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Objective: Postradiation nasopharyngeal necrosis (PRNN) frequently develops after second‐course radiotherapy for nasopharyngeal carcinoma (NPC). PRNN can lead to internal carotid artery (ICA) massive hemorrhage due to ICA rupture, resulting in sudden death. This study aims to explore the pretreatment of the ICA to prevent fatal massive hemorrhage in PRNN patients. Study Design: Retrospective cohort study. Setting: Sun Yat‐sen University Cancer Center. Methods: Patients diagnosed with NPC and PRNN from January 2010 to September 2022 were included. The Cox proportional hazards regression analysis was performed to analyze risk factors for massive hemorrhage and survival. A nomogram was developed to integrate prognostic models and perform parameter calibration. Results: Two hundred and fifty‐four PRNN patients were included in this study. Prophylactic ICA occlusion significantly reduced the risk of ICA hemorrhage compared to no prophylactic ICA occlusion (3.6% vs 40.6%, P <.001). Surgical repair on necrosis significantly prevented hemorrhage and improved survival. The nomogram, incorporating the above 2 factors and the nearest distance from necrosis to ICA ≤ 3 mm, exhibited excellent discriminative ability for hemorrhage. We identified 3 high‐risk factors that indicate the need for prophylactic ICA management in PRNN patients: (1) exposure of ICA by rhinoscopy; (2) signs of ICA erosion on MRA scanning; (3) the depth of soft tissue coverage surrounding the ICA wall within the necrotic cavity is less than 3 mm on magnetic resonance imaging. Conclusion: We have identified 3 high‐risk factors for PRNN patients that necessitate prophylactic ICA management. These findings are expected to contribute to improving the quality of life and overall survival of PRNN patients. [ABSTRACT FROM AUTHOR]

White etching area (WEA) is a primary damage in rolling contact fatigue (RCF) of bearing steels. In spite of extensive investigations, there is a large discrepancy in the existing mechanisms of WEA formation. We attempt to unify the mechanisms from the perspective of shear localization and plastic damage accumulation based on ductile damage. RCF tests were conducted to generate WEAs with various microstructures and compositions. A thermodynamically consistent model of the ductile damage evolution from an inclusion was established by developing the phase field damage coupled with the crystal elastic‐viscoplastic constitutive relationship under RCF. The model was implemented into the FE framework through a user materials subroutine. The results indicated that the WEA is the shear band resulting from shear localization. The large inhomogeneity and scatter in WEA's microstructure are due to the influence of the crystal orientation. The development and orientation of SBs predicted by the model and the experimental observation of the WEA are in good agreement. The large micro‐shear strain in the WEA provides the driving force for mechanically controlled austenite phase transformation. The shear band center, which has the largest strain and the least stress, is where cracks initiate. This demonstrates that contrary to earlier reports that WEA is induced by previously formed crack faces friction, cracks actually initiate from the interior of the WEA. Highlights: WEA presents the form of shear band as a result of shear localization.WEA's orientation is significantly influenced by the crystal orientation.Large micro‐shear strain in WEA is the driving force for phase transformation.Instead of WEA being induced by friction of crack faces, cracks begin in WEA. [ABSTRACT FROM AUTHOR]

Pressure injury (PI) mainly occurs in bedridden older adults or those with physical limitations. Here, we aimed to determine the appropriate timing to conduct flap reconstruction in patients with PIs and identify factors affecting surgical outcomes. We retrospectively reviewed the data of all patients who received debridement or flap reconstruction surgery for PIs in our hospital from January 2016 to December 2021. The extracted data included patient demographics, surgical records, blood test results, vital signs, and flap outcomes. In total, 484 surgical procedures (364 debridements and 120 flaps) were performed on 216 patients. Serum albumin level of ≥2.5 g/dL remarkably increased the likelihood of complete wound healing (odds ratio [OR] = 4.12, P =.032) and reduced the risk of postoperative complications (OR = 0.26, P =.040). In contrast, advanced age (OR = 1.04, P =.045) and serum creatinine level ≥2 mg/dL (OR = 5.07, P =.016) increased the risk of postoperative complications. Thus, patients with a favourable nutrition status have a higher likelihood of achieving complete wound healing. By contrast, patients who are older and have serum creatinine ≥2 mg/dL and serum albumin <2.5 g/dL tend to develop more postoperative complications. Overall, thorough correction for patient inflammation, infection, anaemia, and malnutrition status can provide optimal flap surgery outcomes. [ABSTRACT FROM AUTHOR]

