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Yong J.-H.,Landseed Hospital | Shiau W.-L.,Ming Chuan University
Pacific Asia Conference on Information Systems, PACIS 2016 - Proceedings | Year: 2016

In recent years, digital learning has received more attention from the field of education, and many schools in Taiwan have begun to introduce the cloud-computing classroom platform as another learning environment for students. However, as there remains a lack of research on fit and performance in the cloud-computing classroom, this study attempts to explore students' views and effects when using the cloud-computing classroom. The research methods include case study and survey. Case study involved interviews with 18 students regarding their motivations and usage of the Ming Chuan University cloudcomputing classroom. Based on the interview results, this study proposed three propositions, which were converted to three hypotheses. We collected data from a field survey and our results showed that (1) the user's needs positively and affect the perceived fit; (2) the user's usage of the cloud-computing classroom positively and affects the perceived fit; (3) the perceived fit in the usage of the cloudcomputing classroom positively and affect user performance. Implications for academic researchers and practitioners are discussed.

Hou H.-Y.,Landseed Hospital | Wu K.,Far Eastern Memorial Hospital | Wang C.-T.,National Taiwan University Hospital | Chang S.-M.,Landseed Hospital | And 2 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2010

Background: There is a variety of treatment modalities for unicameral bone cysts, with variable outcomes reported in the literature. Although good initial outcomes have been reported, the success rate has often changed with longer-term follow-up. We introduce a novel, minimally invasive treatment method and compare its clinical outcomes with those of other methods of treatment of this lesion. Methods: From February 1994 to April 2008, forty patients with a unicameral bone cyst were treated with one of four techniques: serial percutaneous steroid and autogenous bone-marrow injection (Group 1, nine patients); open curettage and grafting with a calcium sulfate bone substitute either without instrumentation (Group 2, twelve patients) or with internal instrumentation (Group 3, seven patients); or minimally invasive curettage, ethanol cauterization, disruption of the cystic boundary, insertion of a synthetic calcium sulfate bone-graft substitute, and placement of a cannulated screw to provide drainage (Group 4, twelve patients). Success was defined as radiographic evidence of a healed cyst or of a healed cyst with some defect according to the modified Neer classification, and failure was defined as a persistent or recurrent cyst that needed additional treatment. Patients who sustained a fracture during treatment were also considered to have had a failure. The outcome parameters included the radiographically determined healing rate, the time to solid union, and the total number of procedures needed. Results: The follow-up time ranged from eighteen to eighty-four months. Group-4 patients had the highest radiographically determined healing rate. Healing was seen in eleven of the twelve patients in that group compared with three of the nine in Group 1, eight of the twelve in Group 2, and six of the seven in Group 3. Group-4 patients also had the shortest mean time to union: 3.7 ± 2.3months compared with 23.4 ± 14.9, 12.2 ± 8.5, and 6.6 ± 4.3months in Groups 1, 2, and 3, respectively. Conclusions: This new minimally invasive method achieved a favorable outcome, with a higher radiographically determined healing rate and a shorter time to union. Thus, it can be considered an option for initial treatment of unicameral bone cysts. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.

Chen S.C.-C.,Ditmanson Medical Foundation Chia Yi Christian Hospital | Lin H.-J.,Chi Mei Medical Center | Lin H.-J.,Chia Nan University of Pharmacy and Science | Chen Y.-W.,Landseed Hospital | And 3 more authors.
Stroke | Year: 2013

