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  • 1
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    Online Resource
    Table_1.docx
    Frontiers Media SA ; 2023
    In:  Frontiers in Cardiovascular Medicine Vol. 10 ( 2023-3-3)
    Details
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 10 ( 2023-3-3)
    Abstract: Left ventricular systolic dysfunction (LVSD) characterized by a reduced left ventricular ejection fraction (LVEF) is associated with adverse patient outcomes. We aimed to build a deep neural network (DNN)-based model using standard 12-lead electrocardiogram (ECG) to screen for LVSD and stratify patient prognosis. Methods This retrospective chart review study was conducted using data from consecutive adults who underwent ECG examinations at Chang Gung Memorial Hospital in Taiwan between October 2007 and December 2019. DNN models were developed to recognize LVSD, defined as LVEF & lt;40%, using original ECG signals or transformed images from 190,359 patients with paired ECG and echocardiogram within 14 days. The 190,359 patients were divided into a training set of 133,225 and a validation set of 57,134. The accuracy of recognizing LVSD and subsequent mortality predictions were tested using ECGs from 190,316 patients with paired data. Of these 190,316 patients, we further selected 49,564 patients with multiple echocardiographic data to predict LVSD incidence. We additionally used data from 1,194,982 patients who underwent ECG only to assess mortality prognostication. External validation was performed using data of 91,425 patients from Tri-Service General Hospital, Taiwan. Results The mean age of patients in the testing dataset was 63.7 ± 16.3 years (46.3% women), and 8,216 patients (4.3%) had LVSD. The median follow-up period was 3.9 years (interquartile range 1.5–7.9 years). The area under the receiver-operating characteristic curve (AUROC), sensitivity, and specificity of the signal-based DNN (DNN-signal) to identify LVSD were 0.95, 0.91, and 0.86, respectively. DNN signal-predicted LVSD was associated with age- and sex-adjusted hazard ratios (HRs) of 2.57 (95% confidence interval [CI], 2.53–2.62) for all-cause mortality and 6.09 (5.83–6.37) for cardiovascular mortality. In patients with multiple echocardiograms, a positive DNN prediction in patients with preserved LVEF was associated with an adjusted HR (95% CI) of 8.33 (7.71 to 9.00) for incident LVSD. Signal- and image-based DNNs performed equally well in the primary and additional datasets. Conclusion Using DNNs, ECG becomes a low-cost, clinically feasible tool to screen LVSD and facilitate accurate prognostication.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    URL: Article
    URL: Article
    DOI: 10.3389/fcvm.2023.1070641
    DOI: 10.3389/fcvm.2023.1070641.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2781496-8
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  • 2
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    Corrigendum: Quantifying Coral Reef Resilience to Climate Change and Human Development: An Evaluation of Multiple Empirical Frameworks
    Frontiers Media SA ; 2021
    In:  Frontiers in Marine Science Vol. 8 ( 2021-2-10)
    Details
    In: Frontiers in Marine Science, Frontiers Media SA, Vol. 8 ( 2021-2-10)
    Type of Medium: Online Resource
    ISSN: 2296-7745
    URL: Article
    DOI: 10.3389/fmars.2021.653404
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2757748-X
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  • 3
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    Table_5.docx
    Frontiers Media SA ; 2021
    In:  Frontiers in Marine Science Vol. 7 ( 2021-1-13)
    Details
    In: Frontiers in Marine Science, Frontiers Media SA, Vol. 7 ( 2021-1-13)
    Abstract: The integrity of coral reefs has increasingly been threatened by human development and climate change. As a result, the concept of ecological resilience – an ecosystem's capability to resist and recover from environmental stressors – has become an important aspect of coral reef conservation. In this study, coral reef resilience was quantitatively scored in Kenting National Park (KNP), Taiwan, using four different assessment frameworks: the first uses the opinions of local reef experts, the second includes metrics specific to the local reef context, the third combines the previous two approaches, and the fourth relies solely on ecological metrics from biodiversity surveys. To evaluate the accuracy of each assessment, the resulting resilience scores were compared with historical coral recovery rates, which served as a proxy for resilience. While each approach to measuring resilience has its merits and drawbacks, the picture of resilience became clearest when a few key indicators were included to reflect core ecosystem processes. Trends in resilience scores varied depending on the makeup of the assessment's indicators, and there was little correlation between the baseline metrics measured using different data collection methods. However, all resilience assessment trends indicated that KNP's Nanwan area is high in resilience. This is likely due to the effects of local tidally-induced upwelling, which significantly relieve the growing thermal stress placed on surrounding coral communities. Ultimately, the most successful assessments were those that empirically quantified ecological processes and local factors with only a few indicators, rather than broader approaches that measured many indicators. These findings are particularly relevant for reef managers to consider as they develop and employ resilience-based management strategies.
