Triservice General Hospital

Taiwan

Triservice General Hospital

Taiwan
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Lin C.,TriService General Hospital | Huang Y.,Memorial SloanKettering Cancer Center
Medical Physics | Year: 2011

Purpose: After implementing a new total body irradiation (TBI) technique in clinic, in vivo dosimetry check is essential. We use a navel tool, radiophotoluminescent glass dosimeter (RPLGD), for in vivo dose measurement. It has superior physical and dosimetric characteristics than thermoluminenscent dosimeter (TLD). Method and Materials:Bilateral TBI is performed with the Siemens Prius Linac with a nominal energy of 6 MV photon beam. The patient is at the lying position and the source to midpoint of the patient is 415 cm. Water bags are used to compensate the change in body thickness and arms are positioned laterally at the mid AP‐thickness level to block the lungs. In vivo dose measurements were performed with RPLGDs placed bilaterally at five levels to obtain the entrance dose and exit dose : on brain, chest, abdomen, thigh and lower legs. The midline dose is the average of entrance dose and exit dose. The prescribed dose is 120 cGy per fraction to the umbilicus to a total of 1200 cGy. Results: The absolute dose measured on dose prescribed point is 123.6 cGy and the difference between the prescription and measurement is 3%. The dose at five different levels are normalized to that at the abdomen level. The relative doses of brain, chest, thigh and lower legs are 89%, 99%, 1.03% and 88% respectively. The absorbed doses at brain and lower leg levels may be overcompensated and these can be adjusted by modifying the thickness of water bags. Conclusions: In our preliminary result, RPLGD is an ideal dosimeter to perform the in vivo dose measurement, not only the better physical and dosimetric characteristics but the easy process without annealing and the ability to be readout repeatedly. Conclusion, the RPLGD is a useful tool to for in vivo dosimetry in clinic. © 2011, American Association of Physicists in Medicine. All rights reserved.


Lin C.,TriService General Hospital | Huang Y.,Memorial SloanKettering Cancer Center
Medical Physics | Year: 2010

Purpose: By verifying the consistency between the planning dose and the delivered dose for each segment, we try to figure out the cause of the high dose regions outside the treatment field which only shown in measured dose, but not in the treatment plan. Method and Materials: Our treatment planning system is ADAC Pinnacle version 8.0m. The IMRT plan is transferred to IMP AC oncology management system version 8.3 to drive the LINACs. Instead of taking an overall two dimensional dose distribution, we took the fluence maps for each beam by using Kodak XV films on two ELEKTA Precise LINACs and one ELEKTA Synergy. Results: High dose regions are obviously in only one Precise LINAC and always perpendicular to MLC leakages. By comparing the fluence maps between treatment plan and verification film segment by segment, we find it occurs on the MLC 0.8 cm gap which is designed to prevent one side MLCs to collide with the opposite MLCs. The gap should be blocked by the primary jaw and MLC directional backup jaw. However, because of the machine limitation, the primary jaws are not allowed to cross the central line, the gap is simply blocked by the MLC directional backup jaw only (3cm tungsten) occasionally and slight transmission doses are generated (about 15%). If the backup jaw goes to the wrong position and does not block the MLC gap, a high dose region occurs during dose delivery, but not shown in plan. Conclusion: When the backup jaw position is not compatible with treatment plan, the unanticipated high dose region emerges not only outside of the field but also inside the field. Even if one checks the jaw position by any open field, this situation sometimes occurs. The best way is to recalibrate the jaw mechanical parameters and recheck the incorrect segment. © 2010, American Association of Physicists in Medicine. All rights reserved.


