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Background/purpose: This multi-institutional study was aimed to analyze prognostic factors of completely resected early stage thymoma., Methods: Patients with surgically treated early stage thymoma between 1988 and 2019 were enrolled. Statistical associations were evaluated using the χ 2 test, Fisher's exact test, and Student's t-test. Disease-free survival (DFS) and overall survival (OS) curves were established by the Kaplan-Meier method, and compared using the log-rank test., Results: A total of 229 patients with Masaoka stage I and 131 with Masaoka stage II thymoma were included. The DFS of patients with Masaoka stage I thymoma was associated with neutrophil-to-lymphocyte ratio (NLR, hazard ratio [HR] = 3.18, 95% confidence interval [CI]: 1.34-7.54), and extrathymic malignancies (HR = 4.51, 95% CI: 2.02-10.11), and the OS was associated with NLR (HR = 5.03, 95% CI: 1.61-15.66) and extrathymic malignancies (HR = 7.68, 95% CI: 3.12-18.97). In patients with Masaoka stage II thymoma, DFS was associated with age (HR = 2.50, 95% CI: 1.18-5.27), extent of surgery (HR = 0.41, 95% CI: 0.19-0.87), and NLR (HR = 3.23, 95% CI: 1.11-9.44), and OS was associated with age (HR = 5.77, 95% CI: 1.81-18.34), surgical approach (HR = 8.40, 95% CI: 1.91-37.00), and extrathymic malignancies (HR = 2.96, 95% CI: 1.08-8.12)., Conclusion: In Masaoka stage I thymoma, preoperative NLR and extrathymic malignancies are independently associated with DFS and OS. In Masaoka stage II thymoma, age, extent of surgery, and NLR are independently associated with DFS, and age, surgical approach, and extrathymic malignancies are associated with OS., Competing Interests: Declaration of competing interest All authors declare that there is nothing to be disclosed in this study., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are used as the standard first-line treatment for patients with advanced EGFR-mutated non-small cell lung cancer (NSCLC). However, the impact of comorbidities and treatment toxicities on quality of life (QoL) was seldom investigated., Objective: We aimed to investigate the association of comorbidities, adverse events (AEs), and QoL in treatment-naïve advanced NSCLC patients receiving EGFR-TKI treatments., Methods: This multi-center prospective observational study was conducted to evaluate QoL and AEs at baseline, the 2nd, 4th, 12th, and 24th week. Clinical characteristics, comorbidities, and pre-treatment laboratory data were recorded. QoL was assessed by using the summary score of the EORTC QLQ-C30 and the dermatology life quality index. The impact of comorbidities, neutrophil-to-lymphocyte ratio (NLR), and AEs on QoL was analyzed by generalized estimating equations., Results: A total of 121 patients were enrolled. Diarrhea (p = 0.033), anorexia (p < 0.001), and NLR ≥4 (p = 0.017) were significantly associated with a QoL impairment. Among skin toxicities, acneiform rash (p = 0.002), pruritus (p = 0.002), visual analogue scale for pruritus (≥3 and < 7, p = 0.006; ≥7, p = 0.001) and pain (1-3, p = 0.041) were associated with a QoL impairment. No significant association was found between comorbidities and QoL changes., Conclusion: Diarrhea, anorexia, skin pain, and pruritus may cause a deterioration in QoL in patients receiving EGFR-TKI therapy. NLR may be a potential predictive factor for QoL impairment. Aggressive management and close monitoring for these clinical factors are crucial to improve QoL., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jung-Yueh Chen has received honoraria for speeches from AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Eli Lilly, Novartis, Pfizer, Roche, and Chugai Pharmaceutical. Yu-Feng Wei has received honoraria for speeches from Boehringer Ingelheim, Eli Lilly, AstraZeneca, Novartis, Pfizer, Roche, and Chugai Pharmaceutical. Sheng-kai Liang has received honoraria for speeches from Roche, AstraZeneca, Pfizer, Merck Sharp & Dohme, Novartis, and Boehringer Ingelheim. Kuan-Yu Chen has received honoraria for speeches from Pfizer, Novartis, Merck Sharp & Dohme, AstraZeneca, Roche, Boehringer Ingelheim, Daiichi Sankyo, Chugai Pharmaceutical, and Bristol-Myers Squibb, as well as travel/accommodation/meeting expenses from Merck Sharp & Dohme, Chugai Pharmaceutical, and Boehringer Ingelheim. Chia-Yu Chu has received honoraria for speeches from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novartis, Pfizer, Roche. Tzu-Yi Chuang, Chia-Hung Tu, Yu-Jo Yeh declare that they have no competing interests., (Copyright © 2023. Published by Elsevier B.V.)

