107 results on '"Eric Wu"'
Search Results
2. A hierarchical multilabel graph attention network method to predict the deterioration paths of chronic hepatitis B patients
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Zejian (Eric) Wu, Da Xu, Paul Jen-Hwa Hu, and Ting-Shuo Huang
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Health Informatics - Abstract
Objective Estimating the deterioration paths of chronic hepatitis B (CHB) patients is critical for physicians’ decisions and patient management. A novel, hierarchical multilabel graph attention-based method aims to predict patient deterioration paths more effectively. Applied to a CHB patient data set, it offers strong predictive utilities and clinical value. Materials and Methods The proposed method incorporates patients’ responses to medications, diagnosis event sequences, and outcome dependencies to estimate deterioration paths. From the electronic health records maintained by a major healthcare organization in Taiwan, we collect clinical data about 177 959 patients diagnosed with hepatitis B virus infection. We use this sample to evaluate the proposed method’s predictive efficacy relative to 9 existing methods, as measured by precision, recall, F-measure, and area under the curve (AUC). Results We use 20% of the sample as holdouts to test each method’s prediction performance. The results indicate that our method consistently and significantly outperforms all benchmark methods. It attains the highest AUC, with a 4.8% improvement over the best-performing benchmark, as well as 20.9% and 11.4% improvements in precision and F-measures, respectively. The comparative results demonstrate that our method is more effective for predicting CHB patients’ deterioration paths than existing predictive methods. Discussion and Conclusion The proposed method underscores the value of patient-medication interactions, temporal sequential patterns of distinct diagnosis, and patient outcome dependencies for capturing dynamics that underpin patient deterioration over time. Its efficacious estimates grant physicians a more holistic view of patient progressions and can enhance their clinical decision-making and patient management.
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- 2023
3. Graph deep learning for the characterization of tumour microenvironments from spatial protein profiles in tissue specimens
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Zhenqin Wu, Alexandro E. Trevino, Eric Wu, Kyle Swanson, Honesty J. Kim, H. Blaize D’Angio, Ryan Preska, Gregory W. Charville, Piero D. Dalerba, Ann Marie Egloff, Ravindra Uppaluri, Umamaheswar Duvvuri, Aaron T. Mayer, and James Zou
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Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,Computer Science Applications ,Biotechnology - Published
- 2022
4. 7-UP: generating in silico CODEX from a small set of immunofluorescence markers
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Eric Wu, Alexandro E Trevino, Zhenqin Wu, Kyle Swanson, Honesty J Kim, H Blaize D’Angio, Ryan Preska, Aaron E Chiou, Gregory W Charville, Piero Dalerba, Umamaheswar Duvvuri, Alexander D Colevas, Jelena Levi, Nikita Bedi, Serena Chang, John Sunwoo, Ann Marie Egloff, Ravindra Uppaluri, Aaron T Mayer, and James Zou
- Abstract
Multiplex immunofluorescence (mIF) assays multiple protein biomarkers on a single tissue section. Recently, high-plex CODEX (co-detection by indexing) systems enable simultaneous imaging of 40+ protein biomarkers, unlocking more detailed molecular phenotyping, leading to richer insights into cellular interactions and disease. However, high-plex data can be slower and more costly to collect, limiting its applications, especially in clinical settings. We propose a machine learning framework, 7-UP, that can computationally generate in silico 40-plex CODEX at single-cell resolution from a standard 7-plex mIF panel by leveraging cellular morphology. We demonstrate the usefulness of the imputed biomarkers in accurately classifying cell types and predicting patient survival outcomes. Furthermore, 7-UP’s imputations generalize well across samples from different clinical sites and cancer types. 7-UP opens the possibility of in silico CODEX, making insights from high-plex mIF more widely available.
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- 2023
5. Real-world Outcomes Associated With Poly(ADP-ribose) Polymerase Inhibitor Monotherapy Maintenance in Patients With Primary Advanced Ovarian Cancer
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John K. Chan, Jinan Liu, Jinlin Song, Cheryl Xiang, Eric Wu, Linda Kalilani, Jean A. Hurteau, and Premal H. Thaker
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Cancer Research ,Oncology - Published
- 2023
6. Leveraging Physiology and Artificial Intelligence to Deliver Advancements in Healthcare
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Angela Zhang, Zhenquin Wu, Eric Wu, Matthew Wu, Michael P. Snyder, James Zou, and Joseph C. Wu
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Physiology ,Physiology (medical) ,General Medicine ,Molecular Biology - Abstract
Artificial Intelligence (AI) in healthcare has generated remarkable innovation and progress in the last decade. Significant advancements can be attributed to the utilization of AI to transform physiology data to advance healthcare. In this review, we will explore how past work has shaped the field and defined future challenges and directions. In particular, we focus on three areas of development. First, we give an overview of AI, with special attention to the most relevant AI models. We then detail how physiology data has been harnessed by AI to advance the main areas of healthcare such as automating existing healthcare tasks, increasing access to care, and augmenting healthcare capabilities. Finally, we discuss emerging concerns surrounding the use of individual physiology data and detail an increasingly important consideration for the field, namely the challenges of deploying AI models to achieve meaningful clinical impact.
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- 2023
7. A comprehensive evaluation of hemodynamic energy production and circuit loss using four different <scp>ECMO</scp> arterial cannulae
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Silver Heinsar, Nicole Bartnikowski, Gunter Hartel, Samia M. Farah, E‐Peng Seah, Eric Wu, Sebastiano Maria Colombo, Clayton Semenzin, Andrew Haymet, Indrek Rätsep, Jo Pauls, John F. Fraser, and Jacky Y. Suen
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Biomaterials ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,General Medicine - Published
- 2023
8. The application of in-office aligners in the combination treatment protocol
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Eric Wu
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Orthodontics - Published
- 2022
9. HSR22-154: Treatment Patterns Following Osimertinib Discontinuation in Patients With EGFR Mutated Metastatic NSCLC
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Elizabeth Marrett, Winghan Jacqueline Kwong, Jinlin Song, Ameur M. Manceur, Selvam Sendhil, and Eric Wu
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Oncology - Published
- 2022
10. Outcomes of laparoscopic, robotic, and open pancreatoduodenectomy: A network meta-analysis of randomized controlled trials and propensity-score matched studies
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Eric Wu, Tousif Kabir, Brian K. P. Goh, Juinn Huar Kam, Hwee Leong Tan, and Nicholas Syn
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medicine.medical_specialty ,Network Meta-Analysis ,Operative Time ,Blood Loss, Surgical ,Pancreaticoduodenectomy ,law.invention ,Postoperative Complications ,Robotic Surgical Procedures ,Blood loss ,Randomized controlled trial ,law ,medicine ,Humans ,Propensity Score ,Randomized Controlled Trials as Topic ,Surgical approach ,Gastric emptying ,business.industry ,Odds ratio ,Perioperative ,Length of Stay ,Surgery ,Meta-analysis ,Propensity score matching ,Laparoscopy ,business - Abstract
Background This network meta-analysis was performed to determine the optimal surgical approach for pancreatoduodenectomy by comparing outcomes after laparoscopic pancreatoduodenectomy, robotic pancreatoduodenectomy and open pancreatoduodenectomy. Methods A systematic search of the PubMed, EMBASE, Scopus, and Web of Science databases was conducted to identify eligible randomized controlled trials and propensity-score matched studies. Results Four randomized controlled trials and 23 propensity-score matched studies comprising a total of 4,945 patients were included for analysis. Operation time for open pancreatoduodenectomy was shorter than both laparoscopic pancreatoduodenectomy (mean difference –57.35, 95% CI 26.25–88.46 minutes) and robotic pancreatoduodenectomy (mean difference –91.08, 95% CI 48.61–133.56 minutes), blood loss for robotic pancreatoduodenectomy was significantly less than both laparoscopic pancreatoduodenectomy (mean difference –112.58, 95% CI 36.95–118.20 mL) and open pancreatoduodenectomy (mean difference –209.87, 95% CI 140.39–279.36 mL), both robotic pancreatoduodenectomy and laparoscopic pancreatoduodenectomy were associated with reduced rates of delayed gastric emptying compared with open pancreatoduodenectomy (odds ratio 0.59, 95% CI 0.39–0.90 and odds ratio 0.69, 95% CI 0.50–0.95, respectively), robotic pancreatoduodenectomy was associated with fewer wound infections compared with open pancreatoduodenectomy (odds ratio 0.35, 95% CI 0.18–0.71), and laparoscopic pancreatoduodenectomy patients enjoyed significantly shorter length of stay compared with open pancreatoduodenectomy (odds ratio 0.43, 95% CI 0.28–0.95). There were no differences in other outcomes. Conclusion This network meta-analysis of high-quality studies suggests that when laparoscopic pancreatoduodenectomy and robotic pancreatoduodenectomy are performed in high-volume centers, short-term perioperative and oncologic outcomes are largely comparable, if not slightly improved, compared with traditional open pancreatoduodenectomy. These findings should be corroborated in further prospective randomized studies.
