STUDY OBJECTIVES Polysomnography is the gold standard in identifying sleep stages; however, there... more STUDY OBJECTIVES Polysomnography is the gold standard in identifying sleep stages; however, there are discrepancies in how technicians use the standards. Because organizing meetings to evaluate this discrepancy and/or reach a consensus among multiple sleep centers is time consuming, we developed an artificial intelligence (AI) system to efficiently evaluate the reliability and consistency of sleep scoring, and hence the sleep center quality. METHODS An interpretable machine learning algorithm was used to evaluate interrater reliability (IRR) of sleep stage annotation among sleep centers. The AI system was trained to learn raters from one hospital, and applied to subjects from the same or other hospitals. The results were compared with the experts' annotation to determine IRR. Intra-center and inter-center assessments were conducted on 679 subjects without sleep apnea from six sleep centers in Taiwan. Centers with potential quality issues were identified by the estimated IRR. RESULTS In the intra-center assessment, the median accuracy ranged from 80·3% to 83·3% with the exception of one hospital (designated E) with an accuracy of 72·3%. In the inter-center assessment, the median accuracy ranged from 75·7% to 83·3% when hospital E was excluded from testing and training. The performance of the proposed method was higher for N2, awake, and REM, compared to N1 and N3. The significant IRR discrepancy of hospital E suggested a quality issue. This quality issue is confirmed by the physicians in charge of hospital E. CONCLUSIONS The proposed AI system proved effective in assessing IRR and hence the sleep center quality.
Key messagePhysicians should remain vigilant about alternative causes of shortness of breath even... more Key messagePhysicians should remain vigilant about alternative causes of shortness of breath even when respiratory diseases are being effectively treated. The lateral view of chest radiography can be valuable in discerning the three‐dimensional characteristics of pulmonary abnormalities.
In the context of non-small cell lung cancer (NSCLC) patients treated with EGFR tyrosine kinase i... more In the context of non-small cell lung cancer (NSCLC) patients treated with EGFR tyrosine kinase inhibitors (TKIs), this research evaluated the prognostic value of CT-based radiomics. A comprehensive systematic review and meta-analysis of studies up to April 2023, which included 3111 patients, was conducted. We utilized the Quality in Prognosis Studies (QUIPS) tool and radiomics quality scoring (RQS) system to assess the quality of the included studies. Our analysis revealed a pooled hazard ratio for progression-free survival of 2.80 (95% confidence interval: 1.87–4.19), suggesting that patients with certain radiomics features had a significantly higher risk of disease progression. Additionally, we calculated the pooled Harrell’s concordance index and area under the curve (AUC) values of 0.71 and 0.73, respectively, indicating good predictive performance of radiomics. Despite these promising results, further studies with consistent and robust protocols are needed to confirm the progn...
Background The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are a fi... more Background The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are a first-line therapy for non-small cell lung cancer (NSCLC) with EGFR mutations. Approximately half of the patients with EGFR-mutated NSCLC are treated with EGFR-TKIs and develop disease progression within 1 year. Therefore, the early prediction of tumor progression in patients who receive EGFR-TKIs can facilitate patient management and development of treatment strategies. We proposed a deep learning approach based on both quantitative computed tomography (CT) characteristics and clinical data to predict progression-free survival (PFS) in patients with advanced NSCLC after EGFR-TKI treatment. Methods A total of 593 radiomic features were extracted from pretreatment chest CT images. The DeepSurv models for the progression risk stratification of EGFR-TKI treatment were proposed based on CT radiomic and clinical features from 270 stage IIIB-IV EGFR-mutant NSCLC patients. Time-dependent PFS pred...
This study aimed to investigate the proportion of young OSA adults with sleep-related complaints ... more This study aimed to investigate the proportion of young OSA adults with sleep-related complaints in a sleep center, affiliated with a tertiary medical center for over a decade. This study presents a chronicle change in the numbers of young adults receiving polysomnography (PSG) and young patients with OSA from 2000 to 2017. We further analyzed 371 young patients with OSA among 2378 patients receiving PSG in our sleep center from 2016 to 2017 to capture their characteristics. Young adults constituted a substantial and relatively steady portion of examinees of PSG (25.1% ± 2.8%) and confirmed OSA cases (19.8 ± 2.4%) even though the total numbers increased with the years. Young adults with OSA tend to be sleepier, have a greater body mass index, and have a higher percentage of cigarette smoking and alcohol consumption. They also complained more about snoring and daytime sleepiness. They had a higher apnea–hypopnea index on average and experienced more hypoxemia during their sleep, both...