Chronic obstructive pulmonary disease (COPD) has significant contributions to morbidity and mortality world-wide. Early symptoms of COPD are not readily distinguishable, resulting in a low rate of diagnosis and intervention. Different guidelines and recommendatations for the diagnosis and treatment of COPD exist globally. The first edition of clinical practice guidelines for COPD was published in 2016 by the Ministry of Health and Welfare in Taiwan in collaboration with the Taiwan evidence-based medicine association and Cochrane Taiwan, and was revised in 2019 in order to update recent diagnostic and therapeutic modalities for COPD and its acute exacerbation. This revised guideline covered a range of topics highlighted in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, including strategies for the diagnosis, assessment, monitoring, and management of stable COPD and exacerbations, with particular focus on evidence from Taiwan. The recommendations included in the revised guideline were formed based on a comprehensive systematic review or meta-analysis of specific clinical issues identified by an expert panel that surveyed relevant scientific evidence in the literature and guidelines published by the clinical communities and organizations nationally and internationally. The guidelines and recommendations are applicable to the clinical settings in Taiwan. We expect this revised guideline to facilitate the diagnosis, treatment and management of patients with COPD by physicians and health care professionals in Taiwan. Adaptations of the materials included herein for educational and training purposes is encouraged., (Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background/purpose: This report describes the 2016 consensus of the Taiwanese Dermatological Association (TDA) regarding the definition, classification, diagnosis, prevention, and management of skin toxicities resulting from treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). This consensus is distributed to practices throughout Taiwan to provide recommendations for the diagnosis and treatment of such skin toxicities in order to improve the quality of life of patients undergoing EGFR-TKI treatment. The consensus thus serves as an important reference for dermatologists and other interested clinicians, such as oncologists, throughout Taiwan., Methods: All the consensus contents were voted on by the participating experts, with approval by no less than 75% required for inclusion., Results: The consensus provides a comprehensive overview of EGFR-TKI skin toxicities, including recent advances in identifying their causes and the processes by which they develop., Conclusion: All the consensus meeting attendees agreed that there are several major EGFR-TKI-related skin toxicities, including acneiform rash (i.e., papulopustular rash), xeroderma, pruritus, paronychia, stomatitis, mucositis, and hair changes (such as hair loss, slowed hair growth, and trichomegaly). The experts were also generally unanimous in their voting on the specific definitions, onset times, and care suggestions for each of those skin toxicities. Furthermore, the recommended treatment algorithms for the various skin toxicities were ultimately approved by 100% (15/15) of the consensus attendees., (Copyright © 2017. Published by Elsevier B.V.)

