Search Results (102)

Background: Large language models (LLMs) like ChatGPT are increasingly being explored for medical applications. However, their reliability in providing medication advice for patients with complex clinical situations, particularly those with multiple comorbidities, remains uncertain and under-investigated. This study aimed to systematically evaluate the performance, consistency, and safety of ChatGPT in generating medication recommendations for complex cardiovascular disease (CVD) scenarios. Methods: In this simulation-based study (21 January–1 February 2024), ChatGPT 3.5 and 4.0 were prompted 10 times for each of 25 scenarios, representing five common CVDs paired with five major comorbidities. A panel of five cardiologists independently classified each unique drug recommendation as “high priority” or “low priority”. Key metrics included physician approval rates, the proportion of high-priority recommendations, response consistency (Jaccard similarity index), and error pattern analysis. Statistical comparisons were made using Z-tests, chi-square tests, and Wilcoxon Signed-Rank tests. Results: The overall physician approval rate for GPT-4 (86.90%) was modestly but significantly higher than that for GPT-3.5 (85.06%; p = 0.0476) based on aggregated data. However, a more rigorous paired-scenario analysis of high-priority recommendations revealed no statistically significant difference between the models (p = 0.407), indicating the advantage is not systematic. A chi-square test confirmed significant differences in error patterns (p < 0.001); notably, GPT-4 more frequently recommended contraindicated drugs in high-risk scenarios. Inter-model consistency was low (mean Jaccard index = 0.42), showing the models often provide different advice. Conclusions: While demonstrating high overall physician approval rates, current LLMs exhibit inconsistent performance and pose significant safety risks when providing medication advice for complex CVD cases. Their reliability does not yet meet the standards for autonomous clinical application. Future work must focus on leveraging real-world data for validation and developing domain-specific, fine-tuned models to enhance safety and accuracy. Until then, vigilant professional oversight is indispensable. Full article

This study aimed to develop and evaluate an AI-driven platform, the Adaptive RAG Assistant MRI Platform (ARAMP), for assisting in the diagnosis and reporting of brain metastases using post-contrast axial T1-weighted (AX_T1+C) MRI. In this retrospective study, 2447 cancer patients who underwent MRI between 2010 and 2022 were screened. A subset of 100 randomized patients with confirmed brain metastases and 100 matched non-cancer controls were selected for evaluation. ARAMP integrates quantitative radiomic feature extraction with an adaptive Retrieval-Augmented Generation (RAG) framework based on a large language model (LLM, GPT-4o), incorporating five authoritative medical references. Three board-certified neuroradiologists and an independent LLM (Gemini 2.0 Pro) assessed ARAMP performance. Metrics of the assessment included Pre-/Post-Trained Inference Difference, Inter-Inference Agreement, and Sensitivity. Post-training, ARAMP achieved a mean Inference Similarity score of 67.45%. Inter-Inference Agreement among radiologists averaged 30.20% (p = 0.01). Sensitivity for brain metastasis detection improved from 0.84 (pre-training) to 0.98 (post-training). ARAMP also showed improved reliability in identifying brain metastases as the primary diagnosis post-RAG integration. This adaptive RAG-based framework may improve diagnostic efficiency and standardization in radiological workflows. Full article

This study prepared epoxy–clay nanocomposites (ECNs) by incorporating organophilic clays modified with either non-redox cetyltrimethylammonium bromide (CTAB) or redox-active aniline pentamer (AP), then compared their anticorrosion performance on metal substrates in saline environments. The test solution contained 2 wt% alkaline copper quaternary (ACQ) wood preservatives. Cold-rolled steel (CRS) panels coated with the ECNs were evaluated via electrochemical impedance spectroscopy (EIS) in saline media both with and without ACQ. For CRS coated with unmodified epoxy, the Nyquist plot showed impedance dropping from 255 kΩ to 121 kΩ upon adding 2 wt% ACQ—indicating that Cu²⁺ ions accelerate iron oxidation. Introducing 1 wt% CTAB–clay into the epoxy increased impedance from 121 kΩ to 271 kΩ, while 1 wt% AP–clay raised it to 702 kΩ. This improvement arises because the organophilic clay platelets create a more tortuous path for Cu²⁺ and O₂ diffusion, as confirmed by ICP–MS measurements of Cu²⁺ after EIS and oxygen permeability tests (GPA), thereby slowing iron oxidation. Moreover, ECN coatings containing AP–clay outperformed those with CTAB–clay in corrosion resistance, suggesting that AP not only enhances platelet dispersion but also promotes formation of a dense, passive metal oxide layer at the coating–metal interface, as shown by TEM, GPA, and XRD analyses. Finally, accelerated salt-spray exposure following ASTM B-117 yielded corrosion behavior consistent with the EIS results. Full article

