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Background Few prognostic factors have been proposed for patients with locally advanced renal cell carcinoma (RCC). This study aimed to investigate the possible predictive factors for disease-free survival (DFS) after curative surgery for RCC stage T3 or higher. Methods Patients with locally advanced RCC who underwent cure-intended partial or radical nephrectomy, with or without tumor thrombectomy, at our institution from April 1 st , 2005 to October 31 st , 2013 were retrospectively reviewed. Those undergoing cytoreductive nephrectomy were excluded. Preoperative data, including surgical and pathologic characteristics, were assessed for correlation with DFS. Chi-squared tests, multivariate Cox regression analysis, and Kaplan-Meier survival curve analyses were performed to determine potential predictive factors. A P-value less than 0.05 was considered statistically significant. Results A total of 159 patients were included for analysis. One hundred and nineteen (74.8%) patients remained disease-free during follow-up. Disease recurrence was found in 40 (25.2%) patients, and pathological T stage, capsule penetration, Fuhrman grade, thrombocytosis, and elevated serum alkaline phosphatase and γ-glutamyl transpeptidase levels were significantly associated with disease recurrence on univariate analysis. On multivariate analysis, capsule penetration (hazard ratio [HR] = 2.25, p = 0.038, 95% confidence interval [CI] = 1.05–4.85) and Fuhrman grade 3 or 4 (HR = 8.06, p = 0.003, 95% CI = 2.59–25.02) showed significant associations with DFS. Conclusions In patients with locally advanced RCC, capsule penetration and Fuhrman grade were associated with worse DFS after curative surgery. Urologists should closely monitor patients with capsule penetration and high Fuhrman grades, and adjuvant systemic treatments, other than targeted agents, should be considered.

Background This study aimed to evaluate the association of asymptomatic pyuria before ureterorenoscopic lithotripsy (URSL) with postoperative febrile urinary tract infection (UTI). Methods This observational case–control study identified the patients undergoing URSL for ureteral stones between May 2011 and October 2015. The included patients were classified into two groups: the asymptomatic pyuria group (6–50 white blood cells [WBCs]/high-power field [HPF]) and the non-pyuria group (≤ 5 WBCs/HPF). All data were collected by reviewing medical records. Postoperative outcomes were collected in terms of febrile UTI, emergency visits, and stone-free rate. Results A total of 232 patients were included, 101 in the pyuria group, 131 in the non-pyuria group. Two (0.9%) patients developed febrile UTI after URSL and 12 (5.2%) patients visited emergency department for URSL-related symptoms. The overall stone-free rate was 90.9%. There was no significant difference between the pyuria and non-pyuria groups regarding febrile UTI, emergency visits, and stone-free rate. Multivariate analysis revealed that pyuria was neither significantly associated with postoperative febrile UTI (OR = 1.03, 95% CI = 0.06–18.10, P = 0.98), nor with emergency visits (OR = 0.48, 95% CI = 0.13–1.85, P = 0.29). Conclusions Compared to the patients with sterile urine prior to URSL, those with asymptomatic pyuria were not prone to develop febrile UTI after URSL.

INTRODUCTION AND OBJECTIVE:Renal artery pseudoaneurysm (RAP) after partial nephrectomy is uncommon but a potential life-threatening complication. The aim of the study is to investigate the incidenc...

INTRODUCTION AND OBJECTIVE:To investigate the additional value of phi in predicting csPCa in Asian men with elevated PSA and MRI prostate performed.METHODS:This is a multicentre evaluation of prosp...

Background There are models to predict pathological outcomes based on established clinical and prostate-specific antigen (PSA)-derived parameters; however, they are not satisfactory. p2PSA and its derived biomarkers have shown promise for the diagnosis and prognosis of prostate cancer (PCa). The aim of this study was to investigate whether p2PSA-derived biomarkers can assist in the prediction of aggressive pathological outcomes after radical prostatectomy (RP). Methods We prospectively enrolled patients who were diagnosed with PCa and treated with RP between February 2017 and December 2018. Preoperative blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA), and percentage of p2PSA (%p2PSA). Prostate health index (PHI) was calculated as (p2PSA/fPSA) × √tPSA. Prostate volume was determined by transrectal ultrasound using the ellipsoid formula, and PHI density was calculated as PHI/prostate volume. The areas under the receiver operating characteristic curve were estimated for various PSA/p2PSA derivatives. Aggressive pathological outcomes measured after RP were defined as pathological T3 or a Gleason score (GS) >6 as determined in RP specimens. Results One hundred and forty-four patients were included for analysis. Postoperative GS was >6 in 86.1% of the patients, and pT stage was T3a or more in 54.2%. Among all PSA- and p2PSA-derived biomarkers, PHI density was the best biomarker to predict aggressive pathological outcomes after RP. The odds ratio of having an aggressive pathological outcome of RP was 8.796 (p = 0.001). In multivariate analysis, adding %fPSA to base model did not improve the accuracy (area under curve), but adding PHI and PHI density to base model improved the accuracy by 2% and 16%, respectively, in predicting pT3 stage or GS ≥ 7. The risk of pT3 stage or GS ≥ 7 was 20.8% for PHI density 1.125 (sensitivity: 74.6% and specificity: 88.9%). Conclusion PHI density may further aid in predicting aggressive pathological outcomes after RP. This biomarker may be useful in preoperative counseling and may have potential in decision making when choosing between definitive treatment and active surveillance of newly diagnosed PCa.

