ORCID Profile
0000-0002-1151-1047
Current Organisations
Vanderbilt University Medical Center
,
National Yang Ming Chiao Tung University
,
Taipei Veterans General Hospital
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Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.ATHEROSCLEROSIS.2021.11.028
Abstract: The high false-positive rate of the treadmill exercise test (TET) may lead to unnecessary invasive coronary angiography. We aimed to develop a machine learning-based algorithm to improve the diagnostic performance of TET. Study included 2325 patients who underwent TET and subsequent coronary angiography within one-year interval. The mean age was 58.7 (48.1-69.3) years, 1731 (74.5%) were male, 1858 (79.9%) had positive TET result, and 812 (34.9%) had obstructive coronary artery disease (≥70% stenosis in at least one vessel). The study population were randomly ided into training (70%) and testing (30%) groups for algorithm development. A total of 93 features, including exercise performance, hemodynamics and ST-segment changes were extracted from the TET results. Clinical features included comorbidity, smoking, height, weight, and Framingham risk score. Support vector machine, logistic regression, random forest, k-nearest neighbor and extreme gradient boosting machine learning algorithms were used to build the predictive models. The performance of each model was compared with that of conventional TET. Four of the five models exhibited comparable diagnostic performance and were better than conventional TET. The random forest algorithm had an area under the curve (AUC) of 0.73. When used with clinical features, the AUC improved to 0.74. The major advantage of the algorithm is the reduction of the false-positive rate compared with conventional TET (55% vs. 76.3%, respectively), while maintaining comparable sensitivity (85%). Using the information obtained from conventional TET, a more accurate diagnosis can be made by incorporating an artificial intelligence-based model.
Publisher: Wiley
Date: 09-2022
DOI: 10.1111/JCH.14562
Abstract: Hypertension‐related death is the leading cause of mortality worldwide, making blood pressure (BP) control an important issue. Salt substitute is a non‐pharmaceutical strategy to improve hypertension control. The goal of this study was to evaluate the effect of salt substitute on BP and cardiovascular disease. The authors searched the Cochrane Library and PubMed databases through March 2022, and assessed the risk‐of‐bias for included studies by the Cochrane risk‐of‐bias tool. Twenty‐three randomized controlled trials with 32073 patients were included in our systematic review. A meta‐analysis with random effects was performed to analyze the effects of salt substitute on systolic and diastolic BP, 24‐h urinary sodium and potassium, and cardiovascular and all‐cause mortality. In the random‐effects model, participants consuming salt substitute showed significant reduction in systolic BP (mean difference (MD) −4.80 mmHg, 95% confidence interval (CI) −6.12 to −3.48, P 0.0001) and diastolic BP (MD −1.48 mmHg, 95% CI −2.06 to −0.90, P 0.0001) compared with participants consuming normal salt. In the urine electrolyte analysis, the salt substitute group had significant reduction in 24‐h urine sodium (MD −22.96 mmol/24‐h, P = 0.0001) and significant elevation in 24‐h urine potassium (MD 14.41 mmol/24‐h, P 0.0001). Of the five studies with mortality outcome data, salt substitute significantly reduced all‐cause mortality (hazard ratio 0.88, P = 0.0003). In conclusion, our analyses showed that salt substitute has a strong effect on lowering BP and reducing all‐cause mortality. By modifying the daily diet with salt substitute, the authors can improve BP control by using this non‐pharmaceutical management.
Publisher: The Endocrine Society
Date: 12-05-2023
Abstract: Clinical trials have investigated the role of antiresorptive agents, including bisphosphonates and denosumab, in patients with primary breast cancer receiving adjuvant endocrine therapy, aiming for better bone protection and/or improving survival. To summarize the clinical effects of antiresorptive agents in patients with early breast cancer receiving endocrine therapy. We systematically reviewed and synthesized the clinical benefits and harms of antiresorptive agents in patients with early breast cancer receiving endocrine therapy by calculating the risk ratios (RRs). In the pooled meta-analysis, antiresorptive agents had significant clinical benefits on disease recurrence (RR 0.78, 95% CI 0.67-0.90) and locoregional recurrence (RR 0.69, 95% CI 0.49-0.95) in patients with breast cancer receiving endocrine therapy. Early use of antiresorptive agents has a beneficial effect on secondary endocrine therapy resistance instead of primary resistance. Safety analysis revealed that potential risk for osteonecrosis of the jaw (ONJ, RR 3.29, 95% CI 1.12-9.68) with antiresorptive agents however, there is an insignificant difference in arthralgia. The subgroup analyses revealed that intervention with bisphosphonates might have profound clinical benefits, but also increased the occurrence of ONJ. A network meta-analysis further supported the clinical effects of early antiresorptive agent use compared with delayed use or placebo. Using antiresorptive agents early in patients with breast cancer receiving adjuvant endocrine therapy may provide additional benefits in risk reduction of recurrence, but there is a potential risk of ONJ.
Location: United States of America
Location: Taiwan, Province of China
No related grants have been discovered for Chern-En Chiang.