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1.
J Appl Clin Med Phys ; 22(9): 49-58, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34342134

RESUMO

PURPOSE: To investigate the impact of rectal spacing on inter-fractional rectal and bladder dose and the need for adaptive planning in prostate cancer patients undergoing SBRT with a 0.35 T MRI-Linac. MATERIALS AND METHODS: We evaluated and compared SBRT plans from prostate cancer patients with and without rectal spacer who underwent treatment on a 0.35 T MRI-Linac. Each group consisted of 10 randomly selected patients that received prostate SBRT to a total dose of 36.25 Gy in five fractions. Dosimetric differences in planned and delivered rectal and bladder dose and the number of fractions violating OAR constraints were quantified. We also assessed whether adaptive planning was needed to meet constraints for each fraction. RESULTS: On average, rectal spacing reduced the maximum dose delivered to the rectum by more than 8 Gy (p < 0.001). We also found that D3cc received by the rectum could be 12 Gy higher in patients who did not have rectal spacer (p < 9E-7). In addition, the results show that a rectal spacer can reduce the maximum dose and D15cc to the bladder wall by more than 1 (p < 0.004) and 8 (p < 0.009) Gy, respectively. Our study also shows that using a rectal spacer could reduce the necessity for adaptive planning. The incidence of dose constraint violation was observed in almost 91% of the fractions in patients without the rectal spacer and 52% in patients with implanted spacer. CONCLUSION: Inter-fractional changes in rectal and bladder dose were quantified in patients who underwent SBRT with/without rectal SpaceOAR hydrogel. Rectal spacer does not eliminate the need for adaptive planning but reduces its necessity.


Assuntos
Neoplasias da Próstata , Radiocirurgia , Humanos , Hidrogéis , Imageamento por Ressonância Magnética , Masculino , Órgãos em Risco , Próstata , Neoplasias da Próstata/radioterapia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Reto/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
2.
Front Oncol ; 11: 631813, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34178622

RESUMO

Artificial intelligence (AI) transforms medical images into high-throughput mineable data. Machine learning algorithms, which can be designed for modeling for lesion detection, target segmentation, disease diagnosis, and prognosis prediction, have markedly promoted precision medicine for clinical decision support. There has been a dramatic increase in the number of articles, including articles on ultrasound with AI, published in only a few years. Given the unique properties of ultrasound that differentiate it from other imaging modalities, including real-time scanning, operator-dependence, and multi-modality, readers should pay additional attention to assessing studies that rely on ultrasound AI. This review offers the readers a targeted guide covering critical points that can be used to identify strong and underpowered ultrasound AI studies.

3.
Int J Ment Health Nurs ; 30 Suppl 1: 1386-1394, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34047043

RESUMO

Anorexia nervosa (AN), which primarily affects adolescent girls and young women, is characterized by excessive dieting, leading to severe weight loss and a pathological fear of becoming overweight, or unhealthy behaviours that hinder weight gain. Caring for patients who have AN is particularly challenging for nursing staff, who are on the front line and have the closest contact with patients. However, little is known about how nursing staff care for adolescent patients with AN in Taiwan. This study aimed to explore nurses' perceptions on and experiences in conflict situations in caring for adolescents with AN. A qualitative study approach was conducted. Through semi-structured interviews, ten nursing staff from the paediatric ward at a university-affiliated medical centre in central Taiwan shared their experiences. Recorded interviews were transcribed and analysed by content analysis. This analysis identified three themes with eight subthemes: (i) struggling to develop therapeutic relationships, (ii) selective focusing, and (iii) difficulty changing minds. The findings of this study indicated a need for ongoing support for nursing staff, the development of therapeutic relationships with adolescent patients with AN, extensive nursing staff preparation, and the development of in-service training programs to enable nursing staff to care for these patients with greater understanding.


Assuntos
Anorexia Nervosa , Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem no Hospital , Adolescente , Anorexia Nervosa/terapia , Criança , Feminino , Humanos , Percepção , Pesquisa Qualitativa , Taiwan
4.
J Gastroenterol Hepatol ; 36(10): 2875-2883, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33880797

