Search results for: Ching Yern Chee

Authors: Foong Kiew Ooi, Aidi Naim Mohamad Samsani, Chee Keong Chen, Mohamed Saat Ismail

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Introduction: Prolonged exercise in a hot and humid environment can result in glycogen depletion and associated with loss of body fluid. Carbohydrate contained in sports beverages is beneficial for improving sports performance and preventing dehydration. Carbohydrate contained in honey is believed can be served as an alternative form of carbohydrate for enhancing sports performance. Objective: To investigate the effectiveness of honey drink compared to sports drink as a recovery aid for running performance and physiological parameters in the heat. Method: Ten male recreational athletes (age: 22.2 ± 2.0 years, VO2max: 51.5 ± 3.7 ml.kg-1.min-1) participated in this randomized cross-over study. On each trial, participants were required to run for 1 hour in the glycogen depletion phase (Run-1), followed by a rehydration phase for 2 hours and subsequently a 20 minutes time trial performance (Run-2). During Run-1, subjects were required to run on the treadmill in the heat (31°C) with 70% relative humidity at 70 % of their VO2max. During rehydration phase, participants drank either honey drink or sports drink, or plain water with amount equivalent to 150% of body weight loss in dispersed interval (60 %, 50 % and 40 %) at 0 min, 30 min and 60 min respectively. Subsequently, time trial was performed by the participants in 20 minutes and the longest distance covered was recorded. Physiological parameters were analysed using two-way ANOVA with repeated measure and time trial performance was analysed using one-way ANOVA. Results: Result showed that Acacia honey elicited a better time trial performance with significantly longer distance compared to water trial (P<0.05). However, there was no significant difference between Acacia honey and sport drink trials (P > 0.05). Acacia honey and sports drink trials elicited 249 m (8.24 %) and 211 m (6.79 %) longer in distance compared to the water trial respectively. For physiological parameters, plasma glucose, plasma insulin and plasma free fatty acids in Acacia honey and sports drink trials were significantly higher compared to the water trial respectively during rehydration phase and time trial running performance phase. There were no significant differences in body weight changes, oxygen uptake, hematocrit, plasma volume changes and plasma cortisol in all the trials. Conclusion: Acacia honey elicited greatest beneficial effects on sports performance among the drinks, thus it has potential to be used for rehydration in athletes who train and compete in hot environment.

Keywords: honey drink, rehydration, sports performance, plasma glucose, plasma insulin, plasma cortisol

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Authors: Li-Ching Hung

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The lack of empirical research on portfolio assessment in aboriginal EFL English classes of junior high schools in Taiwan may inhibit EFL teachers from appreciating the utility of this alternative assessment approach. This study addressed the following research questions: 1) understand how aboriginal EFL students and instructors of junior high schools in Taiwan perceive portfolio assessment, and 2) how portfolio assessment affects Taiwanese aboriginal EFL students’ learning outcomes. Ten classes of five junior high schools in Taiwan (from different regions of Taiwan) participated in this study. Two classes from each school joined the study, and each class was randomly assigned as a control group, and one was the experimental group. These five junior high schools consisted of at least 50% of aboriginal students. A mixed research design was utilized. The instructor of each class implemented a portfolio assessment for 15 weeks of the 2015 Fall Semester. At the beginning of the semester, all participants took a GEPT test (pretest), and in the 15th week, all participants took the same level of GEPT test (post-test). Scores of students’ GEPT tests were checked by the researcher as supplemental data in order to understand each student’s performance. In addition, each instructor was interviewed to provide qualitative data concerning students’ general learning performance and their perception of implementing portfolio assessments in their English classes. The results of this study were used to provide suggestions for EFL instructors while modifying their lesson plans regarding assessment. In addition, the empirical data were used as references for EFL instructors implementing portfolio assessments in their classes effectively.

Keywords: assessment, portfolio assessment, qualitative design, aboriginal ESL students

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Authors: Yuan-Jye Tseng, Ching-Yen Chen

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In the design cycle, a main design task is to determine the external shape of the product. The external shape of a product is one of the key factors that can affect the customers’ preferences linking to the motivation to buy the product, especially in the case of a consumer electronic product such as a mobile phone. The relationship between the external shape and the customer preferences needs to be studied to enhance the customer’s purchase desire and action. In this research, a design for customer preferences model is developed for investigating the relationships between the external shape and the customer preferences of a product. In the first stage, the names of the geometric features are collected and evaluated from the data of the specified internet web pages using the developed text miner. The key geometric features can be determined if the number of occurrence on the web pages is relatively high. For each key geometric feature, the numerical values are explored using the text miner to collect the internet data from the web pages. In the second stage, a cluster analysis model is developed to evaluate the numerical values of the key geometric features to divide the external shapes into several groups. Several design suggestion cases can be proposed, for example, large model, mid-size model, and mini model, for designing a mobile phone. A customer preference index is developed by evaluating the numerical data of each of the key geometric features of the design suggestion cases. The design suggestion case with the top ranking of the customer preference index can be selected as the final design of the product. In this paper, an example product of a notebook computer is illustrated. It shows that the external shape of a product can be used to drive customer preferences. The presented design for customer preferences model is useful for determining a suitable external shape of the product to increase customer preferences.

Keywords: cluster analysis, customer preferences, design evaluation, design for customer preferences, product design

Procedia PDF Downloads 159

Authors: Chi-Ching Lee, Po-Jung Huang, Kuo-Yang Huang, Petrus Tang

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Background: Recent advances in high-throughput research technologies such as new-generation sequencing and multi-dimensional liquid chromatography makes it possible to dissect the complete transcriptome and proteome in a single run for the first time. However, it is almost impossible for many laboratories to handle and analysis these “BIG” data without the support from a bioinformatics team. We aimed to provide a web-based analysis platform for users with only limited knowledge on bio-computing to study the functional genomics and proteomics. Method: We use NCI-60 as an example dataset to demonstrate the power of the web-based analysis platform and data delivering system: C-eXpress takes a simple text file that contain the standard NCBI gene or protein ID and expression levels (rpkm or fold) as input file to generate a distribution map of gene/protein expression levels in a heatmap diagram organized by color gradients. The diagram is hyper-linked to a dynamic html table that allows the users to filter the datasets based on various gene features. A dynamic summary chart is generated automatically after each filtering process. Results: We implemented an integrated database that contain pre-defined annotations such as gene/protein properties (ID, name, length, MW, pI); pathways based on KEGG and GO biological process; subcellular localization based on GO cellular component; functional classification based on GO molecular function, kinase, peptidase and transporter. Multiple ways of sorting of column and rows is also provided for comparative analysis and visualization of multiple samples.