Background and Purpose-Various risk score models have been developed to predict symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis for acute ischemic stroke. In this study, we aimed to determine the prediction performance of these risk scores in a Taiwanese population Methods-Prospectively collected data from 4 hospitals were used to calculate probability of SICH with the scores developed by Cucchiara et al, the Hemorrhage After Thrombolysis (HAT) score, the Safe Implementation of Thrombolysis in Stroke-SICH risk score, the Glucose Race Age Sex Pressure Stroke Severity score, and the Stroke Prognostication using Age and National Institutes of Health Stroke Scale-100 index. We used logistic regression to evaluate the effectiveness of each risk model in predicting SICH and the c statistic to assess performance. Results-A total of 548 patients were included. The rates of SICH were 7.3% by the National Institute of Neurological Diseases and Stroke definition, 5.3% by the European-Australasian Cooperative Acute Stroke Study II definition, and 3.5% by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study definition. The Cucchiara score, the HAT score, and the Safe Implementation of Thrombolysis in Stroke-SICH risk score were significant predictors of SICH for all 3 definitions, whereas the Glucose Race Age Sex Pressure Stroke Severity score and the Stroke Prognostication using Age and National Institutes of Health Stroke Scale-100 index predicted well only for 1 or 2 definitions of SICH. The c statistic was highest for the HAT score (range, 0.69-0.73) across the definitions of SICH. Conclusions-The Cucchiara score, the HAT score, and the Safe Implementation of Thrombolysis in Stroke-SICH risk score predicted SICH reasonably well regardless of which SICH definition was used. However, only the HAT score had an acceptable discriminatory ability. © 2013 American Heart Association, Inc.

Chen T.-A.,Landseed Hospital | Horng J.-T.,Asia University, Taiwan | Horng J.-T.,National Central University | Lin W.-C.,National Central University
International Journal of Clinical Oncology | Year: 2013

Background: The risk of metachronous colorectal cancer in patients with colorectal cancer is higher than the rate of sporadic colorectal cancer in the average population. We conducted a large-scale, population-based study, with many more clinical cases than in previously published studies, to calculate the incidence of metachronous colorectal cancer. Methods: This is a retrospective study based on data obtained from the Taiwan Cancer Registry from 1988 to 2007. Between 1988 and 2002, we analyzed 70,906 patients who were diagnosed with colon or rectal cancer and traced the occurrence of metachronous lesions with at least 5 years of follow-up. Results: Of these patients, 1,192 (730 males, 462 females; mean age 62.73 ± 12.92 years) developed metachronous cancers. The 15-year cumulative incidence of metachronous cancer was 1.68%. Within 2 years of the index cancer, 51.69% of the metachronous cancers appeared, and 61.27% of the metachronous cancers appeared within 3 years. Conclusions: Most metachronous lesions were noted within 3 years of initial diagnosis of the index cancer. Surveillance colonoscopy to ensure the absence of metachronous disease is essential for patients after curative surgery within 1 year, especially for those patients who did not receive complete colonoscopy before their first operation for colorectal cancer. © 2012 Japan Society of Clinical Oncology.

Chen T.-A.,Landseed Hospital | Liu K.-Y.,Landseed Hospital | Yeh C.-Y.,Chang Gung Memorial Hospital
Colorectal Disease | Year: 2012

Aim Ligation of the intersphincteric fistula track is a novel surgical procedure with the advantage of avoiding anal incontinence. We conducted a preliminary investigation of a modified technique for complicated trans-sphincteric anal fistula by high ligation of the track using a lateral approach. Method From June 2010 to May 2011, 10 patients received high ligation of the fistula track using a lateral approach. Patients selected for the procedure had a mature trans-sphincteric type of anal fistula that involved a significant amount of the external sphincter. Patients with early fistulous abscess or with a history of previous anal surgery were excluded. The surgical technique involved making an incision from the external opening and extending this towards the direction of the internal opening, dissection of the fistula from the underlying soft tissue, high ligation above the internal sphincter and removal of the distal part of the fistula track for pathological examination. Results Of the 10 patients, eight were men and the mean±SD age was 40.5±7.23years. The median (range) duration of follow-up was 7 (6-10)months. In all patients, the wound was completely healed by the sixth postoperative week. Two cases of recurrence were noted later and were successfully managed by traditional fistulotomy. Conclusion High-ligation surgery of the fistula track for trans-sphincteric anal fistula, aimed at total anal sphincter preservation, has shown encouraging early results. Long-term follow-up and randomized controlled trials are necessary. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