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- 2022
11. Laparoscopic versus open resection of hepatocellular carcinoma in patients with cirrhosis: meta-analysis
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Eric Wu, Zoe Z. X. Tan, Nicholas Syn, Alvin Y H Tan, Brian K. P. Goh, Tousif Kabir, J Daryl Lin, Juinn Huar Kam, Yong Hui, and Joseph J. Zhao
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Liver Cirrhosis ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Cirrhosis ,Blood transfusion ,medicine.medical_treatment ,Gastroenterology ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Aged ,business.industry ,Liver Neoplasms ,Hazard ratio ,Pringle manoeuvre ,Odds ratio ,Perioperative ,Middle Aged ,medicine.disease ,Confidence interval ,Treatment Outcome ,Hepatocellular carcinoma ,Female ,Laparoscopy ,Surgery ,business - Abstract
Background The exact role of laparoscopic liver resection (LLR) in patients with hepatocellular carcinoma (HCC) and underlying liver cirrhosis (LC) is not well defined. In this meta-analysis, both long- and short-term outcomes following LLR versus open liver resection (OLR) were analysed. Methods PubMed, EMBASE, Scopus and Web of Science databases were searched systematically for randomised controlled trials (RCTs) and propensity-score matched (PSM) studies reporting outcomes of LLR versus OLR of HCC in patients with cirrhosis. Primary outcome was overall survival (OS). This was analysed using one-stage (individual participant data meta-analysis) and two-stage (aggregate data meta-analysis) approaches. Secondary outcomes were operation duration, blood loss, blood transfusion, Pringle manoeuvre utilization, overall and major complications, length of hospital stay (LOHS), 90-day mortality and R0 resection rates. Results Eleven studies comprising 1618 patients (690 LLR versus 928 OLR) were included for analysis. In the one-stage meta-analysis, an approximately 18.7 per cent lower hazard rate (HR) of death in the LLR group (random effects: HR 0.81, 95 per cent confidence interval [C.I.] 0.68 to 0.96; P = 0.018) was observed. Two-stage meta-analysis resulted in a pooled HR of 0.84 (95 per cent C.I. 0.74 to 0.96; P = 0.01) in the overall LLR cohort. This indicated a 16–26 per cent reduction in the HR of death for patients with HCC and cirrhosis who underwent LLR. For secondary outcomes, LLR was associated with less blood loss (mean difference [MD] −99 ml, 95 per cent C.I. −182 to −16 ml), reduced overall complications (odds ratio 0.49, 95 per cent C.I. 0.37 to 0.66) and major complications (odds ratio 0.45, 95 per cent C.I. 0.26 to 0.79), and shorter LOHS (MD −3.22 days, 95 per cent C.I. −4.38 to −2.06 days). Conclusion Laparoscopic resection of HCC in patients with cirrhosis is associated with improved survival and perioperative outcomes.
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- 2021
12. EP262/#507 Adoption of new first-line maintenance strategies among patients with primary advanced ovarian cancer after food and drug administration approval
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Jinan Liu, Premal Thaker, Jinlin Song, Cheryl Xiang, Eric Wu, Linda Kalilani, Jean A Hurteau, Michael Richardson, and John K Chan
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- 2022
13. Synergistic Photochemistry of Alcohols Catalyzed by Plasmonic Nanoparticles and a Metal Complex
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Ankita Das, Jaeyoung Heo, Prashant K. Jain, Varun Mohan, and Eric Wu
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Plasmonic nanoparticles ,Materials science ,Renewable Energy, Sustainability and the Environment ,Energy Engineering and Power Technology ,02 engineering and technology ,010402 general chemistry ,021001 nanoscience & nanotechnology ,Photochemistry ,01 natural sciences ,0104 chemical sciences ,Catalysis ,Fuel Technology ,Chemistry (miscellaneous) ,Yield (chemistry) ,Materials Chemistry ,Photocatalysis ,0210 nano-technology ,Scavenging - Abstract
In photocatalytic schemes, it is common practice to employ a sacrificial agent for scavenging photogenerated holes and enhancing the yield and efficiency of electron harvesting. However, little att...
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- 2021
14. 7-UP: generating in silico CODEX from a small set of immunofluorescence markers
- Author
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Eric Wu, Alexandro E. Trevino, Zhenqin Wu, Kyle Swanson, Honesty J. Kim, H. Blaize D’Angio, Ryan Preska, Gregory W. Charville, Piero D. Dalerba, Umamaheswar Duvvuri, Jelena Levi, A. Dimitrios Colevas, Nikita Bedi, Serena Chang, John B. Sunwoo, Aaron T. Mayer, and James Zou
- Abstract
Multiplex immunofluorescence (mIF) assays multiple protein biomarkers on a single tissue section. Recently, high-plex CODEX (co-detection by indexing) systems enable simultaneous imaging of 40+ protein biomarkers, unlocking more detailed molecular phenotyping, leading to richer insights into cellular interactions and disease. However, high-plex imaging can be slower and more costly to collect, limiting its applications, especially in clinical settings. We propose a machine learning framework, 7-UP, that can computationally generate in silico 40-plex CODEX at single-cell resolution from a standard 7-plex mIF panel by leveraging cellular morphology. We demonstrate the usefulness of the imputed biomarkers in accurately classifying cell types and predicting patient survival outcomes. Furthermore, 7-UP’s imputations generalize well across samples from different clinical sites and cancer types. 7-UP opens the possibility of in silico CODEX, making insights from high-plex mIF more widely available.
- Published
- 2022
15. Maximuma posteriorinatural scene reconstruction from retinal ganglion cells with deep denoiser priors
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Alexander Sher, Nora Brackbill, Eero Simoncelli, Eric Wu, E.J. Chichilnisky, and Alan Litke
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Visual information arriving at the retina is transmitted to the brain by signals in the optic nerve, and the brain must rely solely on these signals to make inferences about the visual world. Previous work has probed the content of these signals by directly reconstructing images from retinal activity using linear regression or nonlinear regression with neural networks. Maximuma posteriori(MAP) reconstruction using retinal encoding models and separately-trained natural image priors offers a more general and principled approach. We develop a novel method for approximate MAP reconstruction that combines a generalized linear model for retinal responses to light, including their dependence on spike history and spikes of neighboring cells, with the image prior implicitly embedded in a deep convolutional neural network trained for image denoising. We use this method to reconstruct natural images fromex vivosimultaneously-recorded spikes of hundreds of retinal ganglion cells uniformly sampling a region of the retina. The method produces reconstructions that match or exceed the state-of-the-art in perceptual similarity and exhibit additional fine detail, while using substantially fewer model parameters than previous approaches. The use of more rudimentary encoding models (a linear-nonlinear-Poisson cascade) or image priors (a 1/fspectral model) significantly reduces reconstruction performance, indicating the essential role of both components in achieving high-quality reconstructed images from the retinal signal.
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- 2022
16. Graph deep learning for the characterization of tumour microenvironments from spatial protein profiles in tissue specimens
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Zhenqin, Wu, Alexandro E, Trevino, Eric, Wu, Kyle, Swanson, Honesty J, Kim, H Blaize, D'Angio, Ryan, Preska, Gregory W, Charville, Piero D, Dalerba, Ann Marie, Egloff, Ravindra, Uppaluri, Umamaheswar, Duvvuri, Aaron T, Mayer, and James, Zou
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Deep Learning ,Gene Expression Profiling ,Tumor Microenvironment ,Humans ,Neural Networks, Computer - Abstract
Multiplexed immunofluorescence imaging allows the multidimensional molecular profiling of cellular environments at subcellular resolution. However, identifying and characterizing disease-relevant microenvironments from these rich datasets is challenging. Here we show that a graph neural network that leverages spatial protein profiles in tissue specimens to model tumour microenvironments as local subgraphs captures distinctive cellular interactions associated with differential clinical outcomes. We applied this spatial cellular-graph strategy to specimens of human head-and-neck and colorectal cancers assayed with 40-plex immunofluorescence imaging to identify spatial motifs associated with cancer recurrence and with patient survival after treatment. The graph deep learning model was substantially more accurate in predicting patient outcomes than deep learning approaches that model spatial data on the basis of the local composition of cell types, and it generated insights into the effect of the spatial compartmentalization of tumour cells and granulocytes on patient prognosis. Local graphs may also aid in the analysis of disease-relevant motifs in histology samples characterized via spatial transcriptomics and other -omics techniques.