Keywords: cancer, visualization, database, functional annotation

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Authors: Reza Soleimanpour, Ching Tai Ng

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Fibre-composites are widely used in various structures due to their attractive properties such as higher stiffness to mass ratio and better corrosion resistance compared to metallic materials. However, one serious weakness of this composite material is delamination, which is a subsurface separation of laminae. A low level of this barely visible damage can cause a significant reduction in residual compressive strength. In the last decade, the application of guided waves for damage detection has been a topic of significant interest for many researches. Among all guided wave techniques, nonlinear guided wave has shown outstanding sensitivity and capability for detecting different types of damages, e.g. cracks and delaminations. So far, most of researches on applications of nonlinear guided wave have been dedicated to isotropic material, such as aluminium and steel, while only a few works have been done on applications of nonlinear characteristics of guided waves in anisotropic materials. This study investigates the nonlinear interactions of the fundamental antisymmetric lamb wave (A0) with delamination in composite laminates using three-dimensional (3D) explicit finite element (FE) simulations. The nonlinearity considered in this study arises from interactions of two interfaces of sub-laminates at the delamination region, which generates contact acoustic nonlinearity (CAN). The aim of this research is to investigate the phenomena of CAN in composite laminated beams by a series of numerical case studies. In this study interaction of fundamental antisymmetric lamb wave with delamination of different sizes are studied in detail. The results show that the A0 lamb wave interacts with the delaminations generating CAN in the form of higher harmonics, which is a good indicator for determining the existence of delaminations in composite laminates.

Keywords: contact acoustic nonlinearity, delamination, fibre reinforced composite beam, finite element, nonlinear guided waves

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Authors: Ching-Yi Huang, Pi-Fen Cheng, Hui-Zhu Chen, Shi Ting Huang, Heng-Hua Wang

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This is a case of oral cancer after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap. The nursing period lasted From September 25 to October 3, 2017, through observation, interview, physical assessment, and medical record review, the author identified the following nursing problems: acute pain, impaired oral mucous membrane, and body image change. During the nursing period, the author provided individual and overall nursing care and established mutual trust through the use of empathy. Author listened and eased the patient's physical indisposition, such as wound pain, we use medications and acupuncture massage to relieve pain. However, for oral mucosa change caused by surgery, provide continuous and complete oral care and oral exercise training to improve oral mucosal healing and restore swallowing function. In the body-image changes, guided him to express his feeling after the body-image change, and enhanced support and from the family, and encouraged him to attend head and neck cancer survivor alliance which allowed the patient to accept the altered body image and reaffirm self-worth. Hopefully, through sharing this nursing experience will help to the nursing care quality of nursing care for oral cancer patients after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap.

Keywords: oral cancer, acute pain, impaired oral mucous membrane, body image change

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Authors: Lie-Fen Lin, Tzu-Hsuan Lin, Ching-Heng Lin

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Hospice care for terminally ill patients provides not only a better quality of life but also cost-saving benefits. However, the utilization of home-based hospice care (HBH care) remains low even for countries covered by National Health Insurance (NHI) programs in Taiwan. In the current commercial insurance policy, only hospital-based hospice benefits were covered. It may have an influence on the insureds chosen to receive end-of-life care in a hospitalized manner. Thus, how to propose a feasible method to advocate HBH care utilization rate of public health policies is an important issue. A total of 130,219 cancer decedents in the year 2011-2013 from the National Health Insurance Research Database (NHIRD) in Taiwan were included in this study. By adding a day volume pays benefits of HBH care as a commercial insurance rider, will provide alternative benefits for the insureds. A multiple-state Markov chain model was incorporated to estimate the transition intensities of patients in different states at the end of their lives (Non-hospice, HBH, hospital-based hospice), and the premiums were estimated. HBH care insurance benefits provide financial support and reduce the burden of care for patients. The rate-making of this product is very sensitive while the utilization rate is rising, especially for high ages. The proposed HBH care insurance is a feasible way to reduce the financial burden, enhance the care quality and family satisfaction of insureds. Meanwhile, insurance companies can participate in advocating a good medical policy to enhance the social image. In addition, the medical costs of NHI can reduce effectively.

Keywords: home-based hospice care, commercial insurance, Markov chain model, the day volume pays

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Authors: Chanya Inprasit, Ching-Liang Hsieh, Yi-Wen Lin

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Obesity (OB) is a hazardous global health problem that has been increasing in prevalence, more severely in last decade. It is the mainly resultant from the imbalance between food consumption and energy expenditure, which is concordant with a modern lifestyle, implying an increase in calories with poorer quality of food intake accompanied by a decrease in physical activities. Obesity does not concern the appearance only but is also a major factor contributing to poor physiology, psychology, society and economic issues. Moreover, OB induces low-grade inflammation in the body through the regulatory effect it enacts on the adipocyte function. Various alternative treatments were investigated for body weight control, including Acupoint Catgut Embedding (ACE). ACE is the implantation of absorbable catgut sutures at specific acupoints, displaying durable and potent stimulation and thereby reducing the treatment frequency. Our study utilized a mouse model to exclude any psychological factors of OB and ACE treatment. High-fat diet and body weight were measured once a week before subjects in ACE and Sham group received the ACE treatment or placebo treatment. We hypothesized that ACE can control body weight through the interaction of the TRPV1 pathways, as TRPV1 accordingly responds to inflammatory factors. The results of body weight variation show a significant decrease in body weight in ACE group compared with the baseline of control and Sham group. Meanwhile, converse results were explored in TRPV1 knockout mice, where a significant maintenance of normal body weight throughout the experiment period was observed. There was no significant difference in food consumption of each group. These finding indicated that TRPV1 pathways and its associated pathways may be involved in the maintenance of body weight, which can be controlled by ACE treatment of genetic manipulation.

