Cheng Hsin General Hospital Research Articles

Machine learning-based speech recognition system for nursing documentation – A pilot study

PurposeConsidering the significant workload of nursing tasks, enhancing the efficiency of nursing documentation is imperative. This study aimed to evaluate the effectiveness of a machine learning-based speech recognition (SR) system in reducing the clinical workload associated with typing nursing records, implemented in a psychiatry ward. MethodsThe study was conducted between July 15, 2020, and June 30, 2021, at Cheng Hsin General Hospital in Taiwan. The language corpus was based on the existing records from the hospital nursing information system. The participating ward's nursing activities, clinical conversation, and accent data were also collected for deep learning-based SR-engine training. A total of 21 nurses participated in the evaluation of the SR system. Documentation time and recognition error rate were evaluated in parallel between SR-generated records and keyboard entry over 4 sessions. Any differences between SR and keyboard transcriptions were regarded as SR errors.Findings: A total of 200 data were obtained from four evaluation sessions, 10 participants were asked to use SR and keyboard entry in parallel at each session and 5 entries were collected from each participant. Overall, the SR system processed 30,112 words in 32,456 s (0.928 words per second). The mean accuracy of the SR system improved after each session, from 87.06% in 1st session to 95.07% in 4th session. ConclusionThis pilot study demonstrated our machine learning-based SR system has an acceptable recognition accuracy and may reduce the burden of documentation for nurses. However, the potential error with the SR transcription should continually be recognized and improved. Further studies are needed to improve the integration of SR in digital documentation of nursing records, in terms of both productivity and accuracy across different clinical specialties.

#3736 SACUBITRIL/VALSARTAN IMPROVES THE VASCULAR ACCESS FLOW OF HEMODIALYSIS PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION

Abstract Background and Aims Sacubitril/valsartan improved left ventricular systolic and diastolic function in patients with heart failure with reduced ejection fraction<40% (HFrEF) and end-stage kidney disease. However, there was no report concerning the effect of sacubitril/valsartan on access flow (Qa) of vascular access in maintenance hemodialysis (HD) patients with HFrEF. We aimed to investigate the effect of sacubitril/valsartan on Qa of vascular access in HD patients with HFrEF. Method We retrospectively screened the HD patients who received echocardiogram and Qa measurement in Taipei Veterans General Hospital and Cheng Hsin General Hospital from Jan. 2019 to Dec. 2021. Patients with HFrEF received twice of both echocardiography and Qa at 1 year apart were enrolled and divided into two groups, including those with or without the treatment of sacubitril/valsartan. The difference of Qa at baseline and 1 year later was compared by Wilcoxon signed-rank test, with a statistical significance of P<0.05. Results A total of 33 HD patients with HFrEF were analyzed with a mean HD vintage of 4.7 years. Sixteen patients received sacubitril/valsartan and the other 17 patients received conventional treatment. The mean Qa increased significantly from 633.8 to 948.8 mL/min (P<0.001) and the Qa change correlated with LVEF change [Fig. 1. correlation coefficient (r) =0.70, P=0.006] after 1-year treatment of sacubitril/valsartan; however, there was neither significant change of Qa (from 637.7 to 621.8 mL/min, P=0.44) nor correlation with LVEF change (Fig. 2, r=0.41, P=0.13) for controls after one year. Conclusion Sacubitril/Valsartan improves Qa in HD patients with HFrEF possibly related to the increase of LVEF.

Connected-SegNets: A Deep Learning Model for Breast Tumor Segmentation from X-ray Images.