Background The survival of patients with lung cancer undergoing critical care has improved. An in... more Background The survival of patients with lung cancer undergoing critical care has improved. An increasing number of patients with lung cancer have signed a predefined do-not-intubate (DNI) order before admission to the intensive care unit (ICU). These patients may still be transferred to the ICU and even receive non-invasive ventilation (NIV) support. However, there is still a lack of prognostic predictions in this cohort. Whether patients will benefit from ICU care remains unclear. Methods We retrospectively collected data from patients with advanced lung cancer who had signed a DNI order before ICU admission in a tertiary medical center between 2014 and 2016. The clinical characteristics and survival outcomes were discussed. Results A total of 140 patients (median age, 73 years; 62.1% were male) were included, had been diagnosed with stage III or IV non-small cell lung cancer (NSCLC) (AJCC 7th edition), and signed a DNI. Most patients received NIV during ICU stay. The median APACH...
e24113 Background: The survival of lung cancer patients in critical care has been improved. Incre... more e24113 Background: The survival of lung cancer patients in critical care has been improved. Increasing number of lung cancer patients have signed predefined do-not-intubation (DNI) order before admission to ICU. These patients may still be transferred to ICU and even receive non-invasive ventilation (NIV) supports. However, there is still lack of prognostic prediction in this cohort. Whether patients will be benefit of ICU care remain unclear. Methods: We retrospectively collected data of patients with advanced lung cancer, having signed DNI order before ICU admission in a tertiary medical center. The clinical characteristics and survival outcomes were discussed. The enrollment duration is between 2014 to 2016. Results: Total 140 patients were included. All patients were diagnosed with stage III or IV non-small cell lung cancer (AJCC 7th edition) and signed DNI. The median age was 73 years old and about two-thirds were male. Most patients had received NIV during ICU course. The medi...
Tracheoesophageal fistula (TEF) is a late complication of tracheostomy and may cause fatal pulmon... more Tracheoesophageal fistula (TEF) is a late complication of tracheostomy and may cause fatal pulmonary complications. This case reports a TEF caused by tracheostomy‐cuff‐related pressure necrosis presenting with air leaks and recurrent pneumonia.
Afatinib為二代EGFR-TKI,已被證實對有EGFR突變的非小細胞肺癌有療效。人類免疫不全病毒感染的患者是肺癌的高風險族群,而此類患者使用的抗病毒藥物雞尾酒療法會產生的藥物交互作用。使用... more Afatinib為二代EGFR-TKI,已被證實對有EGFR突變的非小細胞肺癌有療效。人類免疫不全病毒感染的患者是肺癌的高風險族群,而此類患者使用的抗病毒藥物雞尾酒療法會產生的藥物交互作用。使用EGFR-TKI治療肺癌,有1%的機率會產生嚴重的藥物引起的間質性肺炎。過去關於EGFR-TKI藥物引起的間質性肺炎病例報告都著眼於gefitinib或erlotinib,尚未有人分享過發生於人類免疫不全病毒感染的患者的間質性肺炎。因此,我們提出第一位同時使用afatinib及雞尾酒療法後發生間質性肺炎的人類免疫不全病毒感染的肺癌患者,在經過類固醇脈衝治療後恢復的案例。
Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia and sleep fragmentation.... more Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia and sleep fragmentation. While apnea is pronounced with severe desaturation during rapid eye movement (REM) sleep, REM-related OSA is a distinct phenotype of OSA associated with respiratory disturbances predominantly during REM sleep. In this study, we investigated the clinical features of REMrelated OSA in Taiwan. Patients and Methods: All patients diagnosed with OSA in the Taipei Veterans General Hospital from 2015 to 2017 were analyzed retrospectively and classified into REM-related OSA (REM-OSA) group, non-REM related OSA (NREM-OSA) group, and non-stage specific-OSA group. The clinical demographics, OSA-related symptoms, polysomnography results, and medical comorbidities of the three groups were analyzed. Results: Among 1331 patients with OSA, 414 (31.1%) were classified as REM-OSA, 808 (60.7%) as NREM-OSA, and 109 (8.2%) as non-stage specific-OSA. After being adjusted for OSA severity, the REM-OSA group was associated with less portion of males, longer desaturation duration, and lower nadir oxygen saturation (SpO 2) compared with the NREM-OSA group in mild and moderate OSA. In moderate OSA, the non-stage specific-OSA group featured more OSA severity and more desaturation compared with the other groups. The Epworth Sleepiness Scale scores and the prevalence of comorbidities did not vary among the REM-OSA, NREM-OSA, and non-stage specific-OSA groups. High REM-AHI/NREM-AHI ratio was associated with young age, female gender, high BMI, and low AHI. Conclusion: OSA patients with high REM-AHI/NREM-AHI ratio are related to young age, female gender, high BMI, and low AHI. Patients with REM-related OSA presented with longer desaturation duration and lower nadir SpO2 after being adjusted for OSA severity.