BACKGROUND Some patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms hesitate to undergo surgical treatment until acute urinary retention (AUR) occurs. Some of these patients have been found to have hydronephrosis or even renal insufficiency. This study aimed to analyze the risk factors for hydronephrosis in patients with AUR who needed to receive transurethral resection of the prostate (TURP). METHODS We retrospectively analyzed 91 patients from January 2014 to June 2015, who had BPH and received TURP for AUR. Patients with urolithiasis, prostate cancer, bladder cancer, gross hematuria, previous bladder radiation therapy, or urinary tract surgery were excluded. Parameters of intravesical prostatic protrusion (IPP), serum prostatic specific antigen (PSA), total prostate volume (PV), age, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and serum creatinine (Cr) were compared between the hydronephrosis and non-hydronephrosis groups. RESULTS There were significant differences in IPP (p < 0.001) and Serum Cr (p < 0.001) between the hydronephrosis and non-hydronephrosis groups. For IPP, the cut-off values of the highest risk of hydronephrosis was 1.95 cm. There were no significant differences in age, BMI, DM, HTN, CAD, total PV, and PSA between the two groups. IPP was not correlated with total PV (p = 0.423). Most of the patients with hydronephrosis had renal function improvement after TURP. CONCLUSION IPP was a significant risk factor for hydronephrosis in BPH patients. If the patients' IPP exceeded 1.95 cm, they had a higher risk of having hydronephrosis when AUR occurred. Hydronephrosis is a risk factor for renal insufficiency, and Serum Cr levels decreased significantly in the patients of our study.

As urbanization expands and diversifies, weather data produced by a single weather station in a suburb are no longer adequate to represent and reflect microclimatic changes of a city. This study selected 34 automatic weather stations in Tainan City, Taiwan, to conduct temperature and humidity measurements over a period of one year. Based on those observed weather data and urban environment parameters obtained from a geographic information system, as well as morphing approach, this study constructed a method of generating hourly local weather data for urban areas while accounting for urban heat island (UHI) effect in summer. Meanwhile, we discussed the relativities of the urban form and its structure against the variations of local hourly temperature and relative humidity under six buffer scenarios. Error analysis results revealed that minimal prediction errors can be obtained using the buffer scenario involving a 1000 × 1000 m2 four-layer buffer with inner and outer layers and upwind and downwind areas. Finally, using the hourly weather data produced for Tainan City, we calculated the long-term cumulative UHI intensity (UHII) and urban bioclimatic indexes (i.e., thermal stress, use of natural ventilation, and cooling degree day) and investigated how urban form and structure are related to UHII, thermal stress, use of natural ventilation, and cooling degree day. The results can inform urban policy making.

To evaluate the performance of the Prostate Health Index (PHI) in magnetic resonance imaging-transrectal ultrasound (MRI-TRUS) fusion prostate biopsy for the detection of clinically significant prostate cancer (csPCa). We prospectively enrolled 164 patients with at least one Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) ≥ 3 lesions who underwent MRI-TRUS fusion prostate biopsy. Of the PSA-derived biomarkers, the PHI had the best performance in predicting csPCa (AUC 0.792, CI 0.707–0.877) in patients with PI-RADS 4/5 lesions. Furthermore, the predictive power of PHI was even higher in the patients with PI-RADS 3 lesions (AUC 0.884, CI 0.792–0.976). To minimize missing csPCa, we used a PHI cutoff of 27 and 7.4% of patients with PI-RADS 4/5 lesions could have avoided a biopsy. At this level, 2.0% of cases with csPCa would have been missed, with sensitivity and NPV rates of 98.0% and 87.5%, respectively. However, the subgroup of PI-RADS 3 was too small to define the optimal PHI cutoff. PHI was the best PSA-derived biomarker to predict csPCa in MRI-TRUS fusion prostate biopsies in men with PI-RADS ≥ 3 lesions, especially for the patients with PI-RADS 3 lesions who gained the most value.

In Taiwan, the daytime temperature usually exceeds 37 &deg, C in summer, and the increase in air-conditioning usage has led to higher energy demand, which brings a heavy burden to power plants. The Kaohsiung House Project, undertaken by the city government, encourages the installation of greening facilities in buildings, such as photovoltaic (PV) panels on rooftops and vertical gardens on balconies, in order to preserve energy and reduce carbon emissions. In the present study, the urban heat island effect and temperature distribution within the city was examined through the establishment of 16 temperature measurement sites within a 7.5 km &times, 6 km area. A between-site temperature difference of 2 &deg, C was observed between April and August. Areas with higher temperature are recommended to increase their green space ratio through the project. Moreover, relocating PV panels in low-temperature areas increased the overall generation efficiency by 0.8%. Through the analysis of the measured data, this study determined which areas were more appropriate for green space expansion, and which would best serve for green energy generation, all with the aim of improving external environmental comfort and maximizing carbon reduction. Recommendations regarding the implementation of subsequent policies were issued and they provide reference for implementation in other cities.

AIMS Papillary renal neoplasm with reverse polarity (PRNRP) is a newly defined entity with distinct histomorphology and recurrent KRAS mutation. It has been estimated to constitute 4% of previously diagnosed papillary renal cell carcinoma (PRCC). Renal papillary adenoma (PA) is suggested to be the precursor of PRCC. This study aimed to investigate the association between PRNRP and PA, particularly the morphologically similar type D PA. METHODS AND RESULTS Nephrectomy specimens of PRCC and PA from our 10-year pathology archives were retrieved and reviewed. GATA3 immunohistochemistry and RAS/BRAF testing were performed in all cases reclassified as PRNRP and all PAs with sufficient materials. Overall, PRNRP accounted for 9.1% (10 of 110) of PRCC and there was no recurrence/metastasis with a mean follow-up period of 39 months. Three novel morphological features were described, including clear cell change, mast cell infiltration and metaplastic ossification. Nine of the 10 PRNRPs showed diffuse and strong GATA3 expression and KRAS missense mutations at codon 12. One case exhibited moderate GATA3 staining on 80% of the tumour cells and RAS/BRAF wild-type. In a total of 73 PAs, 11 were classified as type D. GATA3 expression was significantly more frequent in type D versus non-type D PAs (100 versus 35%, P