    Type of Medium: Online Resource
    ISSN: 2296-7745
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fmars.2020.610306
    DOI: 10.3389/fmars.2020.610306.s001
    DOI: 10.3389/fmars.2020.610306.s002
    DOI: 10.3389/fmars.2020.610306.s003
    DOI: 10.3389/fmars.2020.610306.s004
    DOI: 10.3389/fmars.2020.610306.s005
    DOI: 10.3389/fmars.2020.610306.s006
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2757748-X
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  • 4
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    Data_Sheet_1.docx
    Frontiers Media SA ; 2021
    In:  Frontiers in Cardiovascular Medicine Vol. 8 ( 2021-12-23)
    Details
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 8 ( 2021-12-23)
    Abstract: Background: Patients with active peptic ulcer (PU) were excluded from direct oral anticoagulant (DOAC) trials for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the safety and effectiveness of DOACs in AF patients with active, inactive and no peptic ulcer (PU). Methods: This study accessed electronic medical records from January 1, 2009 to May 31, 2019 at a multi-center healthcare provider in Taiwan and involved 2,955 AF patients who had undergone esophagogastroduodenoscopy ≤ 1 year before anticoagulation. Subjects were classified into 3 groups: active ( n = 237), inactive ( n = 828) and no-PU ( n = 1,890) groups. We compared the risks of major bleeding, gastrointestinal bleeding, and ischemic stroke/systemic embolism (IS/SE) between DOACs and warfarin among the 3 groups. Results: In the active PU group, there were no significant differences in the risks of major bleeding [hazard ratio (HR) = 0.65, 95% confidence interval (CI) 0.08–4.98, p = 0.676], gastrointestinal bleeding (HR = 0.65, 95% CI 0.08–4.98, p = 0.676) and IS/SE (HR = 2.58; 95% CI 0.53–12.70, p = 0.243) between DOAC and warfarin (as the reference). In the inactive PU group, there were no significant differences in the risks of major bleeding (HR = 0.36, 95% CI 0.09–1.39, p = 0.138), gastrointestinal bleeding (HR = 0.21, 95% CI 0.02–1.80, p = 0.153), and IS/SE (HR = 1.04, 95% CI 0.39–2.82, p = 0.934) between DOAC and warfarin (as the reference). In the no-PU group, DOACs were associated with lower risk of major bleeding (HR = 0.26, 95% CI 0.12–0.53, p & lt; 0.001), gastrointestinal bleeding (HR = 0.25, 95% CI 0.01–0.59, p = 0.002), and similar risk of IS/SE (HR = 0.92, 95% CI 0.55–1.54, p = 0.757) compared to warfarin. Conclusions: DOACs were as effective as warfarin in preventing IS/SE irrespective of PU status and safer than warfarin in reducing major bleeding in the no-PU group. In patients with active or inactive PUs, DOAC and warfarin were not significantly different in their effects on major bleeding or gastrointestinal bleeding.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    URL: Article
    URL: Article
    DOI: 10.3389/fcvm.2021.774072
    DOI: 10.3389/fcvm.2021.774072.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2781496-8
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  • 5
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    Using Artificial Intelligence to Establish Chest X-Ray Image Recognition Model to Assist Crucial Diagnosis in Elder Patients With Dyspnea
    Frontiers Media SA ; 2022
    In:  Frontiers in Medicine Vol. 9 ( 2022-6-3)
    Details
    In: Frontiers in Medicine, Frontiers Media SA, Vol. 9 ( 2022-6-3)
