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Purpose: The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for hepatocellular carcinoma (HCC) has been used since 2018. However, whether any significant difference in overall survival (OS) exists between patients with T1a and T1b HCC who undergo resection has been controversial. We aim to clarify this issue.Methods: We consecutively enrolled newly diagnosed HCC patients who underwent liver resection (LR) from 2010 to 2020 at our institution. OS was estimated using the Kaplan–Meier method and compared using log-rank tests. Prognostic factors for OS were identified by multivariate analysis.Results: This study enrolled 1250 newly diagnosed HCC patients who underwent LR. No significant differences in OS were identified between patients with T1a and T1b tumors among all patients (p=0.694), cirrhotic patients (p=0.753), non-cirrhotic patients (p=0.146), patients with alpha-fetoprotein (AFP) >20 ng/ml (p=0.562), patients with AFP ≤20 ng/ml (p=0.967), patients with Edmondson grade 1 or 2 (p=0.615), patients with Edmondson grade 3 or 4 (p=0.825), patients positive for hepatitis B surface antigen (HBsAg; p=0.308), in patients positive for anti–hepatitis C virus (HCV) antibody (p=0.781), or patients negative for both HBsAg and anti-HCV antibody (p=0.125). Using T1a as the reference, multivariate analysis showed that T1b is not a significant predictive factor for OS (hazard ratio [HR]: 1.338; 95% confidence interval [CI]:0.737–2.431; p=0.339).Conclusion: No significant difference in OS was observed between patients who underwent LR to treat T1a and T1b HCC tumors.

PURPOSE To evaluate the prevalence and extension of macrovascular invasion (MaVI) in a large cohort of hepatocellular carcinoma (HCC) patients and analyze the association between MaVI and overall survival (OS). METHODS From 2011 to 2018, 2540 patients with newly diagnosed HCC who were managed in our institution were enrolled in this retrospective study. Tumor invasion of the intrahepatic branches of the portal or hepatic veins was defined as peripheral MaVI. Tumor invasion of the main portal vein or inferior vena cava was defined as central MaVI. RESULTS MaVI prevalence was 16.2% (n = 411). Among patients with Barcelona Clinic Liver Cancer (BCLC) stage C and Child-Pugh class A, 165 patients presented with peripheral MaVI and 89 patients with central MaVI. The median OS was 13.2 months (95% confidence interval [CI]: 11.4-15.4) in the peripheral MaVI group and 6.6 months (95% CI: 3.6-9.5) in the central MaVI group (p

Tenofovir disoproxil fumarate (TDF) and Entecavir (ETV) are commonly used for patients with chronic hepatitis B (CHB), and renal or bone toxicity are possible concerns. This study is to evaluate the renal and bone effect of TDF compared with ETV in CHB patients. This is a retrospective study at Kaohsiung Chung-Gung memorial hospital, Taiwan, from June 2013 to December 2018. Patients with CHB were prescribed with TDF or ETV for 3 years or above. Renal function was assessed at 12-week intervals. Dual-energy X-ray absorptiometry scans of the spine and femurs were performed at 48-week intervals. The propensity score analysis was conducted to balance the baseline characteristics of patients in both treatment groups. A total of 258 patients were included in this study: TDF (n = 135) and ETV (n = 123). The prevalence of osteopenia was much higher in the TDF group at week 48 and week 96. The TDF group showed significant mean percentage decrease from baseline in bone mineral density throughout the treatment course. Logistic regression analysis adjusted for the propensity score demonstrated that the use of TDF was the only predictive factor of significant bone density loss at week 144. The mean percentage decline of estimated glomerular filtration rate was significant in the TDF group at all time points. Renal threshold phosphate concentration was similar among both treatment groups. This study suggested CHB patients treated with TDF may experience increased risks of bone loss and renal deficits compared to those treated with ETV.

Background Urokinase plasminogen activator (uPA) is an extracellular matrix-degrading protease that is involved in the invasiveness and progression of cancer. There is good evidence that uPA expression is a clinically relevant biomarker in some solid tumors, but its role in hepatocellulcar carcinoma (HCC) is uncertain. We evaluated the prognostic value of serum uPA before surgery in HCC patients receiving curative resection. Methods Serum uPA levels were determined by enzyme-linked immunosorbent assay in 282 HCC patients who received complete liver resections at Kaohsiung Chang Gung Memorial Hospital. Overall survival (OS) curves were constructed using the Kaplan-Meier method and compared using the log-rank test. A Cox proportional -hazards regression model was used to identify independent prognostic factors. The median follow-up time was 52 months. Results Patients with higher pretreatment serum uPA (≥1 ng/ml) had significantly shorter OS (p = 0.002). Patients with liver cirrhosis, hypoalbuminemia, and thrombocytopenia were significantly more likely to present with elevated uPA levels. Multivariate Cox regression analyses indicated that high pretreatment serum uPA [hazard ratio (HR), 1.848, p = 0.006], vascular invasion (HR, 2.940, p p Conclusions We conclude that uPA is a clinically relevant biomarker in HCC patients receiving curative resection, with higher expression of uPA being associated with higher mortality. This also highlights the potential utility of uPA as a therapeutic target for improved treatment strategies.