The zero echo time (ZTE) technique has improved the detection of lung nodules in PET/MRI but respiratory motion remains a challenge in lung scan. We investigated the feasibility and performance of fractionated deep-inspiration breath-hold (FDIBH) three-dimensional (3D) ZTE FDG PET/MRI for assessing lung nodules in patients with proved malignancy. Sixty patients who had undergone ZTE FDG PET/MRI and chest CT within a three-day interval were retrospectively included. Lung nodules less than 2 mm were excluded for analysis. Two physicians checked the adequacy of FDIBH ZTE and compared the lung nodule detection rates of FDIBH 3D ZTE and free-breathing (FB) four-dimensional (4D) ZTE, with chest CT as the reference standard. FDIBH resolved the effect of respiratory motion in 49 patients. The mean number and size of the pulmonary nodules identified in CT were 15 ± 31.3 per patient and 5.9 ± 4.6 mm in diameter. The overall nodule detection rate was 71% for FDIBH 3D ZTE and 70% for FB 4D ZTE (p = 0.73). FDIBH 3D ZTE significantly outperformed FB 4DZTE in detecting lung base nodules (72% and 68%; p = 0.03), especially for detecting those less than 6 mm (61% and 55%; p = 0.03). High inter-rater reliability for FDIBH 3D ZTE and FB 4D ZTE (k = 0.9 and 0.92) was noted. In conclusion, the capability of FDIBH 3D ZTE in respiratory motion resolution was limited with a technical failure rate of 18%. However, it could provide full expansion of the lung in a shorter scan time which enabled better detection of nodules (

Highlights • Surface temperature varies with building height, spacing, materials and greenness. • Low-rise factories made of corrugated iron steel are the warmest. • Mid-rise buildings with compact layout display high temperature. • Areas with buildings above 10 stories tend to be cooler than agricultural lands., This paper assesses the influence of land development patterns on intra-urban thermal variation in a densely-developed subtropical city, considering joint effect from greenspace pattern and built-up geometry. Despite growing research on urban climates, research at a scale that can support urban planning with scientificallyinformed strategies is still not as well documented for warm climate cities as for temperate cities. In response, this paper uses land surface temperature and geoinformation to assess the subtropical city of Taipei, Taiwan. Results show cooler environments are not only associated with natural surfaces, but also their interrelation with different spatial arrangement of buildings. An open layout tends to have lower temperature at low- to mid-rise buildings, whereas a compact layout is the coolest form for high-rise buildings. Cooling benefit from open layouts is, however, related to an increase in greenery. Clustering distribution of greenspaces produces more notable cooling. Accordingly, this paper proposes four heat mitigation strategies for Taipei: 1) increasing the amount of water bodies and vegetation, with greater coverage and coherence; 2) taking building height and shadow into account during regeneration/development; 3) increasing spacing and greenery between low- to midrise buildings; and 4) avoiding construction of compact low-rise buildings with corrugated iron steel.

The intense development of Taipei City has caused high thermal stress in its urban areas. This study used the urban climatic map (UCmap) and the local climate zone (LCZ) to analyze how land development patterns have affected urban thermal conditions. The UCmap is an efficient tool for obtaining information about urban microclimatic conditions based on urban development parameters and the map provides urban planners with information to mitigate the growing problem of thermal stress. The LCZ is system for classifying urban morphology including land cover, buildings, and vegetation, which can be used to relate land patterns to climate conditions. The results of this study indicate that combining UCmap and the LCZ is helpful for assessing thermal conditions in urban areas, and this approach can be used in many cities to determine the most suitable built environment for mitigating thermal stress.

Background The efficacy of thulium laser prostate enucleation (ThuLEP) for large prostates is unclear. This study aimed to explore the expanded utility of 150–200-W ThuLEP by studying patients with a large prostate (> 80 mL). Methods We retrospectively reviewed records of 125 patients with large prostate glands (> 80 mL) who underwent ThuLEP performed by a single surgeon from June 2012 to June 2016. The ThuLEP data from our previous pilot study were used as the control. Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume, and the international prostate symptom score (IPSS) were recorded and analyzed using Student’s t-test, the z-test, and logistic regression analysis. Results Of 366 patients who underwent ThuLEP, 125 (34.15%) were enrolled. The ages and estimated prostate volumes were compared with those of the control. Overall, 39.2% underwent Foley placement and 4% received an anticoagulant agent preoperatively. Maximum urinary flow rates before and 3 and 12 months postoperatively were 9.93, 23.20, and 19.00 mL/s, respectively, which were generally equal to those of the control groups (P = 0.68, 0.18, 0.98, respectively). Preoperative and postoperative IPSSs were 27.09 and 7.35, respectively. The postoperative prostate-specific antigen was reduced by 85.59% in comparison to the preoperative level. The estimated prostate size was reduced by 74.17% postoperatively. The modified Clavien-Dindo classification system was used to identify the overall rate of complications, which was approximately 22.4%. The mortality rate was 0.8%. Conclusions High-power ThuLEP is safe and effective for patients with large prostate glands (> 80 mL). Prostate enucleation using a high-power thulium laser is feasible for patients who exhibit contraindications for surgery.

INTRODUCTION AND OBJECTIVE:The most frequent and potentially life-threatening events associated with partial nephrectomy (PN) are hemorrhagic complications (HC). The aim of this study was to analys...

INTRODUCTION AND OBJECTIVE:Risk models predicting prognosis in non-muscle invasive bladder cancer including European Organization for Research and Treatment of Cancer (EORTC) risk tables, and Spani...

BACKGROUND In vitro studies have confirmed that cardiac glycosides can induce apoptosis in both hormone-dependent and -independent prostate cancer (PCa) cell lines. The aim of this study was to investigate the incidence of PCa among patients treated with and without digoxin using a nationwide population-based database in Taiwan. METHODS We retrieved data of men aged 30 years or older who were newly diagnosed with heart failure between January 1998 and December 2003 from the National Health Insurance program database in Taiwan. We divided the patients into digoxin users and non-digoxin users. Kaplan-Meier curves and Cox proportional hazard analysis were used to examine the risk of subsequent PCa between the digoxin and non-digoxin groups. RESULTS The mean ± SD follow-up (years) periods in the digoxin and non-digoxin groups were 8.6 ± 1.78 and 8.3 ± 1.75, respectively. The cumulative incidence of PCa during the follow-up period was 3.5% (147/4233) in the non-digoxin group compared with 3.0% (65/2154) in the digoxin group. The log-rank test revealed that the digoxin group had a similar incidence of PCa to the non-digoxin group (p = 0.18). After adjusting for age, benign prostatic hyperplasia, and comorbidities, Cox proportional hazard regression analysis showed that digoxin was associated with a significantly decreased risk of developing PCa (hazard ratio, 0.74; 95% CI, 0.548-0.993; p = 0.045). Moreover, logistic regression analysis showed that the risk of PCa decreased with a longer duration of digoxin use during the study period compared to those who had never used digoxin (p = 0.043). CONCLUSION The cardiac glycoside digoxin had significant effects on reducing the incidence of PCa in a time-dependent manner. Our findings may imply the potential application of cardiac glycosides in the prevention and management of PCa.