STUDY OBJECTIVES Polysomnography is the gold standard in identifying sleep stages; however, there... more STUDY OBJECTIVES Polysomnography is the gold standard in identifying sleep stages; however, there are discrepancies in how technicians use the standards. Because organizing meetings to evaluate this discrepancy and/or reach a consensus among multiple sleep centers is time consuming, we developed an artificial intelligence (AI) system to efficiently evaluate the reliability and consistency of sleep scoring, and hence the sleep center quality. METHODS An interpretable machine learning algorithm was used to evaluate interrater reliability (IRR) of sleep stage annotation among sleep centers. The AI system was trained to learn raters from one hospital, and applied to subjects from the same or other hospitals. The results were compared with the experts' annotation to determine IRR. Intra-center and inter-center assessments were conducted on 679 subjects without sleep apnea from six sleep centers in Taiwan. Centers with potential quality issues were identified by the estimated IRR. RESULTS In the intra-center assessment, the median accuracy ranged from 80·3% to 83·3% with the exception of one hospital (designated E) with an accuracy of 72·3%. In the inter-center assessment, the median accuracy ranged from 75·7% to 83·3% when hospital E was excluded from testing and training. The performance of the proposed method was higher for N2, awake, and REM, compared to N1 and N3. The significant IRR discrepancy of hospital E suggested a quality issue. This quality issue is confirmed by the physicians in charge of hospital E. CONCLUSIONS The proposed AI system proved effective in assessing IRR and hence the sleep center quality.
Key messagePhysicians should remain vigilant about alternative causes of shortness of breath even... more Key messagePhysicians should remain vigilant about alternative causes of shortness of breath even when respiratory diseases are being effectively treated. The lateral view of chest radiography can be valuable in discerning the three‐dimensional characteristics of pulmonary abnormalities.
In the context of non-small cell lung cancer (NSCLC) patients treated with EGFR tyrosine kinase i... more In the context of non-small cell lung cancer (NSCLC) patients treated with EGFR tyrosine kinase inhibitors (TKIs), this research evaluated the prognostic value of CT-based radiomics. A comprehensive systematic review and meta-analysis of studies up to April 2023, which included 3111 patients, was conducted. We utilized the Quality in Prognosis Studies (QUIPS) tool and radiomics quality scoring (RQS) system to assess the quality of the included studies. Our analysis revealed a pooled hazard ratio for progression-free survival of 2.80 (95% confidence interval: 1.87–4.19), suggesting that patients with certain radiomics features had a significantly higher risk of disease progression. Additionally, we calculated the pooled Harrell’s concordance index and area under the curve (AUC) values of 0.71 and 0.73, respectively, indicating good predictive performance of radiomics. Despite these promising results, further studies with consistent and robust protocols are needed to confirm the progn...
Background The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are a fi... more Background The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are a first-line therapy for non-small cell lung cancer (NSCLC) with EGFR mutations. Approximately half of the patients with EGFR-mutated NSCLC are treated with EGFR-TKIs and develop disease progression within 1 year. Therefore, the early prediction of tumor progression in patients who receive EGFR-TKIs can facilitate patient management and development of treatment strategies. We proposed a deep learning approach based on both quantitative computed tomography (CT) characteristics and clinical data to predict progression-free survival (PFS) in patients with advanced NSCLC after EGFR-TKI treatment. Methods A total of 593 radiomic features were extracted from pretreatment chest CT images. The DeepSurv models for the progression risk stratification of EGFR-TKI treatment were proposed based on CT radiomic and clinical features from 270 stage IIIB-IV EGFR-mutant NSCLC patients. Time-dependent PFS pred...
This study aimed to investigate the proportion of young OSA adults with sleep-related complaints ... more This study aimed to investigate the proportion of young OSA adults with sleep-related complaints in a sleep center, affiliated with a tertiary medical center for over a decade. This study presents a chronicle change in the numbers of young adults receiving polysomnography (PSG) and young patients with OSA from 2000 to 2017. We further analyzed 371 young patients with OSA among 2378 patients receiving PSG in our sleep center from 2016 to 2017 to capture their characteristics. Young adults constituted a substantial and relatively steady portion of examinees of PSG (25.1% ± 2.8%) and confirmed OSA cases (19.8 ± 2.4%) even though the total numbers increased with the years. Young adults with OSA tend to be sleepier, have a greater body mass index, and have a higher percentage of cigarette smoking and alcohol consumption. They also complained more about snoring and daytime sleepiness. They had a higher apnea–hypopnea index on average and experienced more hypoxemia during their sleep, both...