Simple SummaryThe segmentation of breast tumors is an important step in identifying and classifying benign and malignant tumors in X-ray images. Mammography screening has proven to be an effective tool for breast cancer diagnosis. However, the inspection of breast mammograms for early-stage cancer can be a challenging task due to the complicated structure of dense breasts. Several deep learning models have been proposed to overcome this particular issue; however, the false positive and false negative rates are still high. Hence, this study introduced a deep learning model, called Connected-SegNets, that combines two SegNet architectures with skip connections to provide a robust model to reduce false positive and false negative rates for breast tumor segmentation from mammograms.Inspired by Connected-UNets, this study proposes a deep learning model, called Connected-SegNets, for breast tumor segmentation from X-ray images. In the proposed model, two SegNet architectures are connected with skip connections between their layers. Moreover, the cross-entropy loss function of the original SegNet has been replaced by the intersection over union (IoU) loss function in order to make the proposed model more robust against noise during the training process. As part of data preprocessing, a histogram equalization technique, called contrast limit adapt histogram equalization (CLAHE), is applied to all datasets to enhance the compressed regions and smooth the distribution of the pixels. Additionally, two image augmentation methods, namely rotation and flipping, are used to increase the amount of training data and to prevent overfitting. The proposed model has been evaluated on two publicly available datasets, specifically INbreast and the curated breast imaging subset of digital database for screening mammography (CBIS-DDSM). The proposed model has also been evaluated using a private dataset obtained from Cheng Hsin General Hospital in Taiwan. The experimental results show that the proposed Connected-SegNets model outperforms the state-of-the-art methods in terms of Dice score and IoU score. The proposed Connected-SegNets produces a maximum Dice score of 96.34% on the INbreast dataset, 92.86% on the CBIS-DDSM dataset, and 92.25% on the private dataset. Furthermore, the experimental results show that the proposed model achieves the highest IoU score of 91.21%, 87.34%, and 83.71% on INbreast, CBIS-DDSM, and the private dataset, respectively.

A Simple Algorithm Using Ventilator Parameters to Predict Successfully Rapid Weaning Program in Cardiac Intensive Care Unit Patients.

Background: Ventilator weaning is one of the most significant challenges in the intensive care unit (ICU). Approximately 30% of patients fail to wean, resulting in prolonged use of ventilators and increased mortality. There are numerous high-performance prediction models available today, but they require a large number of parameters to predict and are thus impractical in clinical practice. Objectives: This study aims to create an artificial intelligence (AI) model for predicting weaning time and to identify the most simplified key predictors that will allow the model to achieve adequate accuracy with as few parameters as possible. Methods: This is a retrospective study of to-be-weaned patients (n = 1439) hospitalized in the cardiac ICU of Cheng Hsin General Hospital’s Department of Cardiac Surgery from November 2018 to August 2020. The patients were divided into two groups based on whether they could be weaned within 24 h (i.e., “patients weaned within 24 h” (n = 1042) and “patients not weaned within 24 h” (n = 397)). Twenty-eight variables were collected including demographic characteristics, arterial blood gas readings, and ventilation set parameters. We created a prediction model using logistic regression and compared it to other machine learning techniques such as decision tree, random forest, support vector machine (SVM), extreme gradient boosting, and artificial neural network. Forward, backward, and stepwise selection methods were used to identify significant variables, and the receiver operating characteristic curve was used to assess the accuracy of each AI model. Results: The SVM [receiver operating characteristic curve (ROC-AUC) = 88%], logistic regression (ROC-AUC = 86%), and XGBoost (ROC-AUC = 85%) models outperformed the other five machine learning models in predicting weaning time. The accuracies in predicting patient weaning within 24 h using seven variables (i.e., expiratory minute ventilation, expiratory tidal volume, ventilation rate set, heart rate, peak pressure, pH, and age) were close to those using 28 variables. Conclusions: The model developed in this research successfully predicted the weaning success of ICU patients using a few and easily accessible parameters such as age. Therefore, it can be used in clinical practice to identify difficult-to-wean patients to improve their treatment.