Landseed Hospital and National Central University | Date: 2015-04-29

An alarming method for a ventilator and a ventilator alarm system are provided. The method includes the following. First, a plurality of ventilation parameters are received and detected. If a peak airway pressure of the ventilation parameters conforms to a first condition, whether a plateau pressure conforms to a second condition is determined, wherein the first condition is Y_((k+1), Ppeak)>Y_(k, mean,Ppeak)+3*Y_(k,sd,Ppeak), and the second condition is Y_((k+1), Pplateau)

Wu S.-Y.,Graduate Institute of Medical science | Wu C.-P.,Landseed Hospital | Kang B.-H.,Institute of Aerospace and Undersea Medicine | Li M.-H.,Institute of Aerospace and Undersea Medicine | And 4 more authors.
Critical Care Medicine | Year: 2012

Objective: Although ischemia-reperfusion injury is a major determinant of primary graft dysfunction after lung transplantation, an approach to extend preoperative lung preservation to postoperative protection has not yet been defined. The purpose of this study was to determine the protective effects of and the signal pathway regulated by hypercapnic acidosis in ischemia- reperfusion-induced lung injury. Design: Animal study. Setting: Animal care facility procedure room in a medical center. Subjects: Adult male Sprague-Dawley rats. Interventions: Lung injury was induced in a clinically relevant ex vivo animal model. Animals were divided into a control group (FICO2, 5%; n = 6), ischemia-reperfusion group (FICO2, 5%; n = 6), and hypercapnic acidosis (ischemia-reperfusion + hypercapnic acidosis) group (FICO2, 10%; n = 6). Measurements and Main Results; Ischemia-reperfusion caused significant increases in alveolar lavage and perfusate tumor necrosis factor-α, inflammatory cell infiltration, lung tissue malondialdehyde, bronchoalveolar lavage fluid protein concentration and lactate dehydrogenase activity, lung weight gain, and infiltration coefficient. Ventilation with 10% CO2 significantly suppressed the inflammatory response and attenuated lung ischemia-reperfusion injury. Our results also showed that hypercapnic acidosis significantly inhibited the ischemia-reperfusion-induced phosphorylation and nuclear translocation of nuclear factor-κB. This was associated with elevation of inhibitor of nuclear factor-κB-α level and reduced IκB kinase-β phosphorylation, suggesting a suppression of IκB kinase and thus IκB-α activation. Conclusions: Hypercapnic acidosis may attenuate lung ischemia-reperfusion injury by suppressing the activation of the IκB kinase-nuclear factor-κB pathway. Copyright © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Chuang Y.-F.,Taipei Medical University | Yang H.-Y.,Taipei Medical University | Ko T.-L.,Taipei Medical University | Hsu Y.-F.,Landseed Hospital | And 3 more authors.
Biochemical Pharmacology | Year: 2014

Inflammation and vascular perturbations are increasingly implicated in the pathogenesis of neurodegenerative diseases. Prevailing evidence suggests that valproic acid (VPA), an antiepileptic and mood stabilizer, exhibits not only neuro-protective effects, but also anti-inflammatory effects in neurodegenerative diseases. However, the underlying mechanism contributing to VPA's suppression of inflammatory responses remains unclear. In this study, we explored the inhibitory action of VPA on cyclooxygenase (COX)-2 expression in bEnd.3 mouse brain microvascular endothelial cells exposed to lipopolysaccharide (LPS), a pro-inflammatory stimulus. The LPS-induced increases in COX-2 protein level and COX-2 promoter-luciferase activity were significantly suppressed by VPA. VPA inhibited p38MAPK and JNK phosphorylation in LPS-stimulated bEnd.3 cells. Treatment of cells with a p38MAPK inhibitor (p38MAPK inhibitor III) or a JNK signaling inhibitor (JNK inhibitor II) significantly inhibited LPS-induced COX-2 expression. VPA inhibited LPS-induced NF-κB subunit p65 phosphorylation and κB-luciferase activity. LPS-increased p65 and C/EBPβ binding to the COX-2 promoter region was attenuated in the presence of VPA. In addition, VPA suppression of p38MAPK, JNK and p65 phosphorylation, and subsequent COX-2 expression was restored in cells transfected with mitogen-activated protein kinase phosphatase-1 (MKP-1) dominant negative (DN) mutant. VPA also caused increases in MKP-1 acetylation and MKP-1 phosphatase activity in bEnd.3 cells. In conclusion, VPA may cause MKP-1 activation to dephosphorylate p38MAPK and JNK, leading to decrease in p65 and C/EBPβ binding to the COX-2 promoter region and COX-2 down-regulation in LPS-stimulated bEnd.3 cells. The present study therefore supports the therapeutic value of VPA in alleviating brain inflammatory processes. © 2014 Elsevier Inc.