RESUMO

BACKGROUND AND AIM: This study aims to construct a strategy that uses assistance from artificial intelligence (AI) to assist radiologists in the identification of malignant versus benign focal liver lesions (FLLs) using contrast-enhanced ultrasound (CEUS). METHODS: A training set (patients = 363) and a testing set (patients = 211) were collected from our institute. On four-phase CEUS images in the training set, a composite deep learning architecture was trained and tuned for differentiating malignant and benign FLLs. In the test dataset, AI performance was evaluated by comparison with radiologists with varied levels of experience. Based on the comparison, an AI assistance strategy was constructed, and its usefulness in reducing CEUS interobserver heterogeneity was further tested. RESULTS: In the test set, to identify malignant versus benign FLLs, AI achieved an area under the curve of 0.934 (95% CI 0.890-0.978) with an accuracy of 91.0%. Comparing with radiologists reviewing videos along with complementary patient information, AI outperformed residents (82.9-84.4%, P = 0.038) and matched the performance of experts (87.2-88.2%, P = 0.438). Due to the higher positive predictive value (PPV) (AI: 95.6% vs residents: 88.6-89.7%, P = 0.056), an AI strategy was defined to improve the malignant diagnosis. With the assistance of AI, radiologists exhibited a sensitivity improvement of 97.0-99.4% (P < 0.05) and an accuracy of 91.0-92.9% (P = 0.008-0.189), which was comparable with that of the experts (P = 0.904). CONCLUSIONS: The CEUS-based AI strategy improved the performance of residents and reduced CEUS's interobserver heterogeneity in the differentiation of benign and malignant FLLs.

5.
Front Oncol ; 11: 569515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33718130

RESUMO

Background: Previous studies demonstrated a promising prognosis in advanced hepatocellular carcinoma (HCC) patients who underwent surgery, yet a consensus of which population would benefit most from surgery is still unreached. Method: A total of 496 advanced HCC patients who initially underwent liver resection were consecutively collected. Least absolute shrinkage and selection operator (LASSO) regression was performed to select significant pre-operative factors for recurrence-free survival (RFS). A prognostic score constructed from these factors was used to divide patients into different risk groups. Survivals were compared between groups with log-rank test. The area under curves (AUC) of the time-dependent receiver operating characteristics was used to evaluate the predictive accuracy of prognostic score. Result: For the entire cohort, the median overall survival (OS) was 23.0 months and the median RFS was 12.1 months. Patients were divided into two risk groups according to the prognostic score constructed with ALBI score, tumor size, tumor-invaded liver segments, gamma-glutamyl transpeptidase, alpha fetoprotein, and portal vein tumor thrombus stage. The median RFS of the low-risk group was significantly longer than that of the high-risk group in both the training (10.1 vs 2.9 months, P<0.001) and the validation groups (13.7 vs 4.6 months, P=0.002). The AUCs of the prognostic score in predicting survival were 0.70 to 0.71 in the training group and 0.71 to 0.72 in the validation group. Conclusion: Surgery could provide promising survival for HCC patients at an advanced stage. Our developed pre-operative prognostic score is effective in identifying advanced-stage HCC patients with better survival benefit for surgery.

6.
Transl Oncol ; 14(1): 100866, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33074127

RESUMO

OBJECTIVES: To develop a radiomics algorithm, improving the performance of detecting recurrence, based on posttreatment CT images within one month and at suspicious time during follow-up. MATERIALS AND METHODS: A total of 114 patients with 228 images were randomly split (7:3) into training and validation cohort. Radiomics algorithm was trained using machine learning, based on difference-in-difference (DD) features extracted from tumor and liver regions of interest on posttreatment CTs within one month after resection or ablation and when suspected recurrent lesion was observed but cannot be confirmed as HCC during follow-up. The performance was evaluated by area under the receiver operating characteristic curve (AUC) and was compared among radiomics algorithm, change of alpha-fetoprotein (AFP) and combined model of both. Five-folded cross validation (CV) was used to present the training error. RESULTS: A radiomics algorithm was established by 34 DD features selected by random forest and multivariable logistic models and showed a better AUC than that of change of AFP (0.89 [95% CI: 0.78, 1.00] vs 0.63 [95% CI: 0.42, 0.84], P = .04) and similar with the combined model in detecting recurrence in the validation set. Five-folded CV error in the validation cohort was 21% for the algorithm and 26% for the changes of AFP. CONCLUSIONS: The algorithm integrated radiomic features of posttreatment CT showed superior performance to that of conventional AFP and may act as a potential marker in the early detecting recurrence of HCC.

