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The aim of this prospective study was to evaluate the prognostic value of volumetric metabolic parameters assessed by during and after radiation-based therapy 18 F-FDG PET/CT in patients with stage III non-small cell lung cancer (NSCLC). We enrolled stage III NSCLC patients who had planned to receive definitive chemo-radiation or radiotherapy (RT) and underwent 18 F-FDG PET/CT before treatment (PET1), during RT (at the fifth week, PET2) and after treatment (3 months later, PET3). By comparing with PET1, percentage changes of metabolic tumor volume (ΔMTV) and tumor total lesion glycolysis (ΔTLG) of PET2 and PET3 were calculated. We used medians of ΔTLG and ΔMTV as cut-off values to stratify patients. Their prognostic values were evaluated by progression-free survival (PFS) and overall survival (OS). Thirty patients were enrolled initially. Five were excluded due to multiple metastases or double cancer. The remaining 25 patients had PET2 at a median of 46 Gy. Data on PET3 were available in 19 patients. During-RT ΔTLG (cut-off: 65%) was a significant prognostic factor for PFS (P = 0.02) and OS (P < 0.01). During-RT ΔMTV (cut-off: 42%) had marginal significance for PFS (P = 0.07) and was significant for OS (P = 0.02). Of the PET3 parameters, neither ΔTLG nor ΔMTV was a significant prognostic factor for PFS and OS. We conclude that ΔTLG of during-RT 18 F-FDG PET/CT may predict treatment response and thus provide opportunities to modify treatment for poor responders.

Introduction Carpal tunnel syndrome (CTS) is prevalent in workers who utilize hand-held vibration tools, engage in tasks involving repetitive wrist movements, and suffer from wrist overuse. Although electrical injuries involving the median nerve are a relatively rare but plausible cause of CTS, the related literature is limited. Here, we report a case of CTS in which the symptoms developed after an electrical injury, and review the related literature. Case summary The patient was a right-handed male electrician who often used hand tools but had no symptoms of CTS before the injury, with the left hand as the point of entry. Typical symptoms of CTS manifested after the electrical injury, and a nerve conduction velocity test confirmed the presence of severe CTS in the left hand. Therefore, we believe that the symptoms can be largely attributed to the electrical injury. Conclusions The available literature supports the occurrence of delayed compressive neuropathy caused by scarring from substantial cutaneous burns in patients with electrical injuries. This case shows that electrical injuries may cause CTS in the absence of severe scarring through other mechanisms such as direct injuries to the nerve. Therefore, patients with electrical burns should be routinely examined for peripheral nerve compression symptoms in follow-ups, even when there are minimal cutaneous burns.

OBJECTIVE This study aimed to determine if occupational exposure to whole-body vibration is associated with cervical intervertebral disc herniation among container truck drivers. METHODS We conducted a walk-through survey among container truck drivers and unexposed workers. We also measured the vibration hazard of the container truck over the driver's back and seat when the driver was loading a container and driving the loaded truck. RESULTS AND DISCUSSION Among the 38 workers interviewed, 32 were container truck drivers. Four of them reported cervical herniated discs, and all of these individuals were container truck drivers with a job tenure of greater than 10 years. Self-reported cervical herniated disc, nuchal pain, nocturia, arm/forearm weakness, arm/forearm numbness, and finger numbness were significantly more prevalent as the driver's duration of exposure increased (all p values of test for trend

Aim The geriatric population (aged ≥65 years) accounts for 12–24% of all emergency department (ED) visits. Of them, 10% have a fever, 70–90% will be admitted and 7–10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality. Methods We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point. Results A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine >2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were. Conclusions The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever. Geriatr Gerontol Int 2015; 15: 834–839.

