Hsuan-Hung Lin

Semi-Automatic Segmentation and Classification of Pap Smear Cells

Cytologic screening has been widely used for detecting the cervical cancers. In this study, a semiautomatic PC-based cellular image analysis system was developed for segmenting nuclear and cytoplasmic contours and for computing morphometric and textual features to train support vector machine (SVM) classifiers to classify four different types of cells and to discriminate dysplastic from normal cells. A software program incorporating function, including image reviewing and standardized denomination of file names, was also designed to facilitate and standardize the workflow of cell analyses. Two experiments were conducted to verify the classification performance. The cross-validation results of the first experiment showed that average accuracies of 97.16% and 98.83%, respectively, for differentiating four different types of cells and in discriminating dysplastic from normal cells have been achieved using salient features (8 for four-cluster and 7 for two-cluster classifiers) selected with SVM recursive feature addition. In the second experiment, 70% (837) of the cell images were used for training and 30% (361) for testing, achieving an accuracy of 96.12% and 98.61% for four-cluster and two-cluster classifiers, respectively. The proposed system provides a feasible and effective tool in evaluating cytologic specimens.

Construction of prediction module for successful ventilator weaning

Ventilator weaning is the process of discontinuing mechanical ventilation from patients with respiratory failure. Previous investigations reported that 39%-40% of the intensive care unit (ICU) patients need mechanical ventilator for sustaining their lives. Among them, 90% of the patients can be weaned from the ventilator in several days while other 5%-15% of the patients need longer ventilator support. Modern mechanical ventilators are believed to be invaluable tools for stabilizing the condition of patients in respiratory failure. However, ventilator support should be withdrawn promptly when no longer necessary so as to reduce the likelihood of known nosocomial complications and costs. Although successful ventilator weaning of ICU patients has been widely studied, indicators for accurate prediction are still under investigation. Furthermore, the predication rate of successful weaning is only 35-60% based on previous studies. It is desirable to have objective measurements and predictors of weaning that decrease the dependence on the wisdom and skill of an individual physician. However, one study showed that clinicians were often wrong when predicting weaning outcome. In this study, 189 patients, who had been supported by mechanical ventilation for longer than 21 days and were clinically stable were recruited from our all-purpose ICUs. Twenty-seven variables in total were recorded, while only 8 variables which reached significant level were used for support vector machine (SVM) classification after logistic regression analysis. The result shows that the successful prediction rate achieves as high as 81.5% which outperforms a recently published predictor (78.6%) using combination of sample entropy of three variables, inspiratory tidal volume, expiratory tidal volume, and respiration rate.

Gout and a Subsequent Increased Risk of Erectile Dysfunction in Men Aged 64 and Under: A Nationwide Cohort Study in Taiwan.

Objective. Few studies have examined the relationship between gout and erectile dysfunction (ED). We investigated whether patients with gout exhibited an increased risk of ED. Methods. This longitudinal nationwide cohort study investigated the incidence and risk of ED in 19,368 men with gout who were newly diagnosed between January 2002 and December 2008. A total of 77,472 controls without gout were randomly selected from the general population and frequency-matched according to age and sex. The patients were followed up from the date on which they were included in the study cohort to the date of an ED event, censoring, or December 31, 2010. We conducted the Cox proportional hazard model to estimate the effects of gout on ED risk including age and comorbidities. Results. The gout cohort exhibited a 1.21-fold adjusted HR of subsequent ED development compared with the non-gout cohort (95% CI 1.03–1.44). The incidence of ED increased with age in both cohorts and was higher among the patients in the gout cohort than among those in the non-gout cohort. Compared to the patients without gout and comorbidities, the patients with both gout and any type of comorbidity exhibited a 2.04-fold risk of developing ED (95% CI 1.63–2.57). Further, the patients with gout who had numerous comorbidities exhibited the dose-response effect in developing ED. Conclusion. This nationwide cohort study revealed that ED risk is significantly higher in patients with gout than in the general population.

Digital content development of taiwanese folklore artifacts

Folklore artifacts hold strong cultural meaning for a people. Taiwan Folklore Museum (TFM) is Taiwans first official folklore museum which aims at providing the people of Taiwan with a place where they can reflect about the past and experience how the pioneers lived. There are a great variety of artifacts, which were classified into ten categories according to their life styles and functions, collected in the museum and it attracts a great number of oversea tourists each year. The museum is also the most popular place for students from kindergartens and primary schools and for general citizens to learn what their tradition is and how their ancestors lived. In this paper, we report our current progress in digitization and content development of the artifacts. Totally 1412 collected artifacts have been digitized so far. The originality and function of each collected artifact was described in three different languages, including Chinese, Japanese, and English, in which detailed information of the artifacts were examined and studied by several Taiwanese folklore specialists. To facilitate inter-museum communication, metadata based on Dublin core and its extensions were provided as well. A website (http://www.folkpark.org.tw) dedicated to demonstrate the digital contents of the artifacts and to support digital surrogates for the folklore researchers was also constructed. It allows people from all over the world to surrogate the information about the collected artifacts so that studies regarding Taiwanese folklore artifacts can be done without territory constraint. Future works will focus on the construction of 3D models for the artifacts on demonstrating their global views. E-learning contents for Taiwanese folklore courses will also be authored for providing general publics and children an interactive way of learning on the Internet.