Overview of research work of Prof. Chu on two medical devices

Surgical procedures are relatively common and procedures for broken bones often involve intramedullary nailing to repair the bone and keep it stable. However, there are challenges associated with the process and Professor Woeichyn Chu, who is a distinguished professor based within the Department of Biomedical Engineering at the National Yang Ming Chiao Tung University in Taiwan, is developing a medical device to help surgeons overcome these challenges, benefiting patients and clinicians. The device is called iMET (intra-medullary endo-transilluminating) and came about after Woeichyn Chu spoke with his brother, Dr William Chu, General Orthopedic Department, Cheng Hsin General Hospital, Taiwan, about some of the challenges relating to intramedullary nailing which led the brothers to begin working together to develop a medical device to help target distal locking holes in intramedullary nailing procedures. The iMET device that the brothers are developing is designed to improve target aiming accuracy and reduce dose absorption concerns. In the process, it will save significant time, effort and money. As well as benefiting patients and clinicians, iMET also reduces X-ray fluoroscopy time, which has health benefits for all involved. Woeichyn Chu and his brother are also developing a device called iKypho, which applies negative pressure during bone cement injection in percutaneous vertebroplasty surgeries. iKypho reduces bone cment leakage risks when using low viscosity cement and reducing the costs associated with high viscosity bone cement.

Work Fatigue in a Hospital Setting: The Experience at Cheng Hsin General Hospital.

We aimed to investigate fatigue and its related factors in a medical professional population aged ≥30 years, as appraised by the implementation of an employee health screening program at Cheng Hsin General Hospital in Taipei, Taiwan. The study participants included a total of 2132 (400 males and 1732 females) healthy medical professionals enrolled in a teaching hospital who underwent physical verification in 2019. Demographic characteristics and fatigue information were collected. The overall prevalence of personal- and work-related fatigue in this study population was 41.4% and 39.1%, respectively. The prevalence of a high risk of work- or personal-related fatigue proved to be substantially greater (p-value for chi-square test <0.0001) than it was for a low or moderate risk of personal-related fatigue. Using multinominal logistic regression analysis, seniority and position were statistically significant in relation to a high risk of personal- and work-related fatigue. Personal- and work-related fatigue were found to be prevalent in physicians and nurses. Lower seniority was also related to severe personal- or work-related fatigue. Providing this population with controlled working environments and health improvements is important.

Evolution of impedance values in cochlear implant patients after early switch-on.

Cochlear implantation is currently the most effective treatment modality for severe to profound sensorineural hearing loss. Over the past few years, at the Department of Otolaryngology, Cheng Hsin General Hospital (Taipei, Taiwan), cochlear implant devices have been switched on within 24 hours of their implantation. Differences in impedance evolution after early switch-on for different devices have not been previously discussed. The present study aimed to investigate the impedance evolution of one device and the factors influencing this after early activation. Results are compared to published results of other devices. A total of 16 patients who received Advanced BionicsTM devices and had early activation within 24 hours of implantation, were included in the study. Impedance telemetry was recorded intraoperatively and postoperatively at 1 day, 1 week, 2 weeks, 4 weeks and 8 weeks. A stepwise increase was observed in the impedance evolution. To the best of our knowledge, the present study is the first to investigate the impedance evolution of the different devices after early switch-on within 24 hours of implantation and its influencing factors. Further research with a longitudinal design to compare the differences in electrode impedances between patients activated early versus those activated after a few weeks will be necessary for the disclosure of the underlying mechanisms.

Major adverse cardiac events and functional capacity in patients at intermediate risk undergoing transcatheter versus surgical aortic valve replacement for aortic stenosis with bicuspid valves.