Aims. The purpose of this study was to investigate the effectiveness of chilled/un-chilled baby oil therapy for treating uremic pruritus in haemodialysis patients. Background. Uremic pruritus affects 50–90% of haemodialysis patients, which makes it one of the most common medical problems in this population. Pruritus can cause skin infection, desquamation, pathological skin change, sleep disorder, anxiety, depression and social dysfunction. Design. A prospective, pretest—post-test quasi-experimental design was used. Methods. Haemodialysis patients with uremic pruritus were recruited and randomly assigned to one of three groups: experimental group 1 (chilled baby oil treatment; n = 30), experimental group 2 (un-chilled baby oil treatment; n = 31) and a control group (routine care only; n = 32). Participants in experimental group 1 and experimental group 2 were treated with chilled and un-chilled baby oil, respectively, for 15 minutes at least once daily for three weeks. The control group received no intervention other than standard care. Data collection included demographic data and itch severity. Medical records were also reviewed. Results. The baseline characteristics of subjects in this study were as follows: 59% were male, mean age was 61·88 (SD 12·7) years, mean duration of haemodialysis was 5·31 years, mean duration of uremic pruritus was 40·58 (SD 37·8) months and mean intensity of uremic pruritus was mild. The anti-pruritic effects were significantly larger in subjects treated with either chilled or un-chilled baby oil than in those who received routine care. Anti-pruritic effects did not significantly differ between experimental group 1 and experimental group 2. Conclusions. The study confirmed that, for relieving pruritus in haemodialysis patients, either chilled or un-chilled baby oil is as effective as moisturising lotions and cooling soothing agents. Relevance to clinical practice. Applying baby oil is a simple, safe, inexpensive and easily administered treatment for itchy skin in haemodialysis patients. By preventing or reducing uremic pruritus, baby oil treatment may also improve quality of life in this patient group.

OBJECTIVES To evaluate the clinical and epidemiological characteristics of patients with genitourinary (GU) tract transitional cell carcinoma (TCC) in an endemic area of blackfoot disease (BFD), the arsenic-exposed group, to compare them with characteristics among other non-BFD endemic areas (unexposed group). PATIENTS AND METHODS In all, 474 patients with pathologically diagnosed GU-TCC were enrolled in the study. All follow-up data were prospectively collected and entered into a database throughout the study period. Statistical analysis was used to determine the association between clinical variables and prognosis, and multivariate regression models were used to assess the association between arseniasis and mortality from GU-TCC. RESULTS There were no significant differences between the groups in age, sex, tumour stage and grade. However, the exposed group had a significantly higher proportion of females. The overall 5-year survival rate of patients with upper urinary tract (UUT) TCC was 49%, and the two groups had similar 5-year survival rates. The overall 5-year survival rate of patients with urinary bladder (UB) TCC was 68.3%, and there was a statistically significant difference in survival between the groups, with a 5-year survival rate of 58.7% for the exposed and 72.4% for the unexposed group. For patients with early-stage (pTa and pT1) UB cancers, the death rate was five times higher in exposed patients with tumour progression and recurrence after transurethral resection of bladder tumour than in the unexposed group. CONCLUSIONS There was a significantly higher mortality rate for UB-TCC among exposed patients in the area endemic for arseniasis than in those from other non-endemic areas. The arsenic content of artesian-well water might contribute to the increased ratio of female patients with GU-TCC and the unusually high incidence of UUT-TCC in the BFD endemic area in Taiwan.

However, industrialTMAH is in the form of a concentrated strong alkalineand thus might have severe hazardous effects. We herepresent a mortality case caused by dermal exposure toindustrial TMAH at work.CaseA 22-yr-old male engineer was accidentally drenchedwith concentrated TMAH solution (25%, pH 13.5) whileconducting routine examination of the pipe system in aplant manufacturing thin film transistor liquid crystaldisplays (TFT-LCDs). He was wearing a clean room suitwith plastic goggles, but not a mask. As TMAH sprayedover his head, he closed the valve and took a shower atthe nearby emergency shower facility immediately fordecontamination. When he was found by a co-workerabout 15 min later, he suffered from general weaknessand moderate salivation but was still conscious enoughto describe the accident. The paramedical team arrivedabout 30 min after the accident and found the patientlosing his consciousness with a Glasgow coma scale of 6(E

Objective: To compare quality, quantity, and trends of food supply from 1984 to 2009 and degree of food westernization in Taiwan with Asian countries and world continents by using food balance data(FBS). Methods: We compiled data from FBS of Taiwan and FAO, including five continents and three most populated countries each in Eastern, Southern, and South Eastern Asia over the period 1984-2009. Quantity of food supply per capita was referenced to Taiwan food guides. The population-weighted means of food supply from Europe, North America, South America, and Australia & New Zealand Continents in terms of energy and nutrient distributions, animal/plant sources, and sugar/alcohol contribution were used asindicators of westernization. Findings: Taiwan's food supply, although currently provides sufficient food per capita, showed decreasing trends through recent years. The cereals/roots supply and rice to wheat ratio kept as the lowest, while the meat and oil supplies per capita were the highest among the 10 studi...

