Hsien-Chi Liao

Background: Early rehabilitation in neurocritical care is often underutilized due to fragmented workflows, interdisciplinary coordination challenges, and the absence of structured digital decision support. Traditional clinical decision support systems (CDSS) often address single domains and lack adaptability to the dynamic, multiprofessional workflows of intensive care units (ICUs). Objective: To develop and evaluate the usability of the ERATbi App (Early Recovery After Traumatic Brain Injury App), a modular, tablet-based CDSS was designed to streamline early rehabilitation planning and strengthen interdisciplinary coordination for patients with moderate-to-severe traumatic brain injury (TBI) in intensive care settings. Methods: The ERATbi app integrates four functional modules—delirium risk management, precision nutrition, stepwise early mobilization, and respiratory care for rib fractures—into a unified interface. A simulation-based usability study was conducted with 18 ICU clinicians. Evaluation metrics included System Usability Scale (SUS) scores, task completion rates, error rates, and task durations. Additional user feedback was collected via a 5-point Likert satisfaction survey and semi-structured qualitative interviews. Results: The app demonstrated high usability (mean SUS score 83.6, SD 7.4), a 100% (18/18 participants) task completion rate, and a low error rate (4.2%). Average module completion time was 6.5 minutes, and user satisfaction was high (mean 4.7, SD 0.5). Users highlighted the value of the app’s visual logic, real-time alerts, adaptive thresholds, and modular workflow integration for enhancing team coordination and decision consistency. Conclusions: The ERATbi app demonstrated excellent usability, high user satisfaction, and clinical relevance in simulated ICU workflows. Its logic-driven, workflow- integrated design may support scalable, interdisciplinary implementation of early rehabilitation in neurocritical care settings.

This study aimed to examine the histological and mechanical effects of cryopreservation on human aortic tissues, focussing on storage duration and conditions. Assessments included smooth muscle cell integrity, elastic fibre preservation, and endothelial viability. Cryopreservation with dimethyl sulphoxide (DMSO) significantly reduced smooth muscle cell nuclei loss and maintained elastic fibre integrity. However, elastic fibre thickness increased after 12 months. Isolectin B4 staining showed reduced endothelial cell viability across all groups. No significant changes were observed in mucoid extracellular matrix accumulation or elastic fibre fragmentation. These findings suggest that cryopreservation with DMSO effectively maintains structural integrity for up to 12 months but requires refinement to address endothelial and biomechanical concerns. Cryopreserved aortic allografts demonstrated structural and functional performance when stored at low temperatures, confirming their viability for reconstructive surgeries. The study highlights the importance of the timely utilisation of cryopreserved grafts and optimising preservation techniques to advance surgical applications.

Background: Rib fractures are common chest wall injuries with conservative treatment and surgical stabilization of rib fractures (SSRF) as treatment options. We retrospectively compared the efficacy and long-term prognosis of conservative treatment and SSRF as treatment options for rib fractures. Methods: This retrospective study was conducted at a single trauma center in Taiwan. The study population comprised patients with rib fractures who underwent conservative treatment or SSRF at the National Taiwan University Hospital between 2017 and 2022. We analyzed the outcomes between the operative and non-operative groups, including the length of intensive care unit and hospital stays, pain scales at admission and follow-up, and post-operative complication rates. Results: Of the 217 patients with rib fractures in this study, 103 received SSRF, and 114 received conservative treatment. Patients in the operative group had worse consciousness statuses and higher injury severity scores than those in the non-operative group. In addition, patients in the operative group had more preoperative chest complications than those in the non-operative group. Regarding outcomes and long-term prognoses, patients in the operative group had longer intensive care unit and hospital stays than those in the non-operative group; however, patients in the operative group had better recovery quality than those in the non-operative group. Conclusions: Our study showed that, in patients who meet the surgical indications, SSRF is an effective and safe way to relieve acute pain after thoracic injury and achieve better recovery and quality of life after surgical intervention.

Background/Objectives: For thoracic surgeons, the extent of visceral pleural invasion is a crucial consideration in the surgical approach to adenocarcinoma; this invasion may influence the extent of surgical resection and predict prognosis. With advances in preoperative imaging technology, predicting visceral pleural invasion via computed tomography (CT) characteristics may be feasible. The aim of this study was to evaluate the association between CT characteristics and visceral pleural invasion in patients with surgically resected lung adenocarcinoma. Methods: Patients with lung adenocarcinoma who underwent curative lung tumor resection (n = 643) were retrospectively included in this study between January 2011 and December 2015. Basic demographic CT images were analyzed by experienced thoracic surgeons and radiologists. Postoperative pathology reports were confirmed by experienced pathologists. Univariate and multivariate analyses were performed for potential prognostic factors. Results: Potential visceral pleural invasion characteristics of preoperative CT included tumor size (cm), solid part size, pleural contact of arch distance, ground glass opacity (%), tumor shape, border type, distance from visceral pleura, depth, and invasion site. In addition, solid part size, ground glass opacity (%), consolidation to tumor ratio (%), tumor shape, border type, distance from visceral pleura, and invasion site showed statistical significance for prognosis. Conclusions: Increased precision of image interpretation may provide more predictive clues to improve the identification of visceral pleural invasion before operations. The extent of surgical resection may be more accurately determined, and systemic treatment may be administered earlier for those with poor prognostic factors.

Background: Fetal adenocarcinoma is a very rare subtype of lung adenocarcinoma. Its incidence ranges from 0.1 to 0.87% among all primary lung neoplasms. Low-grade types tend to appear in the younger generation, and the age ranges from 20 to 50 years with a mean age of around 35 years. Surgical resection is currently the best way to treat fetal adenocarcinoma lung cancer without distant metastasis.Case report: This is a 56-year-old female who underwent low-dose computer tomography (LDCT) screening during the health examination. She used to be a heavy smoker for more than 30 years, and the CT images revealed severe bronchiectasis and emphysema. There is a solitary nodule with a diameter of 18.9 x 17.8mm in the central area of the left upper lobe. We decided to conduct left upper lobe S1~S3 segmentectomy under uniportal VATS. The surgery was successful, and the patient was discharged within one week and recovered well. The final diagnosis was fetal adenocarcinoma, low-grade (pT1cN0Mx, stage IA3).Conclusion: The first case reported as fetal adenocarcinoma lung cancer who underwent uniportal video-assisted thoracoscopic segmentectomy. We believe it is a safe and feasible procedure for low-grade types fetal adenocarcinoma patient with poor pulmonary function.