Yang H.-H.,Chi Mei Medical Center | Yang H.-H.,Southern Taiwan University of Science and Technology | Hou C.-C.,Landseed Hospital | Lin M.-T.,Chi Mei Medical Center | Chang C.-P.,Southern Taiwan University of Science and Technology
American Journal of Respiratory Cell and Molecular Biology | Year: 2012

Dextromethorphan (DM) has been shown to protect against endotoxic shock in mice. Heatstroke resembles sepsis in many respects. The objective of this study was to examine the heat-induced acute lung inflammation and injury in rats with or without DM, and for comparison with those of the rats with MK-801 (an N-methyl-Daspartate receptor antagonist), SA4503 (a sigma-1 receptor agonist), or fluoxetine (a serotonin reuptake inhibitor). Heatstroke was induced by exposing the anesthetized rats to heat stress (43°C for 68 min). At 68 minutes after start of heat stress, animals treated with vehicle medium,DM(10-30 mg/kg of body weight, intramuscular), MK-801 (1mg/kg of bodyweight, intraperitoneal), SA4503 (1mg/kg of body weight, intraperitoneal), or fluoxetine (5 mg/kg of body weight, intraperitoneal)wereallowedtorecoverat roomtemperature (26°C). As comparedwith vehicle-treated heatstroke rats (25-31 min; n=8),DM(30mg/kg)-treatedheatstrokerats andMK-801(1mg/kg)- treated heatstroke rats had significantly greater survival time (193-209 min [n=7] and 121-133 min [n=8], respectively). However, the survival times for the SA4503-treated heatstroke rats (28-34 min; n=8) or the fluoxetine-treated heatstroke rats (20-26 min; n=8) were not significantly different from the vehicle-treated heatstroke rats. DM treatment significantly: (1) reduced acute lung injury, including edema, neutrophils infiltration, and hemorrhage scores; (2) decreased acute pleurisy; and (3) decreased bronchoalveolar fluid levels of the proinflammatory cytokines, and ischemia and oxidative damage markers during heatstroke. Our results indicate that DM therapymay improve outcomes of heatstroke in rats by antagonizing the N-methyl-D-aspartate receptors. Copyright © 2012 by the American Thoracic Society.

A link between postoperative pain intensity and heart rate variability (HRV) had not been well established. This study aimed to investigate the correlation between post-operative pain intensity and HRV. The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009 - November 2009. The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain. HRV was measured as the standard deviation of normal RR interval, and by power spectral analysis that included high frequency (HF), low frequency (LF), very low frequency power, and LF/HF ratio. A total of 34 subjects were included in this study. We found that the day after the surgery, the mean VAS score was 47.50 ± 20.98 and the mean SF-MPQ score was 18.06 ± 8.90, indicating a moderate degree of pain. Moderate to severe degrees of tenderness were reported by 70.6% of the patients, moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients, moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients, and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel. The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P < 0.05). The correlation of the standard deviation of normal RR interval, high frequency, very low frequency value and patient's age were negative (P < 0.05). The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P < 0.05). The multidimensional pain assessment tool (SF-MPQ) reflects better the patients' post-operative pain than the single-dimensional assessment tool (VAS). HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.

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