    Abstract: Pneumonia and pulmonary edema are the most common causes of acute respiratory failure in emergency and intensive care. Airway maintenance and heart function preservation are two foundations for resuscitation. Laboratory examinations have been utilized for clinicians to early differentiate pneumonia and pulmonary edema; however, none can provide results as prompt as radiology examinations, such as portable chest X-ray (CXR), which can quickly deliver results without mobilizing patients. However, similar features between pneumonia and pulmonary edema are found in CXR. It remains challenging for Emergency Department (ED) physicians to make immediate decisions as radiologists cannot be on-site all the time and provide support. Thus, Accurate interpretation of images remains challenging in the emergency setting. References have shown that deep convolutional neural networks (CNN) have a high sensitivity in CXR readings. In this retrospective study, we collected the CXR images of patients over 65 hospitalized with pneumonia or pulmonary edema diagnosis between 2016 and 2020. After using the ICD-10 codes to select qualified patient records and removing the duplicated ones, we used keywords to label the image reports found in the electronic medical record (EMR) system. After that, we categorized their CXR images into five categories: positive correlation, negative correlation, no correlation, low correlation, and high correlation. Subcategorization was also performed to better differentiate characteristics. We applied six experiments includes the crop interference and non-interference categories by GoogLeNet and applied three times of validations. In our best model, the F1 scores for pneumonia and pulmonary edema are 0.835 and 0.829, respectively; accuracy rate: 83.2%, Recall rate: 83.2%, positive predictive value: 83.3%, and F1 Score: 0.832. After the validation, the best accuracy rate of our model can reach up to 73%. The model has a high negative predictive value of excluding pulmonary edema, meaning the CXR shows no sign of pulmonary edema. At the time, there was a high positive predictive value in pneumonia. In that way, we could use it as a clinical decision support (CDS) system to rule out pulmonary edema and rule in pneumonia contributing to the critical care of the elderly.
    Type of Medium: Online Resource
    ISSN: 2296-858X
    URL: Article
    DOI: 10.3389/fmed.2022.893208
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2775999-4
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  • 6
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    Image_5.tif
    Frontiers Media SA ; 2022
    In:  Frontiers in Immunology Vol. 13 ( 2022-7-1)
    Details
    In: Frontiers in Immunology, Frontiers Media SA, Vol. 13 ( 2022-7-1)
    Abstract: Ischemic stroke is caused by a sudden reduction in cerebral blood flow that subsequently induces a complex cascade of pathophysiological responses, leading to brain inflammation and irreversible infarction. 4-ethylguaiacol (4-EG) is reported to suppress inflammatory immune responses. However, whether 4-EG exerts anti-inflammatory effects in ischemic stroke remains unexplored. We evaluated the therapeutic potential of 4-EG and examined the cellular and molecular mechanisms underlying the protective effects of 4-EG in ischemic stroke. The effect of 4-EG in ischemic stroke was determined by using a transient middle cerebral artery occlusion (MCAO) animal model followed by exploring the infarct size, neurological deficits, microglia activation, inflammatory cytokine production, blood–brain barrier (BBB) disruption, brain endothelial cell adhesion molecule expression, and microglial heme oxygenase-1 (HO-1) expression. Nrf2 -/- and HO-1 inhibitor ZnPP-treated mice were also subjected to MCAO to evaluate the role of the Nrf2/HO-1 pathway in 4-EG-mediated protection in ischemic stroke. We found that 4-EG attenuated infarct size and neurological deficits, and lessened BBB disruption in ischemic stroke. Further investigation revealed that 4-EG suppressed microglial activation, peripheral inflammatory immune cell infiltration, and brain endothelial cell adhesion molecule upregulation in the ischemic brain. Finally, we identified that the protective effect of 4-EG in ischemic stroke was abolished in Nrf2 -/– and ZnPP-treated MCAO mice. Our results identified that 4-EG confers protection against ischemic stroke and reveal that the protective effect of 4-EG in ischemic stroke is mediated through the induction of the Nrf2/HO1 pathway. Thus, our findings suggest that 4-EG could be developed as a novel therapeutic agent for the treatment of ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 1664-3224
