Yi-Ju Tseng

Li-Chin Chen, Kuo-Hsuan Hung, Yi-Ju Tseng et al.

The inherent nature of patient data poses several challenges. Prevalent cases amass substantial longitudinal data owing to their patient volume and consistent follow-ups, however, longitudinal laboratory data are renowned for their irregularity, temporality, absenteeism, and sparsity; In contrast, recruitment for rare or specific cases is often constrained due to their limited patient size and episodic observations. This study employed self-supervised learning (SSL) to pretrain a generalized laboratory progress (GLP) model that captures the overall progression of six common laboratory markers in prevalent cardiovascular cases, with the intention of transferring this knowledge to aid in the detection of specific cardiovascular event. GLP implemented a two-stage training approach, leveraging the information embedded within interpolated data and amplify the performance of SSL. After GLP pretraining, it is transferred for TVR detection. The proposed two-stage training improved the performance of pure SSL, and the transferability of GLP exhibited distinctiveness. After GLP processing, the classification exhibited a notable enhancement, with averaged accuracy rising from 0.63 to 0.90. All evaluated metrics demonstrated substantial superiority (p < 0.01) compared to prior GLP processing. Our study effectively engages in translational engineering by transferring patient progression of cardiovascular laboratory parameters from one patient group to another, transcending the limitations of data availability. The transferability of disease progression optimized the strategies of examinations and treatments, and improves patient prognosis while using commonly available laboratory parameters. The potential for expanding this approach to encompass other diseases holds great promise.

Yu-Chen Kuo, Yi-Ju Tseng

The inherent multimodality and heterogeneous temporal structures of medical data pose significant challenges for modeling. We propose MedM2T, a time-aware multimodal framework designed to address these complexities. MedM2T integrates: (i) Sparse Time Series Encoder to flexibly handle irregular and sparse time series, (ii) Hierarchical Time-Aware Fusion to capture both micro- and macro-temporal patterns from multiple dense time series, such as ECGs, and (iii) Bi-Modal Attention to extract cross-modal interactions, which can be extended to any number of modalities. To mitigate granularity gaps between modalities, MedM2T uses modality-specific pre-trained encoders and aligns resulting features within a shared encoder. We evaluated MedM2T on MIMIC-IV and MIMIC-IV-ECG datasets for three tasks that encompass chronic and acute disease dynamics: 90-day cardiovascular disease (CVD) prediction, in-hospital mortality prediction, and ICU length-of-stay (LOS) regression. MedM2T outperformed state-of-the-art multimodal learning frameworks and existing time series models, achieving an AUROC of 0.947 and an AUPRC of 0.706 for CVD prediction; an AUROC of 0.901 and an AUPRC of 0.558 for mortality prediction; and Mean Absolute Error (MAE) of 2.31 for LOS regression. These results highlight the robustness and broad applicability of MedM2T, positioning it as a promising tool in clinical prediction. We provide the implementation of MedM2T at https://github.com/DHLab-TSENG/MedM2T.

Kun-Wei Lin, Yu-Chen Kuo, Hsin-Yao Wang et al.

Clinical risk prediction using electronic health records (EHRs) is vital to facilitate timely interventions and clinical decision support. However, modeling heterogeneous and irregular temporal EHR data presents significant challenges. We propose \textbf{KAT-GNN} (Knowledge-Augmented Temporal Graph Neural Network), a graph-based framework that integrates clinical knowledge and temporal dynamics for risk prediction. KAT-GNN first constructs modality-specific patient graphs from EHRs. These graphs are then augmented using two knowledge sources: (1) ontology-driven edges derived from SNOMED CT and (2) co-occurrence priors extracted from EHRs. Subsequently, a time-aware transformer is employed to capture longitudinal dynamics from the graph-encoded patient representations. KAT-GNN is evaluated on three distinct datasets and tasks: coronary artery disease (CAD) prediction using the Chang Gung Research Database (CGRD) and in-hospital mortality prediction using the MIMIC-III and MIMIC-IV datasets. KAT-GNN achieves state-of-the-art performance in CAD prediction (AUROC: 0.9269 $\pm$ 0.0029) and demonstrated strong results in mortality prediction in MIMIC-III (AUROC: 0.9230 $\pm$ 0.0070) and MIMIC-IV (AUROC: 0.8849 $\pm$ 0.0089), consistently outperforming established baselines such as GRASP and RETAIN. Ablation studies confirm that both knowledge-based augmentation and the temporal modeling component are significant contributors to performance gains. These findings demonstrate that the integration of clinical knowledge into graph representations, coupled with a time-aware attention mechanism, provides an effective and generalizable approach for risk prediction across diverse clinical tasks and datasets.