Keywords: acupoint catgut embedding, obesity, hypothalamus, TRPV1

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Authors: Hui-Chi Huang, Su-Ju Yang, Ching-Wei Lin, Jui-Yao Tsai, Liang-Yiang

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Background: Evidence exists that pneumonia is a frequently encountered complication after stroke which is associated with a higher rate of mortality and increased long-term disability Purpose: To determine the predictors associated with the risk of one-year disability in acute stroke. Methods: Data for this longitudinal follow-up study were extracted from a tertiary referral medical center’s stroke registry database in Northern Taipei. Eligible patients with acute stroke admitted to the hospital and completed a one-year follow up were recruited for analysis. Favorable outcome was defined as a modified Rankin Scale score ≤ 2. SAS version 9.2 was used for the multivariable regression analyses to examine the factors correlated with the one-year disability in stroke patients. Results: From January 2012 to December 2013, a total of 1373 (mean age: 70.49±15.4 years, 913(66.5%) males) consecutively administered acute stroke patients were recruited. Overall, the rate of one-year disability was 37.20%(404/1086) in those without post-stroke pneumonia. It increased to 82.93 %(238/287) in patients developed post-stroke pneumonia. Factors associated with increased risk of disability were age ≧ 75(OR= 4.845, p<.0001), female /gender (OR=1.568, p =.0062), previous stroke (OR= 1.868, p = <. 0001) ,dementia (OR= 2.872, p =.0047), ventilator use (OR= 4.653, p <. 0001),age ≧ 75 /pneumonia (OR=1.236, p <. 0001) , ICU admission (OR=3.314, p <.0001) , nasogastric tube insertion (OR= 4.28, p <.0001), speech therapy (OR= 1.79, p =.0142), urinary tract infection (OR= 1.865, p =.0018), estimated glomerular filtration rate (eGFR > 60 )(OR= 0.525, p= .0029), Admission NIHSS >11 (OR= 2.101, p = .0099), Length of hospitalization > 30(d) (OR= 5.182, p <.0001). Conclusion: Older age, severe neurological deficit, complications, rehabilitation intervention, length of hospitalization >30(d), and cognitive impairment were significantly associated with Post-stroke functional impairment, especially those with post-stroke pneumonia. These findings could open new avenues in the management of stroke patients.

Keywords: stroke, risk, pneumonia, disability

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Authors: Chuan-Ching Sue, Kai-Chun Chuang

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Peer-to-Peer (P2P) live streaming systems still suffer a challenge when thousands of new peers want to join into the system in a short time, called flash crowd, and most of new peers suffer long start-up delay. Recent studies have proposed a slot-based user access control mechanism, which periodically determines a certain number of new peers to enter the system, and a user batch join mechanism, which divides new peers into several tree structures with fixed tree size. However, the slot-based user access control mechanism is difficult for accurately determining the optimal time slot length, and the user batch join mechanism is hard for determining the optimal tree size. In this paper, we propose a structured access control (SAC) mechanism, which constructs new peers to a multi-layer mesh structure. The SAC mechanism constructs new peer connections layer by layer to replace periodical access control, and determines the number of peers in each layer according to the system’s remaining upload bandwidth and average video rate. Furthermore, we propose an analytical model to represent the behavior of the system growth if the system can utilize the upload bandwidth efficiently. The analytical result has shown the similar trend in system growth as the SAC mechanism. Additionally, the extensive simulation is conducted to show the SAC mechanism outperforms two previously proposed methods in terms of system growth and start-up delay.

Keywords: peer-to-peer, live video streaming system, flash crowd, start-up delay, access control

Procedia PDF Downloads 291

Authors: Chen-Chi An, Jun-Yi He, Cheng-Han Hsieh, Chen-Ching Ting

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This research has successfully developed an intelligent table tennis ball machine with human play simulate all situations of human play to take the service. It is well known; an excellent ball machine can help the table tennis coach to provide more efficient teaching, also give players the good technical training and entertainment. An excellent ball machine should be able to service all balls based on human play simulation due to the conventional competitions are today all taken place for people. In this work, two counter-rotating wheels are used to service the balls, where changing the absolute rotating speeds of the two wheels and the differences of rotating speeds between the two wheels can adjust the struck forces and the rotating speeds of the ball. The relationships between the absolute rotating speed of the two wheels and the struck forces of the ball as well as the differences rotating speeds between the two wheels and the rotating speeds of the ball are experimentally determined for technical development. The outlet speed, the ejected distance, and the rotating speed of the ball were measured by changing the absolute rotating speeds of the two wheels in terms of a series of differences in rotating speed between the two wheels for calibration of the ball machine; where the outlet speed and the ejected distance of the ball were further converted to the struck forces of the ball. In process, the balls serviced by the intelligent ball machine were based on the received calibration curves with help of the computer. Experiments technically used photosensitive devices to detect the outlet and rotating speed of the ball. Finally, this research developed some teaching programs for technical training using three ball machines and received more efficient training.

Keywords: table tennis, ball machine, human play simulation, counter-rotating wheels

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Authors: Shu-Ching Chen, Li-Yun Lee

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The purpose of the study was to identify the factors associated with head and neck cancer-related lymphoedema (HNCRL)-related symptoms, body image, and HNCRL-related functional outcomes among patients with resected advanced head and neck cancer. A cross-sectional correlational design was conducted to examine the predictors of HNCRL-related functional outcomes in patients with resected advanced head and neck cancer. Eligible patients were recruited from a single medical center in northern Taiwan. Consecutive patients were approached and recruited from the Radiation Head and Neck Outpatient Department of this medical center. Eligible subjects were assessed for the Symptom Distress Scale–Modified for Head and Neck Cancer (SDS-mhnc), Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Head and Neck Cancer (BCSQ-H&N), Body Image Scale–Modified (BIS-m), The MD Anderson Head and Neck Lymphedema Rating Scale (MDAHNLRS), The Foldi’s Stages of Lymphedema (Foldi’s Scale), Patterson’s Scale, UCLA Shoulder Rating Scale (UCLA SRS), and Karnofsky’s Performance Status Index (KPS). The results showed that the worst problems with body HNCRL functional outcomes. Patients’ HNCRL symptom distress and performance status are robust predictors across over for overall HNCRL functional outcomes, problems with body HNCRL functional outcomes, and activity and social functioning HNCRL functional outcomes. Based on the results of this period research program, we will develop a Cancer Rehabilitation and Lymphedema Care Program (CRLCP) to use in the care of patients with resected advanced head and neck cancer.

