Center of Sleep Disorder, National Taiwan University Hospital.

"The way towards precision medicine for obstructive sleep apnea: artificial intelligence based remote sleep apnea management platform"
The artificial intelligence based remote sleep apnea management platform (NTUH-RSAMP) include (1) SVM-based obstructive sleep apnea (OSA) Probability Prediction to identify patients with OSA (2) a single-channel frontal electroencephalography based automatic sleep staging system (ASSS) and (3) an ultra-low-power dual-mode ASSS processor design to integrated HSAT (ASSS-HSAT) and provide the real-time and reliable information of sleep stage. (4) wearable device-based detection of apnea-hypopnea index and sleep stage. Our works show that combining the sleep center big data and AI will provide an efficient insight for OSA management.

Chang Gong Memorial Hospital, Linkon branch

Artificial Intelligence-assisted immunofluorescence pattern recognition and autoantibody prediction

Chang Gung Medical Foundation

Heart failure is a progressive cardiac disease with high mortality. There are over 9 million patients diagnosed with heart failure in Asia area. The prevalence rate in Taiwan is around 300 per 100,000 people, with over 70,000 patients being hospitalized because of acute exacerbation of heart failure. Transthoracic echocardiogram (TTE) is the main diagnosis tool for heart failure and left ventricular ejection fraction (LVEF) with 35% as the threshold for heart systolic function measurement. But TTE needs to be operated with cardio specialist and charged higher health insurance points. 12-lead electrocardiogram (ECG) is an ubiquitous test to detect structural and conduction abnormalities on heart electro-signal changes. This product uses deep learning model with ECG as input to extract subtle changing features to predict heart systolic function as replacement for TTE and risk stratification. The core model for this product was developed and a cloud inference platform is ready for services. In the future, it could be integrated with hospital information system (HIS), and also applied to portable or wearable devices.

Chang Gung Medical Foundation Linkou Branch

Pressuredot is a wireless pressure sensor platform used in critical care to prevent unnecessary laparotomy and prevent organ failure in pancreatitis, traumatic abdomen, and septic patients.
The novel smart capsule, PressureDot, can be use for every patient, who needs the real time intra-abdominal pressure monitoring in emergency and clinical. The low cost PressureDot can save the time and cost of hospital, save the time of nurses, reduce physician misrecognition rate, and reduce the mortality rate of the patient

Chang Gung Medical Foundation, Linkou/ Chen Chin-Kuo Associate Professor

Applying ultrasound to detect middle ear effusion

Chang Gung Medical Foundation、Janus Biomedical International Co. Ltd

The first generation of EZip is restricted in regular wound-assisted closure, however, there are many irregular wounds in clinical. The first generation after modifying (we called the second generation), it can be used in different kind of irregular wounds. In addition, the device loosen or tighten in wound closure only by doctor's clinical experience in the first generation. So our team invent special technology to monitor the tension of wound and collect the clinical database used in quantitative and qualitative analysis. And it could be useful to the medical crew to monitor patient's wound healing accurately and effectively.

Chang Gung Memorial Hospital

Two- or three-stage paramedian forehead flap has been widely applied in nasal reconstruction. It can provide perfect color, texture and volume match to the adjacent structures. In addition, aesthetic nasal subunits principle was proposed by Dr. Burget and Menick and had become the core principle of the nasal reconstruction.
It is more important in Asian patients than in Western one. Asian nasal characteristics are different from the western one. Asians have relatively smaller noses, thicker skin, abundant subcutaneous fibro-fatty tissue, more sebaceous glands, darker skin color, retruded midface, and less developed cartilage than western one.
Ala or heminasal reconstruction is always a huge challenge to the plastic surgeons in order to achieve symmetrical appearance. Traditionally, using contralateral normal side as reference and using foil paper to make a template are the best way to design a forehead flap to meet the nasal defect. It is time-consuming and not 100% accurate. Therefore, We propose a new Method, Computer-aided desing (CAD) and three-dimensional printing. All patients have to take 3DCT as the basic data base. The mirror-image of the normal ala is analyzed and printed out into 3D models in order to estimate the ideal reconstructed ala preoperatively. Two different 3D models are printed. One is contour guide, the other one is framework guide. Using above two guides as references to tailor and design the paramedian forehead flap for the nasal defect to get reasonable results. When CAD guidance and three-dimensional printing was used, there was greater symmetry between reconstructed and native structures of the nose.
. It is the first trial 3D printing technique in nasal reconstruction. It may improve the nasal reconstruction results significantly.