This retrospective study aims to explore whether the COVID‐19 pandemic altered patient conditions and surgery outcomes by studying 213 pressure injury (PI) patients who underwent surgery during 2016 to 2019 (pre‐COVID) and 2020 to 2021 (COVID) in Taiwan. We extracted patient demographics, surgical and blood test records, preoperative vital signs, and flap surgery outcomes. In total, 464 surgeries were performed, including 308 pre‐COVID and 156 COVID. During the COVID period, there were more patients presenting with dementia, and it had significantly more patients with >12 000 white blood cells/μL (24.03% vs 15.59%, P = 0.029), higher C‐reactive protein levels (7.13 ± 6.36 vs 5.58 ± 5.09 mg/dL, P = 0.014), pulse rates (86.67 ± 14.76 vs 81.26 ± 13.66 beats/min, P < 0.001), and respiratory rates (17.87 ± 1.98 vs 17.31 ± 2.39 breaths/min, P = 0.009) but lower haemoglobin levels (9.75 ± 2.02 vs 10.43 ± 1.67 mg/dL, P < 0.001) preoperatively. There were no between‐group differences in flap surgery outcomes but had fewer flap surgeries during COVID‐19. Thus, PI patient condition was generally poor during the COVID‐19 pandemic because of reduced access to medical treatment; this problem may be resolved through holistic care during a future pandemic or pandemic‐like situation. [ABSTRACT FROM AUTHOR]

These surgeries may alter immune function and microbiota, thereby altering the risks of certain diseases.[2] The altered immune function and dysbiosis after appendectomy or tonsillectomy may also alter the risk of allergic diseases. Patients received dual appendectomy-tonsillectomy was at the highest risk of AR (adjusted hazard ratio [aHR] 3.17, 95% confidence interval [CI] 2.28-4.42), followed by those received tonsillectomy (aHR 3.09, 95% CI 2.99-3.20) and those received appendectomy (aHR 1.11, 95% CI 1.09-1.13). The selected patients had no allergic diseases prior to enrollment; 276 patients received dual appendectomy-tonsillectomy (Group 1), 175,353 patients received appendectomy (Group 2), 20,624 patients received tonsillectomy (Group 3), and 20,930,884 patients received no related surgery (Group 4), as displayed in Table 1. [Extracted from the article]

Background: Limited evidence supports the omission of routine bone marrow (BM) examination (biopsy and aspiration) in patients with nasal‐type extranodal NK/T‐cell lymphoma (ENKTCL). This study was aimed at assessing whether BM examination provides valuable information for positron emission tomography/computed tomography (PET/CT)–based staging in this patient population. Patients and Methods: Patients newly diagnosed with ENKTCL who underwent initial staging with both PET/CT and BM examination between 2013 and 2020 were retrospectively identified in two Chinese institutions. Overall, 742 patients were included; the BM examination was positive in 67 patients. Results: Compared with BM biopsy alone, the combination of BM biopsy and aspiration assessment did not afford any additional diagnostic value. No patient with a positive BM biopsy was found to have early‐stage disease by PET/CT. BM biopsy or PET/CT led to upstaging from stage III to IV as a result of BM involvement in 21 patients. In 135 patients with distant organ involvement, BM involvement was associated with worse overall survival (OS) and progression‐free survival (PFS) compared with the corresponding durations in patients without BM involvement (2‐year OS: 35.9% vs. 60.4%, p <.001; PFS: 26% vs. 40.7%, p =.003). No difference in survival was noted between groups judged positive based on PET/CT and BM biopsy. Conclusion: Compared with aspiration, BM biopsy led to the detection of more BM lesions. Baseline PET/CT can be safely used to exclude BM involvement in early‐stage disease. Overall, routine BM examination affords diagnostic or prognostic value over PET/CT in patients with advanced‐stage nasal‐type ENKTCL. Baseline positron emission tomography/computed tomography (PET/CT) can be safely used to exclude bone marrow (BM) involvement in patients with early‐stage nasal‐type extranodal NK/T‐cell lymphoma (ENKTCL). Compared with PET/CT alone, routine BM examination can afford better diagnostic and prognostic value in advanced‐stage nasal‐type ENKTCL. [ABSTRACT FROM AUTHOR]