Keywords: head and neck cancer, resected, lymphedema, symptom, body image, functional outcome

Procedia PDF Downloads 221

Authors: Huan-Chieh Chiu, Hung-Shuo Wu, Chien-Hao Wang, Yu-Cheng Yang, Ching-Ya Tseng, Joe-Air Jiang

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Power failure resulting from tower collapse due to violent seismic events might bring enormous and inestimable losses. The Chi-Chi earthquake, for example, strongly struck Taiwan and caused huge damage to the power system on September 21, 1999. Nearly 10% of extra high voltage (EHV) transmission towers were damaged in the earthquake. Therefore, seismic hazards of EHV transmission towers should be monitored and evaluated. The ultimate goal of this study is to establish a damage level assessment model for EHV transmission towers. The data of earthquakes provided by Taiwan Central Weather Bureau serve as a reference and then lay the foundation for earthquake simulations and analyses afterward. Some parameters related to the damage level of each point of an EHV tower are simulated and analyzed by the data from monitoring stations once an earthquake occurs. Through the Fourier transform, the seismic wave is then analyzed and transformed into different wave frequencies, and the data would be shown through a response spectrum. With this method, the seismic frequency which damages EHV towers the most is clearly identified. An estimation model is built to determine the damage level caused by a future seismic event. Finally, instead of relying on visual observation done by inspectors, the proposed model can provide a power company with the damage information of a transmission tower. Using the model, manpower required by visual observation can be reduced, and the accuracy of the damage level estimation can be substantially improved. Such a model is greatly useful for health and construction monitoring because of the advantages of long-term evaluation of structural characteristics and long-term damage detection.

Keywords: damage level monitoring, drift ratio, fragility curve, smart grid, transmission tower

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Authors: Kai Pei Huang, Ting Chung Hung, Li Ching Wu

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Amyloidosis refers to a variety of conditions wherein amyloid proteins are abnormally deposited in organ or tissues and cause harm. Among the several forms of amyloidosis, the principal types of that in inpatient medical services are the AL amyloidosis (primary) and AA amyloidois (secondary). AL Amyloidois is due to deposition of protein derived from overproduction of immunoglobulin light chain in plasma cell myeloma. Furthermore, it is a systemic disorder that can present with a variety of symptoms, including heavy proteinemia and edema, heptosplenomegaly, otherwise unexplained heart failure. We reported a 78-year-old female presenting dysuria, oliguria and leg edema for several months. Laboratory data showed proteinuria (UPCR:1679.8), leukocytosis (WBC:16.2 x 10^3/uL), results of serum urea nitrogen (39mg/dL), creatinine (0.76 mg/dL), IgG (748 mg/dL.), IgA (635 mg/dL), IgM (63 mg/dL), kappa light chain(18.8 mg/dL), lambda light chain (110.0 mg/dL) and kappa/lambda ratio (0.17). Renal biopsy found amyloid fibrils in glomerular mesangial area, and Congo red stain highlights amyloid deposition in glomeruli. Additional lab studies included serum protein electrophoresis, which shows a major monoclonal peak in β region and minor small peak in gamma region, and the immunotyping studies for serum showed two IgA/λ type. We treated sample with beta-mercaptoethanol which reducing the polymerized immunoglobulin to clarify two IgA/λ are secreted from the same plasma cell clone in bone marrow. Later examination confirmed it existed plasma cell infiltration in bone marrow, and the immunohistochemical staining showed monotypic for λ light chain and are positive for IgA. All findings mentioned above reveal it is a case of plasma cell myeloma with λ Light Chain Amyloidosis.

Keywords: amyloidosis, immunoglobulin light chain, plasma cell myeloma, serum protein electrophoresis

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Authors: Chun-Min Lin, Yuh-Jen Wu, Ching-Ting Chung

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The formulation of tourism policies requires objective academic research and evidence as support, especially research from local academia. Taiwan is a small island, and its economic growth relies heavily on tourism revenue. Taiwanese government has been devoting to the promotion of the tourism industry over the past few decades. Scientific research outcomes by Taiwanese scholars may and will help lay the foundations for drafting future tourism policy by the government. In this study, a total of 120 full journal articles published between 2008 and 2016 from the Journal of Tourism and Leisure Studies (JTSL) were examined to explore the scientific research trend of tourism study in Taiwan. JTSL is one of the most important Taiwanese journals in the tourism discipline which focuses on tourism-related issues and uses traditional Chinese as the study language. The method of co-word analysis from bibliometrics approaches was employed for semantic analysis in this study. When analyzing Chinese words and phrases, word segmentation analysis is a crucial step. It must be carried out initially and precisely in order to obtain meaningful word or word chunks for further frequency calculation. A word segmentation system basing on N-gram algorithm was developed in this study to conduct semantic analysis, and 100 groups of meaningful phrases with the highest recurrent rates were located. Subsequently, co-word analysis was employed for semantic classification. The results showed that the themes of tourism research in Taiwan in recent years cover the scope of tourism education, environmental protection, hotel management, information technology, and senior tourism. The results can give insight on the related issues and serve as a reference for tourism-related policy making and follow-up research.

Keywords: bibliometrics, co-word analysis, word segmentation, tourism research, policy

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Authors: Mei-Ching Ho

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Graduate-level writing practices have gained increasing scholarly attention in recent years. Due to its discipline-specific conventions and requirements, research writing can cause various levels of anxiety for native English speaking and English as a second/foreign language (ESL/EFL) postgraduate students. Although many studies have investigated how writing anxiety can negatively affect writing performance, self-efficacy, and disciplinary discourse socialization process, relatively few have examined the impact of writing anxiety from the perspectives of postgraduate students in EFL contexts. This study aims to 1) examine the level of and the relationship between research writing anxiety and self-efficacy among Taiwanese EFL students at the master's and doctoral levels and 2) to uncover the causes of students' research writing anxiety. The data was collected from an adapted version of Second Language Writing Anxiety Inventory (SLWAI) and Research Writing Self-Efficacy Scale with 218 EFL graduate students in engineering-related fields at two research-oriented universities in Taiwan. A pilot study was conducted to ensure the construct and content validity of the instruments. Semi-structured interviews were also undertaken with 30 survey respondents to better understand the causes of their writing anxiety. The results revealed that while both master's and doctoral students had low to moderate research writing anxiety and self-efficacy, the doctoral students with more experiences in writing research papers in English were more anxious but not necessarily more confident than the master's students. A significantly weak negative correlation was found between the two constructs. The contributing factors for these results include different degree of writing exigency, perceived importance and types of writing tasks, writing for publication as graduation thresholds, and mentoring relationship with thesis/dissertation advisers. The study also identified several causes of graduate-level writing anxiety, of which writing under time constraints and concern on linguistic and rhetorical proficiency appeared to be the major concern. Pedagogical implications regarding facilitating graduate students' writing process and reducing anxiety will also be drawn.