Purpose: For patients with localized upper tract urothelial carcinoma (UTUC), radical nephroureterectomy with ipsilateral bladder cuff excision (RNU + BCE) is the standard treatment. In recent years, robot-assisted RNU with BCE (RaRNU + BCE) has been another choice of surgical intervention. This article was aimed to analyze the efficacy and perioperative outcomes regarding RaRNU + BCE through a single institutional experience. Patients and Methods: From March 2012 to November 2015, a total of 54 patients with UTUC were treated with RaRNU + BCE at Taipei Veterans General Hospital. We collected demographic data, histopathological reports, perioperative complications, and oncologic outcomes. Results: A total of 54 patients were included in our study. The mean age was 71.9 ± 9.9 (range 48–88) and the mean body mass index was 23.5 ± 2.9 (range: 16.4–30.8). The mean operating time was 314 min (RaRNU: 133.9 ± 41.4 min and RaBCE: 72.9 ± 25.7 min). The mean first docking time was 26.8 ± 7.7 min and the mean second docking time was 16.5 ± 6.7 min. The mean EBL was 87.7 ml. Pathological stage distribution was 22.2%, 27.8%, 13.0%, 31.5%, and 5.6% in pTa, pT1, pT2, pT3, and pT4, respectively. Complications occurred in 7 cases (13%), with 4 Grade I and 3 Grade II by Clavien-Dindo classification. Positive tumor involvement at bladder cuff was noted in three patients, and the bladder recurrence rate was 29.6%. Local recurrence, lymph node metastasis, and distant metastasis were all noted for two patients, respectively. The cancer-specific and overall survival rate was 98.1% and 96.3%. Conclusions: Our experience showed that RaRNU + BCE is a technically feasible and safe procedure for selected patients with UTUC.

An urban energy use map that illustrates the building energy consumption of a city can facilitate the formulation of energy policies. This paper used dynamic simulations of building energy consumption and building information from a geographic information system were used to develop urban energy use maps with high spatial resolutions for two urban areas in southern Taiwan. 4000 models for typical residential layouts in Taiwan were generated through the Monte Carlo method and the benchmark values of the buildings’ energy use intensity (EUI) were identified through building energy simulation and uncertainty analysis. Accordingly, the benchmark EUI values, building data, and population data were used as input parameters to derive a convenient equation for predicting energy consumption in each grid of the urban energy use maps. A comparison of the measured and predicted energy consumptions confirmed the precision of this equation. To sum up, relevant data are readily available and can be exploited to prepare urban energy use maps for other large cities in Taiwan. Moreover, the urban energy use map with high spatial resolution can present the differences in small areas, making it an important reference aid for determining energy policies

As urban areas continue to develop and expand, carbon dioxide (CO2) emissions from their energy use are growing exponentially. This has made carbon reduction a global concern. Previous studies have provided a limited understanding of carbon budgets because they have used top-down data on a single spatial or temporal scale. In this study, urban spatial and statistical data for metropolitan Tainan in southwestern Taiwan are used to explore inside and outside of the CO2 system of the city and estimate the amount of CO2 emissions from road traffic, the use of electricity and gas in buildings, and the amount of CO2 absorbed by green spaces and water bodies within the system. Innovative annual and monthly carbon budget maps composed of 200 × 200-m grids are developed for the city through a geographic information system (GIS). An analysis of the highly detailed maps yields the following findings: First, CO2 emissions are concentrated in over-urbanized areas, where the population density is higher than 5000 people/km2. Buildings account for the majority of carbon dioxide emissions (54%) and produced 11% more carbon dioxide in summer than in winter (owing to air-conditioning usage). Second, road traffic is the main source of CO2 emissions for under-urbanized areas (87%), and emissions from this source exhibit insignificant seasonal variation. On the basis of these findings, the carbon budgets of four different over-urbanized areas are formulated and presented on 50 × 50-m grids. The results suggest that green spaces in these areas absorb limited amounts of carbon dioxide. Therefore, this study assesses the annual and monthly carbon-reduction potential of rooftops equipped with solar panels occupying 30% of their area. The annual carbon-reduction potential for the four areas was 4.5–31.1 kg CO2 m−2 yr−1, and the solar energy replacement rate is higher in winter than in summer. In summary, this study presents carbon budgets in high-resolution grids, quantifies the carbon-reduction potential of rooftops with solar panels, and proposes a reduction strategy for reducing CO2 emissions from urban activities to improve the sustainability of urban areas and their environs and inform urban planning and climate change adaptation.

Background Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. Methods In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital. Patients who visited the emergency room (ER) within 48 h after Outpatient ESWL were included in this article. This article analyzes the stone size, stone shape (long to short axis ratio), stone location, previous medical management, urinalysis data, complications and treatment received in the emergency department. Results Among the 844 initial consecutive patients who underwent outpatient ESWL a total of 1095 times, there were 22 (2%) patients who sought help at our emergency room within 48 h after the outpatient ESWL. Of those 22 patients, the mean age was 54.3 ± 12.6 years, and the BMI was 25.9 ± 3.2. The most common complication complaint was flank pain (55.2%). Other complications included hematuria (13.8%), fever (17.2%), nausea with vomiting (6.9%), acute urinary retention (3.4%) and chest tightness with cold sweating (3.4%). In 22 patients who went back to the ER, 7 patients were admitted to the ward and 1 patient again returned to the ER. All patients received medical treatment without ESWL or surgical management. The meaningful risk factor of ER-visiting rate following outpatient ESWL within 48 h was stone location, and the renal stones showed statistic significant ( p = 0.047) when compared to ureteral stones. Conclusion Our study indicated that renal stone contributed to a significantly higher risk of ER-visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while inpatient ESWL is not absolutely necessary.

