = 0.611) for the HMCAA-cohort, although differential risk was observed among the groups at risk. The patients with usage of HMCAA aged ≧ 85 years were associated with a higher risk in dementia (adjusted SHR: 6.243, 95% CI=1.258-21.084, p = 0.001), in comparison to those aged 50-54 years. Furthermore, the patients with usage of HMCAA that had cerebrovascular accidents were associated with an increased risk of dementia. CONCLUSION: The usage of HMCAA was associated with the risk of developing dementia in the patients aged ≧ 85 years.

Diagnostic Value of C-reactive Protein and Interleukin-8 in Risk Stratification of Febrile Neutropenic Children with Allogeneic Hematopoietic Stem Cell Transplantation.

In this analysis, the levels of CRP and IL-8 were employed as a guide for designing the duration of antibiotics administration in the condition of febrile neutropenia. The importance of laboratory biomarkers is in the early diagnosis of critical illness and adjustment of further management. IL-8 is a useful biomarker for the early identification of critically ill patients, compared to CRP in FN.

Subtracted Computed Tomography Angiography in the Evaluation of Coronary Arteries With Severe Calcification or Stents Using a 320-Row Computed Tomography Scanner.

PURPOSE: Coronary computed tomography angiography (CCTA) has its limitations in evaluating arteries with stents or heavy calcification. This study compares the diagnostic performance of subtracted coronary computed tomography angiography (SCCTA) and nonsubtracted coronary computed tomography angiography (NSCCTA) in evaluating coronary artery disease (CAD) and in-stent restenosis (ISR). MATERIALS AND METHODS: Twelve patients with stents and 20 patients with heavy coronary calcifications (total Agatston's score >400) underwent both SCCTA and invasive coronary angiography (ICA) with an interval of <3 months. Four subjects in the stented group also had heavy calcifications. Overall, 30 stented segments and 202 calcified segments were assessed to compare the diagnostic performance of SCCTA and NSCCTA in detecting ISR and CAD. RESULTS: For the 30 stented segments, SCCTA/NSCCTA had a sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) (shown in %) of 66.7/100, 100/55.6, 96.7/60, 100/20, and 96.4/100 in diagnosing ISR, respectively. For the 202 calcified segments, SCCTA/NSCCTA had a sensitivity, specificity, accuracy, PPV, and NPV of 68.8/84.4, 97.6/76.5, 93.1/77.7, 84.6/40.3, and 94.3/96.3 in diagnosing CAD, respectively. For both stented and calcified segments, SCCTA was significantly superior to NSCCTA in specificity and accuracy. For the calcified segments, SCCTA was significantly superior to NSCCTA in PPV. There was no significant difference in the diagnostic performance of SCCTA between the stented and calcified segments. CONCLUSIONS: The diagnostic accuracy and specificity of SCCTA are significantly superior to those of NSCCTA in evaluating CAD and ISR. SCCTA shows no statistical difference in its diagnostic performance between the stented and calcified segments.

Computed Tomography Angiography in Acute Stroke Patients Receiving Recombinant Tissue Plasminogen Activator: Outcome and Safety Evaluations in an Asian Population.

INTRODUCTION: The multiphase computed tomography angiography (mCTA) is superior to the noncontrast computed tomography (NCCT) in selecting patients that would benefit from mechanical thrombectomy following an acute ischemic stroke (AIS). It remains unclear whether the longer examination time of mCTA worsens outcomes of intravenous recombinant tissue plasminogen activator (IV r-tPA) or increases the risk of hemorrhagic transformation (HT) compared to NCCT in Asian stroke patients. METHODS: Between January 2011 and December 2017, 199 AIS patients receiving IV r-tPA with initial National Institute of Health Stroke Scale (NIHSS) scores between 6 and 25 were enrolled in a single medical center. Onset-to-needle time (ONT), door-to-needle time (DNT), and creatinine levels before and after thrombolysis were recorded. We evaluated NIHSS scores 2, 24 h after treatment, and at discharge, the modified Rankin Scale (mRS) at discharge, and mortality rate. The presence of HT was reviewed within 7 days after thrombolysis. RESULTS: DNT, perithrombolysis creatinine levels, NIHSS, and mRS scores at the emergency room were similar between the NCCT and mCTA groups. ONT was shorter in the mCTA group. AIS patients got more significant neurologic improvement (NIHSS decrease ≥4) after thrombolysis and physically independent (mRS ≤2) at discharge in the mCTA group. Mortality rates, symptomatic, and total HT rates were similar between the NCCT and mCTA groups. CONCLUSION: Comparing to NCCT, mCTA-based IV r-tPA would not delay DNT nor worsen the outcome. Furthermore, mCTA provides more information for early identification of candidates for mechanical thrombectomy in Asian AIS patients.