Keywords: writing affect, writing anxiety, writing self-efficacy, EFL, postgraduate students

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Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

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Authors: Ya-Ching Fu, An-Kuo Chou, Boon-Fatt Tan, Chi-Nien Chen, Wen-Chien Yang, Pou-Leng Cheong

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Blind oro-/naso-pharyngeal suction and feeding tube placement are very common practices in neonatal intensive care unit. Though esophageal perforation is a rare complication of these instrumentations, its prevalence is highest in extremely premature neonates. Due to its association with significant morbidity (including respiratory deterioration, pneumothorax, and sepsis) and even mortality, it is an important issue to prevent this iatrogenic complication in the field of premature care. We demonstrate an esophageal perforation in an extreme-low-birth-weight neonate after oro-gastric tube placement. This female baby weighing 680 grams was delivered by caesarean section at 25 weeks of gestational age. She initially received oro-tracheal intubation with mechanical ventilation which was smoothly weaned to non-invasive positive-pressure ventilation at 7-day-old. However, after insertion of a 5-French oro-gastric tube, the baby’s condition suddenly worsened with apnea requiring mechanical ventilation. Her chest radiogram showed the oro-gastric tube in right pleural space, and thus another oro-gastric tube was replaced, and its position was radiographically confirmed. The malpositioned tube was then removed. The baby received 2-week course of intravenous antibiotics for her esophageal perforation. Feeding was then reintroduced and increased to full feeds in a smooth course. She was discharged at 107-day-old. Esophageal perforation in newborn is very rare. Sudden respiratory deterioration in a neonate after naso-/oro-gastric tube placement should alarm us to consider esophageal perforation, and further radiological investigation is required for the diagnosis. Tube materials, patient condition, and age are major risk factors of esophageal perforation. The use of softer tube material, such as silicone, in extreme premature baby might prevent this fetal complication.

Keywords: esophageal perforation, preterm, newborn, feeding tube

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Authors: Li-Ting Huang, Yu-Hsiang Shen, Cing-Ciao Ke, Sheng-Pin Tseng, Fan-Pin Tseng, Yu-Ching Ni, Chia-Yu Lin

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Chest radiography is the most common technique for the diagnosis and follow-up of pulmonary diseases. However, the lesions superimposed with normal structures are difficult to be detected in chest radiography. Chest tomosynthesis is a relatively new technique to obtain 3D section images from a set of low-dose projections acquired over a limited angular range. However, there are some limitations with chest tomosynthesis. Patients undergoing tomosynthesis have to be able to hold their breath firmly for 10 seconds. A digital tomosynthesis system with advanced reconstruction algorithm and high-stability motion mechanism was developed by our research group. The potential for the system to perform a bidirectional chest scan within 10 seconds is expected. The purpose of this study is to realize the influences of the scan speed on the image quality for our digital tomosynthesis system. The major factors that lead image blurring are the motion of the X-ray source and the patient. For the fore one, an experiment of imaging a chest phantom with three different scan speeds, which are 6 cm/s, 8 cm/s, and 15 cm/s, was proceeded to understand the scan speed influences on the image quality. For the rear factor, a normal SD (Sprague-Dawley) rat was imaged with it alive and sacrificed to assess the impact on the image quality due to breath motion. In both experiments, the profile of the ROIs (region of interest) and the CNRs (contrast-to-noise ratio) of the ROIs to the normal tissue of the reconstructed images was examined to realize the degradations of the qualities of the images. The preliminary results show that no obvious degradation of the image quality was observed with increasing scan speed, possibly due to the advanced designs for the hardware and software of the system. It implies that higher speed (15 cm/s) than that of the commercialized tomosynthesis system (12 cm/s) for the proposed system is achieved, and therefore a complete chest scan within 10 seconds is expected.

Keywords: chest radiography, digital tomosynthesis, image quality, scan speed

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Authors: Hui-Chi Huang, Su-Ju Yang, Ching-Wei Lin, Jui-Yao Tsai, Liang-Yiang

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Background: The most common serious complication following acute stroke is pneumonia. It has been associated with the increased morbidity, mortality, and medical cost after acute stroke in elderly patients. Purpose: The aim of this retrospective study was to investigate the relationship between stroke patients, risk factors of pneumonia, and one-year survival rates in a group of patients, in a tertiary referal center in Northern Taiwan. Methods: From January 2012 to December 2013, a total of 1730 consecutively administered stroke patients were recruited. The Survival analysis and multivariate regression analyses were used to examine the predictors for the one-year survival in stroke patients of a stroke registry database from northern Taiwan. Results: The risk of stroke mortality increased with age≧ 75 (OR=2.305, p < .0001), cancer (OR=3.221, p=<.0001), stayed in intensive care unit (ICU) (OR=2.28, p <.0006), dysphagia (OR=5.026, p<.0001), without speech therapy(OR=0.192, p < .0001),serum albumin < 2.5(OR=0.322, p=.0053) , eGFR > 60(OR=0.438, p <. 0001), admission NIHSS >11(OR=1.631, p=.0196), length of hospitalization (d) > 30(OR=0.608, p=.0227), and stroke subtype (OR=0.506, p=.0032). After adjustment of confounders, pneumonia was not significantly associated with the risk of mortality. However, it is most likely to develop in patients who are age ≧ 75, dyslipidemia , coronary artery disease , albumin < 2.5 , eGFR <60 , ventilator use , stay in ICU , dysphagia, without speech therapy , urinary tract infection , Atrial fibrillation , Admission NIHSS > 11, length of hospitalization > 30(d) , stroke severity (mRS=3-5) ,stroke Conclusion: In this study, different from previous research findings, we found that elderly age, severe neurological deficit and rehabilitation therapy were significantly associated with Post-stroke Pneumonia. However, specific preventive strategies are needed to target the high risk groups to improve their long-term outcomes after acute stroke. These findings could open new avenues in the management of stroke patients.

