Chih-Hung Wang’s research while affiliated with National Taiwan University and other places

Twelve-lead electrocardiogram (ECG) may provide prognostic information for in-hospital cardiac arrest (IHCA). This study aimed to identify post-arrest ECG features and their temporal changes associated with IHCA outcomes. This single-center retrospective study included patients experiencing IHCA between 2005 and 2022. Post-arrest ECGs were obtained within 48 h after an IHCA, admission ECGs upon hospital admission, and pre-arrest ECGs within 72 h before an IHCA. Multivariable logistic regression analyses were conducted to identify ECG features associated with neurologically intact survival. A total of 708 patients were included, with 131 (18.5%) achieving neurologically intact survival. The median age was 70.4 years (interquartile range: 59.2–82.6), and 362 (62.7%) patients were male. Four post-arrest ECG features were associated with survival: sinus rhythm (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.11–2.93), QRS duration between 80 and 120 ms (OR: 1.91, 95% CI 1.19–3.08), low QRS voltage (OR: 0.50, 95% CI 0.25–0.99), and prolonged QTc (OR: 1.89, 95% CI 1.08–3.28). Comparing with admission ECGs, new-onset right bundle branch block (OR: 0.39, 95% CI 0.16–0.95) and increases in the number of leads with ST depression (OR: 0.85, 95% CI 0.77–0.94) on post-arrest ECGs were inversely associated with survival. Compared with pre-arrest ECGs, increases in the number of leads with ST depression (OR: 0.91, 95% CI 0.88–0.96) on post-arrest ECGs were also inversely associated with survival. Post-arrest ECGs may serve as a valuable prognostic tool for IHCA. Further exploration is warranted to determine whether incorporating these ECG features can enhance the performance of prediction models for IHCA outcomes.

Background Compared to the microscopic approach (MA), the endoscopic approach (EA) is more challenging for the removal of cholesteatomas and reconstruction of the ossicle chain and canal wall. We presented a surgical technique for rebuilding the canal wall and ossicle chain with tragal cartilage/perichondrium composite grafts in the resection of cholesteatomas under EA. Methods This retrospective study consisted of 24 cases undergoing EA (EA group) for cholesteatomas destroying the ossicles and 28 cases undergoing MA (MA group). The aim of this study was to analyze the outcome of ossiculoplasty, the stability of the reconstructed canal wall and the recurrence rate of cholesteatoma in EA group. The postoperative outcomes between TEA and MA groups were compared. Results In EA subgroup with an intact stapes superstructure, the pre- and postoperative air conduction (AC) thresholds and pre- and postoperative air-bone gap (ABG) were 42 ± 13.0, 37 ± 13.7, 23 ± 13.9 and 18 ± 14.8 dB, respectively. AC thresholds and ABG were significantly improved after the operation ( p =0.003 and p =0.004, respectively). Gain in AC thresholds was 7.2 ± 11.1 dB in EA group and 1.6 ± 14.5 dB in MA group. There was no significant difference in the gain between two groups ( p = 0.615). In EA group, two cases suffered cholesteatoma recurrence, with a recurrence rate of 8.3%. The recurrence rate was 10.7% in MA group. There was no significant difference in the recurrence rate between two groups ( p = 0.772). Conclusion Our endoscopic method had a comparable result to MA in the treatment of cholesteatomas involving the ossicle. The technique has the advantage of leaving both a smaller surgical wound and an invisible scar. The composite graft can be easily modified for reconstruction of canal wall defects and ossiculoplasty. Patients with an intact stapes superstructure had better hearing outcomes.