To understand the effectiveness of a couple-based psychosocial information package (PIP) and multimedia psychosocial intervention (MPI) on patients with prostate cancer and their partners.A random assignment and quasi-experimental design were used.From August 2015-March 2018, 103 newly diagnosed patients with prostate cancer and their partners were divided into a control group (CG) (N = 50), PIP group (N = 25) and MPI group (N = 28). The CG received usual care, the PIP group received information manuals and telephone counselling for 6-week and the MPI group received multimedia films and manuals and professional support for 6 weeks. The three groups were posttested 6, 10, 18 and 24 weeks after the pre-test. The outcome measurements included disease appraisals, emotion status, relationship satisfaction, health-related quality of life (HRQOL) and satisfaction with MPI.Partners in the MPI and PIP groups experienced significant improvements in positive and negative affect or mental HRQOL as compared with the CG. The effectiveness of MPI and PIP on negative affect, mental HRQOL, however, were not statistically significant in patients with prostate cancer. Nevertheless, patients were satisfied with the MPI.Nurses can provide different types of interventions for partners, depending on personal preferences and available resources.There is a lack of studies that focus on the effectiveness of couple-based psychosocial intervention on both the patients with prostate cancer and their partners in Asia. Partners in the multimedia psychosocial intervention group and psychosocial information package group experienced improvements in positive affect, negative affect or health-related quality of life as compared with the control group. Patients in both intervention groups experienced similar negative affect and health-related quality of life as compared with the control group. The couple-based psychosocial interventions can be provided by nurses based on partners' preferences and available resources.目的: 了解基于夫妇的心理社会信息包（PIP）和多媒体心理社会干预（MPI）对前列腺癌患者及其伴侣的治疗效果。 设计: 采用随机分配和准实验设计。 方法: 从2015年8月至2018年3月，将103位新诊断的前列腺癌患者及其伴侣分为对照组（CG）（N = 50）、PIP组（N = 25）和MPI组（N = 28）。对照组接受常规护理，PIP组接受为期6周的信息手册和电话咨询，MPI组接受为期6周的多媒体电影、手册以及专业支持。在预测试后的第6、10、18和24周对这三组进行后测试。结果测量包括疾病评估、情绪状态、关系满意度、健康相关生活质量（HRQOL）和MPI满意度。 结果/发现: 与对照组相比，MPI组和PIP组的伴侣在积极和负面影响或心理HRQOL方面都有显著改善。MPI组和PIP组队前列腺癌患者的负面情绪、精神生活质量的影响在统计学不显著。然而，患者对MPI很满意。 结论: 护士可以根据个人喜好和可用资源为伴侣提供不同类型的干预措施。 影响: 在亚洲，目前还缺乏对前列腺癌患者及其伴侣进行基于夫妇的心理社会干预效果的研究。与对照组相比，多媒体心理社会干预组和心理社会信息包组的伴侣在积极情感、消极情感或健康相关的生活质量方面有所改善。与对照组相比，两个干预组的患者经历相似的负面影响和与健康相关的生活质量。护士可以根据伴侣的喜好和可用资源提供基于夫妇的心理社会干预。.

Few prospective studies have focused on the performance of the Prostate Health Index (PHI) in Asian populations. Therefore, we aimed to evaluate the performance of the PHI in predicting prostate cancer (PCa) compared with standard prostate-specific antigen (PSA) tests.We prospectively enrolled patients with suspected PCa with a total PSA (tPSA) level 4 to 10 ng/mL or tPSA4 ng/mL and a suspicious digital rectal examination between February 2017 and September 2018. All of the patients underwent a 12-core transrectal ultrasound-guided prostate biopsy. Prebiopsy blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA), and percentage of p2PSA (%p2PSA). The PHI was calculated as (p2PSA/fPSA) × √tPSA. The areas under the receiver operating characteristic curve (AUCs) were estimated for the PSA derivatives in addition to their specificities at a prespecified sensitivity of 90%.Of the 307 enrolled patients, 95 (30.9%) had PCa on biopsy. Excluding fPSA, all of the PSA derivatives were significantly different between the positive and negative biopsy groups. Of the various derivatives, the PHI (AUC: 0.783) showed the best performance in predicting the results of the initial biopsy compared with tPSA (AUC: 0.611). At a sensitivity of 90%, the PHI had the best specificity of 46.7% compared with 23.2% for tPSA. Using a PHI cutoff value of 35.15 for biopsy, 108 (35.2%) patients could have avoided undergoing a biopsy. To detect Gleason score ≥ 7 disease at 90% sensitivity, the threshold for PHI was 36.96 with a specificity of 52.1%.PHI was the best biomarker among the PSA derivatives in predicting PCa at biopsy in men with tPSA10 ng/mL. The risk of a Gleason score ≥ 7 increased with increasing PHI.