Keywords: stroke, risk, pneumonia, survival

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Authors: Sophia Ming Lee Wen, Chao-Ching Kuo, Yu-Line Hu, Yu-Lung Ho, Chih-Cheng Huang, Yi-Hwa Lee

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Teaching and learning should involve social issues by which effectiveness and humanity is due consideration as a guideline for sharing and co-creating knowledge. A qualitative method was used after a pioneer study to confirm pre-service teachers’ awareness of open knowledge. There are 17 in-service teacher candidates sampling from 181 schools in Taiwan. Two questions are to resolve: a) How did teachers change their educational ideas, in particular, their attitudes to meet the needs of knowledge sharing and co-creativity; and b) How did they acknowledge the necessity of working out an appropriate way between the educational efficiency and the nature of education for high performance management. This interview investigated teachers’ attitude of sharing and co-creating knowledge. The results show two facts in Taiwan: A) Individuals who must be able to express themselves will be capable of taking part in an open learning environment; and B) Teachers must lead the direction to inspire high performance and improve students’ capacity via knowledge sharing and co-creating knowledge, according to the student-centered philosophy. Collected data from interviewing showed that the teachers were well aware of changing their teaching methods and make some improvements to balance the educational efficiency and the nature of education. Almost all teachers acknowledge that ICT is helpful to motivate learning enthusiasm. Further, teaching integrated with ICT saves teachers’ time and energy on teaching preparation and promoting effectiveness. Teachers are willing to co-create knowledge with students, though using information is not easy due to the lack of operating skills of the website and ICT. Some teachers are against to co-create knowledge in the informational background since they hold that is not feasible for there being a knowledge gap between teachers and students. Technology would easily mislead teachers and students to the goal of instrumental rationality, which makes pedagogy dysfunctional and inhumane; however, any high quality of teaching should take a dialectical balance between effectiveness and humanity.

Keywords: critical thinking, dialectic between effectiveness and humanity, open knowledge, pedagogy

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Authors: Yu-Ching Liu

Abstract:

Background: Family numbers usually take responsibility for taking care of their elderly relatives, especially parents. Caring for a patient with chronic diseases is a stressful experience, which makes carers suffer physical and mental health stress, difficulties maintaining family relationships and issues in participating in the labor market, which may lower their quality of life (QoL). The issue of providing care to relatives with chronic illness has been widely explored in Taiwan, but most studies focus on the need for full-time caregivers. Objective: The main goal of this study was to examine the topic of working carers involved in the decision-making process of LTC services and to explore what affects working carers considering when they choose the care services for their disabled, elderly relatives. Method: A total of 7 working caregivers were enrolled in this study. A face-to-face and semi-structured in-depth qualitative interview study were conducted to explore the caregivers' perspectives. Results: Working carers have a positive experience of using LTC service because it allows them to kill two birds with one stone, continue employment, and care for an elderly disabled relative. However, working carers have still been struggling to find friendly community-based LTC services. There were no longer available community services that could be used with the illness condition of patients getting worse. As such, patients have to be cared for at home, which might increase the caregiver burden of carers. Conclusion: Working family caregivers suffer from heavy physical and psychological burdens as they not only have to maintain their employment but care for elderly disabled relatives; however, the current support provided is insufficient. The design of services should consider working carers' employment situation and need rather than the only caring situation of patients at home.

Keywords: family caregiver, Long-term care, work-life balance, decision-making

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Authors: Yu-Ju Tsai, Ching-Chun Wang, Wen-Tzu Tang, Huei-Ming Chai

Abstract:

A pronated foot is frequently associated with a hypermobile first ray, then developing further severe foot problems. Low-Dye taping with athletic tape has been widely used to restrict excessive first ray motion and re-build height of the medial longitudinal arch in general population with pronated foot. It is not the case, however, for sprinters since they feel too much restriction of foot motions. Currently, the kinesio tape, more elastic than the athletic tape, has been widely used to re-adjust joint positions. It was interesting whether modified low-Dye taping using kinesio tape was beneficial for altering first ray mobility and still giving enough arch support. The purpose of this study was to investigate the effect of modified low-Dye taping on first ray mobility test and 60-m sprint time for sprinters with pronated foot. The significance of this study provides new insight into a treatment alternative of modified low-Dye taping for sprinter with pronated foot. Ten young male sprinters, aged 20.8±1.6 years, with pronated foot were recruited for this study. The pronated foot was defined as the foot that the navicular drop test was greater than 1.0 cm. Three optic shutters were placed at the start, 30-m, and 60-m sites to record sprint time. All participants were asked to complete 3 trials of the 60-m dash with both taping and non-taping conditions in a random order. The low-Dye taping was applied using the method postulated by Ralph Dye in 1939 except the kinesio tape was used instead. All outcome variables were recorded for taping and non-taping conditions. Paired t-tests were used to analyze all outcome variables between 2 conditions. Although there were no statistically significant differences in dorsal and plantar mobility between taping and non-taping conditions, a statistical significance was found in a total range of motion (dorsiflexion plus plantarflexion angle) of the first ray when a modified low-Dye taping was applied (p < 0.05). Time to complete 60-m sprint was significantly increased with low-Dye taping (p < 0.05) while no significance was found for time to 30-m. it indicated that modified low-Dye taping changed maximum sprint speed of 60-m dash. Conclusively, modified low-Dye taping was capable of increasing first ray mobility and further altered maximum sprint speed.