A digital library for preservation of folklore crafts, skills, and rituals and its role in folklore education

The importance of folklore can be manifested by Alan Jabbours speech in the 100th anniversary of American Folklore Society-“folklore reflects on the ancestral missions that have shapes us, the inherited values that we reflect and must radiate into the future”. Currently, most of the digital preservation projects focus mainly on digitizing artifacts, in which the crafts of how to make them and skills of how to use them are neglected. Besides, folklore and religious rituals embed spiritual meanings. Step-by-step procedure of a ritual is not trivial for a people or a religion. The motivation of this project are manifested in three aspects: (1) folklore crafts, skills, and rituals play the same important roles in preserving our ancestors wisdom in addition to folklore artifacts; (2) media richness facilitates learning of courses with high uncertainty and equivocality; and (3) e-learning with interactive videos gains more learner satisfaction than non-interactive and traditional classroom learning according to recent studies. In this paper, video clips are used for recording step-by-step crafts, skills, and rituals. The metadata used here are modified from our previous work regarding digital preservation of Taiwanese folklore artifacts by emphasizing the “Relation” element in linking individual steps together. A website served as an extension to digital library of folklore artifacts has been constructed to be used as an e-learning platform for folklore education in obligatory and higher education. The system not only constructs a digital library for folklore preservation but provides instructional interactive materials with media richness to support a more effective method for folklore education than non-interactive or traditional classroom learning.

Bronchiectasis and increased risk of ischemic stroke: a nationwide population-based cohort study

Background Bronchiectasis is characterized by permanent dilatation of the bronchial tree caused by recurrent airway infection and inflammation. The association of atherosclerosis and inflammation is well established. However, studies on the relationship between bronchiectasis and stroke are scant. Objective We conducted a population-based cohort study to investigate the incidence and risk of ischemic stroke in patients with bronchiectasis. Methods Data of 1,295 patients newly diagnosed as bronchiectasis between 2000 and 2008 were retrieved from the Taiwan National Health Insurance Research Database. A total of 6,475 controls without bronchiectasis at a ratio of 5:1 were randomly selected from the general population based on frequency-matched age and sex to the patients. All participants were followed up to the date of ischemic stroke development, censoring, or the end of 2010. The Cox proportional hazard model was used to identify the risk of ischemic stroke in patients with bronchiectasis compared with those without bronchiectasis. Results The patients with bronchiectasis exhibited a higher incidence rate of ischemic stroke (9.18 vs 4.66 per 1,000 person-years) than the patients without bronchiectasis, with an adjusted hazard ratio of 1.74 (95% confidence interval =1.28–2.35). The patients with bronchiectasis and any comorbidities exhibited a 2.66-fold adjusted hazard ratio of ischemic stroke compared with those with neither bronchiectasis nor comorbidity (95% confidence interval =1.85–3.84). The patients with bronchiectasis carried a dose response of ischemic stroke according to the number of emergency visits and hospitalizations per year. Conclusion This study indicated that bronchiectasis is an independent risk factor of ischemic stroke.

Digital Content Development of Folklore Artifacts and Activities for Folklore Education

Digital preservation of museum artifacts has been widely promoted by governments around the world in recent years. However, the artifacts collected by national or local museums are not very exhaustive. Recently, the collected folklore artifacts accompanied with crafts in how to make them and skills and rituals in how to use them have been digitized in Taiwanese Folklore Museum. In order to supplement insufficiency of artifacts collected by the museum, folklore hobbyists are regularly invited to demonstrate their private collections. At the mean time, the task force of digital preservation team digitizes the artifacts for extending its contents. Another way to aggressively increase the number of digitized contents is to sign cooperation agreements with members of the folklore associations by giving services to digitize their personal collections. After having extended the digital contents, we expect that the website of Taiwanese Folklore Museum will become even more popular for teachers and students, especially in kindergartens and elementary schools, to extract and prepare useful materials for folklore education. In conclusion, the paper presents the digital contents which include folklore artifacts and folklore activities developed in Taiwan Folklore Museum. Additionally, other digital contents developed in other museums or personal collectors can be retrieved by using XML technique. The scheme supplements the insufficiency of national or local museums and provides inter-museum architecture for supporting more complete contents for folklore education.