Objectives: Peripheral arterial disease (PAD) is a common vascular condition with amputation as a major complication. While muscle volume and vascular severity is often considered in risk prediction, the prognostic value of muscle density remains underexplored. Methods: In this exploratory study, we retrospectively analyzed 134 patients undergoing lower-limb computed tomography angiography between January 2018 and December 2023. Muscle density (MD), muscle volume, intermuscular adipose tissue (IMAT), and vascular severity scores were quantified using deep learning software. Patients were stratified into non-PAD, mild PAD, and critical limb ischemia (CLI) groups. Multivariate Cox regression assessed associations with amputation risk. Results: PAD patients, especially those with CLI, had lower muscle volumes (e.g., total leg: 7945.3 ± 2012.5 cm³ in CLI vs. 11,161.6 ± 4670.4 cm³ in non-PAD), lower muscle densities (e.g., lower leg: 34.0 ± 10.5 HU in CLI vs. 44.1 ± 6.9 HU in non-PAD), higher intermuscular adipose tissue volume percentage (e.g., total leg: 15.6 ± 5.4% in CLI vs. 10.5 ± 3.6% in non-PAD), and higher vascular severity scores (e.g., total leg: 12.6 ± 5.0 in CLI vs. 0.1 ± 0.3 in non-PAD), compared to non-PAD individuals. Only muscle density (MD) including that of abdominal muscle, thigh muscle, and lower leg muscle remained significant predictors of amputation risk after adjusting for confounders. Multivariate Cox regression models, adjusted for demographics and comorbidities, revealed that lower MD of abdomen (<18.7 HU; HR, 6.50, 95% CI, 1.95–21.77), thigh (<27.8 HU; HR, 5.00, 95% CI, 1.60–15.66), and lower leg (<32.4 HU; HR, 6.89, 95% CI, 2.17–21.93) muscles were independently associated with increased amputation risk. Conclusions: Muscle density, reflecting muscle quality rather than quantity, was an independent predictor of amputation risk in PAD. These findings highlight the prognostic value of muscle quality and support the integration of advanced imaging techniques, such as automated CTA-based body composition analysis, for risk stratification in PAD patients. Full article

Background: Anemia is a common complication of chronic kidney disease (CKD), yet no study has explored differences in anemia risk factors based on disease severity and gender. Therefore, this study investigates potential differences in anemia risk among individuals with varied kidney disease severities and sexes. Methods: This multicenter, longitudinal cohort study was conducted using data (2008–2016) from the Epidemiology and Risk Factors Surveillance of CKD database. This database was associated with Taiwan’s National Health Insurance Research Database (for the 2008–2019 period). To identify predictive risk factors for anemia, we developed a subset multivariate logistic model using stepwise variable selection. Additionally, 10-fold cross-validation was conducted to facilitate model selection and internal validation. Results: Of the 5656 patients with CKD, 519 (9.18%) with anemia and 5137 (90.82%) without. After adjusting for age, sex, and serum creatinine, stepwise logistic regression analysis identified the main independent predictive factors for anemia in CKD patients. Notably, “Receive low sodium diet education” (OR: 0.66, 95% CI: 0.446–0.975), “DBP (mmHg)” (OR: 0.98, 95% CI: 0.965–0.999), “Gout” (OR: 1.86, 95% CI: 1.175–2.937), and “Congestive heart failure” (OR: 1.85, 95% CI: 1.131–3.028) was significantly associated with the presence of anemia among CKD patients. Conclusions: This study identifies gout and cardiovascular disease as important correlates of anemia in patients with CKD. Moreover, it reveals an inverse association between elevated diastolic blood pressure and receiving education on a low-sodium diet with the occurrence of anemia. Full article