7.
Hu Li Za Zhi ; 67(6): 4-5, 2020 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-33274419

RESUMO

We remain in the midst of the global COVID-19 epidemic. As of November 11th, 2020, cases of COVID-19 have been confirmed in 189 countries/regions around the world, with a total of 51,510,611 confirmed cases and more than 1,275,211 deaths, with a global fatality rate of 2.48% (Taiwan Centers for Disease Control, Ministry of Health and Welfare, ROC, 2020b). Therefore, countries are facing lockdown crises and their populations face daily lives full of chaos, anxiety, and reorganization. The characteristics of this epidemic are most often described as "unprecedented" and replete with "uncertainty" (Davidson et al., 2020). In order to prevent the spread of this virus, health measures such as quarantine, wearing protective masks, and enforced lockdowns have been adopted by governments around the world, producing psychosocial (emotional distress, anxiety, suicide) and economic side-effects (Lima et al., 2020; Montemurro, 2020). Despite its close geographical proximity to China, Taiwan's number of confirmed infections has been relatively small (584 people diagnosed as of November 11th, with 7 total COVID-19-related fatalities; Taiwan Centers for Disease Control, Ministry of Health and Welfare, ROC, 2020b). Taiwan's tragic experience 17 years ago with the SARS epidemic helped prepare the government to respond rapidly to the COVID-19 threat, make thorough preparations and advanced deployments, and formulate relevant anti-epidemic border control measures, quarantine and isolation measures, mask-wearing requirements, and public education strategies. Actions such as mask wearing, washing hands frequently, and practicing proper social distancing by the public and the government maintaining a master travel history, occupation, contact history, and cluster (TOCC) database have proven effective in detecting and diagnosing cases early (Taiwan Centers for Disease Control, Ministry of Health and Welfare, ROC, 2020a; Yang et al., 2020). Furthermore, providing first-line personnel with appropriate protective equipment, education, and training as well as timely and transparent information and epidemic prevention guidelines have kept nurses supplied with appropriate personal protective equipment, infection-prevention and control education, training and exercises, and sufficient professional knowledge and skills to provide care safely to patients (Chen et al., 2020; Huang & Chen, 2020; Yang et al., 2020). Concurrently, it has been a challenge to nursing educators regarding how to suspend classes while not stopping academic education and to plan meaningful, alternative clinical experiences during the pandemic (Morin, 2020) and how to redefine and evaluate student performance to maintain teaching quality and learning effectiveness. In addition, "disaster nursing" is a critical area of professional knowledge for nurses in the 21st century, and all nurses should have an appropriate level of competence in professional disaster nursing. Therefore, core concepts related to infection control, disasters, and disaster preparedness should be incorporated into the curriculum and objectives. Finally, although we in Taiwan have faced the COVID-19 challenge in an environment in which the pandemic risk has been relatively well controlled, our daily lives are no longer taken for granted. When we look back on this experience, what will we learn from these experiences and how will this experience change how we approach healthcare and pandemic threats in the future? These changes will bring us more thoughts and challenges in nursing.


Assuntos
COVID-19 , Infecções por Coronavirus , Enfermagem , Pneumonia Viral , Betacoronavirus , China , Humanos , Pandemias , SARS-CoV-2 , Taiwan
8.
BMC Cancer ; 20(1): 468, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32450841

RESUMO

BACKGROUND: Neoadjuvant chemotherapy is a promising treatment option for potential resectable gastric cancer, but patients' responses vary. We aimed to develop and validate a radiomics score (rad_score) to predict treatment response to neoadjuvant chemotherapy and to investigate its efficacy in survival stratification. METHODS: A total of 106 patients with neoadjuvant chemotherapy before gastrectomy were included (training cohort: n = 74; validation cohort: n = 32). Radiomics features were extracted from the pre-treatment portal venous-phase CT. After feature reduction, a rad_score was established by Randomised Tree algorithm. A rad_clinical_score was constructed by integrating the rad_score with clinical variables, so was a clinical score by clinical variables only. The three scores were validated regarding their discrimination and clinical usefulness. The patients were stratified into two groups according to the score thresholds (updated with post-operative clinical variables), and their survivals were compared. RESULTS: In the validation cohort, the rad_score demonstrated a good predicting performance in treatment response to the neoadjuvant chemotherapy (AUC [95% CI] =0.82 [0.67, 0.98]), which was better than the clinical score (based on pre-operative clinical variables) without significant difference (0.62 [0.42, 0.83], P = 0.09). The rad_clinical_score could not further improve the performance of the rad_score (0.70 [0.51, 0.88], P = 0.16). Based on the thresholds of these scores, the high-score groups all achieved better survivals than the low-score groups in the whole cohort (all P < 0.001). CONCLUSION: The rad_score that we developed was effective in predicting treatment response to neoadjuvant chemotherapy and in stratifying patients with gastric cancer into different survival groups. Our proposed strategy is useful for individualised treatment planning.


Assuntos
Algoritmos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Neoadjuvante/mortalidade , Nomogramas , Neoplasias Gástricas/mortalidade , Tomografia Computadorizada por Raios X/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Taxa de Sobrevida
9.
J Mol Neurosci ; 70(7): 1140-1152, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32170713