Disulfide connectivity prediction based on structural information without a prior knowledge of the bonding state of cysteines

Previous studies predicted the disulfide bonding patterns of cysteines using a prior knowledge of their bonding states. In this study, we propose a method that is based on the ensemble support vector machine (SVM), with the structural features of cysteines extracted without any prior knowledge of their bonding states. This method is useful for improving the predictive performance of disulfide bonding patterns. For comparison, the proposed method was tested with the same dataset SPX that was adopted in previous studies. The experimental results demonstrate that bridge classification and disulfide connectivity predictions achieve 96.5% and 89.2% accuracy, respectively, using the ensemble SVM model, which outperforms the traditional method (51.5% and 51.0%, respectively) and the model that is based on a single-kernel SVM classifier (94.6% and 84.4%, respectively). For protein chain and residue classifications, the sensitivity, specificity, and accuracy of ensemble and single-kernel SVM approaches are better than those of the traditional methods. The predictive performances of the ensemble SVM and single-kernel models are identical, indicating that the ensemble model can converge to the single-kernel model for some applications.

Somatoform disorder as a predictor of interstitial cystitis/bladder pain syndrome: Evidence from a nested case-control study and a retrospective cohort study

Abstract Interstitial cystitis/bladder pain syndrome (IC/BPS) has several well-known comorbid psychiatric manifestations, including insomnia, anxiety, and depression. We hypothesized that somatoform disorder, which is a psychosomatic disease, can be used as a sensitive psychiatric phenotype of IC/BPS. We investigated whether somatoform disorder increases the risk of IC/BPS. A nested case-control study and a retrospective cohort study were followed up over a 12-year period (2002–2013) in the Taiwan Health Insurance Reimbursement Database. In the nested case-control study, 1612 patients with IC/BPS were matched in a 1:2 ratio to 3224 controls based on propensity scores. The odds ratio for somatoform disorder was calculated using conditional logistic regression analysis. In the retrospective cohort study, 1436 patients with somatoform disorder were matched in a 1:2 ratio to 2872 patients with nonsomatoform disorder based on propensity scores. Cox regression analysis was used to estimate the hazard ratio associated with the development of IC/BPS in patients with somatoform disorder, and the cumulative survival probability was tested using the Kaplan–Meier analysis. We found that the odds ratio for somatoform disorder was 2.46 (95% confidence interval [CI], 1.05–5.76). Although the average time until IC/BPS development in the control subjects was 11.5 ± 1.3 years, this interval was shorter in patients with somatoform disorder (6.3 ± 3.6 years). The hazard ratio for developing IC/BPS was 2.50 (95% CI 1.23–5.58); the adjusted hazard ratio was 2.26 (95% CI 1.002–5.007). The patients and controls also differed significantly in their cumulative survival probability for IC/BPS (log rank P < .05). Evidence from the nested case-control study and retrospective cohort study consistently indicated that somatoform disorder increases the risk for IC/BPS. Our study suggests that somatoform disorder can be used as a sensitive psychiatric phenotype to predict IC/BPS. Any past history of somatoform disorder should be documented while examining patients with IC/BPS.

Somatic symptoms are sensitive in predicting interstitial cystitis/bladder pain syndrome: A nationwide cohort study

Objectives Somatic symptoms are somatic complaints accompanied by disproportionate thoughts, feelings, and behaviors related to such symptoms. The study investigated five International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses hallmarked by somatic symptoms. The study hypothesized an increased risk of interstitial cystitis/bladder pain syndrome in patients with somatic symptoms. Methods The raw data were obtained from a nationwide health insurance reimbursement database over a 12-year period from 2002 to 2013. The study followed a somatic symptoms cohort (n = 34,393) and non-somatic symptoms cohort (n = 637,999) for interstitial cystitis/bladder pain syndrome. Both cohorts were stratified into three subgroups based on propensity scores calculated by sex, age, and 17 comorbidities of interstitial cystitis/bladder pain syndrome. Results The incidence density of interstitial cystitis/bladder pain syndrome between the somatic symptoms cohort and non-somatic symptoms cohort was significantly different in the three subgroups (relative ratio [95% confidence interval], 2.14 [1.01, 4.53], 1.52 [1.47, 1.57], and 1.59 [1.28, 1.98], respectively). The adjusted hazard ratio for interstitial cystitis/bladder pain syndrome was significantly greater in the female-dominant and older age subgroups—subgroup 2 and subgroup 3 (adjusted hazard ratios, 1.47 [1.07, 2.01] and 1.72 [1.38, 2.16], respectively). Conclusion The longitudinal investigation identified a subsequent risk of interstitial cystitis/bladder pain syndrome in patients with somatic symptoms. Somatic symptoms might be linked to biological pathways that might increase the risk of interstitial cystitis/bladder pain syndrome, much like more traditional psychosocial factors.