Pi-Ju Tsai, Charkkri Limbud, Kuan-Fu Chen et al.

Sepsis is a heterogeneous syndrome. Identifying clinically distinct phenotypes may enable more precise treatment strategies. In recent years, many researchers have applied clustering algorithms to sepsis patients. However, the clustering process rarely incorporates clinical relevance, potentially limiting to reflect clinically distinct phenotypes. We propose NPCNet, a novel deep clustering network with a target navigator that integrates temporal Electronic Health Records (EHRs) to better align sepsis phenotypes with clinical significance. We identify four sepsis phenotypes ($α$, $β$, $γ$, and $δ$) with divergence in SOFA trajectories. Notably, while $α$ and $δ$ phenotypes both show severe conditions in the early stage, NPCNet effectively differentiates patients who are likely to improve ($α$) from those at risk of deterioration ($δ$). Furthermore, through the treatment effect analysis, we discover that $α$, $β$, and $δ$ phenotypes may benefit from early vasopressor administration. The results show that NPCNet enhances precision treatment strategies by uncovering clinically distinct phenotypes.

Chia-Fu Lin, Yi-Ju Tseng

Second primary cancer (SPC), a new cancer in patients different from previously diagnosed, is a growing concern due to improved cancer survival rates. Early prediction of SPC is essential to enable timely clinical interventions. This study focuses on lung cancer survivors treated in Taiwanese hospitals, where the limited size and geographic scope of local datasets restrict the effectiveness and generalizability of traditional machine learning approaches. To address this, we incorporate external data from the publicly available US-based Surveillance, Epidemiology, and End Results (SEER) program, significantly increasing data diversity and scale. However, the integration of multi-source datasets presents challenges such as feature inconsistency and privacy constraints. Rather than naively merging data, we proposed a loss fusion horizontal federated learning (LF2L) framework that can enable effective cross-institutional collaboration while preserving institutional privacy by avoiding data sharing. Using both common and unique features and balancing their contributions through a shared loss mechanism, our method demonstrates substantial improvements in the prediction performance of SPC. Experiment results show statistically significant improvements in AUROC and AUPRC when compared to localized, horizontal federated, and centralized learning baselines. This highlights the importance of not only acquiring external data but also leveraging it effectively to enhance model performance in real-world clinical model development.

Chih-Chuan Cheng, Yi-Ju Tseng

We propose SG-XDEAT (Sparsity-Guided Cross Dimensional and Cross-Encoding Attention with Target Aware Conditioning), a novel framework designed for supervised learning on tabular data. At its core, SG-XDEAT employs a dual-stream encoder that decomposes each input feature into two parallel representations: a raw value stream and a target-conditioned (label-aware) stream. These dual representations are then propagated through a hierarchical stack of attention-based modules. SG-XDEAT integrates three key components: (i) Cross-Dimensional self-attention, which captures intra-view dependencies among features within each stream; (ii) Cross-Encoding self-attention, which enables bidirectional interaction between raw and target-aware representations; and (iii) an Adaptive Sparse Self-Attention (ASSA) mechanism, which dynamically suppresses low-utility tokens by driving their attention weights toward zero--thereby mitigating the impact of noise. Empirical results on multiple public benchmarks show consistent gains over strong baselines, confirming that jointly modeling raw and target-aware views--while adaptively filtering noise--yields a more robust deep tabular learner.