Transcatheter aortic valve replacement (TAVR) is not always the optimal option for aortic valve stenosis (AS) patients with bicuspid aortic valves (BcAVs) and many studies exclude this group of patients. The aim of our study was to compare the rate of a major adverse cardiovascular event (MACE) and functional capacity in AS patients with BcAV after surgical aortic valve replacement (SAVR) and TAVR. This study included 130 patients who underwent SAVR or TAVR from July 2013 to August 2018 at the Cheng Hsin General Hospital. The main outcome was MACE. Events recorded included noncardiovascular (CV) mortality, CV mortality, recurrent nonfatal stroke, recurrent nonfatal myocardial infarction (MI), and important events. The secondary outcome was functional recovery, which was defined according to the metabolic equivalent (MET) 6 months after the aortic procedure. The mean age of patients was 56.8 ± 26.9 years and the mean Society of Thoracic Surgeons score was 3.29 ± 4.69. Logistic regression analyses indicated that SAVR was a significant predictor of functional recovery. Patients who underwent SAVR had a higher rate of functional recovery (>3 METs; 87.8%, p = .000) and had a significantly higher odds ratio (3.56; 95% confidence interval, 1.19-10.63, p = .023). The Kaplan-Meier survival analysis showed that the MACE rate was not associated with the aortic procedure. Our analysis showed that SAVR is a significant predictor of better functional recovery and TAVR is associated with a lower level of functional capacity. In summary, TAVR is an acceptable option for AS patients with BcAV, and for a better prognosis, an early intervention aimed at improving functional capacity is highly recommended for this group of patients.

Twin peaks diversity with sacubitril/valsartan treatment responses in cardiomyopathic heart failure patients of non-ischemic compared to ischemic etiologies

Abstract Background Ischemic cardiomyopathy (ICM) has been associated with increased mortality when compared with non-ischemic cardiomyopathy (NICM) from several heart failure (HF) cohorts. Instead, PARADIGM study demonstrated similar event rates of cardiovascular (CV) death, all-cause mortality and HF readmissions between ICM and NICM patients. Although the beneficiary effect of sacubitril/valsartan (SAC/VAL) compared to enalapril on these endpoints was consistent across etiologic categories, PARADIGM study did not analyze the effect of ventricular remodeling of SAC/VAL on patients with different HF etiologies, which may significantly affect treatment outcomes. Purpose We aim to compare alterations of left ventricular ejection fraction (LVEF) following SAC/VAL treatment and its association with clinical outcomes in patients with different HF etiologies. Methods Treatment with angiotensin receptor neprilysin inhibitor for Taiwan heart failure patients (TAROT-HF) study is a multicenter study which enrolled 1552 patients with LVEF &amp;lt;40%, whom had been on SAC/VAL treatment from 9 hospitals between 2017 and 2018. After excluding patients without having follow-up echocardiographic studies, patients were grouped by HF etiologies and by LVEF changes following treatment for 8-month period. LVEF improvement ≥15% was defined as “significant improvement”, 5–15% as “marginal improvement”, and &amp;lt;5% or worse as “lack of improvement”. The primary endpoint was a composite of CV death or a first hospitalization for HF. Mean follow-up period was 726 days. Results A total of 1230 patients were analyzed. Patients with ICM were significantly older, more male, and prone to have associated hypertension and diabetes. On the other hand, patients with NICM had lower LVEF and higher likelihood of atrial fibrillation. LVEF increase was significantly greater in patients with NICM compared to those with ICM (11.2±12.4% vs. 6.9±9.8, p&amp;lt;0.001). The effect of ventricular remodeling of SAC/VAL on patients with NICM showed twin peaks diversity (Significant improvement 37.1%, lack of improvement 42.3%), whereas in patients with ICM the proportions of significant, marginal and lack of improvement groups were 19.4%, 28.2% and 52.4%, respectively. The primary endpoint showed twin peaks diversity also in patients with NICM in line with LVEF changes: adjusted HR for patients with NICM and significant improvement was 0.41 (95% CI 0.29–0.57, p&amp;lt;0.001), for patients with NICM and lack of improvement was 1.54 (95% CI 1.22–1.94, p&amp;lt;0.001). Analyses for CV death, all-cause mortality, and HF readmission demonstrated consistent results. Conclusion Patients with NICM had higher degree of LVEF improvement than those with ICM following SAC/VAL treatment, and significant improvement of LVEF in NICM patients may indicate favorable outcome. NICM patients without response to SAC/VAL treatment should serve as an indicator for poor clinical outcome and warranted meticulous HF management. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Cheng Hsin General Hospital

Differences in the impedance of cochlear implant devices within 24 hours of their implantation.