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fimmu.2022.887000
    DOI: 10.3389/fimmu.2022.887000.s001
    DOI: 10.3389/fimmu.2022.887000.s002
    DOI: 10.3389/fimmu.2022.887000.s003
    DOI: 10.3389/fimmu.2022.887000.s004
    DOI: 10.3389/fimmu.2022.887000.s005
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
    detail.hit.zdb_id: 2606827-8
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  • 7
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    DataSheet_1.pdf
    Frontiers Media SA ; 2023
    In:  Frontiers in Immunology Vol. 14 ( 2023-3-31)
    Details
    In: Frontiers in Immunology, Frontiers Media SA, Vol. 14 ( 2023-3-31)
    Abstract: Tissue plasminogen activator (tPA) is the only FDA-approved drug for the treatment of ischemic stroke. Delayed tPA administration is associated with increased risks of blood-brain barrier (BBB) disruption and hemorrhagic transformation. Studies have shown that interferon beta (IFNβ) or type I IFN receptor (IFNAR1) signaling confers protection against ischemic stroke in preclinical models. In addition, we have previously demonstrated that IFNβ can be co-administered with tPA to alleviate delayed tPA-induced adverse effects in ischemic stroke. In this study, we investigated the time limit of IFNβ treatment on the extension of tPA therapeutic window and assessed the effect of IFNβ on modulating microglia (MG) phenotypes in ischemic stroke with delayed tPA treatment. Mice were subjected to 40 minutes transient middle cerebral artery occlusion (MCAO) followed by delayed tPA treatment in the presence or absence of IFNβ at 3h, 4.5h or 6h post-reperfusion. In addition, mice with MG-specific IFNAR1 knockdown were generated to validate the effects of IFNβ on modulating MG phenotypes, ameliorating brain injury, and lessening BBB disruption in delayed tPA-treated MCAO mice. Our results showed that IFNβ extended tPA therapeutic window to 4.5h post-reperfusion in MCAO mice, and that was accompanied with attenuated brain injury and lessened BBB disruption. Mechanistically, our findings revealed that IFNβ modulated MG polarization, leading to the suppression of inflammatory MG and the promotion of anti-inflammatory MG, in delayed tPA-treated MCAO mice. Notably, these effects were abolished in MG-specific IFNAR1 knockdown MCAO mice. Furthermore, the protective effect of IFNβ on the amelioration of delayed tPA-exacerbated ischemic brain injury was also abolished in these mice. Finally, we identified that IFNβ-mediated modulation of MG phenotypes played a role in maintaining BBB integrity, because the knockdown of IFNAR1 in MG partly reversed the protective effect of IFNβ on lessening BBB disruption in delayed tPA-treated MCAO mice. In summary, our study reveals a novel function of IFNβ in modulating MG phenotypes, and that may subsequently confer protection against delayed tPA-exacerbated brain injury in ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 1664-3224
    URL: Article
    URL: Article
    DOI: 10.3389/fimmu.2023.1148069
    DOI: 10.3389/fimmu.2023.1148069.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2606827-8
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  • 8
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    Table_4.doc
    Frontiers Media SA ; 2018
    In:  Frontiers in Psychiatry Vol. 9 ( 2018-5-29)
    Details
    In: Frontiers in Psychiatry, Frontiers Media SA, Vol. 9 ( 2018-5-29)
    Type of Medium: Online Resource
    ISSN: 1664-0640
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fpsyt.2018.00227
    DOI: 10.3389/fpsyt.2018.00227.s001
    DOI: 10.3389/fpsyt.2018.00227.s002
    DOI: 10.3389/fpsyt.2018.00227.s003