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- 2022
17. SPACE-GM: geometric deep learning of disease-associated microenvironments from multiplex spatial protein profiles
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Zhenqin Wu, Alexandro E. Trevino, Eric Wu, Kyle Swanson, Honesty J. Kim, H. Blaize D’Angio, Ryan Preska, Gregory W. Charville, Piero D. Dalerba, Ann Marie Egloff, Ravindra Uppaluri, Umamaheswar Duvvuri, Aaron T. Mayer, and James Zou
- Abstract
Multiplexed immunofluorescence imaging enables high-dimensional molecular profiling at subcellular resolution. However, learning disease-relevant cellular environments from these rich imaging data is an open challenge. We developed SPAtial CEllular Graphical Modeling (SPACE-GM), a geometric deep learning framework that flexibly models tumor microenvironments (TMEs) as cellular graphs. We applied SPACE-GM to 658 head-and-neck and colorectal human cancer samples assayed with 40-plex immunofluorescence imaging to identify spatial motifs associated with cancer recurrence and patient survival after immunotherapy. SPACE-GM is substantially more accurate in predicting patient outcomes than previous approaches for modeling spatial data using neighborhood cell-type compositions. Computational interpretation of the disease-relevant microenvironments identified by SPACE-GM generates insights into the effect of spatial dispersion of tumor cells and granulocytes on patient prognosis.
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- 2022
18. Machine Learning Prediction of Clinical Trial Operational Efficiency
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Kevin Wu, Eric Wu, Michael DAndrea, Nandini Chitale, Melody Lim, Marek Dabrowski, Klaudia Kantor, Hanoor Rangi, Ruishan Liu, Marius Garmhausen, Navdeep Pal, Chris Harbron, Shemra Rizzo, Ryan Copping, and James Zou
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Machine Learning ,Clinical Trials as Topic ,Patient Selection ,Humans ,Pharmaceutical Science ,Forecasting - Abstract
Clinical trials are the gatekeepers and bottlenecks of progress in medicine. In recent years, they have become increasingly complex and expensive, driven by a growing number of stakeholders requiring more endpoints, more diverse patient populations, and a stringent regulatory environment. Trial designers have historically relied on investigator expertise and legacy norms established within sponsor companies to improve operational efficiency while achieving study goals. As such, data-driven forecasts of operational metrics can be a useful resource for trial design and planning. We develop a machine learning model to predict clinical trial operational efficiency using a novel dataset from Roche containing over 2,000 clinical trials across 20 years and multiple disease areas. The data includes important operational metrics related to patient recruitment and trial duration, as well as a variety of trial features such as the number of procedures, eligibility criteria, and endpoints. Our results demonstrate that operational efficiency can be predicted robustly using trial features, which can provide useful insights to trial designers on the potential impact of their decisions on patient recruitment success and trial duration.
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- 2022
19. Poly (adenosine diphosphate [ADP]-ribose) polymerase inhibitor first-line maintenance among patients with newly diagnosed advanced ovarian cancer in a real-world database (351)
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Jinan Liu, John Chan, Jinlin Song, Linda Kalilani, Karen Yang, Eric Wu, Jean Hurteau, and Premal Thaker
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Oncology ,Obstetrics and Gynecology - Published
- 2022
20. Author Correction: Surgical Treatment Patterns, Healthcare Resource Utilization, and Economic Burden in Patients with Tenosynovial Giant Cell Tumor Who Underwent Joint Surgery in the United States
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Feng Lin, Winghan Kwong, Sherry Shi, Irina Pivneva, Eric Wu, and John Abraham
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Health Policy ,Public Health, Environmental and Occupational Health - Published
- 2022
21. Chronic Myeloid Leukemia: Part I-Real-World Treatment Patterns, Healthcare Resource Utilization, and Associated Costs in Later Lines of Therapy in the United States
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Ehab Atallah, Rodrigo Maegawa, Dominick Latremouille-Viau, Carmine Rossi, Annie Guérin, Eric Wu, and Pallavi Patwardhan
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Health Policy ,Public Health, Environmental and Occupational Health - Abstract
Background: Despite advances in tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia in chronic phase (CML-CP), a sizeable proportion of patients with CML-CP remains refractory or intolerant to these agents. Objectives: Treatment patterns, healthcare resource utilization (HRU), and costs were evaluated among patients with CML who received third or later lines of therapy (3L+), a clinical population that has not been previously well-studied, with unmet treatment needs as TKI therapy has repeatedly failed. Methods: Adult patients with CML who received 3L+ were identified in the IBM® MarketScan® Databases (January 1, 2001–June 30, 2019) and the SEER-Medicare–linked database (January 1, 2006–December 31, 2016). Treatment patterns were observed from CML diagnosis. HRU and direct healthcare costs (payer’s perspective, 2019 USD) were measured in a 3L+ setting. Results: Among 296 commercially insured patients with 3L+ (median age, 58.5 years; female, 49.7%), the median duration of first-line (1L), second-line (2L), and 3L therapy was 8.5, 4.2, and 8.3 months, respectively. The annual incidence rate during 3L+ was 3.4 for inpatient days, 30.8 for days with outpatient services, and 1.2 for emergency department visits. Mean per-patient-per-month (PPPM) total healthcare costs (pharmacy + medical costs) were $18 784 in 3L+, $15 206 in 3L, and $19 546 in 4L, with inpatient costs driving most of the difference between 3L and 4L (mean [3L] = $2528 PPPM, mean [4L] = $6847 PPPM). Among 53 Medicare-insured patients with 3L+ (median age, 72.0 years; female, 39.6%), the median duration of 1L, 2L, and 3L therapy was 9.7, 5.0, and 7.0 months, respectively. During 3L+, the annual incidence rate was 10.3 for inpatient days, 61.9 for days with outpatient services, and 1.5 for emergency department visits. Mean PPPM total healthcare costs were $14 311 in 3L+, $15 100 in 3L, and $16 062 in 4L. Discussion: Patients with CML receiving 3L+ rapidly cycled through multiple lines. Costs increased from 3L to 4L; in commercially insured patients, inpatient costs were responsible for most of the cost increase between 3L and 4L, underlying these patients’ continued need for care. Conclusions: These findings support the need for better treatment options in patients with CML undergoing later lines of therapy.
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- 2022
22. Health-care resource use and costs associated with diabetic and idiopathic gastroparesis: A claims analysis of the first 3 years following the diagnosis of gastroparesis
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Yaozhu J. Chen, Wenxi Tang, Raluca Ionescu‐Ittu, Rajeev Ayyagari, Eric Wu, Susanna Y. Huh, and Henry P. Parkman
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Adult ,Insurance Claim Review ,Gastroparesis ,Endocrine and Autonomic Systems ,Physiology ,Gastroenterology ,Diabetes Mellitus ,Humans ,Health Care Costs ,Patient Acceptance of Health Care ,Retrospective Studies - Abstract
Due to limited treatment options, many patients with diabetic gastroparesis (DG) or idiopathic gastroparesis (IG) experience inadequate symptom control resulting in increased health-care resource utilization (HRU) and associated costs. We compared all-cause HRU and health-care costs over the 3 years after patients' first gastroparesis diagnosis with that of matched controls without gastroparesis.Newly diagnosed adults with DG or IG were identified in Optum's de-identified ClinformaticsDemographics and comorbidities were balanced between patients with gastroparesis (n = 18,015 [DG]; n = 14,305 [IG]) and controls. In each of the Years 1-3 post-index, patients with DG or IG had significantly higher annual HRU and costs versus controls (mean total cost differences PPY: DG Year 1 $34,885, Year 2 $28,071, Year 3 $25,606; IG Year 1 $23,176, Year 2 $16,627, Year 3 $14,396) (all p 0.05). Across all 3 years, DG/IG cohorts had approximately twice the costs of controls. HRU and costs were highest in Year 1 post-index for both DG and IG.The economic burden of gastroparesis remains high several years after diagnosis, emphasizing the need for chronic treatment to effectively manage symptoms and consequently reduce the burden of this disorder.