RESUMO

Many protein aggregation diseases (PAD) affect the nervous system. Deposits of aggregated disease-specific proteins are found within or around the neuronal cells of neurodegenerative diseases. Although the main protein component is disease-specific, oligomeric aggregates are presumed to be the key agents causing the neurotoxicity. Evidence has shown that protein aggregates cause a chronic inflammatory reaction in the brain, resulting in neurodegeneration. Therefore, strategies targeting anti-inflammation could be beneficial to the therapeutics of PAD. PHA-767491 was originally identified as an inhibitor of CDC7/CDK9 and was found to reduce TDP-43 phosphorylation and prevent neurodegeneration in TDP-43 transgenic animals. We recently identified PHA-767491 as a GSK-3ß inhibitor. In this study, we established mouse hippocampal primary culture with tau-hyperphosphorylation through the activation of GSK-3ß using Wortmannin and GF109203X. We found that PHA-767491 significantly improved the neurite outgrowth of hippocampal primary neurons against the neurotoxicity induced by GSK-3ß. We further showed that PHA-767491 had neuroprotective ability in hippocampal primary culture under oligomeric Aß treatment. In addition, PHA-767491 attenuated the neuroinflammation in mouse cerebellar slice culture with human TBP-109Q agitation. Further study of SCA17 transgenic mice carrying human TBP-109Q showed that PHA-767491 ameliorated the gait ataxia and the inflammatory response both centrally and peripherally. Our findings suggest that PHA-767491 has a broad spectrum of activity in the treatment of different PAD and that this activity could be based on the anti-inflammation mechanism.


Assuntos
Anti-Inflamatórios/farmacologia , Neurônios/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Piperidonas/farmacologia , Agregação Patológica de Proteínas/tratamento farmacológico , Inibidores de Proteínas Quinases/farmacologia , Pirróis/farmacologia , Peptídeos beta-Amiloides/toxicidade , Animais , Anti-Inflamatórios/uso terapêutico , Proteínas de Ciclo Celular/antagonistas & inibidores , Proteínas de Ciclo Celular/metabolismo , Células Cultivadas , Cerebelo/efeitos dos fármacos , Cerebelo/metabolismo , Quinase 9 Dependente de Ciclina/antagonistas & inibidores , Quinase 9 Dependente de Ciclina/metabolismo , Proteínas de Ligação a DNA/metabolismo , Hipocampo/citologia , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Neurônios/metabolismo , Fármacos Neuroprotetores/uso terapêutico , Piperidonas/uso terapêutico , Agregação Patológica de Proteínas/metabolismo , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Serina-Treonina Quinases/antagonistas & inibidores , Proteínas Serina-Treonina Quinases/metabolismo , Pirróis/uso terapêutico
10.
AJR Am J Roentgenol ; 214(6): 1377-1383, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32160054

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous transhepatic cholangial drainage (PTCD) and consequent percutaneous US cholangiography in managing the dilated biliary tracts of children who have undergone hepatobiliary surgery. SUBJECTS AND METHODS. Sixteen children (11 boys, five girls; age range, 3-144 months) who underwent hepatobiliary surgery from December 2016 to October 2018 and had US evidence of biliary dilatation were included. All patients had undergone US-guided PTCD because of elevated postoperative serum bilirubin levels or bile duct infection. Immediately after the PTCD procedure, diluted sulphur hexafluoride microbubbles dispersion was injected through the PTCD tube to evaluate the anastomosis and the intrahepatic bile duct tree. Laboratory results, including those of serum bilirubin measurement, liver function tests, and routine blood tests, were evaluated before and after PTCD. Nine of 16 patients also underwent percutaneous transhepatic cholangiography (PTC). The percutaneous US cholangiography findings were evaluated and compared with the PTC findings. RESULTS. Liver enzyme levels decreased after PTCD with a statistically significant difference from the values before PTCD. Percutaneous US cholangiography showed that the anastomosis in 6 of the 16 patients (37.5%) was patent and depicted the morphologic featuresof intrahepatic bile duct tree in five of these patients. In the other 10 patients, the anastomosis was completely obstructed, and percutaneous US cholangiography depicted the morphologic features of intrahepatic bile duct tree in eight patients. In the nine patients who underwent PTC, the percutaneous US cholangiographic findings were the same as the PTC findings. CONCLUSION. US-guided PTCD is helpful in relieving jaundice and inflammation in children who have undergone hepatobiliary surgery and have biliary dilatation. Findings at consequent percutaneous US cholangiography are comparable to those of PTC in depicting the anastomosis in these patients.


Assuntos
Doenças Biliares/cirurgia , Colangiografia , Drenagem/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Ultrassonografia de Intervenção , Ductos Biliares Intra-Hepáticos , Bilirrubina/sangue , Criança , Pré-Escolar , Meios de Contraste , Dilatação Patológica , Estudos de Viabilidade , Feminino , Humanos , Lactente , Testes de Função Hepática , Masculino , Microbolhas
11.
Radiol Med ; 125(8): 697-705, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32200455