Background/purpose: Serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), a detector of acute inflammatory response to microbial products and a good marker for diagnosing sepsis and pneumonia, has not yet been described as a predictor for infection or a prognostic factor in patients with acute respiratory distress syndrome (ARDS)., Methods: This prospective observational cohort study enrolled 63 ventilated adult patients with ARDS; 50 as septic and 13 as non-septic, and followed them for 28 days in intensive care units at a university hospital in Taiwan. Serial serum sTREM-1 levels and cytokines, such as interleukin (IL)-1, IL-8, and tumor necrosis factor-α, on days 1, 3, 5, 7 and 14 were measured by an enzyme-linked immunosorbent assay. The association between biomarkers and clinical infectious diagnosis/outcome in ARDS was explored., Results: Serum sTREM-1 and cytokine levels could not differentiate septic from non-septic ARDS. Serum log sTREM-1 and inflammatory cytokine levels were correlated positively (r = 0.325 for IL-1β; r = 0.247 for IL-8; r = 0.480 for tumor necrosis factor-α). As prognostic factors, higher serum sTREM-1 level on day 1 and increasing levels over time, especially in the first 5 days, were independent predictors of mortality on day 28, using a multivariate Cox regression model. Serum sTREM-1 levels remained stable or even increased in the non-surviving patients, but decreased in the survivors., Conclusion: Serum sTREM-1 level might not be a reliable marker for infection in ARDS patients. However, as an inflammatory marker, initial serum sTREM-1 level and its trend over time, especially in the first 5 days, could be predictive of short-term mortality. A progressive decline in serum sTREM-1 levels during follow-up indicates a favorable outcome, whereas persistently elevated sTREM-1 indicates a poor prognosis and should lead to a re-evaluation of therapy., (Copyright © 2010 Formosan Medical Association & Elsevier. Published by Elsevier B.V. All rights reserved.)

Background/purpose: There remains uncertainty regarding the treatment strategy for patients with peripheral tuberculous lymphadenitis (pTBL) in areas endemic for tuberculosis. The purpose of this study was to demonstrate the clinical features and assess the predictors of a complicated treatment course in pTBL., Methods: A retrospective analysis of 97 pTBL patients from January 1995 through to December 2004 was conducted. Patient characteristics with and without a complicated treatment course, defined as prolonged treatment (>9 months) and/or relapse, were compared for determining the predictors., Results: The disease occurred predominantly in females (57.7%) with a mean age of 37. Most patients (72%) were asymptomatic. Cervical nodes were the most common (72%) manifestations. Fifty-six patients completed a 6-9 month course of therapy without relapse; 28 had a prolonged but complete treatment course, and 13 relapsed within a mean of 8.5 months after treatment (range, 3-42 months; median, 7.8 months). Of 97 pTBL patients, six had enlarged or newly appeared lymph nodes during treatment. Multivariate analysis indicated that low body mass index and bilateral cervical nodes were independent determinants of a complicated treatment course with the odds ratios of 1.2 (95% CI, 1.01-1.41; p=0.042) and 3.9 (95% CI, 1.08-14.0; p=0.038), respectively., Conclusion: This study found that pTBL is more likely to occur in young female patients. For patients who present with bilateral cervical nodes and low body mass index, a prolonged treatment course to ensure disease control should be considered.

Recombinant factor VIIa (rFVIIa) was developed for the treatment of bleeding in hemophilic patients with inhibitors. It has also been used to stop bleeding in nonhemophilic patients who fail to respond to conventional treatment. We report a case of catastrophic hemothorax in which bleeding was stopped by administration of rFVIIa. A 68-year-old woman with chronic hepatitis C-related liver cirrhosis was admitted due to pneumonia and parapneumonic effusion. The patient developed hemothorax and hypovolemic shock after thoracentesis. Conventional therapies including tube thoracostomy and transarterial embolization failed to stop the life-threatening bleeding. The bleeding stopped after administration of rFVIIa 100 microg/kg/BW at 2-hour intervals for a total of two doses on the 3rd day of hospitalization. Despite intensive care, however, the patient died due to nosocomial infection and multiple organ failure on the 12th day of hospitalization. Hemothorax in a nonhemophilic patient can be successfully treated with rFVIIa.

Hemoperitoneum caused by ruptured hepatocellular carcinoma (HCC) is not uncommon in patients with HCC. Hemothorax due to rupture of metastatic HCC, however, is a very rare complication with high mortality because of uncontrollable hemorrhage. We describe a 42-year-old male HCC patient with chest wall metastasis complicated by hemothorax with an unusual presentation of massive hemoptysis. He received tube thoracotomy immediately and emergency surgery because of persistent bleeding. Hemostasis was achieved transiently. Despite intensive care, he died of multiple organ failure on the 6th postoperative day. We conclude that hemothorax due to a ruptured HCC, as in this case, indicates a very poor prognosis despite intensive treatment.