Background: New-onset atrial fibrillation (AF) is associated with an increased risk of stroke in hospitalized patients with severe sepsis. Post-cardiac arrest patients experience conditions similar to sepsis. This study investigated whether pre-arrest AF is associated with poor neurological recovery following in-hospital cardiac arrest (IHCA). Methods: This single-centre retrospective study included patients experiencing IHCA between 2005 and 2020. Pre-arrest electrocardiograms (ECGs) were reviewed, including twelve-lead ECGs and ECG strips. New-onset AF was defined as AF absent on electronic health records (EHRs, including admission diagnosis, past medical history and hospitalization notes) but present on pre-arrest ECG. Without considering EHRs, AF-presence was defined as AF present on pre-arrest ECG. Results: A total of 2466 patients were included, including 93 (3.8%) with new-onset AF and 131 (5.3%) with evidence of AF on pre-arrest ECG. The median age was 67.6 (interquartile range [IQR]: 22.3) years and the median CHA₂DS₂-VASc score was 3.0 (IQR: 3.0). A total of 405 (16.4%) patients survived to hospital discharge, with 228 (9.2%) patients achieving favourable neurological recovery. Multivariable logistic regression analysis indicated that both new-onset AF (odds ratio [OR]: .34, 95% confidence interval [CI]: .12-.94, p-value: .04) and AF-presence (OR: .35, 95% CI: .15-.85, p-value: .02) were inversely associated with favourable neurological recovery in the primary and sensitivity analyses, respectively. Conclusions: Pre-arrest AF is a significant risk factor for poor neurological recovery following IHCA. Further research is needed to understand the underlying mechanisms, which could inform the development of strategies to improve outcomes in this patient subgroup.

Introduction: The military population is one of the high-risk groups for acute hearing loss. This retrospective study aims to examine acute acoustic trauma (AAT) and idiopathic sudden sensorineural hearing loss (ISSNHL) among military personnel. Materials and Methods: A total of 111 cases of acute hearing loss from a tertiary hospital between 2009 and 2021 were divided into AAT (53 cases) and ISSNHL (58 cases) groups. The time interval between trauma and treatment initiation, accompanying symptoms, and hearing thresholds before and after treatment were examined for all cases. Results: Two-thirds of the AAT group participants experienced damage to the left ear, and all individuals in this group presented with tinnitus at the time of trauma, but vertigo was less common in the AAT group than in the ISSNHL group. Hearing improvement after treatment was significant in both groups. An intergroup comparison of post-treatment hearing recovery revealed that prognosis was primarily determined by the initial severity of hearing loss rather than the underlying condition of AAT or ISSNHL. Conclusions: This finding emphasizes the importance of prompt and aggressive treatment in severe cases and the need for tailored strategies within military healthcare systems to improve hearing outcomes.

This article examines the transformation of Arbor Day in postwar Taiwan, focusing on how it has been used to relocate the imaginary nation—shifting from associations with mainland China toward alignment with the island-based regime in Taiwan. Using the framework of performance politics, we analyze how Arbor Day serves as a contested arena where various social actors—ranging from the central government and local authorities to civil society—compete to reassemble the mise-en-scène of nature. We argue that performative acts from these different sectors collectively distance Arbor Day from its early reliance on the mainland-oriented Founding Father narrative, redirecting attention toward localized concerns such as urban greening, environmental conservation, and urban governance. In this process, a “relocated” nation gradually emerges as the imagined setting of Arbor Day, reflecting Taiwan's shifting national identity. While Arbor Day continues to express nationalism, what changes over time is the scale of the nation these performances seek to address at different historical moments and for various purposes.

Cisplatin-induced ototoxicity occurs in approximately half of patients treated with cisplatin, and pediatric patients are more likely to be affected than adults. The oxidative stress elicited by cisplatin is a key contributor to the pathogenesis of ototoxicity. Notoginsenoside R1 (NGR1), the main bioactive compound of Panax notoginseng saponins, has antioxidant and antiapoptotic effects. This study investigated the ability of NGR1 to protect against cisplatin-induced damage in auditory HEI-OC1 cells and neonatal murine cochlear explants. The viability of HEI-OC1 cells treated with NGR1 and cisplatin was greater than that of cells treated with cisplatin alone. The results of Western blots and immunostaining for cleaved caspase-3 revealed that the level of cleaved caspase-3 in the cells treated with cisplatin was repressed by NGR1. NGR1 attenuated cisplatin-induced cytotoxicity in HEI-OC1 cells. Intracellular reactive oxygen species (ROS) were detected with a DCFDA assay and immunostaining for 4-HNE. The result revealed that its expression was induced by cisplatin and was significantly reduced by NGR1. Moreover, NGR1 can promote heme oxygenase-1 (HO-1) expression at both the mRNA and protein levels. ZNPPIX, an HO-1 inhibitor, was administered to cisplatin-treated cells to investigate the role of HO-1 in the protective effect of NGR1. The suppression of HO-1 activity by ZNPPIX markedly abolished the protective effect of NGR1 on cisplatin-treated cells. Therefore, NGR1 protects cells from cisplatin-induced damage by activating HO-1 and its antioxidative activity. In cochlear explants, NGR1 protects cochlear hair cells and attenuates cisplatin-induced ototoxicity by inhibiting ROS generation. In the group treated with cisplatin alone, prominent loss of outer hair cells and severe damage to the structure of the stereociliary bundles of inner and outer hair cells were observed. Compared with the group treated with cisplatin alone, less loss of outer hair cells (p = 0.009) and better preservation of the stereociliary bundles of hair cells were observed in the group treated with cisplatin and NGR1. In conclusion, these findings indicate that NGR1 can protect against cisplatin-induced ototoxicity by inducing HO-1 expression and suppressing oxidative stress.