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- 2022
23. Clinical and Economic Outcomes of Erythropoiesis-Stimulating Agent Hyporesponsiveness in the Post-Bundling EraPlain-Language Summary
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Borut Cizman, Helen T. Smith, Rodrigo Refoios Camejo, Linda Casillas, Harjeet Dhillon, Fan Mu, Eric Wu, Jipan Xie, Peter Zuckerman, and Daniel Coyne
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ESA hyporesponsiveness ,hemodialysis ,health care resource utilization ,hemic and lymphatic diseases ,erythropoietin ,USRDS Medicare ,lcsh:Diseases of the genitourinary system. Urology ,lcsh:RC870-923 ,anemia of chronic kidney disease - Abstract
Rationale & Objective: Since the change in erythropoiesis-stimulating agent (ESA) labeling and bundling of dialysis services in the United States, few studies have addressed the clinical importance of ESA hyporesponsiveness and none have considered health care resource use in this population. We aimed to further explore ESA hyporesponsiveness and its consequences. Study Design: Retrospective observational cohort study. Setting & Participants: US Renal Data System Medicare participants receiving dialysis with a minimum 6 months of continuous ESA use from 2012 to 2014. Predictors: Erythropoietin resistance index (≥2.0 U/kg/wk/g/L) and ESA dose were used to identify ESA hyporesponders and hyporesponsive subgroups: isolated, intermittent, and chronic. Outcomes: Associations between ESA responsiveness and mortality, cardiovascular hospitalization rates, and health care resource use were evaluated and compared across subgroups. Analytical Approach: Baseline characteristics were compared using Wilcoxon rank sum tests for continuous variables and χ2 tests for categorical variables. Incidence rates of health care resource use were modeled using an unadjusted and adjusted generalized linear model. Results: Of 834,115 dialysis patients in the CROWNWeb database, 38,891 ESA hyporesponders and 59,412 normoresponders met all inclusion criteria. Compared with normoresponders, hyporesponders were younger women, weighed less, and had longer durations of dialysis (all P < 0.001). Hyporesponders received 3.8-fold higher ESA doses (mean, 94,831 U/mo) and erythropoietin resistance index was almost 5 times higher than in normoresponders. Hyporesponders had lower hemoglobin levels and parathyroid hormone levels > 800 pg/mL, and iron deficiency was present in 26.5% versus 10.9% in normoresponders. One-year mortality was higher among hypo- compared with normoresponders (25.3% vs 22.6%). Hyporesponders also had significantly higher rates of hospitalization for cardiovascular events, emergency department visits, inpatient stays, home health agency visits, skilled nursing facility, and hospice days. Limitations: Only US Medicare patients were included and different hyporesponder definitions may have influenced the results. Conclusions: This study explored ESA hyporesponsiveness using new definitions and incorporated clinical and economic outcomes. It established that ESA-hyporesponsive dialysis patients had higher mortality, cardiovascular hospitalization rates, and health care costs as compared with ESA-normoresponsive patients.
- Published
- 2020
24. Minimally Invasive Versus Open Radical Antegrade Modular Pancreatosplenectomy: A Meta-Analysis
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Tousif Kabir, Eric Wu, Brian K. P. Goh, and Joseph J. Zhao
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medicine.medical_specialty ,genetic structures ,Gastric emptying ,business.industry ,musculoskeletal, neural, and ocular physiology ,Perioperative ,Vascular surgery ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Pancreatectomy ,Pancreatic fistula ,Meta-analysis ,medicine ,Resection margin ,Splenectomy ,Humans ,Lymph Nodes ,business ,Prospective cohort study ,human activities ,Pancreas ,Abdominal surgery - Abstract
Radical antegrade modular pancreatosplenectomy (RAMPS) was introduced to improve the tangential resection margin rates and N1 node clearance following resection of malignancies of the pancreatic body and tail. Owing to its technical complexity, minimally invasive RAMPS (MI-RAMPS) has only been reported by a few centers worldwide. We performed this meta-analysis to compare both short- and long-term outcomes between open RAMPS (O-RAMPS) and minimally invasive RAMPS (MI-RAMPS). A systematic search of the electronic databases PubMed, Medline (via PubMed), Cochrane Register of Controlled Trials (CENTRAL), EMBASE, Scopus and Web of Science was performed to identify eligible studies published in the English language regardless of study design. The outcomes of interest were operation time, estimated blood loss, transfusion rates, overall complications, Grade B/C post-operative pancreatic fistula (POPF) rates, post-pancreatectomy hemorrhage (PPH), delayed gastric emptying (DGE), length of stay (LOS), R0 resection rates, lymph node (LN) yield and overall survival (OS). Five non-randomized studies comprising of a total 229 patients (89 MI-RAMPS, 140 O-RAMPS) were included for analysis. Intra-operative blood loss was observed to be significantly reduced in MI-RAMPS as compared to O-RAMPS (MD –256.16, P
- Published
- 2021
25. Safety, Pharmacokinetics, and Pharmacodynamics of Etavopivat (FT-4202), an Allosteric Activator of Pyruvate Kinase-R, in Healthy Adults: A Randomized, Placebo-Controlled, Double-Blind, First-in-Human Phase 1 Trial
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Sanjeev Forsyth, Patricia Schroeder, James Geib, Leela Vrishabhendra, Diamantis G. Konstantinidis, Kari LaSalvia, Maria D. Ribadeneira, Eric Wu, Patrick Kelly, and Theodosia A. Kalfa
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Adult ,Hemoglobins ,Dose-Response Relationship, Drug ,Double-Blind Method ,Pyruvate Kinase ,Pharmaceutical Science ,Humans ,Pharmacology (medical) ,Anemia, Sickle Cell - Abstract
Etavopivat (FT-4202) is an orally administered, small-molecule allosteric activator of erythrocyte pyruvate kinase-R (PKR) in clinical development for the treatment of sickle cell disease and other hemoglobin disorders. This randomized, placebo-controlled, double-blind, first-in-human combination single-ascending dose and multiple-ascending dose phase 1 trial (NCT03815695) evaluated the safety and pharmacokinetics/pharmacodynamics of etavopivat in 90 healthy adult subjects. In 4 single-ascending dose cohorts, 8 participants were randomized 3:1 to a single oral dose of either etavopivat (n = 6) or placebo (n = 2). In four 14-day multiple-ascending dose cohorts, 12 participants were randomized 3:1 to 14 days of etavopivat (n = 9) or placebo (n = 3). In these studies, most treatment-emergent adverse events were of mild severity (grade 1) and none led to study discontinuation. Etavopivat exhibited a linear and time-independent pharmacokinetic profile (at doses ≤400 mg) and elicited the expected pharmacodynamic effects of PKR activation (decreased 2,3-diphosphoglycerate and increased adenosine triphosphate) and evidence of improved hemoglobin-oxygen affinity. In addition, pharmacodynamic responses were durable with effects continuing for 48 to 72 hours after the last dose, thereby supporting once-daily dosing. Food appeared to have no clinically meaningful effects on etavopivat exposure, thus facilitating administration with or without food. In conclusion, the evaluation of etavopivat in healthy subjects demonstrated proof of mechanism (PKR activation) without significant adverse events. This study also allowed for the selection of dose levels, projected to have an acceptable safety profile and provide therapeutic benefit, for evaluation in future trials in patients with sickle cell disease.