Dam removal has the potential to efficiently solve the problems caused by fragmented stream habitats but may simultaneously cause negative impacts on biotic communities. To conserve the critically endangered Formosan landlocked salmon (Oncorhynchus masou formosanus), a 15-m-tall check dam was partially removed from the Chichiawan Stream at the end of May 2011, before the flood season. Using this dam removal experience, we aimed to cast dam removal as an action comparable to a natural flood event. We applied a before-after-control-impact (BACI) design and quantified the environmental factors and major biotic communities at four sampling sites in the stream bimonthly before (2010) and after (2012 and 2013) the dam removal and monthly in the year of the dam removal (2011). After the dam removal, a faster current velocity and more turbid water were observed at the downstream sites, and the area’s deposition consisted of small-grained sediments. Despite this, our results show that the dam removal was performed during a suitable period. There was no obvious influence on tadpoles as they metamorphosed into adult frogs and left the stream before the dam removal. Fish exhibited a greater resistance to the alteration in flow resulting from the dam removal. An increase in fish abundance at the upstream sites after the dam removal suggests that the corridors created by the dam removal allowed access to more habitats for the fish. In particular, the periphyton biomass and aquatic insect densities decreased markedly at the downstream sites after the dam removal, but they recovered within a year, demonstrating the resilience of these taxa. Coleoptera, Plecoptera and Trichoptera were more resistant than the periphyton, Diptera and Ephemeroptera after the dam removal and an extreme flood event. In conclusion, the responses of stream communities to dam removal were similar to the responses to an extreme flood event. To mitigate the impacts caused by dam removal, our results suggest that stream communities may respond to dam removal as a natural flow alteration if the timing of the dam removal occurs just before the flood season.

Dam removal is analyzed as a conservation strategy for the Formosan landlocked salmon Oncorhynchus masou formosanus, a critically endangered species whose last refuge is the Wuling basin in central Taiwan. In a previous study, a stochastic age-structured simulation model was developed and used to assess the effectiveness of removing four dams in increasing salmon abundance in Kaoshan Stream in the context of climate change. Three check dams remain intact in Chichiawan Stream and one of its tributaries. In this study, the model is recalibrated for these regions and simulates the removal of each of these dams. Model analysis suggests that the combined effect of dam removal and climate change decreases the effectiveness of dam removal while increasing the negative impact of climate change on abundance. A simple graphing technique is presented for comparing the predicted impact of the removal of each dam under consideration. The model predicts that removing the dam in Chichiawan Stream has the largest potential for increasing the 2035 abundance, but only under narrow conditions of climate change and effectiveness of dam removal. The potential benefit from removing one of the tributary dams is smaller, but the conditions for reaching closer to its potential are less restrictive. This type of analysis is useful for dam removal management decisions regarding habitat restoration.

Understanding spatial variation in fish trophic structures along large river systems remains a challenge, and the influence of fish food selectivity and diet shifts on these structures remains unknown. In this study, the assemblage composition and stomach contents of fish in the subtropical East River of southern China were analyzed to determine their diet composition (DC) and identify prey-oriented feeding groups. Ten prey items were identified and used to cluster 106 fish species into 23 feeding groups. The number of groups increased longitudinally due to the accumulated emergence of site-specific prey sources in fish DC, although this number decreased sharply near the estuary due to the loss of insectivorous fish. The fish assemblages showed a longitudinal decrease in abundance and an increase in biomass, with higher values observed in the rainy season than the dry season. A downstream decrease in insectivores and epiphytivores and increase in detritivores and molluscivores represented the basic patterns observed along the river. Seven widespread fish species exhibited spatial dietary shifts, among which three generalist feeders with a high abundance notably influenced the fish trophic structures, and four specialist feeders with high food selectivity were significantly (P

This study aims to explore the impact of energy prices on energy consumption and energy efficiency using industry data for Taiwan over the period of 1982–2011. A frontier-based framework is proposed with a microeconomic foundation to measure energy efficiency and decompose energy consumption into energy utilization and energy wastage in the short and the long run. We learn that the traditional energy efficiency indicators are essentially ambiguous measures. In contrast, the frontier-based framework can focus the measure on energy relatively specifically and capture the essence of a proper efficiency measure more precisely. The empirical analyses reveal that the values of short- and long-run energy efficiency in the Taiwan manufacturing sector are on average 0.6016 and 0.8040, respectively. Moreover, energy utilization is price inelastic in the short run, but in the long run, it is elastic at −0.79. The energy price elasticity of energy wastage in the short run is −0.61, which is somewhat higher than the −0.52 in the long run. The energy price elasticity of energy efficiency in the short run is 0.077 and that in the long run is 0.144. All the energy price elasticities obtained using the frontier-based framework are lower than those obtained using the common framework of the past without distinguishing the heteroscedasticity between the energy utilization and energy wastage.