Cochlear implantation is a surgical procedure, which is performed on severely hearing-impaired patients. Impedance field telemetry is commonly used to determine the integrity of the cochlear implant device during and after surgery. At the Department of Otolaryngology, Cheng Hsin General Hospital (Taipei, Taiwan), the cochlear implant devices are switched on within 24 hours of their implantation. In the present study, the impedance changes of Advanced Bionics™ cochlear implant devices were compared with previous studies and other devices. The aim was to confirm previous hypotheses and to explore other potential associated factors that could influence impedance following cochlear implantation. The current study included 12 patients who underwent cochlear implantation at Cheng Hsin General Hospital with Advanced Bionics cochlear implant devices. The cochlear devices were all switched on within 24 hours of their implantation. The impedance was measured and compared across all contact channels of the electrode, both intra-operatively and post-operatively. The intra-operative impedance was compared with the switch-on impedance (within 24 hours of the cochlear implantation); the impedance was notably increased for all contact channels at switch-on. Of the 16 channels examined, 4 channels had a significant increase in impedance between the intra-operative measurement and the switch-on measurement. To the best of our knowledge, the impedance of a cochlear implant device can be affected by the diameter of the electrode, the position of the electrode arrays in the scala tympani, sheath formation and fibrosis surrounding the electrode after implantation and electrical stimulation during or after surgery. When the results of the current study were compared with previous studies, it was found that the impedance changes were opposite to that of Cochlear™ implant devices. This may be explained by the position of the electrode arrays, sheath formation, the blow-out effect and differences in electrical stimulation.

Use of Internal Endoconduit for Unfavorable Iliac Artery Anatomy in Patients Undergoing Transcatheter Aortic Valve Replacement - A Single Center Experience.

Transfemoral (TF) access is associated with lower rates of surgical conversion and mortality compared with non-TF access for transcatheter aortic valve replacement (TAVR). Therefore, efforts should be made to make this procedure even less invasive, allowing more TAVR procedures to be performed through femoral access. We herein describe our single-center experience of using one-stage percutaneous internal endoconduits for TAVR in patients with unfavorable iliac artery anatomy. Between March 2013 andMarch 2016, 113 consecutive patients with severe aortic stenosis at high risk for conventional cardiac surgery underwent TAVR at the Cheng Hsin General Hospital. The patients can be divided into Cohort A (March 2013-December 2014) and Cohort B (January 2015-March 2016). In the Cohort A, 6 out of the 53 (11.4%) with unfavorable iliac artery anatomy were treated by trans-subclavian approach (n = 3, 5.7%) or direct aortic approach (n = 3, 5.7%); while in the Cohort B, none (0%) of the 5 patients with unfavorable iliac artery anatomy among 60 consecutive TAVR cases needed non-TF approach (Cohort A vs. Cohort B = 11.4% vs. 0%, p = 0.024) and they were all successfully treated with the use of an internal endoconduit. The use of internal endoconduits can further increase the number of patients who can be treated through femoral artery access for TAVR and substantially reduce the need of non-TF approaches.