Lin C.,TriService General Hospital | Huang Y.,Sloan Kettering Cancer Center
Medical Physics | Year: 2011

Purpose: By verifying the consistency between the planning dose and the delivered dose for each segment, we figure out the cause of the low dose regions inside the treatment field which only occur in verification images, but not in the treatment plan. Methods: The treatment planning system is ADAC Pinnacle version 9.0 with SmartArc. The IMRT plan is transferred to IMPAC oncology management system version 8.3 to drive the LINACs. Instead of taking an overall two or three dimensional dose distribution, we take the fluence maps for each beam by using Kodak XV films on two ELEKTA Precise LINACs and one ELEKTA Synergy LINAC. Results: Low dose regions are discovered in only Synergy LINAC and always in gun‐to‐target (G‐T) direction. By comparing the fluence maps between treatment plan and verification film segment by segment, we find these low dose regions result from the jaw position, i.e. the MLC directional backup jaw is too close to cause these unplanned underdoses in the treatment volume. We recheck the light‐field and the radiation field again; there is coincidence between the light‐field and the radiation field and just on the correct position. According to the statute, each radiation field edge is to be aligned with the displayed diaphragm within ±1 mm and each light‐field edge is to be aligned with the radiation field edge within ±1 mm. We recalibrate the MLC directional backup jaws and MLCs position to 0.5 mm larger than display and recheck the fluence maps, the low dose regions disappear eventually Conclusions: When doing the radiation field size calibration, one should calibrate the MLC moving directional radiation field size 0.5 mm larger than display each side on ELEKTA machine to prevent the unanticipated low dose regions inside the tumor in IMRT delivery. © 2011, American Association of Physicists in Medicine. All rights reserved.


Yu M.-C.,Chang Gung Childrens Hospital | Lo F.-S.,Chang Gung Childrens Hospital | Yu M.-K.,Changhua Christian Hospital | Huang W.-H.,Chang Gung Memorial Hospital | And 3 more authors.
European Journal of Pediatrics | Year: 2012

People with type 1 diabetes mellitus are at an increased risk of cardiovascular mortality. Studies comparing arterial stiffness between subjects with type 1 diabetes and nondiabetic controls have provided controversial findings.We investigated brachial-ankle pulse wave velocity (baPWV) in 87 teenagers with type 1 diabetes mellitus and in 21 matched healthy controls. Our data show that baPWV was not increased in teenagers after a median illness of 5 years. © Springer-Verlag 2011.


PubMed | Cheng Hsin General Hospital, TriService General Hospital, China Medical University at Taichung, Post University and Ching Cheng High School
Type: Journal Article | Journal: Molecular medicine reports | Year: 2015

Chitosan and Agaricus blazei Murill (ABM) extracts possess antitumor activities. The aim of the present study was to investigate whether chitosan, ABM extract or the two in combination were effective against tumors in tumorbearing mice. The mice were subcutaneously injected with SK-Hep 1 cells and were then were divided into the following six groups: Group 1, control group; group 2, chitosan 5 mg/kg/day; group 3, chitosan 20 mg/kg/day; group 4, ABM (246 mg/kg/day) and chitosan (5 mg/kg/day) combined; group 5, ABM (984 mg/kg/day) and chitosan (20 mg/kg/day) combined; and group 6, ABM (984 mg/kg/day). The mice were treated with the different concentrations of chitosan, ABM or combinations of the two for 6 weeks. The levels of glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT) and vascular endothelial growth factor (VEGF), and tissue histopathological features were examined in the surviving animals. Based on the results of the investigation, the treatments performed in groups 2, 3 and 4 were identified as being capable of reducing the weights of the tumors, however, group 4, which was treated with chitosan (5 mg/kg/day) in combination with ABM (246 mg/kg/day) was able to reduce the levels of GOT and VEGF. As a result, treatment with chitosan in combination with ABM may offer potential in cancer therapy and requires further investigation.


