Publications by authors named "J-K Chang"

Background: Transthoracic echocardiography (TTE) is the primary modality for diagnosing aortic stenosis (AS), yet it requires skilled operators and can be resource-intensive. We developed and validated an artificial intelligence (AI)-based system for evaluating AS that is effective in both resource-limited and advanced settings.

Methods: We created a dual-pathway AI system for AS evaluation using a nationwide echocardiographic dataset (developmental dataset, n = 8427): 1) a deep learning (DL)-based AS continuum assessment algorithm using limited 2D TTE videos, and 2) automating conventional AS evaluation.

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Background/aims: The incidence of steatotic liver disease (SLD) is increasing across all age groups as the incidence of obesity increases worldwide. The existing noninvasive prediction models for SLD require laboratory tests or imaging and perform poorly in the early diagnosis of infrequently screened populations such as young adults and individuals with healthcare disparities. We developed a machine learning-based point-of-care prediction model for SLD that is readily available to the broader population with the aim of facilitating early detection and timely intervention and ultimately reducing the burden of SLD.

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SARS-CoV-2 continues to be a public health burden, driven in-part by its continued antigenic diversification and resulting emergence of new variants. By increasing herd immunity, current vaccines have improved infection outcomes for many. However, prophylactic and treatment interventions that are not compromised by viral evolution of the Spike protein are still needed.

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Introduction: Leadership in medical emergencies is variable and frequently suboptimal, contributing to poor patient care and outcomes. Simulation training can improve leadership in both simulated practice and real clinical emergencies. Thoughtful debriefing is essential.

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  • Vertebrobasilar artery stent placement (VBS) is used to prevent posterior circulation strokes, but little is known about the differences in outcomes based on whether the stent is placed intracranially or extracranially.
  • In a study of 105 patients, those with intracranial VBS experienced significantly higher rates of in-stent restenosis (21.9% vs 4.9%) and stented-territory ischemic events (32.8% vs 7.3%) compared to those with extracranial VBS.
  • The procedure for intracranial VBS took longer and had a higher rate of residual stenosis immediately after the procedure, indicating more complications associated with intracranial st
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Background: Microvascular dysfunction after heart transplantation leads to restrictive cardiac allograft physiology (RCP), which is classified as severe coronary allograft vasculopathy (CAV); however, the prognosis of RCP remains unclear. Therefore, in this study, we aimed to elucidate the prognosis of RCP in comparison with that of severe angiographic CAV.

Methods: We assessed 116 patients with severe CAV who underwent heart transplantation between 2004 and 2023.

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  • The study investigates the effectiveness of the anti-EGFR monoclonal antibody panitumumab combined with carboplatin and paclitaxel for treating chemotherapy-resistant triple-negative breast cancer (TNBC) patients.
  • It included 43 patients who had not sufficiently responded to prior doxorubicin and cyclophosphamide treatment, achieving a combined pathological complete response/residual cancer burden class I rate of 30.2%.
  • The results indicate that panitumumab shows promise as part of neoadjuvant therapy for TNBC, warranting further evaluation in larger clinical trials.
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The rapid emergence of SARS-CoV-2 variants of concern (VoC) and the threat of future zoonotic sarbecovirus spillover emphasizes the need for broadly protective next-generation vaccines and therapeutics. We utilized SARS-CoV-2 spike ferritin nanoparticle (SpFN), and SARS-CoV-2 receptor binding domain ferritin nanoparticle (RFN) immunogens, in an equine model to elicit hyperimmune sera and evaluated its sarbecovirus neutralization and protection capacity. Immunized animals rapidly elicited sera with the potent neutralization of SARS-CoV-2 VoC, and SARS-CoV-1 pseudoviruses, and potent binding against receptor binding domains from sarbecovirus clades 1b, 1a, 2, 3, and 4.

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Performance evaluation is important for improving medical quality and services. But, there is a lack of research for medical quality in traditional Chinese medicine (TCM) hospitals. This study examines the medical quality and various indicators of tertiary public traditional Chinese medicine hospitals in Gansu Province, to establish a foundation for improving the medical and management standards of these hospitals.

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Purpose: To assess macular microstructural changes associated with internal limiting membrane peeling (ILMP) using 3-dimensional optical coherence tomography (3D-OCT) in primary macula-off rhegmatogenous retinal detachment (RRD) repairs with vitrectomy and silicone oil (SO) tamponade.

Design: Retrospective, consecutive, interventional case series.

Methods: Setting: Institutional practice.

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Introduction: Animal models indicate that hepatic insulin resistance (IR) promotes cholesterol gallstone disease (GSD). We sought to determine whether hepatic and whole-body IR is associated with incident GSD.

Methods: At baseline, 450 Southwestern Indigenous American adults without GSD were included.

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Background CT performed for various clinical indications has the potential to predict cardiometabolic diseases. However, the predictive ability of individual CT parameters remains underexplored. Purpose To evaluate the ability of automated CT-derived markers to predict diabetes and associated cardiometabolic comorbidities.