In environments with ultra-low humidity, workers may have excessive body water loss due to evaporation through the skin, which can lead to dehydration. Before the development of clinical symptoms and signs, concentrated urine may be applied as an early indicator of dehydration. We used urine specific gravity (USG) as a biomarker to evaluate the hydration status of workers working in such an environment. We collected the urine samples from workers at a lithium battery plant during their annual health examination, and the relative humidity of some working areas called "dry rooms" in the plant was 1.5 +/- 1%. We recruited workers in those dry rooms as the exposure group (N=50) and defined the remaining workers, including administration office workers, as the comparison group (N=122). The prevalence of abnormally concentrated urine (USG>1.030) and related factors were compared between these two groups. While the exposure group were younger and had shorter employment durations compared to the comparison group (p

Aims: This study investigates the relationship between β2GPI gene polymorphism and antiphospholipid syndrome (APS) in Chinese subjects. Methods: Twenty-five APS patients, 80 lupus patients and 100 healthy individuals were enrolled into the study. The genetic polymorphism of position 247 of β2GPI gene was analyzed by the restriction fragment length polymorphism polymerase chain reaction. Results: Low frequency of V allele was noted in these Chinese. The frequency of V allele was similar among healthy individuals, lupus patients and APS patients. There was statistically significant correlation between the V allele expression and the presence of anti-β2GPI antibodies. Conclusion: The inter-population differences exist in β2GPI gene polymorphism. Although there was no association of V allele at the position 247 with the Chinese APS patients, significant correlation was found between the V allele expression and the presence of anti-β2GPI antibodies.

Objectives: With the knowledge of differences in anatomic structures between the trachea and the esophagus, the authors conducted an animal study to evaluate the usefulness of endotracheal cuff pressure in distinguishing endotracheal and esophageal intubations. Methods: Six swine were anesthetized and endotracheally intubated with 7.5-mm cuffed endotracheal tubes. The intubations were confirmed by fiberoptic bronchoscopy. Each pilot balloon was connected to a 10-mL syringe and a manometer via a three-way stopcock. The cuff pressures were measured for each 1-mL incremental filling of air (1‐10 mL). After removal of the endotracheal tubes, each swine was then intubated with the same endotracheal tubes into its esophagus. The cuff pressures of the esophageal intubation were measured with the same procedure. The cuff pressures and the pressure‐volume relationships in both intubations were compared. Results: The cuff pressure increased significantly in the esophageal intubation in comparison with the endotracheal intubation in all the comparisons from 1 mL to 10 mL (p ¼ 0.028 for all Wilcoxon signed-rank tests). The slope of the pressure‐volume curve of the cuff pressure was also significantly higher in the esophageal intubation during the inflation of the cuff on average (0.047 vs. 0.032 cm H2O/mL; p ¼ 0.001), particularly in the first 5 mL of air inflation. Conclusions: The cuff pressure in the esophageal intubation was significantly higher than that in the endotracheal intubation under the same inflated volume from 1 to 10 mL. This may provide the basis for an adjunctive, simple, rapid, and reliable method to verify endotracheal intubation.Key words: endotracheal intubation; esophageal intubation; verification of endotracheal tube; endotracheal cuff pressure. ACADEMIC EMERGENCY MEDICINE 2005; 12:1153‐1157.

Musculoskeletal disorder (MSD) is a common problem among workers. In spite of the numerous reports on MSD in various specific groups of workers, few data on the prevalence in the general working population are available except for back pain. We analyzed the information collected through a nationwide survey in Taiwan in 1994 to estimate the prevalence of MSD by age, gender, and education level and identify high-risk industries. In the survey, a standard questionnaire was distributed to a representative sample of 22,475 non-self-employed workers in Taiwan. National estimates were obtained by applying a weight to each participant. Among the sampled workers, 18,942 (84.3%) participated, and 37.0% (standard error=0.4%) had MSD. Female workers had a significantly higher overall prevalence than male workers (39.5% vs. 35.2%, p