Background The survival of patients with lung cancer undergoing critical care has improved. An in... more Background The survival of patients with lung cancer undergoing critical care has improved. An increasing number of patients with lung cancer have signed a predefined do-not-intubate (DNI) order before admission to the intensive care unit (ICU). These patients may still be transferred to the ICU and even receive non-invasive ventilation (NIV) support. However, there is still a lack of prognostic predictions in this cohort. Whether patients will benefit from ICU care remains unclear. Methods We retrospectively collected data from patients with advanced lung cancer who had signed a DNI order before ICU admission in a tertiary medical center between 2014 and 2016. The clinical characteristics and survival outcomes were discussed. Results A total of 140 patients (median age, 73 years; 62.1% were male) were included, had been diagnosed with stage III or IV non-small cell lung cancer (NSCLC) (AJCC 7th edition), and signed a DNI. Most patients received NIV during ICU stay. The median APACH...
e24113 Background: The survival of lung cancer patients in critical care has been improved. Incre... more e24113 Background: The survival of lung cancer patients in critical care has been improved. Increasing number of lung cancer patients have signed predefined do-not-intubation (DNI) order before admission to ICU. These patients may still be transferred to ICU and even receive non-invasive ventilation (NIV) supports. However, there is still lack of prognostic prediction in this cohort. Whether patients will be benefit of ICU care remain unclear. Methods: We retrospectively collected data of patients with advanced lung cancer, having signed DNI order before ICU admission in a tertiary medical center. The clinical characteristics and survival outcomes were discussed. The enrollment duration is between 2014 to 2016. Results: Total 140 patients were included. All patients were diagnosed with stage III or IV non-small cell lung cancer (AJCC 7th edition) and signed DNI. The median age was 73 years old and about two-thirds were male. Most patients had received NIV during ICU course. The medi...
Tracheoesophageal fistula (TEF) is a late complication of tracheostomy and may cause fatal pulmon... more Tracheoesophageal fistula (TEF) is a late complication of tracheostomy and may cause fatal pulmonary complications. This case reports a TEF caused by tracheostomy‐cuff‐related pressure necrosis presenting with air leaks and recurrent pneumonia.
Afatinib為二代EGFR-TKI,已被證實對有EGFR突變的非小細胞肺癌有療效。人類免疫不全病毒感染的患者是肺癌的高風險族群,而此類患者使用的抗病毒藥物雞尾酒療法會產生的藥物交互作用。使用... more Afatinib為二代EGFR-TKI,已被證實對有EGFR突變的非小細胞肺癌有療效。人類免疫不全病毒感染的患者是肺癌的高風險族群,而此類患者使用的抗病毒藥物雞尾酒療法會產生的藥物交互作用。使用EGFR-TKI治療肺癌,有1%的機率會產生嚴重的藥物引起的間質性肺炎。過去關於EGFR-TKI藥物引起的間質性肺炎病例報告都著眼於gefitinib或erlotinib,尚未有人分享過發生於人類免疫不全病毒感染的患者的間質性肺炎。因此,我們提出第一位同時使用afatinib及雞尾酒療法後發生間質性肺炎的人類免疫不全病毒感染的肺癌患者,在經過類固醇脈衝治療後恢復的案例。
Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia and sleep fragmentation.... more Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia and sleep fragmentation. While apnea is pronounced with severe desaturation during rapid eye movement (REM) sleep, REM-related OSA is a distinct phenotype of OSA associated with respiratory disturbances predominantly during REM sleep. In this study, we investigated the clinical features of REMrelated OSA in Taiwan. Patients and Methods: All patients diagnosed with OSA in the Taipei Veterans General Hospital from 2015 to 2017 were analyzed retrospectively and classified into REM-related OSA (REM-OSA) group, non-REM related OSA (NREM-OSA) group, and non-stage specific-OSA group. The clinical demographics, OSA-related symptoms, polysomnography results, and medical comorbidities of the three groups were analyzed. Results: Among 1331 patients with OSA, 414 (31.1%) were classified as REM-OSA, 808 (60.7%) as NREM-OSA, and 109 (8.2%) as non-stage specific-OSA. After being adjusted for OSA severity, the REM-OSA group was associated with less portion of males, longer desaturation duration, and lower nadir oxygen saturation (SpO 2) compared with the NREM-OSA group in mild and moderate OSA. In moderate OSA, the non-stage specific-OSA group featured more OSA severity and more desaturation compared with the other groups. The Epworth Sleepiness Scale scores and the prevalence of comorbidities did not vary among the REM-OSA, NREM-OSA, and non-stage specific-OSA groups. High REM-AHI/NREM-AHI ratio was associated with young age, female gender, high BMI, and low AHI. Conclusion: OSA patients with high REM-AHI/NREM-AHI ratio are related to young age, female gender, high BMI, and low AHI. Patients with REM-related OSA presented with longer desaturation duration and lower nadir SpO2 after being adjusted for OSA severity.
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