RESUMO

PURPOSE: To test the technical reproducibility of acquisition and scanners of CT image-based radiomics model for early recurrent hepatocellular carcinoma (HCC). METHODS: We included primary HCC patient undergone curative therapies, using early recurrence as endpoint. Four datasets were constructed: 109 images from hospital #1 for training (set 1: 1-mm image slice thickness), 47 images from hospital #1 for internal validation (sets 2 and 3: 1-mm and 10-mm image slice thicknesses, respectively), and 47 images from hospital #2 for external validation (set 4: vastly different from training dataset). A radiomics model was constructed. Radiomics technical reproducibility was measured by overfitting and calibration deviation in external validation dataset. The influence of slice thickness on reproducibility was evaluated in two internal validation datasets. RESULTS: Compared with set 1, the model in set 2 indicated favorable prediction efficiency (the area under the curve 0.79 vs. 0.80, P = 0.47) and good calibration (unreliability statistic U: P = 0.33). However, in set 4, significant overfitting (0.63 vs. 0.80, P < 0.01) and calibration deviation (U: P < 0.01) were observed. Similar poor performance was also observed in set 3 (0.56 vs. 0.80, P = 0.02; U: P < 0.01). CONCLUSIONS: CT-based radiomics has poor reproducibility between centers. Image heterogeneity, such as slice thickness, can be a significant influencing factor.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Recidiva Local de Neoplasia/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/instrumentação , Adulto , Idoso , Algoritmos , Biomarcadores Tumorais/análise , Carcinoma Hepatocelular/cirurgia , Meios de Contraste , Feminino , Hepatectomia , Humanos , Iohexol/análogos & derivados , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Risco
12.
Eur Radiol ; 30(6): 3473-3485, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32048035

RESUMO

OBJECTIVES: We used the status of microvascular invasion (MVI) at primary resection to help treatment selection for hepatitis B virus-positive (HBV+) recurrent hepatocellular carcinoma (rHCC) patients in Barcelona Clinic Liver Cancer (BCLC) stage B-C. METHODS: From 2009 to 2017, we enrolled 221 consecutive HBV+ rHCC patients at BCLC stage B-C who underwent re-resection (RR), radiofrequency ablation (RFA), or transarterial chemoembolization (TACE). Post recurrence survival (PRS) and overall survival (OS) were compared between RR/RFA and TACE according to MVI status. A one-to-one propensity score matching analysis was performed. RESULTS: For MVI(-) patients, the median PRS was 62.3 months for the RR/RFA group and 21.1 months for the TACE group (p = 0.039). The corresponding OS was 71.4 months and 26.6 months, respectively (p = 0.010). For MVI(+) patients, the median PRS in the RR/RFA group and TACE group was 14.7 months and 10.1 months (p = 0.115). The corresponding OS was 23.4 months and 16.4 months, respectively (p = 0.067). After matching, the dominance of RR/RFA over TACE remained in MVI(-) patients for both PRS (62.3 months vs 15.3 months, p = 0.019) and OS (98.1 months vs 33.4 months, p = 0.046). No significant difference was found in MVI(+) patients for either PRS (14.7 months vs 11.8 months, p = 0.593) or OS (23.4 months vs 28.1 months, p = 0.662). CONCLUSIONS: MVI status definitely helps select treatment options in HBV+ rHCC patients. For MVI(-) patients, RR/RFA provided better survival than TACE while for MVI(+) patients, TACE shared similar survival outcomes. KEY POINTS: • This study aimed at the determination of the optimal treatment options (ablation /resection vs TACE) in case of recurrent HBV-related HCC. • It showed that MVI status, established at primary resection of HCC, was a powerful marker for selecting the best treatment option in these patients. • In MVI(-) patients, RR/RFA achieved a better survival than TACE. In MVI(+) patients, TACE shared similar survival.


Assuntos
Carcinoma Hepatocelular/terapia , Ablação por Cateter , Quimioembolização Terapêutica , Hepatectomia , Hepatite B Crônica/complicações , Neoplasias Hepáticas/terapia , Microvasos/patologia , Recidiva Local de Neoplasia/terapia , Adulto , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Terapia Combinada , Feminino , Vírus da Hepatite B , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Seleção de Pacientes , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
13.
Hu Li Za Zhi ; 66(5): 4-5, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31549374