Background Toll-like receptors (TLRs) are effectors of the innate immune system that are able to recognize hepatitis C virus (HCV) and give rise to an immune response. Failure of interferon (IFN)-α-based treatment is related to host immunity. Therefore, we sought to study the clinical importance of TLRs in HCV genotype 1 patients who received pegylated IFN (PEG-IFN) plus ribavirin (RBV) therapy. Methods We enrolled 79 treatment-naïve patients with HCV genotype 1. Patients completed a 24- to 48-week course of response-guided therapy. Peripheral blood monocyte (PBMC) expression of mRNA for TLRs 2, 3, 4, 7, and 9 was quantified by real-time PCR before therapy. TLR mRNA expression is shown as a log ratio relative to GAPDH mRNA (log 2 -(∆Ct)). Results Forty-five patients (57.0 %) showed a rapid virological response (RVR). Univariate analysis revealed that TLR 2, 3, 4, 7, and 9 were significantly lower in the RVR group than in the non-RVR group (P = 0.001, 0.014

Early prediction of lamivudine (LAM) response by individualized monitoring of serum HBV DNA like roadmap concept, and investigation of the outcome after LAM discontinuation in renal transplant recipients (RTRs) with chronic hepatitis B (CHB).We conducted a study on 19 RTRs with HBV infection receiving LAM treatment for 2 years from 2004 to 2007. HBV DNA level was assessed at baseline, 12, 24, 52, and 104 weeks after treatment. Risk factors of tyrosine-methionine-aspartate-aspartate (YMDD) mutation on treatment and relapse rate of HBV after LAM discontinuation were analyzed.HBV DNA levels became undetectable in 32, 37, 63, and 53% of patients after 12, 24, 52, and 104 weeks of LAM treatment, respectively. Overall, three (16%) and five (33%) patients were detected with YMDD mutations at week 52 and 104, respectively. In the concept of roadmap, of the seven patients with inadequate virologic response (IAVR) at week 24, five had YMDD mutations. There was no significant association of YMDD mutations with age, gender, genotype, cirrhosis, HBeAg status, baseline HBV DNA, precore/core promoter mutations, and primary response, except IAVR at week 24 (P = 0.001). The relapse rate of HBV after LAM discontinuation was high (75%) during a median follow-up of 65 weeks.The rate of LAM resistance in RTRs is similar to immunocompetent CHB patients in a 2-year therapy. By roadmap concept, RTRs with IAVR require a change in therapy to prevent viral resistance. Relapse after LAM withdrawal is frequent. Long-term antiviral therapy is crucial for immunosuppressed patients.

This paper is an extension of the metafrontier Malmquist productivity index, which takes into account the effect of scale efficiency change in its decomposition for both the non-parametric and parametric frameworks. Meanwhile, the ‘catch-up’ in the index is also disintegrated as two components: pure technological catch-up and frontier catch-up. An empirical application that uses unbalanced panel data of the Taiwanese and Chinese commercial banking industry is also conducted under a parametric framework. The results reveal that the adverse scale efficiency change is the key factor to inducing the inferior productivity growth seen in Chinese banks compared with Taiwanese banks, which spotlights the importance of the scale efficiency change term on productivity measures. It also provides one possible explanation for the recent hot issue about the motives for the two shores of the Taiwan Straits advancing financial openness to each other and mutually signing a banking Memorandum of Understanding.

This hospital-based analysis was conducted to identify prognostic factors of hepatocellular carcinoma (HCC) in a hepatitis B virus endemic area.A total of 6381 HCC cases, diagnosed from 1986 to 2002, were enrolled, and 2890 (42.3%) of them were not treated. Survival rates were analyzed by correlation with the national mortality databank. Missing data and correlations among prognostic factors were considered in the analysis.The overall 1-year, 3-year, 5-year, and 7-year survival rates were 44.3%, 24.9%, 17.1%, and 13%, respectively. Multivariate analysis revealed that the independent factors influencing survival were the initial treatment modality, degree of liver function impairment, hepatitis B surface antigen positivity, tumor status, and alpha-fetoprotein. Besides these well-known prognostic factors, high alanine aminotransferase (ALT) levels and a high aspartate aminotransferase (AST)/ALT ratio were identified as independent poor prognostic factors.This study, which considered untreated cases, missing data, and correlations between variables and official survival data sets, provides a large-scale comprehensive survival analysis. According to our results, high ALT and high AST/ALT were independent poor prognostic factors. Therefore, viral activity should be controlled in HCC patients, and patients with elevated AST/ALT ratios should be carefully monitored.