- Published
- 2021
26. 78: A British Columbia Based Population Study on the Treatment and Long-Term Outcomes of Thymoma: A 25-Year Retrospective Review
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Eric Wu, Daegan Sit, Heather Derocher, Tami Yu-Yu Lin, Angela Lin, Delia Sauciuc, Sonja Murchison, Jodi Siever, and Siavash Atrchian
- Subjects
Oncology ,Radiology, Nuclear Medicine and imaging ,Hematology - Published
- 2022
27. Starting dose of niraparib as first-line maintenance among patients with newly diagnosed advanced ovarian cancer in a real- world database (352)
- Author
-
Jinan Liu, Premal Thaker, Jinlin Song, Linda Kalilani, Helen Guo, Eric Wu, Jean Hurteau, and John Chan
- Subjects
Oncology ,Obstetrics and Gynecology - Published
- 2022
28. Advancing the development of real-world data for healthcare research in China: challenges and opportunities
- Author
-
Jia Zhong, Jun Zhang, Honghao Fang, Larry Liu, Jipan Xie, and Eric Wu
- Subjects
China ,Humans ,Health Services Research ,General Medicine ,Delivery of Health Care - Abstract
Various real-world data (RWD) sources have emerged in China with the intention of generating real-world evidence (RWE) that can be used in clinical and regulatory decision-making. Despite these efforts, significant barriers remain that hinder high-quality healthcare research. A workshop with 30 representatives from healthcare research agencies, technology companies focused on healthcare big data and pharmaceutical companies was held in December 2020 to identify strategies to overcome the barriers associated with the usability and quality of RWD in China. Across all sectors, examples of barriers identified included inconsistencies in terminology and non-standardised coding practices; the absence of longitudinal data; the absence of transparent data processing and validation practices; and the inability to access and share RWD. While cutting-edge technological innovations and data solutions provided powerful tools, the development of collaborative and synergistic research networks across multiple stakeholders is key to generate accessible, high-quality RWD in China. RWD has the potential to provide clinical, regulatory and reimbursement decision-makers with critical insights that can improve healthcare delivery in China. However, barriers to its access, collection and use must be addressed to generate RWE to guide healthcare stakeholders.
- Published
- 2022
29. Efficient cytosolic delivery of proteins by nontoxic, pH-triggered, pore-forming peptides
- Author
-
Eric Wu
- Subjects
Biophysics - Published
- 2022
30. The impact of achieving and maintaining near-complete or complete skin clearance on patient quality of life in moderate-to-severe psoriasis
- Author
-
Caitriona Ryan, Luis Puig, Carla Zema, Elizabeth H.Z. Thompson, Min Yang, Eric Wu, Arielle Bensimon, Xin Huang, Avani D. Joshi, and Boni Elewski
- Subjects
Treatment Outcome ,Quality of Life ,Humans ,Psoriasis ,Dermatology ,Severity of Illness Index ,Skin - Published
- 2021
31. How medical AI devices are evaluated: limitations and recommendations from an analysis of FDA approvals
- Author
-
James Zou, Kevin Wu, Eric Wu, Roxana Daneshjou, David Ouyang, and Daniel E. Ho
- Subjects
0301 basic medicine ,Device Approval ,Computer science ,Process (engineering) ,Extramural ,United States Food and Drug Administration ,MEDLINE ,food and beverages ,General Medicine ,Data science ,General Biochemistry, Genetics and Molecular Biology ,United States ,Food and drug administration ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Databases as Topic ,Equipment and Supplies ,Artificial Intelligence ,030220 oncology & carcinogenesis ,Humans ,Algorithms - Abstract
A comprehensive overview of medical AI devices approved by the US Food and Drug Administration sheds new light on limitations of the evaluation process that can mask vulnerabilities of devices when they are deployed on patients.
- Published
- 2021
32. Application of corrosion-resistant corning advanced-flow reactors for multiphase Bunsen reaction-part one: investigation on SO2 absorption
- Author
-
Hui Wang, Armin Moniri, and Xinjun (Eric) Wu
- Subjects
Materials science ,Bunsen reaction ,Continuous reactor ,Corrosion resistant ,Analytical chemistry ,Absorption (electromagnetic radiation) - Published
- 2019
33. Application of corrosion-resistant Corning advanced-flow reactors for multiphase Bunsen reaction - Part two: investigation on multiphase reaction
- Author
-
Hui Wang, Armin Monir, and Xinjun (Eric) Wu
- Abstract
Bunsen reaction ( 2 H 2 O + I 2 + S O 2 → H 2 S O 4 + 2 H I ) is a key step for hydrogen production from either the H2S splitting cycle or the sulfur-iodine (S-I) cycle of water splitting. As pointed out in part one, when engineering this reaction, many challenges such as side reactions and corrosion impede scaling up this process. Using iodine-toluene solution to provide flowing iodine below the melting point of iodine renders the Bunsen reaction to be conducted at ambient temperature such that these challenges can be either overcome or eased. However, using toluene as the iodine solvent makes the Bunsen reaction a multiphase reaction system which includes gas, aqueous, and organic phases. Glass-made Corning® advanced-flowTM reactors (AFRs) can be used for Bunsen reaction because they are good at resisting corrosion, improving mixing efficiency of multiphase fluids, and allowing seamless scaling up. Part one has studied the absorption behavior of SO2 gas in the liquids used for Bunsen reaction (water, toluene and water-toluene mixture). Part two (this work) mainly studies the Bunsen reaction using the Corning® microscale (LF) and milliscale (G1) AFRs. When I2 was dissolved in toluene, the Bunsen reaction was conducted by feeding SO2 gas, water, and I2/toluene solution into the AFRs. SO2 and I2 were used as the limiting reactants in turn, and the effects of operating conditions such as gas and liquid flow rates, water to toluene ratio, and temperature in the range (22-80 oC) on the absorption rates of SO2 and the I2 reaction rate were studied. The results confirm the seamless scaling-up capability of the Corning reactors when the flow rates were increased twenty times from AFR-LF to AFR-G1.
- Published
- 2019
34. Identifying Quality Gaps in Preventive Care for Outpatients With Cirrhosis Within a Large, Academic Health Care System
- Author
-
Elizabeth S. Aby, Folasade P. May, Eric Wu, Liu Yang, Adam Winters, Nathan G. Kim, Camille Soroudi, Sean Delshad, Peter Beah, Ani Kardashian, Arpan Patel, and Vivy T. Cusumano
- Subjects
Liver Cancer ,medicine.medical_specialty ,Cirrhosis ,Chronic Liver Disease and Cirrhosis ,Rare Diseases ,Esophageal varices ,Spontaneous bacterial peritonitis ,Clinical Research ,Internal medicine ,Health care ,medicine ,Cancer ,Hepatology ,business.industry ,Prevention ,Liver Disease ,Odds ratio ,Original Articles ,Health Services ,medicine.disease ,Confidence interval ,Good Health and Well Being ,Cohort ,Original Article ,Digestive Diseases ,business ,Varices - Abstract
This study examines the quality of outpatient preventive care in a large, ethnically diverse cohort of outpatients with cirrhosis at a high‐volume tertiary liver transplant center. Receipt of evidence‐based quality indicators, including preventive processes for ascites, esophageal varices, hepatic encephalopathy, hepatocellular carcinoma, liver transplantation, and general cirrhosis care, was variable and overall low. These findings suggest that larger system redesign efforts are needed to improve the quality of care, beyond just improving access to specialty providers., We sought to identify specific gaps in preventive care provided to outpatients with cirrhosis and to determine factors associated with high quality of care (QOC), to guide quality improvement efforts. Outpatients with cirrhosis who received care at a large, academic tertiary health care system in the United States were included. Twelve quality indicators (QIs), including preventive care processes for ascites, esophageal varices, hepatic encephalopathy, hepatocellular carcinoma (HCC), and general cirrhosis care, were measured. QI pass rates were calculated as the proportion of patients eligible for a QI who received that QI during the study period. We performed logistic regression to determine predictors of high QOC (≥ 75% of eligible QIs) and receipt of HCC surveillance. Of the 439 patients, the median age was 63 years, 59% were male, and 19% were Hispanic. The median Model for End‐Stage Liver Disease–Sodium score was 11, 64% were compensated, and 32% had hepatitis C virus. QI pass rates varied by individual QIs, but were overall low. For example, 24% received appropriate HCC surveillance, 32% received an index endoscopy for varices screening, and 21% received secondary prophylaxis for spontaneous bacterial peritonitis. In multivariable analyses, Asian race (odds ratio [OR]: 3.7, 95% confidence interval [CI]: 1.3‐10.2) was associated with higher QOC, and both Asian race (OR: 3.3, 95% CI: 1.2‐9.0) and decompensated status (OR: 2.1, 95% CI: 1.1‐4.2) were associated with receipt of HCC surveillance. A greater number of specialty care visits was not associated with higher QOC. Conclusion: Receipt of outpatient preventive cirrhosis QIs was variable and overall low in a diverse cohort of patients with cirrhosis. Variation in care by race/ethnicity and illness trajectory should prompt further inquiry into identifying modifiable factors to standardize care delivery and to improve QOC.