RESUMO

The concept of body image has been applied in various disciplines, including neurology, clinical psychology, psychopathology, behavioral science, and nursing (Cash, 2004; Rhoten, 2017). Meleau-Ponty (1962) identified the body as the subject of perception and considered the body not as an object but as an embodied subject that lives in the world. "Body image" refers to an individual's body, which generates a sensory message through contact with the environment during internal physiological operations and establishes a preliminary mental understanding of the body (Schilder, 1970). Body image is also affected by the external environment. As Plato remarked, "We are bound to our bodies like an oyster is to its shell." Indeed, our life experiences are integrally influenced by the body we happen to live in (Cash, 2004). Because body image is formed primarily by individuals interacting with others, Schilder (1970) called body image a social entity. People desire to keep their body image intact and unaffected by changes, damage, or losses in terms of function or body parts. Any change is perceived as a threat and thus induces anxiety and fear (Rochlin, 1973). In caring for a patient facing body-image changes, a nurse may help the patient using her in-depth knowledge of the potential impacts of this change on the body, mind, social relationships, bodily functions, self-concept, and self-esteem (Roberts, 1978). Under what circumstances do individuals experience body image change? The most common clinical conditions of body image change are: perceiving sensational change (physical discomfort/signs and symptoms), receiving medical treatments/procedures (receiving blood transfusions, injections, punctures), receiving nursing interventions/ procedures (enema, urethral catheterization) pain, taking medications (moon face), experiencing amputation/dysfunction or alteration/disfigurement, becoming pregnant or undergoing labor, acquiring physical diseases or injuries (cancer, HIV/AIDS, skin diseases, burns), and experiencing role failure (Cash, 2004; Rhoten, 2017; Roberts, 1978). Therefore, when a patient complains to a nurse about physical discomforts, it is necessary to understand that the patient is experiencing body image change and will benefit from timely and effective assistance to overcome and accept this change. Body image change is an important issue that should continue to be better understood and addressed in the field of nursing. This article provides a rich account of body image discourse that may be used as a reference in clinical nursing care, education, and research.


Assuntos
Imagem Corporal , Cuidados de Enfermagem , Humanos
14.
Hu Li Za Zhi ; 66(5): 7-13, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31549375

RESUMO

Although the concept of body image was first introduced to Taiwan nursing in 1975, its application in the context of clinical nursing with regard to promoting humanistic patient-centered care has yet to be examined. This paper adopts a field-study approach to reinterpret the concept of body image with deeper and broader strength using patient vignettes, nursing case studies, and the findings of prior nursing research. The four main issues covered in this paper are: 1. The body image concept, 2. Building body schema and a postural model based on body experiences, 3. The characteristics of body image, and 4. The extended meaning of body image, including self-concept and the role function of relationship. This paper is expected to help nurses better understand the concept of body image and further apply this concept in clinical practice in order to improve the provision of humanistic patient-centered care.


Assuntos
Imagem Corporal , Cuidados de Enfermagem , Humanismo , Humanos , Assistência Centrada no Paciente
15.
J Prof Nurs ; 35(3): 240-244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31126402

RESUMO

INTRODUCTION: Today's global nursing shortage is having an adverse impact on health systems around the world and in Taiwan. Many universities in the United States have implemented accelerated BSN (ABSN) programs to create a shortcut for students who have bachelor's degrees in other fields to become nurses. Previous studies have revealed that students feel stress during the programs, especially in their first year. Students' first-year experiences in an ABSN program in the Taiwanese context are worthy of study. STUDY AIM: The purpose of the study was to understand nursing students' first-year experiences in an ABSN program in Taiwan. DESIGN: A qualitative research design was used in this study. SETTING AND PARTICIPATIONS: A total of 25 students from a university in central Taiwan participated in this study to share their first-year experiences of studying in an ABSN program. METHODS: Data were collected from 3 focus group interviews and students' written reflections and were analyzed by qualitative content analysis with the help of ATLAS.ti 7.0. FINDINGS: Five themes were identified: (1) pursuing a brighter future, (2) positively facing doubts (3) challenges of surviving, (4) changing their learning attitudes and methods, and (5) seeking support. CONCLUSIONS: The findings of this study may help nursing schools to provide the support students need and serve school administrators as a reference for refining such programs in the future.


Assuntos
Escolha da Profissão , Bacharelado em Enfermagem/tendências , Aprendizagem , Estudantes de Enfermagem/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pesquisa em Educação de Enfermagem , Pesquisa Qualitativa , Taiwan
16.
Am J Transl Res ; 11(3): 1864-1875, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30972210

RESUMO

BACKGROUND: Recurrent hepatocellular carcinoma (rHCC) patients with microvascular invasive (MVI) positive at first resection usually had poorly differentiated tumors and worse survivals. The optimal treatment for this population remains to be elucidated. METHODS: We retrospectively analyzed 319 rHCC patients with MVI-positive at first resection from June, 2009 to June, 2017. Survival and costs between curative treatments [re-resection (RR) and radiofrequency ablation (RFA)] and transarterial chemoembolization (TACE) were compared. Subgroup comparisons were made in patients in Barcelona Clinic Liver Cancer (BCLC) stage 0-A and BCLC stage B-C, respectively. A one-to-one propensity score matching (PSM) was used to diminish bias. RESULTS: In BCLC stage 0-A, 98 received RR/RFA, and 49 received TACE. The median overall survival (OS) of RR/RFA group was not reached, while the OS of TACE group was 26.3 months (P=0.001). After matching, the OS of the RR/RFA group was longer than that of the TACE group (39.5 vs. 26.3 months, P=0.045). In BCLC stage B-C, 137 patients received TACE, 11 received RR and 24 received RFA. The median OS was 29.8 months, 17.9 months and 11.1 months for RR, RFA and TACE group, respectively. No significant difference was found between RR and TACE (P=0.237) or RFA and TACE (P=0.484) after matching. Costs of the TACE group was significantly lower than that of the RR group but similar to that of the RFA group. CONCLUSION: RR/RFA provided better survival outcomes for rHCC patients with MVI-positive at first resection in selected BCLC stage 0-A. In selected BCLC stage B-C, TACE shared a similar efficacy with RR and RFA but a lower cost than RR.