Using Oncotype DX as an additional treatment decision tool in early breast cancer: a retrospective analysis from a single institution in Taiwan

Background: Gene expression analysis is increasingly employed in breast cancer. This study is aimed to investigate the application of Oncotype DX as an additional treatment decision tool in early breast cancer in our institute. Methods: Early breast cancer patients using Oncotype DX as a treatment decision tool at Cheng Hsin General Hospital from 2009 to 2014 were analyzed retrospectively. Thirty patients were enrolled. Results: Seventeen patients (56.7%) had a low recurrence score (RS); 9 (30%) had intermediate RS; and 4 (13.3%) had high RS. All those with high RS received adjuvant chemotherapy, and none of the low and intermediate RS groups had adjuvant chemotherapy. The concordance of ER, PR, HER2/neu immunohistochemistry (IHC), and HER2/neu fluorescence in situ hybridization (FISH) was 96.7%, 90.0%, 100%, and 93.3%, respectively. No local recurrence and distant metastasis were reported. Conclusions: This study offers our experience of using Oncotype DX in Taiwan. The results show a significant impact on the patient’s decision of choosing adjuvant chemotherapy for early breast cancer patients. To confirm these findings, large scale studies are warranted.

Factors affecting survival of medulloblastoma in children: the changing concept of management.

Medulloblastoma (MB) is a type of malignant tumor arising only in the cerebellum that was first defined by Cushing and Bailey in 1920s. In this review paper, we trace the evolution of risk stratification and the correlated changing concept of management in the past years. Outcome analysis of the hospital series of the Taipei Veterans General Hospital, Cheng Hsin General Hospital, and Taipei Medical University Hospital was performed to correlate prognostic indicators with reported studies. The purpose is to provide clues for age-specific and risk-adjusted optimal, effective, but beneficial and protective treatment strategies of these tumors in children.

Testicular capillary hemangioma: Case report

Testicular capillary hemangioma: Case report

19-1 A pioneer in development of aquatic therapy in Taiwan - Cheng Hsin General Hospital

19-1 A pioneer in development of aquatic therapy in Taiwan - Cheng Hsin General Hospital

Evidence-Based Medicine for Gallstone Disease Screening: An Experience at Cheng-Hsin General Hospital, Taipei, Taiwan

Epidemiologic and clinical studies have shown that gallstone disease is a common gastrointestinal disease; more than 14% of adults are affected by this disorder. From the preventive medicine perspective, the most crucial topic for preventing gallstone disease is how to achieve early detection and early treatment by using effective screening tools. To understand the morbidity rate of gallstone disease and to prevent its occurrence requires considering the progression of the disease. Early prevention of gallstone disease necessitates understanding the relevant risk factors of gallstone disease occurrence and its transitional influence. This paper discusses the epidemiologic and economic evaluation of gallstone disease based on a hospital-based screening experience in Taipei, Taiwan. This screening experience will hopefully provide additional information for establishing screening strategies and health management programs for gallstone disease.

Comment to the paper "The response and survival of children with recurrent diffuse intrinsic pontine glioma based on phase II study of antineoplastons A10 and AS2-1 in patients with brain stem glioma" by Burzynski et al.