- Published
- 2020
35. IgE-activated mast cells enhance TLR4-mediated antigen-specific CD4
- Author
-
Binh L, Phong, Shaina J, D'Souza, Robin L, Baudier, Eric, Wu, Victoria E, Immethun, David L, Bauer, and James B, McLachlan
- Subjects
CD4-Positive T-Lymphocytes ,Lipopolysaccharides ,Mice, Inbred C57BL ,Toll-Like Receptor 4 ,Mice ,Allergy ,CD4 Antigens ,Mast cells ,Animals ,Immunoglobulin E ,Article ,Lymphocyte activation - Abstract
Mast cells are potent mediators of allergy and asthma, yet their role in regulating adaptive immunity remains ambiguous. On the surface of mast cells, the crosslinking of IgE bound to FcεRI by a specific antigen recognized by that IgE triggers the release of immune mediators such as histamine and cytokines capable of activating other immune cells; however, little is known about the mast cell contribution to the induction of endogenous, antigen-specific CD4+ T cells. Here we examined the effects of specific mast cell activation in vivo on the initiation of an antigen-specific CD4+ T cell response. While CD4+ T cells were not enhanced by FcεRI stimulation alone, their activation was synergistically enhanced when FcεRI activation was combined with TLR4 stimulation. This enhanced activation was dependent on global TLR4 stimulation but appeared to be less dependent on mast cell expressed TLR4. This study provides important new evidence to support the role of mast cells as mediators of the antigen-specific adaptive immune response.
- Published
- 2020
36. Author response for 'Inhibition of fatty acid synthase with <scp>FT</scp> ‐4101 safely reduces hepatic de novo lipogenesis and steatosis in obese subjects with <scp>NAFLD</scp> non‐alcoholic fatty liver disease: results from two early phase randomized trials'
- Author
-
null Carine Beysen, null Patricia Schroeder, null Eric Wu, null Julie Brevard, null Maria Ribadeneira, null Wei Lu, null Kiran Dole, null Terry E O’Reilly, null Linda Morrow, null Marcus Hompesch, null Marc K Hellerstein, null Kelvin Li, null Lars Johansson, and null Patrick F Kelly
- Published
- 2020
37. REAL-WORLD EXPERIENCE AND UNMET NEEDS IN THE CURRENT MANAGEMENT OF RECURRENT PERICARDITIS: A PHYSICIAN SURVEY AND MEDICAL CHART REVIEW
- Author
-
Ajit B. Raisinghani, Leo F. Buckley, Yan Song, Jay Chatfield, Yao Wang, Alexandra Malinowski, Richard Berman, Chujun He, Eric Wu, and Dana R. Martin
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2022
38. Focal Electrical Stimulation of Human Retinal Ganglion Cells for Vision Restoration
- Author
-
Alex R. Gogliettino, H. Nguyan, Ruwan A. Silva, G. Aggarwal, Alexandra Kling, M. Hays, Sasidhar Madugula, Alexander Sher, E. J. Chichilnisky, Moosa Zaidi, Alan Litke, Eric Wu, Pawel Hottowy, Victoria H. Fan, Ramandeep S. Vilkhu, and Nishal P. Shah
- Subjects
Retina ,Cell type ,genetic structures ,biology ,Somatic cell ,Retinal implant ,Stimulation ,Stimulus (physiology) ,Macaque ,Retinal ganglion ,eye diseases ,medicine.anatomical_structure ,biology.animal ,medicine ,sense organs ,Neuroscience - Abstract
Electrical stimulation of retinal ganglion cells (RGCs), which transmit visual information to the brain, is used in retinal implants to treat blindness caused by photoreceptor degeneration. However, the performance of existing clinical implants is limited by indiscriminate stimulation of many cells and cell types. Recent work in isolated macaque retina has shown the ability to precisely evoke spikes in the major RGC types by direct electrical stimulation at safe current levels, with single-cell, single-spike resolution and avoidance of axon bundle activation in many cases. However, these findings have not been verified in the human retina. Here, electrical activation of the major human RGC types was examined using large-scale, multi-electrode recording and stimulation and compared to results from several macaque retinas obtained using the same methods. Electrical stimulation of the major human RGC types closely paralleled results in macaque, with similar somatic and axonal stimulation thresholds, cellular and cell type selectivity of stimulation, avoidance of axon bundle stimulation by calibration, targeting of different cell types based on their distinct electrical signatures, and potential efficacy of real-time stimulus optimization for artificial vision. The results indicate that the macaque retina provides a quantitatively accurate picture of how focal electrical stimulation can be used in future high-resolution implants.
- Published
- 2020
39. Functional Organization of Midget and Parasol Ganglion Cells in the Human Retina
- Author
-
Alan Litke, Nora Brackbill, E. J. Chichilnisky, Alexandra Kling, Ruwan A. Silva, Nishal P. Shah, Alex R. Gogliettino, Alexander Sher, and Eric Wu
- Subjects
Retina ,Cell type ,genetic structures ,Biology ,Spatial response ,Macaque ,eye diseases ,Ganglion ,medicine.anatomical_structure ,Retinal ganglion cell ,Receptive field ,biology.animal ,medicine ,sense organs ,Functional organization ,Neuroscience - Abstract
The functional organization of diverse retinal ganglion cell (RGC) types, which shapes the visual signal transmitted to the brain, has been examined in many species. The unique spatial, temporal, and chromatic properties of the numerically dominant RGC types in macaque monkey retina are presumed to most accurately model human vision. However, the functional similarity between RGCs in macaques and humans has only begun to be tested, and recent work suggests possible differences. Here, the properties of the numerically dominant human RGC types were examined using large-scale multi-electrode recordings with fine-grained visual stimulation in isolated retina, and compared to results from dozens of recordings from macaque retina using the same experimental methods and conditions. The properties of four major human RGC types -- ON-parasol, OFF-parasol, ON-midget, and OFF-midget -- closely paralleled those of the same macaque RGC types, including the spatial and temporal light sensitivity, precisely coordinated mosaic organization of receptive fields, ON-OFF asymmetries, spatial response nonlinearity, and sampling of photoreceptor inputs over space. Putative smooth monostratified cells and polyaxonal amacrine cells were also identified based on similarities to cell types previously identified in macaque retina. The results suggest that recently proposed differences between human and macaque RGCs probably reflect experimental differences, and that the macaque model provides an accurate picture of human RGC function.
- Published
- 2020
40. Is the provision of rehabilitation in adult hearing services warranted? A cost benefit analysis
- Author
-
Eric Wu, Anthony Hogan, Melanie A. Ferguson, Isabelle Boisvert, and David Donnelly
- Subjects
Adult ,030506 rehabilitation ,Rehabilitation ,Cost–benefit analysis ,medicine.medical_treatment ,Cost-Benefit Analysis ,Middle Aged ,03 medical and health sciences ,0302 clinical medicine ,Cross-Sectional Studies ,Hearing Aids ,Nursing ,Hearing ,Surveys and Questionnaires ,medicine ,Humans ,Business ,0305 other medical science ,030217 neurology & neurosurgery ,Aged - Abstract
To examine the extent to which there is a basic economic case for the provision of rehabilitation services within a publicly funded, device-centred approach to adult hearing services.Five representative cross-sectional surveys of people aged 50 years and over were conducted in Australia between 2013 and 2019 (Among respondents 27% reported that their hearing was fair or poor, and 14% reported hearing aid ownership. 45% of hearing aid owners were regular device users. Approximately 1:4 people (24%) who owned a hearing aid had not used it in the past three months; with an estimated cost of $au87.4 million per annum. The provision of hearing rehabilitation services in addition to or instead of hearing aids could provide clients with a more comprehensive service at an estimated saving of between 62% to 81% of existing program costs.Cost benefit analysis supports the provision of hearing rehabilitation within a hearing services program, either as an alternative to the existing service, or adjunct to it. Such a service would enhance client outcomes and reduce the level of wastage currently associated with the current device-centred approach.Implications for rehabilitationClients identified as not being immediately ready to progress to hearing aids could benefit from rehabilitation programs while still having access to either assistive listening devices or hearing aids.The proposed approach could result in significant cost savings to publicly funded programs while ensuring better outcomes for service users through the more effective, efficient and ethical use of public monies.