17.
Cancer Imaging ; 19(1): 11, 2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30813956

RESUMO

OBJECTIVE: To construct a prediction model based on peritumoral radiomics signatures from CT images and investigate its efficiency in predicting early recurrence (ER) of hepatocellular carcinoma (HCC) after curative treatment. MATERIALS AND METHODS: In total, 156 patients with primary HCC were randomly divided into the training cohort (109 patients) and the validation cohort (47 patients). From the pretreatment CT images, we extracted 3-phase two-dimensional images from the largest cross-sectional area of the tumor. A region of interest (ROI) was manually delineated around the lesion for tumoral radiomics (T-RO) feature extraction, and another ROI was outlined with an additional 2 cm peritumoral area for peritumoral radiomics (PT-RO) feature extraction. The least absolute shrinkage and selection operator (LASSO) logistic regression model was applied for feature selection and model construction. The T-RO and PT-RO models were constructed. In the validation cohort, the prediction efficiencies of the two models and peritumoral enhancement (PT-E) were evaluated qualitatively by receiver operating characteristic (ROC) curves, calibration curves and decision curves and quantitatively by area under the curve (AUC), the category-free net reclassification index (cfNRI) and integrated discrimination improvement values (IDI). RESULTS: By comparing AUC values, the prediction accuracy in the validation cohort was good for the PT-RO model (0.80 vs. 0.79, P = 0.47) but poor for the T-RO model (0.82 vs. 0.62, P < 0.01), which was significantly overfitted. In the validation cohort, the ROC curves, calibration curves and decision curves indicated that the PT-RO model had better calibration efficiency and provided greater clinical benefits. CfNRI indicated that the PT-RO model correctly reclassified 47% of ER patients and 32% of non-ER patients compared to the T-RO model (P < 0.01); additionally, the PT-RO model correctly reclassified 24% of ER patients and 41% of non-ER patients compared to PT-E (P = 0.02). IDI indicated that the PT-RO model could improve prediction accuracy by 0.22 (P < 0.01) compared to the T-RO model and by 0.20 (P = 0.01) compared to PT-E. CONCLUSION: The CT-based PT-RO model can effectively predict the ER of HCC and is more efficient than the T-RO model and the conventional imaging feature PT-E.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Técnicas de Ablação , Adulto , Idoso , Anatomia Transversal , Feminino , Hepatectomia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
18.
Psychopharmacology (Berl) ; 236(2): 763-773, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30426182

RESUMO

RATIONALE: Hyperglycemia accelerates the progression of Alzheimer's disease (AD), and GSK3ß plays a potential link between AD and hyperglycemia. Therefore, a direct or indirect GSK3ß inhibition may have potential to delay the progression of AD. Our previous biochemical assay identified AM404 as a GSK3ß inhibitor at high dose (IC50 = 5.353 µM); however, other study suggests that AM404 impaired synaptic plasticity of hippocampus at high dose (10 mg/kg; i.p.). Therefore, the dose and duration of treatment are crucial for the effects of AM404. OBJECTIVE: The effects and molecular mechanisms of AM404 at low dose were evaluated from in vitro to in vivo models. METHODS: AM404 (0.1-0.5 µM) was tested on tau hyperphosphorylated mouse hippocampal primary cultures treated with Wortmannin (WT) and GF109203X (GFX). Hyperglycemic triple transgenic AD (3×Tg-AD) mice at 6 months old were intraperitoneally injected with AM404 (0.25 mg/kg) for 4 weeks. The spatial learning and memory of mice were measured using the Morris water maze. Mouse brain and serum samples were collected for pathological analyses. RESULTS: AM404 (0.5 µM) exhibited significantly augmented neuroprotection toward tau hyperphosphorylation in primary cultures. The chronic systemic administration of AM404 (0.25 mg/kg) attenuated cognitive deficits in hyperglycemic 3×Tg-AD mice. Moreover, chronic low dose of AM404 significantly attenuated Aß production, tau protein phosphorylation, and inflammation associated with an increase of pS473Akt and pS9-GSK3ß. Therefore, AM404 at low dose, not only increased neuroprotection, but also ameliorated cognitive deficit, could be partly by regulating the Akt/GSK3ß signaling, which may contribute to downregulation of Aß, tau hyperphosphorylation, and inflammation in hyperglycemic 3×Tg-AD mice. CONCLUSIONS: These results highlight that chronic administration of AM404 at low dose may be through the Akt/GSK3ß pathway to ameliorate the impairment in hyperglycemic 3×Tg-AD mice.