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  • A study analyzed 4,199 ophthalmology publications from 2002, 2012, and 2022 across major journals to identify geographical trends and associations with study designs and funding sources.
  • North America dominated the research output but saw a significant decline (10.6%), while Asia, particularly China, experienced substantial growth (25.4%), and received a large percentage of government funding.
  • Africa and South America had minimal representation, and despite a drop in U.S. research contributions, North America and Europe still held a strong presence in top academic journals.
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  • The study evaluates the clinical effectiveness of AI-based electrocardiogram (ECG) analysis for predicting obstructive coronary artery disease (CAD) in patients with stable angina using a large data set of ECG images.
  • A deep learning framework was trained with over 50,000 ECG images and tested for its ability to assign risk scores, showing strong predictive validity for both obstructive and extensive CAD.
  • The findings suggest that the AI model, known as QCG, effectively predicts CAD severity and offers additional insights beyond traditional clinical risk factors, indicating its feasibility for use in clinical settings.
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  • In vitro models studying autoimmunity often lack the complex immune environment and epithelial interactions necessary for accurate research, particularly regarding coeliac disease (CeD), which involves gluten triggering immune responses.
  • Researchers created air-liquid interface (ALI) duodenal organoids from biopsies, preserving both epithelial cells and local immune cells, allowing for a more realistic study of CeD.
  • The findings highlighted that gluten peptides led to significant epithelial damage in CeD organoids, mediated by immune responses including the action of IL-7, a critical factor in the disease's pathology, especially in active cases compared to those on gluten-free diets.
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  • - The study evaluated how various cardiometabolic risk factors, such as metabolic syndrome and individual factors like high fasting glucose and low HDL cholesterol, impact the progression of coronary plaque and the likelihood of major cardiovascular events in patients with stable coronary artery disease.
  • - In a cohort of 1,200 patients followed over several years, 28% experienced rapid coronary plaque progression, identified primarily through increased atheroma volume, which indicates worsening arterial health.
  • - The findings suggest that a combination of risk factors, particularly high blood sugar and blood pressure, significantly forecast both plaque progression and serious cardiovascular incidents, highlighting the importance of monitoring these factors in at-risk patients.
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The Radiological Society of North of America (RSNA) and the Medical Image Computing and Computer Assisted Intervention (MICCAI) Society have led a series of joint panels and seminars focused on the present impact and future directions of artificial intelligence (AI) in radiology. These conversations have collected viewpoints from multidisciplinary experts in radiology, medical imaging, and machine learning on the current clinical penetration of AI technology in radiology and how it is impacted by trust, reproducibility, explainability, and accountability. The collective points-both practical and philosophical-define the cultural changes for radiologists and AI scientists working together and describe the challenges ahead for AI technologies to meet broad approval.

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Background: Evaluating left ventricular diastolic function (LVDF) is crucial in echocardiography; however, the complexity and time demands of current guidelines challenge clinical use. This study aimed to develop an artificial intelligence (AI)-based framework for automatic LVDF assessment to reduce subjectivity and improve accuracy and outcome prediction.

Methods: We developed an AI-based LVDF assessment framework using a nationwide echocardiographic dataset from five tertiary hospitals.

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Purpose: Meningiomas represent the most common primary tumor of the central nervous system. Current treatment options include surgical resection with or without adjuvant radiation therapy (RT), definitive RT, and observation. However, the radiation dose, fractionation, and margins used to treat patients with WHO grade 2 meningiomas, which account for approximately 20% of all meningiomas, are not clearly defined, and deciding on the optimal treatment modality can be challenging owing to the lack of randomized data.

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The purposes of this study were to develop an artificial intelligence (AI) model for future breast cancer risk prediction based on mammographic images, investigate the feasibility of the AI model, and compare the AI model, clinical statistical risk models, and Mirai, a state of-the art deep learning algorithm based on screening mammograms for 1-5-year breast cancer risk prediction. We trained and developed a deep learning model using a total of 36,995 serial mammographic examinations from 21,438 women (cancer-enriched mammograms, 17.5%).

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Radiographic assessment plays a crucial role in the management of patients with central nervous system (CNS) tumors, aiding in treatment planning and evaluation of therapeutic efficacy by quantifying response. Recently, an updated version of the Response Assessment in Neuro-Oncology (RANO) criteria (RANO 2.0) was developed to improve upon prior criteria and provide an updated, standardized framework for assessing treatment response in clinical trials for gliomas in adults.

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  • Nirsevimab is approved in the US for preventing RSV in neonates and infants, particularly during their first RSV season, based on safety data from three clinical trials involving different populations.
  • In the studies, participants were given a single dose of nirsevimab or a comparator treatment, with safety data showing that most adverse events (AEs) were mild to moderate and largely unrelated to the treatment.
  • The conclusion indicated that nirsevimab has a favorable safety profile for preventing RSV disease, regardless of the infants' gestational age or pre-existing conditions.
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  • Amyotrophic lateral sclerosis (ALS) primarily affects motor areas of the brain and spinal cord, but this study investigates less understood cerebellar involvement which may worsen symptoms like speech and balance issues.
  • The research involved 113 healthy individuals and 212 ALS patients, focusing on specific genetic groups, to assess changes in cerebellar structure and connectivity over time using advanced neuroimaging techniques.
  • Findings revealed significant reductions in certain cerebellar regions and connectivity impairments in ALS patients, particularly those with sporadic forms of the disease, highlighting the cerebellum's role in the progression of ALS symptoms.
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Hypertension remains a leading cause of cardiovascular and kidney diseases. Failure to control blood pressure with ≥ 3 medications or control requiring ≥ 4 medications is classified as resistant hypertension (rHTN) and new therapies are needed to reduce the resulting increased risk of morbidity and mortality. Here, we report genetic evidence that relaxin family peptide receptor 2 (RXFP2) is associated with rHTN in men, but not in women.

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Luminal androgen receptor (LAR)-enriched triple-negative breast cancer (TNBC) is a distinct subtype. The efficacy of AR inhibitors and the relevant biomarkers in neoadjuvant therapy (NAT) are yet to be determined. We tested the combination of the AR inhibitor enzalutamide (120 mg daily by mouth) and paclitaxel (80 mg/m weekly intravenously) (ZT) for 12 weeks as NAT for LAR-enriched TNBC.

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