Bisphosphonates are considered an effective inhibitor of glutamine synthetase and thus can be used for treating tuberculosis (TB). However, its clinical benefit in TB remains unknown. We conducted a population‐based cohort study by using the Taiwan National Health Insurance Research Database and TB databases of the Taiwan Centers for Disease Control. Patients with osteoporosis and a history of bone fracture from 2007 to 2014 were identified. Among them, bisphosphonate users and propensity score–matched nonusers were selected. A stratified multivariable Cox proportional hazard regression model was employed to investigate the independent predictors of TB. Among 218 908 patients with osteoporosis and bone fracture, 46 842 bisphosphonate users and 46 842 propensity score–matched nonusers were selected. Within the 2‐year follow‐up, 723 patients—348 in the user group and 375 in the nonuser group—developed TB. Bisphosphonate use was not an independent predictor of TB in the multivariable Cox proportional hazard model (adjusted hazard ratio, 0.86; 95%CI, 0.71‐1.04); however, male sex, older age, being bedridden, and steroid use were independent risk factors. The real‐world data revealed that bisphosphonate use did not protect patients with osteoporosis against TB. [ABSTRACT FROM AUTHOR]

Objective: Salvage endoscopic nasopharyngectomy (ENPG) is a reasonable choice for resectable recurrent nasopharyngeal carcinoma (rNPC). However, in past decades, complete removal of the tumor was not feasible when the recurrent lesion was adjacent to the internal carotid artery (ICA). The present article introduces innovative strategies to ensure sufficient surgical margins while avoiding accidental injury to the ICA. Study Design: Retrospective study. Setting: Tertiary care center. Methods: We retrospectively reviewed rT2-3 rNPC patients with tumor lesions adjacent to the ICA (<5 mm) who underwent ENPG at the Sun Yat-sen University Cancer Center between January 2015 and June 2020. Thirty-seven patients were selected for this study. Seventeen patients underwent ENPG using direct dissection, 10 patients underwent endoscopic-assisted transcervical protection of the parapharyngeal ICA combined with ENPG, and 10 patients underwent ICA embolization followed by ENPG. Results: With a median follow-up duration of 31 months (range, 5 to 53 months), the 2-year overall survival, progression-free survival, locoregional recurrence-free survival, and distant metastasis-free survival rates of salvage ENPG for rNPC adjacent to the ICA were 88.7%, 72.0%, 72.0%, and 97.3%, respectively. The incidences of grade 1-2 and grade 3-5 postoperative complications were 16.2% and 13.5%, respectively. Two patients experienced ICA rupture during direct dissection but were out of danger after vascular embolization therapy. One patient had a positive margin. Two patients had severe nasopharyngeal wound infections with mucosal flap necrosis. Conclusion: ENPG combined with ICA pretreatment allows the feasible and effective resection of rNPC lesions adjacent to the ICA. [ABSTRACT FROM AUTHOR]

Objectives: The data concerning the association between Tx and ADs remain unclear and are scarce. This study was undertaken to investigate whether people with Tx are more likely to develop ADs, compared to those without Tx. Methods: Individuals who received Tx between 2002 and 2015 were identified and matched on age and sex with individuals without Tx. We performed multivariate and stratified analysis using the Kaplan–Meier method and Cox proportional hazards models in order to estimate the association between Tx and the risk of developing ADs. Results: A total of 2550 thymectomized (Txd) patients and 24,664.941 non‐Txd comparison subjects were selected from NHIRD. Tx‐MG (myasthenia gravis) as compared with general population (nonTx‐nonMG), adjusted hazard ratio (aHR) were higher for incident Addison disease (aHR = 10.40, 95% CI 1.01–107), autoimmune hemolytic anemia (aHR = 21.54, 95% CI 2.06–14.8), Hashmoto thyroiditis (aHR = 5.52, 95% CI 1.34–34.7), ankylosing spondylitis (aHR = 2.73, 95% CI 1.09–6.84), rheumatoid arthritis (aHR = 5.25, 95% CI 1.79–15.47), primary Sjogren syndrome (pSS) (aHR = 3.77, 95% CI 1.30–11.0), and systemic lupus erythemtoasus (aHR = 10.40). Tx‐nonMG as compared with general population, aHR were higher for incident autoimmune hemolytic anemia (aHR = 25.50), Hashmoto thyroiditis (aHR = 6.75) and systemic lupus erythematosus (SLE) (aHR = 13.38). NonTx‐MG as compared with general population, aHR were higher for incident Hashmoto thyroiditis (aHR = 6.57), pSS (aHR = 4.50), SLE (aHR = 17.29), and systemic vasculitis (aHR = 25.86). Interpretation: In conclusion, based on a retrospective cohort study throughout Taiwan, patients with Tx have a higher risk of new onset ADs than patients without Tx. [ABSTRACT FROM AUTHOR]