Lo H.-C.,Taoyuan Armed Forces General Hospital | Lo H.-C.,Triservice General Hospital | Lo H.-C.,Koo Foundation | Kuo D.-P.,Taoyuan Armed Forces General Hospital | Chen Y.-L.,Taoyuan Armed Forces General Hospital
Archives of Medical Science | Year: 2017

Introduction: The aim of this study was to determine the best site for bone mineral density (BMD) measurements based on T-scores, age, and beverage consumption. Material and methods: In this prospective study, 271 women stratified by age (average age: 61.9 years) underwent dual energy X-ray absorptiometry (DEXA) scanning of their lumbar spine, hips, and forearms. Osteoporosis was defined as a BMD of 2.5 standard deviations or more below the mean peak bone mass based on a reference population of adult women (translated as a T-score ≤ -2.5), as measured by DEXA. Participants were also evaluated regarding alcohol and caffeine consumption by a semiquantitative questionnaire. Results: A significant discrepancy was observed in the classification of osteoporosis at different locations, with hip and forearm showing the best correlation (Pearson's r = 0.627, p < 0.001). In addition, for participants over 50 years of age, hip and forearm showed the best correlation. Significant correlations were also noted between forearm T-scores and caffeine consumed and, to a lesser extent, the level of alcohol consumption. In the group ≤ 50 years of age, lumbar spine and forearm T-scores were only associated with alcohol consumption. In the group over 50 years of age, hip and forearm T-scores were only associated with caffeine consumption. Conclusions: Bone mineral density measurements at the hip and forearm correlated with caffeine consumption in elderly Taiwanese women. This is an important finding since age and caffeine consumption are known risk factors for osteoporosis. © 2016 Termedia & Banach.


Chiang H.-H.,Triservice General Hospital | Lin L.,University of California at San Francisco | Lee T.S.-H.,National Taiwan Normal University
Geriatrics and Gerontology International | Year: 2016

Aim: Happiness is an important indicator of mental and physical health. It has been emphasized as one kind of well-being, and its definition varies from culture to culture. The main objective of the present study was to examine the psychometric integrity and dimensions of the Chinese Happiness Inventory (CHI) in relation to scores on Ryff's Psychological Well-Being Scale among retired older people in Taiwan. Methods: A cross-sectional study was carried out at social service centers in Taipei, Taiwan. Retired adults gave informed consent from September to November 2010, and completed a package of structured questionnaires measuring happiness and psychological well-being. Internal consistency, the factor structure of the CHI and criterion validity were assessed. Results: Results from an exploratory factor analysis showed a three-factor solution for the CHI. These factors were named Positive Affect, Life Satisfaction and Interpersonal Relationships. Internal consistency coefficients were 0.95 (Positive Affect), 0.91 (Life Satisfaction), 0.85 (Interpersonal Relationships) and 0.97 (total scale). The results of a canonical correlation analysis showed the presence of a strong relationship between CHI and Ryff's Psychological Well-Being Scale (r = 0.69), and that two canonical variates could be derived from the relationship between them. Conclusions: The results show that the CHI is a three-dimensional scale with high reliability and validity. The construct of happiness emphasizes relationships in relation to others and environment rather than autonomy in this sample. Although the components of happiness might be similar for Positive Affect and Life Satisfaction, their weights for Interpersonal Relationships should be considered when measuring happiness in different cultures. Geriatr Gerontol Int 2016; 16: 865–872. © 2015 Japan Geriatrics Society


PubMed | Triservice General Hospital, University of California at San Francisco and National Taiwan Normal University
Type: Journal Article | Journal: Geriatrics & gerontology international | Year: 2016

Happiness is an important indicator of mental and physical health. It has been emphasized as one kind of well-being, and its definition varies from culture to culture. The main objective of the present study was to examine the psychometric integrity and dimensions of the Chinese Happiness Inventory (CHI) in relation to scores on Ryffs Psychological Well-Being Scale among retired older people in Taiwan.A cross-sectional study was carried out at social service centers in Taipei, Taiwan. Retired adults gave informed consent from September to November 2010, and completed a package of structured questionnaires measuring happiness and psychological well-being. Internal consistency, the factor structure of the CHI and criterion validity were assessed.Results from an exploratory factor analysis showed a three-factor solution for the CHI. These factors were named Positive Affect, Life Satisfaction and Interpersonal Relationships. Internal consistency coefficients were 0.95 (Positive Affect), 0.91 (Life Satisfaction), 0.85 (Interpersonal Relationships) and 0.97 (total scale). The results of a canonical correlation analysis showed the presence of a strong relationship between CHI and Ryffs Psychological Well-Being Scale (r=0.69), and that two canonical variates could be derived from the relationship between them.The results show that the CHI is a three-dimensional scale with high reliability and validity. The construct of happiness emphasizes relationships in relation to others and environment rather than autonomy in this sample. Although the components of happiness might be similar for Positive Affect and Life Satisfaction, their weights for Interpersonal Relationships should be considered when measuring happiness in different cultures. Geriatr Gerontol Int 2016; 16: 865-872.