Many high-tech industries do some manufacturing processes in clean-rooms to ensure high quality and yield. To prevent contamination, workers need to put on special clothing and go through certain cleaning procedures before entry. Therefore, some workers may limit their water intake and try not to go the bathroom, which are both risk factors of urinary tract infection (UTI). To assess the prevalence and risk factors of UTI among the workers, we conducted a study in an industrial park. We recruited workers who came to the clinic in the park for an annual health examination between September 1 and December 31, 2000. From each participant we collected a urine sample and obtained related information through a questionnaire. All the 1, 054 qualified workers, including 416 men and 638 women, participated, and 693 (65.7%) were clean-room workers. Most clean-room workers were women (71.3%), and they tended to be younger and had lower frequencies of drinking water and going to the bathroom during the shift. A higher prevalence of UTI (6.2% vs. 2.5%, p=0.008) was observed among clean-room workers. After adjusting for age, frequency of drinking water, and working in clean-rooms, female gender was a significant risk factor (odds ratio [OR]=18.3, 95% confidence interval [CI]: 4.1 to 82.1) and going to the bathroom three times or more during a shift was a protective factor (OR=1.3, 95% CI: 0.1 to 1.0). In conclusion, UTI is prevalent among clean-room workers, and frequent voiding is recommended for prevention of the disease.

Aims To assess the factors associated with successful discontinuation of insulin therapy after diabetic ketoacidosis (DKA) in adult patients. Methods Patients (≥ 18 years) attending the Endocrine and Metabolism Clinic at a major hospital in southern Taiwan were recruited. After recovery from the acute stage, those with no contraindications to oral antidiabetic agents, with adequate β cell reserve, and with no antiglutamic acid decarboxylase (GAD) antibody were treated with oral agents. Results Sixty-six patients (38 males, 28 females, aged 18–76 years) were included, and 21 qualified for treatment with oral agents. These 21 patients were older at diagnosis of diabetes (45.5 ± 14.0 vs. 40.0 ± 13.8 years, P = 0.047), had shorter diabetes duration (median 0 vs. 5.5 months, P = 0.040), higher BMI (median 23.4 vs. 19.5 kg/m2, P

The current U.S. EPA standard for inorganic arsenic in drinking water is 50 ppb (microgram/L), dating to the National Interim Primary Drinking Water Regulation of 1976. The current EPA risk analysis predicts an increased lifetime skin cancer risk on the order of 3 or 4 per 1000 from chronic exposure at that concentration. Revision of the standard to only a few ppb, perhaps even less than 1 ppb, may be indicated by the EPA analysis to reduce the lifetime risk to an acceptable level. The cost to water utilities, and ultimately to their consumers, to conform to such a large reduction in the standard could easily reach several billion dollars, so it is particularly important to assess accurately the current risk and the risk reduction that would be achieved by a lower standard. This article addresses the major sources of uncertainty in the EPA analysis with respect to this objective. Specifically, it focuses on uncertainty and variability in the exposure estimates for the landmark study of Tseng and colleagues in Taiwan, analyzed using a reconstruction of the their exposure data. It is concluded that while the available dataset is suitable to establish the hazard of skin cancer, it is too highly summarized for reliable dose-response assessment. A new epidemiologic study is needed, designed for the requirements of dose-response assessment.

Back pain accounts for about one fourth of workers' compensation claims in the United States. The Occupational Health Supplement to the 1988 National Health Interview Survey provided an opportunity to assess the scope of this problem. The 30,074 respondents who worked in the 12 months before the interview were defined as "workers", and those with back pain every day for a week or more during that period were defined as "cases." A weighting factor was applied to the answers to derive national estimates. In 1988, about 22.4 million back pain cases (prevalence 17.6%) were responsible for 149.1 million lost workdays; 65% of cases were attributable to occupational activities. For back pain attributed to activities at work, the risk was highest for construction laborers among males (prevalence 22.6%) and nursing aides among females (18.8%). Our analyses show that back pain is a major cause of morbidity and lost production for U.S. workers and identifies previously unrecognized high risk occupations, such as carpenters, automobile mechanics, maids, janitors, and hairdressers, for future research and prevention.

A high incidence of bladder cancer (23.53/100,000 population per annum from 1981-1985) was found in an endemic area of peripheral vascular disease known as black foot disease (BFD) on the southwest coast of Taiwan. The average incidence of bladder cancer in the whole of the Taiwan area was 2.29/100,000 during the same period. The incidence of female bladder cancer (21.10/100,000) in this area was also high. The ratio of male to female bladder cancer in the BFD endemic area and the neighbouring area was 1.24 and 1.09, lower than that in the whole Taiwan area (2.75) and elsewhere around the world. The high content of arsenic and the high concentration of a "fluorescent substance" in artesian well water in this area are the only 2 related factors identified so far. Determination of the actual carcinogen requires further investigation.