Objective: We studied the risk of dementia in patients with primary Sjögren's syndrome (pSS) using a nationwide, population‐based cohort in Taiwan. Methods: Our study analyzed the medical data of the Taiwanese population from 2000 to 2014. We identified 17,072 patients with pSS and 68,270 controls. Dementia risk was analyzed using a Cox proportional hazards regression model stratified by sex, age, and comorbidities. Results: A higher incidence of dementia development in the pSS group during the observation period (P = 0.0001). In multivariate analysis adjusted by age groups, gender, and the comorbidities, the adjusted hazard ratio (aHR) of developing dementia was 1.246 (95% CI 1.123–1.384) times greater in the pSS group than in the non‐pSS group. When stratified by sex, age, and comorbidities, the patients with pSS less than 60 years (aHR 1.67, 95% CI 1.16–2.41), and without any comorbidity (aHR 2.27, 95% CI 1.76–2.93) were particularly associated with a higher risk of dementia. Furthermore, the patients with pSS combined with any other comorbidity had an additionally higher risk of dementia (aHR: 3.978, 95% CI 3.309–4.782), also suggesting that pSS was an independent risk factor for the development of dementia. Interpretation: Primary Sjogren's syndrome is associated with increased dementia risk and further study is needed to understand why and what the specific dementia phenotypes are. [ABSTRACT FROM AUTHOR]

KCNQ1 encodes a potassium voltage-gated channel and represents a susceptibility locus for type 2 diabetes mellitus (T2DM). Here, we explored the association between KCNQ1 polymorphisms and hypertension risk in individuals with T2DM, as well as the role of KCNQ1 in vascular smooth muscle cell contraction in vitro. To investigate the relationship between KCNQ1 and the risk of developing hypertension in patients with T2DM, we divided the T2DM cohort into hypertension ( n = 452) and non-hypertension ( n = 541) groups. The Mann-Whitney U test, chi-square test, and multivariate regression analyses were used to assess the clinical characteristics and genotypic frequencies. In vitro studies utilized the rat aortic smooth muscle A10 cell line. Patients in the hypertension group were significantly older at the time of enrollment and had higher levels of body mass index, waist-to-hip ratio, and triglyceride than those in the non-hypertension group. The KCNQ1 rs3864884 and rs12576239 genetic variants were associated with hypertension in T2DM. KCNQ1 expression was lower in the individuals with the CC versus the CT and TT genotypes. Smooth muscle cell contractility was inhibited by treatment with a KCNQ1 inhibitor. These results suggest that KCNQ1 might be associated with hypertension in individuals with T2DM. [ABSTRACT FROM AUTHOR]

We examined the overall survival rates of a national cohort to determine optimal treatments and prognostic factors for patients with metachronous second primary head and neck squamous cell carcinomas (msp HNSCCs) at different stages and sites. We analyzed data of msp HNSCC patients collected from the Taiwan Cancer Registry database. The patients were categorized into four groups based on the treatment modality: Group 1 (control arm; chemotherapy [ CT] alone), Group 2 (reirradiation [re- RT] alone with intensity-modulated radiotherapy [ IMRT]), Group 3 (concurrent chemoradiotherapy alone [irradiation with IMRT]), and Group 4 (salvage surgery with or without RT or CT). We enrolled 1741 msp HNSCC patients without distant metastasis. Multivariate Cox regression analyses revealed that Charlson comorbidity index ( CCI) ≥6, stage of second HNSCC, stage of first HNSCC, and duration from first primary HNSCC of <3 years were significant poor independent prognostic risk factors for overall survival. After adjustment, adjusted hazard ratios and 95% confidence intervals for the overall all-cause mortality risk at msp HNSCC clinical stages III and IV were 0.72 (0.40-1.82), 0.52 (0.35-0.75), and 0.32 (0.22-0.45) in Groups 2, 3, and 4, respectively. A Cox regression analysis indicated that a re- RT dose of ≥6000 cGy was an independent protective prognostic factor for treatment modalities. CCI ≥ 6, stage of second HNSCC, stage of first HNSCC, and duration from first primary HNSCC of <3 years were significant poor independent prognostic risk factors for overall survival. A re- RT dose of ≥6000 cGy may be necessary for msp HNSCCs. [ABSTRACT FROM AUTHOR]