Lo H.-C.,Tao Yuan Armed Forces General Hospital | Lo H.-C.,Triservice General Hospital | Hung S.-T.,Tao Yuan Armed Forces General Hospital | Kuo D.-P.,Tao Yuan Armed Forces General Hospital | And 2 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2016

Background: This study investigated diffusion-weighted (DWI) magnetic resonance imaging (MRI) as an alternative to fat-suppressed T2-weighted imaging (FS-T2WI) for assessment of partial-thickness rotator cuff tears (RCTs). Methods: Patients with arthroscopy proven partial-thickness RCTs who also received MRI (FS-T2WI and DWI) before surgery were prospectively included. Receiver operating characteristic curves were used to compare DWI vs. FS-T2WI using lesion-to-muscle signal intensity ratios. A cutoff point for predicting partial-thickness tears was determined using the Youden index. Results: Included were 146 patients, with a mean age of 48.3 years (range, 19-86 years), of whom 43 had full-thickness RCTs, 67 had partial-thickness RCTs, and 36 had no tears. Areas under receiver operating characteristic curves for diagnosing partial-thickness tears were significantly higher for DWI (0.910) than for FS-T2WI (0.822, P = .016). Lesion-to-muscle signal intensity ratio cutoff values were 1.06 for DWI vs. 1.65 for FS-T2WI, respectively. The sensitivity and accuracy of DWI (89.1% [98 of 110] and 87.7% [128 of 146], respectively) for diagnosing partial-thickness and full-thickness tears were higher than for FS-T2WI (65.5% [72 of 110] and 72.6% [106 of 146], respectively). FS-T2WI, however, had higher specificity (94.4% [34 of 36]) than DWI (83.3% [30 of 36]). Conclusions: DWI is more accurate and sensitive than FS-T2WI for diagnosing partial-thickness RCTs. © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees.


Chung R.-H.,National Health Research Institute | Tsai W.-Y.,National Health Research Institute | Hsieh C.-H.,Triservice General Hospital | Hung K.-Y.,National Health Research Institute | And 2 more authors.
Genetic Epidemiology | Year: 2015

Simulation tools that simulate sequence data in unrelated cases and controls or in families with quantitative traits or disease status are important for genetic studies. The simulation tools can be used to evaluate the statistical power for detecting the causal variants when planning a genetic epidemiology study, or to evaluate the statistical properties for new methods. We previously developed SeqSIMLA version 1 (SeqSIMLA1), which simulates family or case-control data with a disease or quantitative trait model. SeqSIMLA1, and several other tools that simulate quantitative traits, do not specifically model the shared environmental effects among relatives on a trait. However, shared environmental effects are commonly observed for some traits in families, such as body mass index. SeqSIMLA1 simulates a fixed three-generation family structure. However, it would be ideal to simulate prespecified pedigree structures for studies involving large pedigrees. Thus, we extended SeqSIMLA1 to create SeqSIMLA2, which can simulate correlated traits and considers the shared environmental effects. SeqSIMLA2 can also simulate prespecified large pedigree structures. There are no restrictions on the number of individuals that can be simulated in a pedigree. We used a blood pressure example to demonstrate that SeqSIMLA2 can simulate realistic correlation structures between the systolic and diastolic blood pressure among relatives. We also showed that SeqSIMLA2 can simulate large pedigrees with large chromosomal regions in a reasonable time frame. © 2014 WILEY PERIODICALS, INC.

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