Background Liposomes are drug nano-carriers that are capable of targeting therapeutics to tumor sites because of enhanced permeability retention (EPR). In several preclinical studies with various tumor-bearing mice models, 188Re-liposome that has been developed by the Institute of Nuclear Energy Research (INER) demonstrates favorable in vivo tumor targeting, biodistribution, pharmacokinetics, and dosimetry. It inhibits the growth of tumors, increased survival, demonstrates good synergistic combination, and was safe to use. This study conducts a phase 0 low-radioactivity clinical trial of nano-targeted radiotherapeutics 188Re-liposome to evaluate the effectiveness with which it targets tumors and the pharmacokinetics, biodistribution, dosimetry, and its safety in use. Twelve patients with metastatic cancers are studied in this trial. Serial whole-body scans and SPECT/CT are taken at 1, 4, 8, 24, 48, and 72 h after intravenous injection of 111 MBq of 188Re-liposome. The effectiveness with which tumors are targeted, the pharmacokinetics, biodistribution, dosimetry, and safety are evaluated using the VelocityAI and OLINDA/EXM software. Blood samples are collected at different time points for a pharmacokinetics study and a safety evaluation that involves monitoring changes in liver, renal, and hematological functions. Results The T½z for 188Re-liposome in blood and plasma are 36.73 ± 14.00 h and 52.02 ± 45.21 h, respectively. The doses of radiation that are absorbed to vital organs such as the liver, spleen, lung, kidney, and bone marrow are 0.92 ± 0.35, 1.38 ± 1.81, 0.58 ± 0.28, 0.32 ± 0.09, and 0.06 ± 0.01 mGy/MBq, respectively, which is far less than the reference maximum tolerance dose after injection of 188Re-liposome. 188Re-liposome is absorbed by metastatic tumor lesions and the normal reticuloendothelial (RES) system. Certain patients exhibit a therapeutic response. Conclusion This phase 0 exploratory IND study shows that nanocarrier 188Re-liposome achieves favorable tumor accumulation and tumor to normal organ uptake ratios for a subset of cancer patients. The clinical pharmacokinetic, biodistribution, and dosimetry results justify a further dose-escalating phase 1 clinical trial. Trial registration Taiwan FDA MA1101G0 (Jan 31, 2012).

INTRODUCTION AND OBJECTIVES:Risk stratification with different models in bladder cancer have been introduced for prognosis prediction, including European Organization for Research and Treatment of ...

The accuracy in diagnosing prostate cancer (PCa) has increased with the development of multiparametric magnetic resonance imaging (mpMRI). Biparametric magnetic resonance imaging (bpMRI) was found to have a diagnostic accuracy comparable to mpMRI in detecting PCa. However, prostate MRI assessment relies on human experts and specialized training with considerable inter-reader variability. Deep learning may be a more robust approach for prostate MRI assessment. Here we present a method for autosegmenting the prostate zone and cancer region by using SegNet, a deep convolution neural network (DCNN) model. We used PROSTATEx dataset to train the model and combined different sequences into three channels of a single image. For each subject, all slices that contained the transition zone (TZ), peripheral zone (PZ), and PCa region were selected. The datasets were produced using different combinations of images, including T2-weighted (T2W) images, diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) images. Among these groups, the T2W + DWI + ADC images exhibited the best performance with a dice similarity coefficient of 90.45% for the TZ, 70.04% for the PZ, and 52.73% for the PCa region. Image sequence analysis with a DCNN model has the potential to assist PCa diagnosis.

Facing the impacts of climate change and urbanization, adaptation and resilience to climate extremes have become important issues of global concern [...]

Motivated by the increasing thermal load in urban environment, this work established Urban Climatic map (UCmap) focusing on thermal environment issues based on urban development factors, e.g., land cover and building characteristics, representing thermal load of human body and ventilation path in the urban structures. In the established process of UCmap in this work, Tainan city, which is a highly developed city in southern Taiwan, is selected as the research area. A 50-m resolution grid is used to capture urban development factors and the climate data based on 1 year of mobile and fix-point measurements, from which the thermal load and the wind environment map are constructed. The results herein reveal that a higher urban development level is associated with a higher thermal load, and similar areas are more likely than others to suffer from an extreme thermal load and low wind pass conditions. Open and sparse low-rise buildings constitute the most appropriate urban characteristics for urban built environment in Tainan. By the simple approach of establishing UCmap, the microclimate condition and development intensity of regions can be easily detected and linked, for example the compact high-rise areas should be limited by floor area ratio in order to prevent the formation of hot spots. The government, urban planners, and architects without a meteorological background can efficiently obtain climate information by way of mapping the certain area, and making regulations to mitigate the growing problem of thermal stress and urban heat island.

Background The purpose of this study was to evaluate the prostate cancer yield rate of targeted transrectal ultrasound (TRUS)-guided biopsy with cognitive magnetic resonance imaging (MRI) registration without concurrent systematic biopsy in patients with previous negative systematic TRUS-guided biopsy results and persistently elevated prostate-specific antigen (PSA) levels. Methods In this prospective study conducted from August 2013 to January 2015, patients with at least one previous negative systematic TRUS-guided biopsy and persistently high PSA (≥4 ng/mL) levels were referred for multiparametric MRI (mpMRI). Those patients with suspicious findings on mpMRI received a subsequent cognitive MRI-TRUS fusion biopsy. The cancer-detection rate, tumor location, and Gleason score were confirmed, and PSA-related data were compared between cancer-yield and noncancer-yield groups. Results In total, 48 patients were included in this study. MRI was designated to be four and five in 17 patients. Fifteen patients received a cognitive fusion-targeted biopsy, and prostate cancers were detected in 10 patients. The cancer-detection rate was 20.8% (10/48), and the positive-predictive value of MRI was 66.7%. No significant differences were observed in the PSA level, PSA velocity, or transitional zone volume between the cancer-yield and noncancer-yield groups; however, the corresponding difference in PSA transitional zone density was significant ( p =0.025). Conclusion Cognitive MRI-TRUS fusion-targeted biopsy without concurrent systematic biopsy can detect significant prostate cancer in patients with previous negative systematic biopsy results and persistently elevated PSA levels. Noncancer-yield patients should undergo active surveillance and further follow-ups.

Background Bladder cancer is a disease frequently seen in the elderly. Frail and elderly patients with muscle-invasive bladder cancer (MIBC) are often unfit for surgery. While concurrent chemoradiotherapy (CCRT) is a well-established alternative treatment modality, only a small proportion of elderly patients receive CCRT. The purpose of this article is to review our experience with CCRT in elderly MIBC patients. Methods Between January 1, 2007 and December 31, 2013, we retrospectively reviewed patients aged >75 who were treated with CCRT at Taipei Veterans General Hospital. Patients' characteristics, therapeutic strategy, clinical outcomes, and treatment-related toxicities were assessed. Results Nineteen patients (4 females and 15 males) were identified. The median age was 79.5 years (range, 78.5–84.0 years) and the median follow-up was 33.7 months (interquartile range, 19.1–51.8 months). The major adverse event was grade 3 or grade 4 neutropenia, which developed in 10 of the 19 patients. No treatment-related mortality occurred. We found no association between prognosis and the chemotherapy regimen. Chemotherapy with a conventional dose of gemcitabine (800–1000 mg/m2) was well tolerated. The two-year and three-year estimated overall survival rates were 74% and 60%, respectively. Conclusion CCRT after complete transurethral resection of the bladder tumor is feasible for elderly patients with MIBC. The conventional dose of gemcitabine as a chemosensitizer is adequate in the elderly population, but further investigation is needed.