    DOI: 10.3389/fpsyt.2018.00227.s004
    DOI: 10.3389/fpsyt.2018.00227.s005
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2018
    detail.hit.zdb_id: 2564218-2
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  • 9
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    Association between the risk of heart failure hospitalization and end-stage renal disease with digoxin usage in patients with cardiorenal syndrome: A population-based study
    Frontiers Media SA ; 2023
    In:  Frontiers in Public Health Vol. 10 ( 2023-1-17)
    Details
    In: Frontiers in Public Health, Frontiers Media SA, Vol. 10 ( 2023-1-17)
    Abstract: The management of the coexistence of heart disease and kidney disease is increasingly challenging for clinicians. Chronic kidney disease (CKD) is not only a prevalent comorbidity of patients with heart failure but has also been identified as a noteworthy risk factor for all-cause mortality and poor clinical outcomes. Digoxin is one of the commonest treatments for heart disease. There are few trials investigating the role of digoxin in patients with cardiorenal syndrome (CRS). This study aims to examine the association between digoxin usage and clinical outcomes in patients with CRS in a nationwide cohort. Method We conducted a population-based study that included 705 digoxin users with CRS; each patient was age, sex, comorbidities, and medications matched with three non-users who were randomly selected from the CRS population. Cox proportional hazards regression analysis was conducted to estimate the effects of digoxin on the incidence of all-cause mortality, congestive heart failure (CHF) hospitalization, coronary artery disease (CAD) hospitalization, and end-stage renal disease (ESRD). Results The all-cause mortality rate was significantly higher in digoxin users than in non-users (adjusted hazard ratio [aHR] = 1.26; 95% confidence interval [CI] = 1.09–1.46, p = 0.002 ). In a subgroup analysis, there was significantly high mortality in the 0.26–0.75 defined daily dose (DDD) subgroup of digoxin users (aHR = 1.49; 95% CI = 1.23–1.82, p & lt; 0.001 ). Thus, the p for trend was 0.013 . With digoxin prescription, the CHF hospitalization was significantly higher [subdistribution HR (sHR) = 1.17; 95% CI = 1.05–1.30, p = 0.004 ], especially in the & gt; 0.75 DDD subgroup (sHR = 1.19; 95% CI = 1.01–1.41, p = 0.046; p for trend = 0.006 ). The digoxin usage lowered the coronary artery disease (CAD) hospitalization in the & gt; 0.75 DDD subgroup (sHR = 0.79; 95% CI = 0.63–0.99, p = 0.048 ). In renal function progression, more patients with CRS entered ESRD with digoxin usage (sHR = 1.34; 95% CI = 1.16–1.54, p & lt; 0.001 ). There was a significantly greater incidence of ESRD in the & lt; 0.26 DDD and 0.26 – 0.75 DDD subgroups of digoxin users (sHR = 1.32; 95% CI = 1.06–1.66, p = 0.015 ; sHR = 1.44; 95% CI = 1.18–1.75; p for trend & lt; 0.001 ). Conclusion Digoxin should be prescribed with caution to patients with CRS.
    Type of Medium: Online Resource
    ISSN: 2296-2565
    URL: Article
    DOI: 10.3389/fpubh.2022.1074017
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2023
    detail.hit.zdb_id: 2711781-9
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  • 10
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    HDAC2 and HDAC5 Up-Regulations Modulate Survivin and miR-125a-5p Expressions and Promote Hormone Therapy Resistance in Estrogen Receptor Positive Breast Cancer Cells
    Frontiers Media SA ; 2017
    In:  Frontiers in Pharmacology Vol. 8 ( 2017-12-13)
    Details
    In: Frontiers in Pharmacology, Frontiers Media SA, Vol. 8 ( 2017-12-13)
    Type of Medium: Online Resource
    ISSN: 1663-9812
    URL: Article
    DOI: 10.3389/fphar.2017.00902
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2017
    detail.hit.zdb_id: 2587355-6
    SSG: 15,3
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