The Taiwan Precision Medicine Initiative (TPMI), a project initiated by the Academia Sinica in collaboration with 16 major medical centers around Taiwan, has recruited 565,390 participants who consented to provide DNA samples for genetic profiling and grant access to their electronic medical records (EMR) for studies to develop precision medicine. Access to the EMR is both retrospective and prospective, allowing researchers to conduct prospective studies over time. Genetic profiling is done with population-optimized SNP arrays for the Han Chinese populations that enable genetic analyses such as genome-wide association, phenome-wide association, and polygenic risk score studies to evaluate common disease risk and pharmacogenetic response. Furthermore, the TPMI participants agree to be contacted for future research opportunities related to their genetic risks and receive personalized genetic risk profiles with health management recommendations. TPMI has established the TPMI Data Access Platform (TDAP), a central database and analysis platform that both safeguards the security of the data and facilitates academic research. The TPMI is the largest non-European cohort that merges genetic profiles with EMR in the world. With a cohort that can be followed over time, it can be utilized to validate genetic risk prediction models, conduct clinical trials to show the efficacy of risk-based health management, and optimize health policies based on genetic risks. In this report, we describe the TPMI study design, the population and genetic characteristics of the TPMI cohort, and the power it provides to conduct crucial studies in developing precision medicine on a population and personal level. As Han Chinese represent almost 20% of the world's population, the results of TPMI studies will benefit >1.4 billion people around the world and serve as a model for developing population-based precision medicine.

Background The aim of this study was to validate and compare the performance of statistical (Utstein‐Based Return of Spontaneous Circulation and Shockable Rhythm–Witness–Age–pH) and machine learning–based (Prehospital Return of Spontaneous Circulation and Swedish Cardiac Arrest Risk Score) models in predicting the outcomes following out‐of‐hospital cardiac arrest and to assess the impact of the COVID‐19 pandemic on the models' performance. Methods and Results This retrospective analysis included adult patients with out‐of‐hospital cardiac arrest treated at 3 academic hospitals between 2015 and 2023. The primary outcome was neurological outcomes at hospital discharge. Patients were divided into pre‐ (2015–2019) and post‐2020 (2020–2023) subgroups to examine the effect of the COVID‐19 pandemic on out‐of‐hospital cardiac arrest outcome prediction. The models' performance was evaluated using the area under the receiver operating characteristic curve and compared by the DeLong test. The analysis included 2161 patients, 1241 (57.4%) of whom were resuscitated after 2020. The cohort had a median age of 69.2 years, and 1399 patients (64.7%) were men. Overall, 69 patients (3.2%) had neurologically intact survival. The area under the receiver operating characteristic curves for predicting neurological outcomes were 0.85 (95% CI, 0.83–0.87) for the Utstein‐Based Return of Spontaneous Circulation score, 0.82 (95% CI, 0.81–0.84) for the Shockable Rhythm–Witness–Age–pH score, 0.79 (95% CI, 0.78–0.81) for the Prehospital Return of Spontaneous Circulation score, and 0.79 (95% CI, 0.77–0.81) for the Swedish Cardiac Arrest Risk Score model. The Utstein‐Based Return of Spontaneous Circulation score significantly outperformed both the Prehospital Return of Spontaneous Circulation score ( P <0.001) and the Swedish Cardiac Arrest Risk Score model ( P =0.007). Subgroup analysis indicated no significant difference in predictive performance for patients resuscitated before versus after 2020. Conclusions In this external validation, both statistical and machine learning–based models demonstrated excellent and fair performance, respectively, in predicting neurological outcomes despite different model architectures. The predictive performance of all evaluated clinical scoring systems was not significantly influenced by the COVID‐19 pandemic.