Differences in urban context can lead to distinct local microclimates. The data provided by a single weather station are insufficient for evaluating residential thermal conditions and the air conditioning energy consumption of microscale areas throughout cities. The purpose of this study was to quantify the urban heat island (UHI) effect on air conditioning energy consumption and overheating risk in buildings. This study generated localized microclimate files of microscale areas from their urban contexts. A common three-story townhouse in Tainan City, Taiwan, was used as an example. EnergyPlus was used to simulate and analyze the effect of microclimate on residential overheating risk and air conditioning energy consumption citywide. Tainan was divided into 1496 microscale areas, and the analysis results indicated that dwellings in downtown and suburban areas faced an overheating risk for 3–5 months and exhibited a natural ventilation potential of 43%–47% from May to October. Furthermore, the air conditioning energy consumption of 60% of these microscale areas was 14.5–21.5 kWh/m2, with 8% exceeding 21.5 kWh/m2. By contrast, the natural ventilation potential of dwellings in the countryside and peripheral areas was 63%–72%, and air conditioning energy consumption was ≤11.0 kWh/m2. These results highlight the importance of using localized microclimate files for evaluating building energy performance in urban areas.

Due to the various local weather conditions in different regions of the city, the demand for air conditioning (AC) of housing is different, too. It happened occasionally to underestimate the energy consumption of AC in urban areas, because of using suburban/rural weather station data for building energy simulation. This study set up 34 automatic weather stations in the urban area of Tainan City, Taiwan for a year-round collection of local temperature and relative humidity data. Those weather measurement, the GIS information of a buffer zone and multiple regression analysis were used to establish the relationship between the weather factors, needed for the morphing approach, and the parameters of landscape use and cover. The buffer zone is an area of 1000×1000 m2 around the measured point, and is divided to two layers with upwind and downwind parts. Local hourly weather-year files for a whole of the city with a resolution of 200×200 m2 were generated by the morphing approach. With the different local hourly weather-year files, the AC-required hours and energy consumption from May to October for a typical residential with hybrid ventilation mode was obtained by using the EnergyPlus. And the cumulative UHI of each grid between May and October is calculated by taking the average of the five lowest temperatures as the reference value. The result shows that the number of AC hours of residential will increase by 10%, and the energy consumption increase from 1000 kWh to 2500 kWh, when long-term UHI intensity increases from 2000 °C-hour to 9000 °C-hour.

Taiwan, located in the East Asia, is an island country with limited natural resources. To increase economic growth and reduce CO2 emission levels, the Taiwanese government is promoting a sustainable low-carbon tourism industry. This study investigated the CO2 emission coefficient of tourist activities and identified the CO2 emissions (CE) patterns of international visitors to Taiwan. The total CO2 emission per visitor without considering international transportation was estimated using a questionnaire. The total CO2 emission comprises the CO2 emission of transportation, the CO2 emission of accommodation, and the CO2 emission of tourist activities. The results suggest that more convenient public transportation might help to reduce the total CO2 emission. Without considering CO2 emission from international air travel, in contrast to many non-island countries where CO2 emission of transportation is the main contributor to total CO2 emission, the CO2 emission of accommodation was the main contributor to total CO2 emission in Taiwan. To reduce the CO2 emission of accommodation, the Taiwanese government should improve the energy-use efficiency of devices in tourist hotels and promote bed-and-breakfast accommodations with low CO2 emission coefficients. Visitors enjoyed culinary journeys and shopping, both of which are activities that contribute highly to the CO2 emission of tourist activities because of their high CO2 emission coefficients.

Climate not only influences the behavior of people in urban environments but also affects people's schedules and travel plans. Therefore, providing people with appropriate long-term climate evaluation information is crucial. Therefore, we developed an innovative climate assessment system based on field investigations conducted in three cities located in Northern, Central, and Southern Taiwan. The field investigations included the questionnaire surveys and climate data collection. We first analyzed the relationship between the participants and climate parameters comprising physiologically equivalent temperature, air temperature, humidity, wind speed, solar radiation, cloud cover, and precipitation. Second, we established the neutral value, comfort range, and dissatisfied range of each parameter. Third, after verifying that the subjects' perception toward the climate parameters vary based on individual preferences, we developed the customized rating assessment of climate suitability (CRACS) approach, which featured functions such as personalized and default climate suitability information to be used by users exhibiting varying demands. Finally, we performed calculations using the climate conditions of two cities during the past 10 years to demonstrate the performance of the CRACS approach. The results can be used as a reference when planning activities in the city or when organizing future travel plans. The flexibility of the assessment system enables it to be adjusted for varying regions and usage characteristics.

Most campus buildings in public education in Taiwan are naturally ventilated. Since it is hot and humid in summer, these free-running classrooms are vulnerable to overheating, which may impair the students’ learning ability. We studied a Diamond-certified green building campus to determine the effectiveness of the strategies adopted to prevent overheating by quantifying the in-room thermal comfort via long-term in situ monitoring of temperatures. The passive planning and design means used in the case are presented in detail, and the resulting synthesis effect in terms of the relation of indoor thermal comfort to student learning performance is also discussed. The maximum percentage of dissatisfaction in classrooms is 15–22% less than that in the outdoor condition, and the severity of overheating is 12.5%–18.5% of that of the outdoors. The average learning performance is around 1.3% higher than in the outdoor condition. The green building certification system (EEWH) practiced in Taiwan evaluates various aspects regarding thermal comfort enhancement, the studied naturally ventilated school building demonstrates that by complying to these EEWH credits the indoor thermal quality can successfully be ensured.