Keywords: first ray mobility, kinesio taping, pronated foot, sprint time

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Authors: Hsin-Yu Lin, Ching-Hsia Hung

Abstract:

Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway during sleep. The vulnerable sites of upper airway collapses are consequences of sleep state-dependent reductions in tone in specific pharyngeal dilators. Clinical examinations reveal multilevel collapses of the upper airway among the patients with OSA. Therefore, an anatomically-based oropharyngeal rehabilitation should comprise a multilevel approach, including retropalatal, retroglossal, hypopharyngeal, temporomandibular, and facial levels, all of which involve different muscle groups and contribute to multifunctional interaction and coordination, such as swallowing, breathing, and phonation. The purpose of the study was to exam the effects of this rehabilitation program with a multilevel approach. In this study, fifteen subjects with newly diagnosed moderate or severe OSA (Apnea-Hypopnea-Index≥15) were randomized into an intervention group and control group. The intervention group (N=8) underwent a 12-week-intervention of a hospital-based rehabilitation program, while the control group (N=7) was kept on the waiting list. The 12-week-intervention comprised an anatomically based multilevel approach. The primary outcome was Polysomnography (PSG) data, and the secondary outcome was oropharyngeal and respiratory muscle function. In the intervention group, Apnea-Hypopnea-Index significantly improved (46.96±19.45 versus 32.78±10.78 events/h, p=0.017) compared with control group (35.77±17.49 versus 42.96±17.32 events/h, p=0.043). While the control group remained no change, the intervention group demonstrated other PSG outcomes significantly improvement, including arousal index (46.04±18.9 versus 32.98±8.35/h, p=0.035), mean SpO2 (92.88±2.1 versus 94.13±1.46%, p=0.039). Besides, the intervention group demonstrated significant improvement in oropharyngeal and respiratory muscle function compared to the control group. This anatomically-based oropharyngeal rehabilitation with a multilevel approach can be proven as a non-invasive therapy for patients with OSA.

Keywords: obstructive sleep apnea, upper airway, oropharyngeal rehabilitation, multilevel approach

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Authors: Long-Shan Wu, Ming-Chen Ko, Chien-Chang Ho, Po-Fu Lee, Jenn-Woei Hsieh, Ching-Yu Tseng

Abstract:

This study aimed to determine the effects of whole-body vibration (WBV) training on lower-extremity muscle strength and balance control performance among community-dwelling middle-aged and older adults in the United States. Twenty-nine participants without any contraindication of performing WBV exercise completed all the study procedures. Participants were randomly assigned to do body weight exercise with either an individualized vibration frequency and amplitude, a fixed vibration frequency and amplitude, or no vibration. Isokinetic knee extensor power, limits of stability, and sit-to-stand tests were performed at the baseline and after 8 weeks of training. Neither the individualized frequency-amplitude WBV training protocol nor the fixed frequency-amplitude WBV training protocol improved isokinetic knee extensor power. The limits of stability endpoint excursion score for the individualized frequency-amplitude group increased by 8.8 (12.9%; p = 0.025) after training. No significant differences were observed in fixed and control group. The maximum excursion score for the individualized frequency-amplitude group at baseline increased by 9.2 (11.5%; p = 0.006) after training. The average weight transfer time score significantly decreased by 0.21 s in the fixed group. The participants in the individualized group showed a significant increase (3.2%) in weight rising index score after 8 weeks of WBV training. These results suggest that 8 weeks of WBV training improved limit of stability and sit-to-stand performance. Future studies need to determine whether WBV training improves other factors that can influence posture control.

Keywords: whole-body vibration training, muscle strength, balance control, middle-aged and older adults

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Authors: Yu-Ching Cheng, Yi-Kai Juan, Daniel Castro

Abstract:

Energy consumption of buildings has been an increasing concern for researchers and practitioners in the last decade. Sustainable building renovation can reduce energy consumption and carbon dioxide emissions; meanwhile, it also can extend existing buildings useful life and facilitate environmental sustainability while providing social and economic benefits to the society. School buildings are different from other designed spaces as they are more crowded and host the largest portion of daily activities and occupants. Strategies that focus on reducing energy use but also improve the students’ learning environment becomes a significant subject in sustainable school buildings development. A decision model is developed in this study to solve complicated and large-scale combinational, discrete and determinate problems such as school renovation projects. The task of this model is to automatically search for the most cost-effective (lower cost and higher quality) renovation strategies. In this study, the search process of optimal school building renovation solutions is by nature a large-scale zero-one programming determinate problem. A* is suitable for solving deterministic problems due to its stable and effective search process, and genetic algorithms (GA) provides opportunities to acquire global optimal solutions in a short time via its indeterminate search process based on probability. These two algorithms are combined in this study to consider trade-offs between renovation cost and improved quality, this decision model is able to evaluate current school environmental conditions and suggest an optimal scheme of sustainable school buildings renovation strategies. Through adoption of this decision model, school managers can overcome existing limitations and transform school buildings into spaces more beneficial to students and friendly to the environment.

Keywords: decision model, school buildings, sustainable renovation, genetic algorithm, A* search algorithm

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Authors: Hsiao-ting Lin

Abstract:

This paper analyzes the history of Taiwan’s secret program to develop its nuclear weapons during the Cold War. In July 1971, US President Richard Nixon shocked the world when he announced that his national security adviser Henry Kissinger had made a secret trip to China and that he himself had accepted an invitation to travel to Beijing. This huge breakthrough in the US-PRC relationship was followed by Taipei’s loss of political legitimacy and international credibility as a result of its UN debacle in the fall that year. Confronted with the Nixon White House’s opening to the PRC, leaders in Taiwan felt being betrayed and abandoned, and they were obliged to take countermeasures for the sake of national interest and regime survival. Taipei’s endeavor to create an effective nuclear program, including the possible development of nuclear weapons capabilities, fully demonstrates the government’s resolution to pursue its own national policy, even if such a policy was guaranteed to undermine its relations with the United States. With hindsight, Taiwan’s attempt to develop its own nuclear weapons did not succeed in sabotaging the warming of US-PRC relations. Worse, it was forced to come to a full stop when, in early 1988, the US government pressured Taipei to close related facilities and programs on the island. However, Taiwan’s abortive attempt to develop its nuclear capability did influence Washington’s and Beijing’s handling of their new relationship. There did develop recognition of a common American and PRC interest in avoiding a nuclearized Taiwan. From this perspective, Beijing’s interests would best be served by allowing the island to remain under loose and relatively benign American influence. As for the top leaders on Taiwan, such a policy choice demonstrated how they perceived the shifting dynamics of international politics in the 1960s and 1970s and how they struggled to break free and pursue their own independent national policy within the rigid framework of the US-Taiwan alliance during the Cold War.