- Published
- 2020
41. Severe community acquired adenovirus pneumonia in an immunocompetent host successfully treated with IV Cidofovir
- Author
-
Eric Wu, Chian Yong Low, Ashton Yap, Joseph J. Zhao, and Jane Yap
- Subjects
Pulmonary and Respiratory Medicine ,viruses ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Immunity ,Intensive care ,Case report ,Medicine ,Adenovirus ,lcsh:RC705-779 ,business.industry ,Respiratory infection ,lcsh:Diseases of the respiratory system ,Pneumonia ,medicine.disease ,respiratory tract diseases ,030228 respiratory system ,chemistry ,030220 oncology & carcinogenesis ,Immunology ,business ,Cidofovir - Abstract
Adenovirus is a common cause of acute febrile respiratory infection in children and are generally self-limiting although pneumonia can occur in neonates and adults with compromised immunity. However, severe adenovirus pneumonia in healthy adults has been rarely described. Here, we report a case of severe community-acquired adenovirus pneumonia in a previously healthy patient successfully treated with intravenous Cidofovir.
- Published
- 2020
42. A mimic of bronchogenic carcinoma - pulmonary melioidosis
- Author
-
Eric Wu, Ashton Yap, Joseph J. Zhao, and Jane Yap
- Subjects
Pulmonary and Respiratory Medicine ,Thorax ,medicine.medical_specialty ,Melioidosis ,Burkholderia pseudomallei ,Mediastinal lymphadenopathy ,Case Report ,Pericardial effusion ,medicine ,Fluorodeoxyglucose ,lcsh:RC705-779 ,Lung ,medicine.diagnostic_test ,biology ,business.industry ,Pulmonary mass ,lcsh:Diseases of the respiratory system ,medicine.disease ,biology.organism_classification ,medicine.anatomical_structure ,Positron emission tomography ,Radiology ,business ,medicine.drug - Abstract
We report a case of a patient with pulmonary melioidosis which radiologically mirrored a bronchogenic carcinoma with mediastinal lymphadenopathy. Such findings were observed in a Computed Tomography (CT) scan (Thorax) and Positron Emission Tomography (PET) scan (Body) in a previously healthy 57-year-old man with no significant medical risk factors for melioidosis other than his previous exposures to soil during outfield military training in Thailand, 37 and 28 years ago. He presented with acute symptoms of dry cough, pleuritic pain and fever. A CT Scan thorax revealed a left lower lobe mass with left pleural and pericardial effusion and mediastinal lymph nodes. Similarly, the PET scan showed various fluorodeoxyglucose (FDG)-positron uptake in these areas. However the lung mass biopsy cultured Burkholderia pseudomallei concurrently with a Melioidosis serology titre of >1:1024. He responded to intravenous Meropenem followed by Co-Trimoxazole and Doxycycline over the course of 21 weeks, ultimately leading to the resolution of any significant radiological findings. Keywords: Melioidosis, Pulmonary mass, Burkholderia pseudomallei
- Published
- 2020
43. Robust breast cancer detection in mammography and digital breast tomosynthesis using an annotation-efficient deep learning approach
- Author
-
A. Gregory Sorensen, Gopal R. Vijayaraghavan, Jorge Onieva Onieva, Giorgia Grisot, Mack Bandler, Bryan Haslam, Kevin Wu, Jerrold L. Boxerman, William Lotter, Jiye G. Kim, Yun Boyer, Abdul Rahman Diab, Eric Wu, and Meiyun Wang
- Subjects
0301 basic medicine ,Adult ,medicine.medical_specialty ,Computer science ,Population ,Breast Neoplasms ,General Biochemistry, Genetics and Molecular Biology ,Article ,03 medical and health sciences ,Annotation ,0302 clinical medicine ,Breast cancer ,Deep Learning ,medicine ,Mammography ,Humans ,Medical physics ,Breast ,education ,Early Detection of Cancer ,Interpretability ,education.field_of_study ,Modalities ,medicine.diagnostic_test ,business.industry ,Deep learning ,Cancer ,General Medicine ,Middle Aged ,medicine.disease ,030104 developmental biology ,030220 oncology & carcinogenesis ,Female ,Artificial intelligence ,business - Abstract
Breast cancer remains a global challenge, causing over 600,000 deaths in 2018 (ref. 1). To achieve earlier cancer detection, health organizations worldwide recommend screening mammography, which is estimated to decrease breast cancer mortality by 20–40% (refs. 2,3). Despite the clear value of screening mammography, significant false positive and false negative rates along with non-uniformities in expert reader availability leave opportunities for improving quality and access4,5. To address these limitations, there has been much recent interest in applying deep learning to mammography6–18, and these efforts have highlighted two key difficulties: obtaining large amounts of annotated training data and ensuring generalization across populations, acquisition equipment and modalities. Here we present an annotation-efficient deep learning approach that (1) achieves state-of-the-art performance in mammogram classification, (2) successfully extends to digital breast tomosynthesis (DBT; ‘3D mammography’), (3) detects cancers in clinically negative prior mammograms of patients with cancer, (4) generalizes well to a population with low screening rates and (5) outperforms five out of five full-time breast-imaging specialists with an average increase in sensitivity of 14%. By creating new ‘maximum suspicion projection’ (MSP) images from DBT data, our progressively trained, multiple-instance learning approach effectively trains on DBT exams using only breast-level labels while maintaining localization-based interpretability. Altogether, our results demonstrate promise towards software that can improve the accuracy of and access to screening mammography worldwide. A generalizable and interpretable artificial-intelligence system achieves clinical accuracy for screening and early breast-cancer detection on 2D and 3D mammograms.
- Published
- 2020
44. Dialysis Catheter–related Bloodstream Infections in Patients Receiving Hemodialysis on an Emergency-only Basis: A Retrospective Cohort Analysis
- Author
-
Nicolas W. Cortes-Penfield, Sreedhar Mandayam, Maulin Shah, Robert L. Atmar, Roya Zamani, Jingbo Niu, Daniel Chen, Eric Wu, and Hal Zhang
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,Emergency Medical Services ,medicine.medical_specialty ,medicine.medical_treatment ,030106 microbiology ,Population ,Hemodialysis Catheter ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Sepsis ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,education ,Articles and Commentaries ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Mortality rate ,Disease Management ,Retrospective cohort study ,Dialysis catheter ,Middle Aged ,Infectious Diseases ,Catheter-Related Infections ,Cohort ,Etiology ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business - Abstract
Background An estimated 6500 undocumented immigrants with end-stage renal disease (ESRD) live in the United States. Those living in states that do not provide undocumented immigrants scheduled hemodialysis receive intermittent hemodialysis only when life-threatening conditions arise. Little is known about catheter-related bloodstream infections (CRBSIs) in this population. Methods We conducted a retrospective cohort study of emergency-only hemodialysis patients in the Harris Health System in Houston, Texas, between January 2012 and December 2015. We assessed CRBSI risk factors including demographics, comorbidities, and duration and frequency of hemodialysis. We investigated the microbiologic etiology of these infections, rates of recurrent CRBSI, and associated morbidity and mortality. Results The cohort included 329 patients; 90% were Hispanic, 60% had diabetes, and the average age was 51 years. A total of 101 CRBSIs occurred, with a rate of 0.84 infections per 1000 catheter-days. Cirrhosis and duration of hemodialysis during the study period were associated with increased risk of CRBSI. Seventeen CRBSIs were recurrent; infection with gram-positive bacteria predicted recurrence. Adherence to catheter-related infection guidelines was improved by infectious diseases consultation and associated with fewer recurrent infections. CRBSI was associated with prolonged hospitalization (mean, 15 days), composite complication rate of 8%, and a 4% mortality rate. Conclusions Patients receiving emergency-only hemodialysis via tunneled catheters have a high CRBSI rate compared with infection rates previously reported in patients receiving scheduled maintenance hemodialysis. Increased CRSBI risk likely contributes to the increased morbidity and mortality seen in ESRD patients receiving emergency-only hemodialysis.
- Published
- 2018
45. Abstracts from the 44th ESAO and 7th IFAO Congress, 6–9 September 2017, Vienna, Austria
- Author
-
Waniewski Jacek, Allicja Siewnicka, Bahram Haddadi, Paolo Zunino, Eric Wu, Giustina Casagrande, and Jo Philipp Pauls
- Subjects
Biomaterials ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,General Medicine - Published
- 2017
46. An Argument-Based Approach to Test Fairness
- Author
-
Eric Wu and Yan Jin
- Subjects
College English ,Linguistics and Language ,Multiple forms ,Cheating ,Computer Science Applications ,Education ,Test (assessment) ,Argument ,Language assessment ,Equating ,Mathematics education ,Computer Vision and Pattern Recognition ,Psychology ,Reliability (statistics) - Abstract
This article aims to demonstrate how innovative testing practices can effectively prevent high-tech mass cheating and improve fairness in language assessment. The article first introduces Xi's (2010) view of validity and fairness and her proposal of an argument-based approach to empirically examining test fairness. The article then describes the threat to fair testing posed by high-tech cheating on the College English Test (CET). A study of multiple-form equating was conducted and reported in the article, which was aimed at achieving alternate form reliability when multiple versions and multiple forms were used in the CET. The article then concludes with a discussion on the usefulness of an argument-based approach to empirically examining test fairness.