In statistical applications, logistic regression is a popular method for analyzing binary data accompanied by explanatory variables. But when one of the two outcomes is rare, the estimation of model parameters has been shown to be severely biased and hence estimating the probability of rare events occurring based on a logistic regression model would be inaccurate. In this article, we focus on estimating the probability of rare events occurring based on logistic regression models. Instead of selecting a best model, we propose a local model averaging procedure based on a data perturbation technique applied to different information criteria to obtain different probability estimates of rare events occurring. Then an approximately unbiased estimator of Kullback-Leibler loss is used to choose the best one among them. We design complete simulations to show the effectiveness of our approach. For illustration, a necrotizing enterocolitis (NEC) data set is analyzed. [ABSTRACT FROM AUTHOR]

Aim It remains unclear whether long-term daily icodextrin use can decrease technique failure and improve survival in peritoneal dialysis ( PD) patients. The aim of the present study was to investigate whether icodextrin use, once daily, can decrease technique failure and prolong patient survival in incident PD patients. Methods Incident PD patients who survived more than 90 days were recruited from the China Medical University Hospital, Taiwan, between 1 January 2007 and 31 December 2011. All patients were followed until transfer to haemodialysis ( HD), renal transplantation, transfer to another centre, death, or 31 December 2011. Results A total of 306 incident PD patients (89 icodextrin users, 217 icodextrin non-users) were recruited during the study period. Icodextrin users were more likely to have hypertension, diabetes and high or high-average peritoneal transport compared with non-users. During the follow-up period, 43 patients were transferred to HD: seven (7.87%) of the icodextrin group, and 36 (16.59%) of the non-icodextrin group. Thirty-two patients died during the follow-up period: five (5.62%) of the icodextrin group, and 27 (12.44%) of the non-icodextrin group. Icodextrin use was significantly associated with a better prognosis, in terms of technique failure (adjusted HR = 0.32; 95% CI = 0.14-0.72). With regard to patient survival, icodextrin use (adjusted HR = 0.33; 95% CI = 0.12-0.87) was associated with a significantly lower risk of death. Conclusion The use of icodextrin once daily may decrease technique failure and improve survival in incident PD patients. [ABSTRACT FROM AUTHOR]

Background: Research on the cardiovascular toxicity of angiogenesis inhibitors among patients with cancer in Taiwan is lacking. This observational study explored the risk of major adverse cardiovascular events (MACEs) associated with angiogenesis inhibitors in Taiwan., Methods and Results: We conducted a nested case-control study using the TCR (Taiwan Cancer Registry) linked with the Taiwan National Insurance Claim Database. We matched every case with 4 controls using risk-set sampling by index date, age, sex, cancer type, and cancer diagnosis date. Conditional logistic regression was used to evaluate the risks of MACEs and different cardiovascular events using propensity score adjustment or matching. Sensitivity analyses were used to evaluate the risks matched by cancer stages or exposure within 1 year. Among a cohort of 284 292 after the exclusion of prevalent cases, the incidences of MACEs among the overall cohort and those exposed to angiogenesis inhibitors were 22.5 and 32.5 events per 1000 person-years, respectively. We matched 17 817 cases with 70 740 controls, with a mean age of 74.9 years, and 56.8% of patients were men. After propensity score adjustment, angiogenesis inhibitors were associated with increased risks of MACEs (odds ratio, 4.56; 95% CI, 1.78-11.59). Significantly increased risks were noted for heart failure hospitalization, myocardial infarction, cerebrovascular accident, and venous thromboembolism, but not for new-onset atrial fibrillation. Similar results were observed after matching by cancer stage or restriction of 1-year exposure., Conclusions: Angiogenesis inhibitors were associated with increased risks of MACEs among patients with various malignancies in Taiwan but were not associated with new-onset atrial fibrillation.

In the title complex, [Pr(C(9)H(4)N(2)O(4))(C(2)H(3)O(2))(H(2)O)](n), the Pr(III) ion is coordinated by five O atoms and one N atom from four benzimidazole-5,6-dicarboxyl-ate ligands, two O atoms from an acetate ligand and one water mol-ecule, giving a tricapped trigonal-prismatic geometry. The benzimidazole-5,6-dicarboxyl-ate and acetate ligands connect the Pr(III) ions, forming a layer in the ac plane; the layers are further linked by N-H⋯O and O-H⋯O hydrogen bonding and π-π stacking inter-actions between neighboring pyridine rings [the centroid-centroid distance is 3.467 (1) Å], assembling a three-dimensional supra-molecular network. The acetate methyl group is disordered over two positions with site-occupancy factors of 0.75 and 0.25.