Keywords: taiwan, richard nixon, nuclear program, chiang Kai-shek, chiang ching-kuo

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Authors: Chee Wee Gan, Anthony Herr Cheun Ng, Yee Shan Wong, Subbu Venkatraman, Lynne Hsueh Yee Lim

Abstract:

Otitis media with effusion (OME) is the leading cause of hearing loss in children worldwide. Surgery to insert grommet tube into the eardrum is usually indicated for OME unresponsive to antimicrobial therapy. It is the most common surgery for children. However, current commercially available grommet tubes are non-bioresorbable, not drug-treated, with unpredictable duration of retention on the eardrum to ventilate middle ear. Their functionality is impaired when clogged or chronically infected, requiring additional surgery to remove/reinsert grommet tubes. We envisaged that a novel fully bioresorbable grommet tube with sustained antibiotic release technology could address these drawbacks. In this study, drug-loaded bioresorbable poly(L-lactide-co-ε-caprolactone)(PLC) copolymer grommet tubes were fabricated by microinjection moulding technique. In vitro drug release and degradation model of PLC tubes were studied. Antibacterial property was evaluated by incubating PLC tubes with P. aeruginosa broth. Surface morphology was analyzed using scanning electron microscopy. A preliminary animal study was conducted using guinea pigs as an in vivo model to evaluate PLC tubes with and without drug, with commercial Mini Shah grommet tube as comparison. Our in vitro data showed sustained drug release over 3 months. All PLC tubes revealed exponential degradation profiles over time. Modeling predicted loss of tube functionality in water to be approximately 14 weeks and 17 weeks for PLC with and without drug, respectively. Generally, PLC tubes had less bacteria adherence, which were attributed to the much smoother tube surfaces compared to Mini Shah. Antibiotic from PLC tube further made bacteria adherence on surface negligible. They showed neither inflammation nor otorrhea after 18 weeks post-insertion in the eardrums of guinea pigs, but had demonstrated severe degree of bioresorption. Histology confirmed the new PLC tubes were biocompatible. Analyses on the PLC tubes in the eardrums showed bioresorption profiles close to our in vitro degradation models. The bioresorbable antibiotic-loaded grommet tubes showed good predictability in functionality. The smooth surface and sustained release technology reduced the risk of tube infection. Tube functional duration of 18 weeks allowed sufficient ventilation period to treat OME. Our ongoing studies include modifying the surface properties with protein coating, optimizing the drug dosage in the tubes to enhance their performances, evaluating their functional outcome on hearing after full resoption of grommet tube and healing of eardrums, and developing animal model with OME to further validate our in vitro models.

Keywords: bioresorbable polymer, drug release, grommet tube, guinea pigs, otitis media with effusion

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Authors: Zhipeng Yan, Janice Wing-Tung Kwong, Ching-Lung Lai

Abstract:

Background: Advanced melanoma accounts for the majority of skin cancer death due to its poor prognosis. Nivolumab and ipilimumab are monoclonal antibodies targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocytes antigen 4 (CTLA-4). Nivolumab and ipilimumab combination therapy has been proven to be effective for advanced melanoma. This systematic review and meta-analysis are to evaluate its clinical efficacy and adverse events. Method: A systematic search was done on databases (Pubmed, Embase, Medline, Cochrane) on 21 June 2020. Search keywords were nivolumab, ipilimumab, melanoma, and randomised controlled trials. Clinical trials fulfilling the inclusion criteria were selected to evaluate the efficacy of combination therapy in terms of prolongation of progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The odd ratios and distributions of grade 3 or above adverse events were documented. Subgroup analysis was performed based on PD-L1 expression-status and BRAF-mutation status. Results: Compared with nivolumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR in combination therapy were 0.64 (95% CI, 0.48-0.85; p=0.002), 0.84 (95% CI, 0.74-0.95; p=0.007) and 1.76 (95% CI, 1.51-2.06; p < 0.001), respectively. Compared with ipilimumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR were 0.46 (95% CI, 0.37-0.57; p < 0.001), 0.54 (95% CI, 0.48-0.61; p < 0.001) and 6.18 (95% CI, 5.19-7.36; p < 0.001), respectively. In combination therapy, the odds ratios of grade 3 or above adverse events were 4.71 (95% CI, 3.57-6.22; p < 0.001) compared with nivolumab monotherapy, and 3.44 (95% CI, 2.49-4.74; p < 0.001) compared with ipilimumab monotherapy, respectively. High PD-L1 expression level and BRAF mutation were associated with better clinical outcomes in patients receiving combination therapy. Conclusion: Combination therapy is effective for the treatment of advanced melanoma. Adverse events were common but manageable. Better clinical outcomes were observed in patients with high PD-L1 expression levels and positive BRAF-mutation.

Keywords: nivolumab, ipilimumab, advanced melanoma, systematic review, meta-analysis

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Authors: Janet Wing-Chong Wai, Alex Chiu-Wing Lee, Hailey Hoi-Ching Tsang, Jeffrey Chiu, Kwok-Wing Tang

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Background: Mammography has limited sensitivity and specificity though it is the primary imaging technique for detection of early breast cancer. Ultrasound imaging and contrast-enhanced MRI are useful adjunct tools to mammography. The advantage of breast MRI is high sensitivity for invasive breast cancer. Therefore, indications for and use of breast magnetic resonance imaging have increased over the past decade. Objectives: 1. Cases demonstration on different indications for breast MR imaging. 2. To review of the common artifacts and pitfalls in breast MR imaging. Materials and Methods: This is a retrospective study including all patients underwent dynamic contrast-enhanced breast MRI examination in our centre, performed from Jan 2011 to Dec 2017. The clinical data and radiological images were retrieved from the EPR (electronic patient record), RIS (Radiology Information System) and PACS (Picture Archiving and Communication System). Results and Discussion: Cases including (1) Screening of the contralateral breast in patient with a new breast malignancy (2) Breast augmentation with free injection of unknown foreign materials (3) Finding of axillary adenopathy with an unknown site of primary malignancy (4) Neo-adjuvant chemotherapy: before, during, and after chemotherapy to evaluate treatment response and extent of residual disease prior to operation. Relevant images will be included and illustrated in the presentation. As with other types of MR imaging, there are different artifacts and pitfalls that can potentially limit interpretation of the images. Because of the coils and software specific to breast MR imaging, there are some other technical considerations that are unique to MR imaging of breast regions. Case demonstration images will be available in presentation. Conclusion: Breast MR imaging is a highly sensitive and reasonably specific method for the detection of breast cancer. Adherent to appropriate clinical indications and technical optimization are crucial for achieving satisfactory images for interpretation.

Keywords: MRI, breast, clinical, cancer

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