Background: Fluorescent gold nanoclusters conjugated with α-lipoic acid (FANCs) have shown great promise for drug development. In a previous study, FANCs did not show any acute or subacute toxicity under 0.6–20 μM/100 μL/25 g body weight in male and female ICR mice. However, the chronic toxicity of FANCs has not been studied. Aim of study: This study used oral administration of FANCs to determine the long-term safety profile and adverse effects in ICR mice. Methods: In vivo chronic toxicity was examined via oral administration of FANCs to male and female ICR mice. The daily food consumption, body weight, hematological profile, serum biochemical profile, organ coefficient, histopathological changes, and survival rate of the mice were calculated. Results: FANCs did not result in mortality due to chronic toxicity in both male and female mice. The animal behavior, body weight, hematological profile, serum biochemical profile, and organ coefficient showed no treatment-related malignant changes. This indicates that FANCs do not cause liver, renal, or other organ damage. Conclusions: These results indicate that the no-observed-adverse-effect level (NOAEL) is 20 μM/100 μL/25 g for 6 months of treatment in male and female ICR mice. Full article

Background: Invasive coronary angiography is the gold standard for assessing in-stent restenosis (ISR) in patients with coronary artery disease. However, the predictive value of non-invasive Tissue Doppler Imaging (TDI) to evaluate patients with ISR has not been studied extensively. Methods: A total of 41 patients (19 with acute myocardial infarction and 22 with stable angina pectoris) who received percutaneous coronary intervention (PCI) were enrolled in the study. Time-to-peak velocities (TpV) of 12 non-apical segments of the left ventricle, by pulse wave TDI echocardiography, were obtained within two days prior to the PCI and six months later. Results: A 12-segmental mean TpV ≥ 279.6 ms at six months after PCI was able to detect ISR (odds ratio: 2.09, 95% CI 1.004–4.352, p = 0.049). Moreover, a significant decrease in the standard deviation of TpV was demonstrated in patients without ISR (85.8 ± 44.8 vs. 60.3 ± 31.7 ms, p = 0.001), but not in patients with ISR (97.7 ± 53.3 vs. 91.2 ± 52.6 ms, p = 0.57). Conclusions: Pulse-wave TDI echocardiography is a promising tool in the detection of ISR six months after PCI in patients with coronary artery disease. Full article

Background/Objectives: The aim of this study is to assess the effectiveness of cetuximab combination therapy in patients with recurrent or metastatic head and neck cancer treated at a hospital in Southern Taiwan. Methods: This study analyzed a retrospective cohort of 67 patients who were treated between January 2020 and May 2024 with two cetuximab regimens, cetuximab combined with cisplatin and 5-Fu, which were administered every four weeks during hospitalization (CPF4) and every two weeks as outpatient treatment (CPF2), respectively. The clinical outcomes, including overall survival and progression-free survival (PFS), were compared across the treatment regimens and age groups using Kaplan–Meier survival curves and Cox proportional hazard models. Results: The median overall survival was 11.1 months (95% confidence interval, 7.8–14.5), with CPF2 showing a potential PFS advantage in patients aged 46–60 years (p = 0.049). No significant differences in overall survival were observed between CPF2 and CPF4. CPF2, which was administered in an outpatient setting, was associated with improved convenience, reduced hospitalization, and potentially lower risks of hospital-acquired infections. Conclusions: CPF2 exhibits practical advantages and comparable effectiveness, making it the preferred treatment regimen for eligible patients. Further studies with larger populations and molecular stratifications are needed to confirm these findings and develop better treatment strategies. Full article