Comments The authors conducted a single-arm phase II study on antineoplaston (ANP) for the efficacy and safety in the treatment of recurrent pediatric diffuse intrinsic pontine tumors (RPDIPGs) by using a combination of A10 and AS2-1 in a group of 17 patients with mean age of 8.8 years at recurrence. The overall response rate (OR) was 29.5 % with complete response rate (CR) of 6 %, partial response rate (PR) of 23.5 %, stable disease (SD) of 11.8 %, progressive disease of 47 %, and acceptable toxicity. Counting from the first day of ANP administration, the 6-month progression-free survival was 35.3 % and 1-year overall survival was 29.4 % with one long-term survival for more than 15 years. However, the series was small and the enrollment of patients lasted from 1996 to 2006 [1]. In a recently reported series of 31 RPDIPG patients with mean age of 7.8 years at the start of the first treatment for tumor recurrence or progression, the results were as follows: no long-term survival, no CR, PR 12 %, SD 34 %, and PD 53%. The mean event-free survival (EFS) was 2 months. This study highlighted that repeat radiation to the primary tumor was most effective with mean EFS of 3.9 months [2]. Comparing with the treatment results of these two series for RPDIPGs and reports of clinical trials for diffuse intrinsic pontine tumors (DIPGs), although the series of ANP phase II study was small to conclude, the outcome seemed promising [1–3]. There has been a clinical question whether histological grading of DIPGs influences survival and if there are some other diffuse pontine lesions. Referring to a reported study of prognostic factors for DIPGs, stereotactic biopsy and histological diagnosis of high-grade or low-grade gliomas were available in 63 adults and 37 children. This study showed that histological grade was a significant prognostic factor in DIPGs with statistical significance in adult patients (p=0.0001), but there was no statistical significance in pediatric patients (p=0.0755). However, in children, the 1-year actuarial survival rate was higher in low-grade gliomas (80.4± 0.08 %) than high-grade gliomas (48.6±0.14 %). In the same study, the histological diagnosis of stereotactic biopsy of 142 brain stem lesions in adults and children, only 106 cases (74.6 %) were astrocytic tumors [4]. The same study group also reported the histological diagnosis of intrinsic brain stem tumors in children. Biopsies were performed in 44 children with intrinsic brain stem lesion. Histological diagnosis obtained in 41 (93.1 %) patients included 37 diffuse brain stem gliomas, 2 pilocytic astrocytomas, 1 ependymoma, and 1 ganglioglioma [5]. Roujeau et al. reported stereotactic biopsy of diffuse pontine lesions in 24 children. There were 22 highgrade infiltrative astrocytomas (WHO grade III and IV), 1 grade II astrocytoma, and 1 pilocytic astrocytoma [6]. In our unreported experience of biopsy of diffuse pontine tumors in children, the histological diagnosis obtained included five glioblastoma multiformes (GBMs), eight AAs, six astrocytomas, and three pilocytic astrocytomas. The proportion of highgrade and low-grade gliomas varies in different series. Diffuse pontine pilocytic astrocytoma can have long-term survival. There is also a possibility of other pathologies, higher in brain stem lesions in general and sporadic cases in diffuse pontine lesions. In the study series of APN in 17 patients, only four T.<T. Wong (*) Pediatric Neurosurgery, Division of Neurosurgery, Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan e-mail: ttwong@vghtpe.gov.tw

P962 A COMPARISON OF CLINICAL MANIFESTATIONS, TREATMENT MODALITIES AND PROGNOSES BETWEEN PATIENTS WITH HEPATOCELLULAR CARCINOMA WITH CHILD–PUGH SCORE 5 AND 6

P962 A COMPARISON OF CLINICAL MANIFESTATIONS, TREATMENT MODALITIES AND PROGNOSES BETWEEN PATIENTS WITH HEPATOCELLULAR CARCINOMA WITH CHILD–PUGH SCORE 5 AND 6 C.-W. Su, H.-H. Hung, J.-C. Wu, Y. Chao, Y.-Y. Chiou, T.-I. Huo, Y.-H. Huang, G.-Y. Chau, K.-C. Lee, H.-C. Lin, S.-D. Lee. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Department of Medical Research and Education, Cancer Center, Division of Gastrointestinal Radiology, Department of Radiology, Taipei Veterans General Hospital, Institute of Pharmacology, School of Medicine, National Yang-Ming University, Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan E-mail: cwsu2@vghtpe.gov.tw

A Kind of D-Amino Acid Oxidase Inhibitor, Sodium Benzoate, Might Relieve Panic Symptoms in a First-Episode, Drug-Naïve Panic-Disorder Patient

A Kind of D-Amino Acid Oxidase Inhibitor, Sodium Benzoate, Might Relieve Panic Symptoms in a First-Episode, Drug-Naïve Panic-Disorder Patient

P018 The Prognostic Implications of Chinese Type 2 Diabetic Patients with Coronary Artery Disease after Coronary Bypass Grafting: Experience at Cheng-Hsin General Hospital

P018 The Prognostic Implications of Chinese Type 2 Diabetic Patients with Coronary Artery Disease after Coronary Bypass Grafting: Experience at Cheng-Hsin General Hospital