- Published
- 2017
47. Analyzing the Limitations of the Rider and Electric Motorcycle at the Pikes Peak International Hill Climb Race
- Author
-
Lennon Rodgers, Ryan Biffard, Bjørn Møller, Mark Jeunnette, Koen Matthys, and Eric Wu
- Subjects
Aeronautics ,Climb ,Sociology - Abstract
This paper describes a post-race analysis of team KOMMIT EVT's electric motorcycle data collected during the 2016 Pikes Peak International Hill Climb (PPIHC). The motorcycle consumed approximately ...
- Published
- 2019
48. Deep learning based bladder cancer treatment response assessment
- Author
-
Richard H. Cohan, Eric Wu, Elaine M. Caoili, Caleb Richter, Ravi K. Samala, Chintana Paramagul, Kenny H. Cha, Heang Ping Chan, Alon Z. Weizer, Ajjai Alva, and Lubomir M. Hadjiiski
- Subjects
Treatment response ,Bladder cancer ,business.industry ,Deep learning ,medicine.disease ,Convolutional neural network ,medicine ,Segmentation ,Artificial intelligence ,Stage (cooking) ,Transfer of learning ,Nuclear medicine ,business ,Complete response ,Mathematics - Abstract
We compared the performance of different Deep Learning - Convolutional Neural Network (DL-CNN) models for bladder cancer treatment response assessment based on transfer learning by freezing different DL-CNN layers and variation of the DL-CNN structure. Pre- and post-treatment CT scans of 123 patients (129 cancers, 158 pre- and posttreatment cancer pairs) undergoing chemotherapy were collected. 33% of patients had T0 stage cancer (complete response) after chemotherapy. Regions of interest (ROIs) of pre- and post-treatment scans were extracted from the segmented lesions and combined into hybrid pre-post image pairs. The dataset was split into training (94 pairs and 6209 hybrid ROIs), validation (10 pairs) and test sets (54 pairs). The DL-CNN consists of 2 convolution (C1, C2), 2 locally connected (L1, L2), and 1 fully connected layers, implemented in TensorFlow. The DL-CNN was trained to classify the bladder cancers as fully responding (stage T0) or not fully responding to chemotherapy based on the hybrid ROIs. Two blinded radiologists provided an estimate of the likelihood of the lesion being stage T0 post-treatment by reading the pairs of pre- and post-treatment CT volumes. The test AUC was 0.73 for T0 prediction by the base DL-CNN structure with randomly initialized weights. The base DL-CNN structure with transfer learning pre-trained weights (no frozen layers) achieved a test AUC of 0.79. The test AUCs for 3 modified DL-CNN structures (different C1, C2 max pooling filter sizes, strides, and padding, with transfer learning) were 0.72, 0.86, and 0.69, respectively. For the base DL-CNN with (C1) frozen, (C1, C2) frozen, and (C1, C2, L3) frozen during transfer learning, the test AUCs were 0.81, 0.78, and 0.71, respectively. The radiologists’ AUCs were 0.76 and 0.77. The DL-CNN performed better with pre-trained than randomly initialized weights.
- Published
- 2019
49. Deep Learning Approach for Assessment of Bladder Cancer Treatment Response
- Author
-
Caleb Richter, Heang Ping Chan, Ajjai Alva, Eric Wu, Chintana Paramagul, Kenny H. Cha, Richard H. Cohan, Elaine M. Caoili, Alon Z. Weizer, Lubomir M. Hadjiiski, and Ravi K. Samala
- Subjects
Treatment response ,Transfer, Psychology ,030232 urology & nephrology ,Computed tomography ,Antineoplastic Agents ,transfer learning ,Cystectomy ,Sensitivity and Specificity ,deep-learning ,03 medical and health sciences ,0302 clinical medicine ,Deep Learning ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,bladder ,treatment response ,segmentation ,Research Articles ,Bladder cancer ,Artificial neural network ,medicine.diagnostic_test ,business.industry ,Deep learning ,Cancer ,Urography ,medicine.disease ,Decision Support Systems, Clinical ,Neoadjuvant Therapy ,3. Good health ,Treatment Outcome ,ROC Curve ,Urinary Bladder Neoplasms ,030220 oncology & carcinogenesis ,Radiographic Image Interpretation, Computer-Assisted ,Artificial intelligence ,Drug Monitoring ,Transfer of learning ,business ,Nuclear medicine ,Tomography, X-Ray Computed ,CT - Abstract
We compared the performance of different Deep learning-convolutional neural network (DL-CNN) models for bladder cancer treatment response assessment based on transfer learning by freezing different DL-CNN layers and varying the DL-CNN structure. Pre- and posttreatment computed tomography scans of 123 patients (cancers, 129, pre- and posttreatment cancer pairs, 158) undergoing chemotherapy were collected. After chemotherapy 33% of patients had T0 stage cancer (complete response). Regions of interest in pre- and posttreatment scans were extracted from the segmented lesions and combined into hybrid pre -post image pairs (h-ROIs). Training (pairs, 94, h-ROIs, 6209), validation (10 pairs) and test sets (54 pairs) were obtained. The DL-CNN consisted of 2 convolution (C1-C2), 2 locally connected (L3-L4), and 1 fully connected layers. The DL-CNN was trained with h-ROIs to classify cancers as fully responding (stage T0) or not fully responding to chemotherapy. Two radiologists provided lesion likelihood of being stage T0 posttreatment. The test area under the ROC curve (AUC) was 0.73 for T0 prediction by the base DL-CNN structure with randomly initialized weights. The base DL-CNN structure with pretrained weights and transfer learning (no frozen layers) achieved test AUC of 0.79. The test AUCs for 3 modified DL-CNN structures (different C1-C2 max pooling filter sizes, strides, and padding, with transfer learning) were 0.72, 0.86, and 0.69. For the base DL-CNN with (C1) frozen, (C1-C2) frozen, and (C1-C2-L3) frozen, the test AUCs were 0.81, 0.78, and 0.71, respectively. The radiologists' AUCs were 0.76 and 0.77. DL-CNN performed better with pretrained than randomly initialized weights.
- Published
- 2019
50. Residual Attention based Network for Hand Bone Age Assessment
- Author
-
Lu Yi, Bin Kong, Xin Wang, Youbing Yin, Junjie Bai, Eric Wu, Feng Gao, Shaoting Zhang, Qi Song, Kunlin Cao, and Siwei Lyu
- Subjects
FOS: Computer and information sciences ,Computer Science - Machine Learning ,business.industry ,Computer science ,Deep learning ,Computer Vision and Pattern Recognition (cs.CV) ,Computer Science - Computer Vision and Pattern Recognition ,020207 software engineering ,Bone age ,02 engineering and technology ,Machine learning ,computer.software_genre ,Residual ,Pipeline (software) ,030218 nuclear medicine & medical imaging ,Machine Learning (cs.LG) ,03 medical and health sciences ,0302 clinical medicine ,Bone age assessment ,0202 electrical engineering, electronic engineering, information engineering ,Key (cryptography) ,Segmentation ,Artificial intelligence ,business ,computer - Abstract
Computerized automatic methods have been employed to boost the productivity as well as objectiveness of hand bone age assessment. These approaches make predictions according to the whole X-ray images, which include other objects that may introduce distractions. Instead, our framework is inspired by the clinical workflow (Tanner-Whitehouse) of hand bone age assessment, which focuses on the key components of the hand. The proposed framework is composed of two components: a Mask R-CNN subnet of pixelwise hand segmentation and a residual attention network for hand bone age assessment. The Mask R-CNN subnet segments the hands from X-ray images to avoid the distractions of other objects (e.g., X-ray tags). The hierarchical attention components of the residual attention subnet force our network to focus on the key components of the X-ray images and generate the final predictions as well as the associated visual supports, which is similar to the assessment procedure of clinicians. We evaluate the performance of the proposed pipeline on the RSNA pediatric bone age dataset 1 and the results demonstrate its superiority over the previous methods.1http://rsnachallenges.cloudapp.net/competitions/4
- Published
- 2018
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