This study presents a novel simultaneous double-exposure contact mirror-based method for fabricating holographic multi-notch filters with dual operational central wavelengths. The proposed method leverages coupled wave theory, the geometric relationships of K-vectors, and a reflection-type recording setup, incorporating additional reflecting mirrors to guide the recording beams. To validate the approach, a holographic notch filter was fabricated using photopolymer recording materials, resulting in operational wavelengths of 531.13 nm and 633.01 nm. The measured diffraction efficiencies at these wavelengths were η_s = 52.35% and η_p = 52.45% for 531.13 nm, and η_s = 67.30% and η_p = 67.40% for 633.01 nm. The component’s performance was analyzed using s- and p-polarized spectral transmission intensities at various reconstruction angles, revealing polarization-independent characteristics under normal incidence and polarization-dependent behavior under oblique incidence. The study also explored the relationships between recording parameters, such as incident angle, wavelength, emulsion expansion, and dispersion. The findings demonstrate that the first operational central wavelength is primarily influenced by the recording wavelength, while the second is primarily determined by the incident angle, covering a range from visible light to near-infrared. This method offers significant potential for cost-effective, mass-produced filters in optoelectronic applications. Full article

A portion of individuals diagnosed with primary central nervous system lymphomas (PCNSL) may experience early relapse or refractory (R/R) disease following treatment. This research explored the potential of MRI-based radiomics in forecasting R/R cases in PCNSL. Forty-six patients with pathologically confirmed PCNSL diagnosed between January 2008 and December 2020 were included in this study. Only patients who underwent pretreatment brain MRIs and complete postoperative follow-up MRIs were included. Pretreatment contrast-enhanced T1WI, T2WI, and T2 FLAIR imaging were analyzed. A total of 107 radiomic features, including 14 shape-based, 18 first-order statistical, and 75 texture features, were extracted from each sequence. Predictive models were then built using five different machine learning algorithms to predict R/R in PCNSL. Of the included 46 PCNSL patients, 20 (20/46, 43.5%) patients were found to have R/R. In the R/R group, the median scores in predictive models such as support vector machine, k-nearest neighbors, linear discriminant analysis, naïve Bayes, and decision trees were significantly higher, while the apparent diffusion coefficient values were notably lower compared to those without R/R (p < 0.05). The support vector machine model exhibited the highest performance, achieving an overall prediction accuracy of 83%, a precision rate of 80%, and an AUC of 0.78. Additionally, when analyzing tumor progression, patients with elevated support vector machine and naïve Bayes scores demonstrated a significantly reduced progression-free survival (p < 0.05). These findings suggest that preoperative MRI-based radiomics may provide critical insights for treatment strategies in PCNSL. Full article

This work demonstrates a high-quality erbium-doped fiber (EDF) ring laser in the L-band gain range by combining the Rayleigh backscattering (RB) feedback signal and unpumped EDF induced saturable absorber (SA) filter. The optical filter effect induced by the RB feedback injection and EDF SA could generate single-longitudinal-mode (SLM) behavior and shrink the linewidth to sub-kHz. The output linewidth, power, and optical-signal-to-noise ratio (OSNR) of the fiber ring laser were also shown within the 42 nm wavelength bandwidth of 1565.0 to 1607.0 nm. Also, the instabilities of output power and central wavelength of each lasing lightwave were analyzed with a measurement time of 45 min. Full article

Background and Objectives: Genomic studies have identified several SNP loci associated with schizophrenia in East Asian populations. Environmental factors, particularly urbanization, play a significant role in schizophrenia development. This study aimed to identify schizophrenia susceptibility loci and characterize their biological functions and molecular pathways in Taiwanese urban Han individuals. Materials and Methods: Participants with schizophrenia were recruited from the Taiwan Precision Medicine Initiative at Tri-Service General Hospital. Genotype–phenotype association analysis was performed, with significant variants annotated and analyzed for functional relevance. Results: A total of 137 schizophrenia patients and 26,129 controls were enrolled. Ten significant variants (p < 1 × 10⁻⁵) and 15 expressed genes were identified, including rs1010840 (SOWAHC and RGPD6), rs11083963 (TRPM4), rs11619878 (LINC00355 and LINC01052), rs117010638 (AGBL1 and MIR548AP), rs1170702 (LINC01680 and LINC01720), rs12028521 (KAZN and PRDM2), rs12859097 (DMD), rs1556812 (ATP11A), rs78144262 (LINC00977), and rs9997349 (ENPEP). These variants and associated genes are involved in immune response, blood pressure regulation, muscle function, and the cytoskeleton. Conclusions: Identified variants and associated genes suggest a potential genetic predisposition to schizophrenia in the Taiwanese urban Han population, highlighting the importance of potential comorbidities, considering population-specific genetic and environmental interactions. Full article