Assuntos
Ácidos Araquidônicos/administração & dosagem , Disfunção Cognitiva/tratamento farmacológico , Hiperglicemia/tratamento farmacológico , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/genética , Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/genética , Peptídeos beta-Amiloides/metabolismo , Animais , Disfunção Cognitiva/genética , Disfunção Cognitiva/metabolismo , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Glicogênio Sintase Quinase 3 beta , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Humanos , Hiperglicemia/genética , Hiperglicemia/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Obesos , Camundongos Transgênicos , Gravidez , Proteínas tau/genética , Proteínas tau/metabolismo
19.
J Crohns Colitis ; 13(5): 593-599, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-30544185

RESUMO

BACKGROUND AND AIM: Penetrating disease is a common condition complicating Crohn's disease [CD]. Establishing the presence of a fistula and the anatomical definition of the fistulous tracts are essential for deciding on appropriate treatment strategies. We aimed to assess the diagnostic accuracy of intra-cavitary contrast-enhanced ultrasound [IC-CEUS] for the detection of a fistulous tract associated with abscesses in CD patients. METHODS: In this prospective cohort study, consecutive CD patients suspected of having an intra-abdominal abscess, who were referred for US-guided aspiration were recruited. IC-CEUS was performed by injecting diluted contrast agent [SonoVue] into the abscess cavity immediately following the ultrasound-guided needle abscess aspiration and drainage. The diagnostic accuracy of IC-CEUS in demonstrating the presence of fistulous tracts was compared with that of computed tomography enterography/magnetic resonance enterography [CTE/MRE], using surgical and gross pathological findings as the reference standard. RESULTS: Thirty-one patients who underwent IC-CEUS and subsequent surgery were included in the final analysis. IC-CEUS demonstrated fistulous/sinus tracts in 26 of 31 participants with a sensitivity and specificity of 86.7 % (95% confidence interval [CI], 68.4-95.6%) and 100% [95% CI, 5.5-100.0%], respectively. Moreover, IC-CEUS correctly demonstrated fistulous/sinus tracts in 13 participants without delineation of fistulous/sinus tracts on CTE/MRE. Combining IC-CEUS and CTE/MRE, the fistula/sinus tract was clearly demonstrated in 29 patients [93.5%, 29/31]. The mean duration of the IC-CEUS procedure was 8.6 min [range 5.0-12.0]. No severe adverse events occurred during the IC-CEUS procedure. CONCLUSION: In this pilot study, IC-CEUS accurately delineated the anatomical definition of fistulous/sinus tracts associated with intra-abdominal abscesses in CD patients. As a radiation-free and safe technique, IC-CEUS may be used as an alternative/adjunctive method to CTE/MRE for detecting penetrating disease in patients with CD.


Assuntos
Abscesso Abdominal/diagnóstico por imagem , Doença de Crohn/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Doenças do Colo Sigmoide/diagnóstico por imagem , Ultrassonografia/métodos , Abscesso Abdominal/etiologia , Adulto , Meios de Contraste , Doença de Crohn/complicações , Humanos , Fístula Intestinal/etiologia , Imageamento por Ressonância Magnética , Masculino , Estudos Prospectivos , Sensibilidade e Especificidade , Doenças do Colo Sigmoide/etiologia , Tomografia Computadorizada por Raios X
20.
Drug Alcohol Depend ; 194: 264-270, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30469097

RESUMO

BACKGROUND: To evaluate the relationship of patients with a history of alcohol use disorders (AUD) and its diagnostic categories with risk of subsequent mesenteric ischemia in Taiwan. METHODS: A nationwide population-based cohort study was conducted using data from the Taiwan's National Health Insurance Research Database. We identified 73,583 patients hospitalized for AUD between 2001 and 2010, and matched each case with four comparison patients based on age, gender, Charlson comorbidity index, and the index date. Cox proportional hazard models were used to evaluate the risk of mesenteric ischemia between the AUD and non-AUD cohorts. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. RESULTS: Patients with AUD exhibited a significantly increased risk of developing mesenteric ischemia (HR = 2.25; 95% CI 1.92-2.64) compared with those with non-AUD after adjustment for patient sociodemographic, coexisting comorbid conditions, and hospital characteristics. Furthermore, a 2.29- and 2.17-fold higher risk of mesenteric ischemia was observed in patients with alcohol abuse/dependence (HR = 2.29; 95% CI 1.94-2.71) and alcoholic psychosis (HR = 2.17; 95% CI 1.72-2.73), respectively, than in non-AUD comparisons after covariate adjustment. CONCLUSIONS: This study confirmed that the risk of mesenteric ischemia was significantly higher among patients with different diagnostic categories of AUD, particularly for those with alcohol abuse/dependence.


Assuntos
Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/epidemiologia , Adulto , Estudos de Coortes , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
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