Chang Gung Memorial Hospital at Chiayi / Jen-Tsung Yang Dean's Team

Regardless of healthy or illness people, if they don’t get enough water intake and continue to lose body fluid under conditions of excessive sweating, high temperature or diseases, dehydration will most often occur.
The current methods for detecting dehydration are still invasive and inconvenient to collect the samples in the modern age, and require to be sent to the laboratory for testing, which can’t provide immediate diagnosis and treatment to dehydrated patients. Our research team develops a portable device to monitor the body hydration status in real time.
The method will be easy to operate, small in size, and the price will be affordable for the home use. It is expected to be an excellent auxiliary diagnostic tool of dehydration for health care workers. The demand of the dehydration market is wide, the new device could be used in different groups, such as athletes, labors, elderly, children and disease patients.

Chang Gung Memorial Hospital, Linkou

Osteoporosis and the associated low-impact fracture is a global problem, particularly in the aging population. Patients with a femoral neck fractures had a higher mortality rate; for patients older than 65 years, 20% of them died within one year from fracture. The prevalence of osteoporosis among people older than 50 years is estimated at approximately 30%; however, only 10% of them are diagnosed. Furthermore, only 27% of the people who had fractures undergone bone density testing. These data suggest a large unmet medical need in the detection of osteoporosis. The gold standard modality to measure bone mineral density (BMD) is the dual-energy x-ray absorptiometry (DXA). However, cost and accessibility prevents its large scale population screening. In contrast, plain pelvis film is standard x-ray which is of low cost and has a much higher population coverage and accessibility. Therefore, we developed a deep learning algorithm that can detect bone density directly by conventional pelvic X-rays. We had obtained a large number of patients with the pelvic X-ray images and their DXA reports to train a deep learning algorithm to extract subtle image features that can be used to estimate the BMD. The model is accurate in detecting people with osteoporosis (T-score

Chang Gung Memorial Hospital, Taoyuan, Taiwan

Background
Maxillomandibular advancement(MMA) is the most effective surgical treatment for patients with obstructive sleep apnea(OSA). However, the perioperative management is crucial to keep patients safe from various critical complications. The aim of this study is to review the perioperative management of patients undergoing MMA.
Method
A retrospective review of medical records was conducted on OSA patients underwent MMA in Craniofacial Center, Chang Gung Memorial Hospital. The parameters monitored are clinical history, anaesthetic evaluation before surgery, intraoperative events, anaesthesia records, recovery room records and progression notes during admission. A comparison of plysomnographic indices before and 3 months after surgery is performed to exam the efficacy of MMA.
Results
Of consecutive 123 patients, aged 32(±9.8) and 80% were male. The BMI was 23.2(±3.2)kg/m2. The Apnea-Hypopnea Indices were 31.06(±23.7) and 4.5(±7.6)/hr before and after surgery. The American Society of Anaesthesiologist(ASA) score was II in 114 and III in 9 patients. During surgery, hypotensive anaesthesia with blood pressure of 50(±2.1)mmHg and HR 74(±7.9)/min were maintained. The average blood loss calculated during surgery was 929(±452)ml. All the patients were extubated in the operating room and kept in recovery room for observation before they were transferred in the ward. Patients stay in the hospital for 3(±1.4) nights before discarge. No patients required reintubation or emergent tracheostomy.
Conclusion
Following proper patient selection, meticulous anesthetic control, and precise surgical conduction, relief of intermaxillary fixation and endotracheal extubation can be a standard procedure. With comprehensive management, OSA patients undergoing MMA may experience a safe and non-critical perioperative care, and expeditious recovery.