BackgroundThis study evaluated the performance of histogram analysis in the time course of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for differentiating cancerous tissues from benign tissues in the prostate.MethodsWe retrospectively analyzed the histograms of DCE-MRI of 30 patients. Histograms within regions of interest(ROI) in the peripheral zone (PZ) and transitional zone (TZ) were separately analyzed. The maximum difference wash-in slope (MWS) and delay phase slope (DPS) were defined for each voxel. Differences in histogram parameters, namely the mean, standard deviation (SD), the coefficient of variation (CV), kurtosis, skewness, interquartile range (IQR), percentile (P10, P25, P75, P90, and P90P10), Range, and modified full width at half-maximum (mFWHM) between cancerous and benign tissues were assessed.ResultsIn the TZ, CV for ROIs of 7.5 and 10mm was the only significantly different parameter of the MWS (P = 0.034 and P = 0.004, respectively), whereas many parameters of the DPS (mean, skewness, P10, P25, P50, P75 and P90) differed significantly (P = ConclusionThe histogram analysis of DCE-MRI is a potentially useful approach for differentiating prostate cancer from normal tissues. Different histogram parameters of the MWS and DPS should be applied in the TZ and PZ.

This study aims to develop a model for predicting thermal distribution in cities based on urban development patterns. Featured by the process of urbanization and land use policy, built environments are varied in land cover, density, building height, and usage. This study applied the classification scheme of Local Climate Zones (LCZs) to categorize land development patterns from the Landsat 8 images. By exploring the relationship between LCZs and air temperature in previous local study, a thermal model was developed. This study utilized the model to predict the thermal distribute condition in Taipei Basin and compared the result with land surface temperature derived from satellite image. Accordingly, parameters and factors used in the model were adjusted to enhance the validity of thermal prediction. As the model can be rapidly applied to predict thermal environments based on land development patterns of different cities, it will assist in identifying areas subjects to heat risk and help decision makers to develop evidence-based mitigation strategies.

In the field of the tourism, hotels and homestay facilities account for considerable amounts of energy consumption and CO 2 emissions. This study presents an investigation conducted on the CO 2 emissions from four types of hotel in Taiwan. According to the results, the average CO 2 emissions of international tourist hotels, standard tourist hotels, general hotels, and homestay facilities are 28.9, 19.2, 12.5, and 6.3 kg-CO 2 /person-night, respectively. Hotels with higher service levels produce higher average CO 2 emissions per person-night. Analytical results indicate that increasing stays at hotels with low CO 2 emissions (such as homestay facilities and general hotels), accommodating more guests together per room, and enhancing energy usage efficiency, can effectively reduce hotel CO 2 emissions without reducing the total number of guests. The results of this study may be applied to CO 2 reduction programmes for tourists, hotel enterprises, and contribute toward the formulation of government policy in Taiwan.

Thermal comfort is a subjective psychological perception of people based also on physiological thermoregulation mechanisms when the human body is exposed to a combination of various environmental factors including air temperature, air humidity, wind speed, and radiation conditions. Due to the importance of gender in the issue of outdoor thermal comfort, this study compared and examined the thermal comfort-related differences between male and female subjects using previous data from Taiwanese questionnaire survey. Compared with males, the results indicated that females in Taiwan are less tolerant to hot conditions and intensely protect themselves from sun exposure. Our analytical results are inconsistent with the findings of previous physiological studies concerning thermal comfort indicating that females have superior thermal physiological tolerance than males. On the contrary, our findings can be interpreted on psychological level. Environmental behavioral learning theory was adopted in this study to elucidate this observed contradiction between the autonomic thermal physiological and psychological-behavioral aspects. Women might desire for a light skin tone through social learning processes, such as observation and education, which is subsequently reflected in their psychological perceptions (fears of heat and sun exposure) and behavioral adjustments (carrying umbrellas or searching for shade). Hence, these unique psychological and behavioral phenomena cannot be directly explained by autonomic physiological thermoregulation mechanisms. The findings of this study serve as a reference for designing spaces that accommodates gender-specific thermal comfort characteristics. Recommendations include providing additional suitable sheltered areas in open areas, such as city squares and parks, to satisfy the thermal comfort needs of females.

Outdoor thermal environments influence thermal adaptation, thereby affecting the utilization of space. To determine the effects of thermal comfort and adaptation on attendance regarding different shading levels and activity types, this study conducted field investigations at a public park located in southern Taiwan, using micrometeorological measurements, estimations of park attendance, and questionnaire surveys on thermal comfort. The results indicate that participants' acceptable range of thermal comfort leads to substantial changes in overall park attendance during different seasons, whereas characteristics of thermal adaptations influence the individual differences of utilization in various ways within diverse spaces. In addition, this study reveals that in unshaded areas within parks, the number of visitors increases following rising thermal conditions during cool seasons, whereas the number of visitors decreases during hot seasons. However, the number of visitors to shaded areas increases with rising thermal conditions in both cool and hot seasons. Because of the possibility and effectiveness of personal behavior adjustments (e.g., decreases in the amount of clothing worn, the wearing of hats, or carrying of an umbrella) in decreasing thermal discomfort, people choose to seek adjustments in external environments. That is, they move from unshaded to shaded areas to relieve their perception of thermal discomfort. The results of this study reveal the importance of shading facilities within parks in the hot climate zone of Taiwan, and can be used as references in future park designs.

The paper is an effort toward thermal comfort assessment for urban parks under the climatic conditions of Taiwan to help architects achieve better climatic design. Field interviews, observations, and micrometeorological measurements were conducted in this study. The WBGT was used as the thermophysiological index to investigate the effects of thermal conditions on visitor’s thermal perception and adaptive behavior in outdoor urban spaces. In this study, behavioral adaptations used by visitors as a means of achieving comfort were evaluated. Observational results showed that the overall attendance was influenced by sun and thermal conditions. There was a robust relationship between thermal sensation votes, as well as thermal acceptability, and thermal environment, in terms of WBGT. The upper and lower limits of 80% acceptability are 26°C WBGT and 20°C WBGT, respectively.