Background: For patients with obstructive jaundice and who are indicated for pancreaticoduodenectomy (PD) or biliary intervention, either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography and drainage (PTCD) may be indicated preoperatively. However, the possibility of procedure-related postoperative biliary tract infection (BTI) should be a concern. We tried to evaluate the impact of ERCP and PTCD on postoperative BTI. Methods: Patients diagnosed from June 2013 to March 2022 with periampullary lesions and with PD indicated were enrolled in this cohort. Patients without intraoperative bile culture and non-neoplastic lesions were excluded. Clinical information, including demographic and laboratory data, pathologic diagnosis, results of microbiologic tests, and relevant infectious outcomes, was extracted from medical records for analysis. Results: One-hundred-and-sixty-four patients from the cohort (164/689) underwent preoperative biliary intervention, either ERCP (n = 125) or PTCD (n = 39). The positive yield of intraoperative biliary culture was significantly higher in patients who underwent ERCP than in PTCD (90.4% vs. 41.0%, p < 0.001). Although there was no significance, a trend of higher postoperative BTI (13.8% vs. 2.7%) and BTI-related septic shock (5 vs. 0, 4.0% vs. 0%) in the ERCP group was noticed. While the risk factors for postoperative BTI have not been confirmed, a trend suggesting a higher incidence of BTI associated with ERCP procedures was observed, with a borderline p-value (p = 0.05, regarding ERCP biopsy). Conclusions: ERCP in patients undergoing PD increases the positive yield of intraoperative biliary culture. PTCD may be the favorable option if preoperative biliary intervention is indicated. Full article

In this demonstration, we present two erbium-doped fiber (EDF) lasers, with series and parallel three sub-ring configurations, respectively, to achieve tunable channel output and stable single longitudinal mode (SLM) operation in the L-band range. Here, the fiber ring cavity contains the L-band EDF as a gain medium. Based on the measured results of the two quad-ring structures of the EDF lasers, tunable output bandwidth for the two lasers can be obtained from 1558.0 to 1618.0 nm simultaneously. All the 3 dB linewidths measured for both fiber lasers are 312.5 Hz over the effective wavelength output range. Furthermore, the related optical signal-to-noise ratio (OSNR), output power, output stabilities of the central wavelength and power, and equal output power range of the two proposed EDF lasers are also examined and discussed. Full article

Previous studies showed that NaIO₃ can induce oxidative stress-mediated retinal pigment epithelium (RPE) damage to simulate age-related macular degeneration (AMD). Lemon peel is rich in antioxidants and components that can penetrate the blood–retinal barrier, but their role in retinal oxidative damage remains unexplored. Here, we explore the protection of lemon peel ultrasonic-assisted water extract (LUWE), containing large amounts of flavonoids and polyphenols, against NaIO₃-induced retinal degeneration. We initially demonstrated that LUWE, orally administered, prevented retinal distortion and thinning on the inner and outer nuclei layers, downregulating cleaved caspase-3 protein expression in RPE cells in NaIO₃-induced mice. The effect of LUWE was achieved through the suppression of apoptosis and the associated proteins, such as cleaved PARP and cleaved caspase-3, as suggested by NaIO₃-induced ARPE-19 cell models. This is because LUWE reduced reactive oxygen species-mediated mitochondrial fission via regulating p-Drp-1 and Fis1 expression. We further confirmed that LUWE suppresses the expression of p-MEK-1/2 and p-ERK-1/2 in NaIO₃-induced ARPE-19 cells, thereby providing the protection described above, which was confirmed using PD98059 and U0126. These results indicated that LUWE prevents mitochondrial oxidative stress-mediated RPE damage via the MEK/ERK pathway. Elucidation of the molecular mechanism may provide a new protective strategy against retinal degeneration. Full article