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Chun-Yen Yu,1,* Po-Hsun Huang,1,* Leo Leung-Chit Tsang,1 Hsien-Wen Hsu,1 Wei-Xiong Lim,1 Ching-Chun Weng,1 Tung-Liang Huang,1 Chien-Chin Hsu,2 Chao-Long Chen,3 Hsin-You Ou,1 Yu-Fan Cheng1 1Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan*These authors contributed equally to this workCorrespondence: Yu-Fan Cheng; Hsin-You Ou, Tel/Fax +88677317123-3027, Email prof.chengyufan@gmail.com; ouhsinyou@gmail.comBackground: The purpose of this study was to assess the safety and efficacy of Yttrium-90 radioembolization using in unresectable hepatocellular carcinoma.Methods: From 2017 to 2021, 32 patients with unresectable hepatocellular carcinoma, with mean tumor diameter about 7cm (21 males, 11 females; median age, 57.5 years of age), treated with Yttrium-90 radioembolization using resin microspheres were reviewed at pre-Yttrium-90 and post-Yttrium-90 follow-up. Tumor response was assessed according to the modified Response Evaluation Criteria in Solid Tumors. Outcomes including overall survival and progression-free survival were reported.Results: Median follow-up was 18 months. At follow-up examinations at 3-, 6-, and 12-months follow-up, the overall survival rates were 94%, 87% and 59%, and the progression-free survival rates were 78%, 64% and 60%, respectively. Complete response, partial response, stable disease, and progressive disease were noted in 7 (21.9%), 14 (43.7%), 4 (12.5%), and 7 (21.9%) patients, respectively. The disease control rate was 78.1%, the objective response rate was 65.6%, and the successful downstage rate was 34.4% (11 of 32). Nine of thirty-two patients underwent resection or transplantation after Yttrium-90 radioembolization with 2-year overall survival being 100%. No serious adverse events occurred after Yttrium-90 treatment. Worse overall survival was related to the larger tumor, higher stage, Eastern Cooperative Oncology Group performance status, and Child-Pugh score. And worse progression-free survival was related to the higher tumor burden, and pre-Yttrium-90 serum α-fetoprotein level > 100.Conclusion: Yttrium-90 Radioembolization can control hepatocellular carcinoma well even in advanced diseases. Patients successfully downstaging/bridging to resection or transplantation have excellent overall survival.Keywords: Yttrium-90 radioembolization, selective internal radiation therapy, hepatocellular carcinoma

Wei-Hung Chan,1,2 Yu-Juei Hsu,3 Chiao-Pei Cheng,1 Kuan-Nien Chou,2,4 Chin-Li Chen,5 Shih-Ming Huang,6 Wei-Chih Kan,7,8,* Yi-Lin Chiu6,* 1Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China; 2Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei City, Taiwan, Republic of China; 3Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China; 4Department of Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China; 5Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China; 6Department of Biochemistry, National Defense Medical Center, Taipei City, Taiwan, Republic of China; 7Department of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan City, Taiwan, Republic of China; 8Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan City, Taiwan, Republic of China*These authors contributed equally to this workCorrespondence: Yi-Lin Chiu, Department of Biochemistry, National Defense Medical Center, Rm. 7323, 7F, No. 161, Sec. 6, Minquan E. Road, Neihu Dist, Taipei City, 114201, Taiwan, Republic of China, Tel +886 02 87923100#18828, Fax +886 02 87910776, Email yilin1107@mail.ndmctsgh.edu.twPurpose: In this study, we use animal models combined with bioinformatics strategies to investigate the potential changes in overall renal transcriptional expression after traumatic brain injury.Methods: Microarray analysis was performed after kidney acquisition using unilateral controlled cortical impact as the primary mouse TBI model. Multi-oriented gene set enrichment analysis was performed for differentially expressed genes.Results: The results showed that TBI affected the gene set associated with mitochondria function in kidney cells, and a negative enrichment of gene sets associated with immune cell migration and epidermal development was also observed. Analysis of the disease phenotype gene set revealed that differential expression of mitochondria-related genes was associated with lactate metabolism. Alternatively, activation and adhesion of immune cells associated with the complement system may promote autoinflammation in kidney tissue. The simulated immune cell infiltration analysis showed an increase in the proportion of activated memory CD4 T cells and a decrease in the proportion of resting memory CD4 T cells, suggesting that activated memory CD4 T cell infiltration may be involved in the inflammation of renal tissue and cause damage to renal cells, such as principal cells, mesangial cells and loops of Henle cells.Conclusion: This study is the first to reveal the effects of brain trauma on the kidney. TBI may affect the expression of mitochondria function-related gene sets in renal cells by increasing lactate. It may also affect renal mesangial cells by inducing increased infiltration of immune cells through mechanisms related to complement system activation or autoimmune antibodies.Keywords: traumatic brain injury, nephropathy, complement system, lactate metabolism, immune cell infiltration

Rahmat Dani Satria,1– 4,&ast; Ming-Kai Jhan,4,5,&ast; Chia-Ling Chen,6 Po-Chun Tseng,4,7 Yung-Ting Wang,4 Chiou-Feng Lin4,5,7 1International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; 2Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia; 3Clinical Laboratory Installation, Dr. Sardjito Central General Hospital, Yogyakarta, 55281, Indonesia; 4Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; 5Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; 6School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; 7Core Laboratory of Immune Monitoring, Office of Research & Development, Taipei Medical University, Taipei, 110, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chiou-Feng Lin, Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan, Tel +886 2 27361661 ext. 7156, Email cflin2014@tmu.edu.twBackground: Infection with dengue virus (DENV) causes hematological complications in dengue diseases characterized by thrombocytopenia accompanied by macrophage activation syndrome and hemophagocytosis in fatal patients.Methods: In this study, we investigate the undefined mechanisms underlying the progression of thrombocytopenia caused by thrombophagocytosis based on an ex vivo whole-blood co-culture model of DENV infection for mimicking the acute febrile phase of infection.Results: In this model, complete blood count test showed a decrease in monocytes (p < 0.01), but not neutrophils nor other white blood cells, accompanied by a low thrombocyte count (p < 0.01) in DENV infection with a positive correlation (r = 0.636, p < 0.05). Furthermore, DENV exposure caused significant thrombophagocytosis in mononuclear cells (p < 0.05). Abnormal production of tumor necrosis factor (TNF)-α was highly associated with induction of thrombophagocytosis (r = 0.758, p < 0.01), decreased monocytes (r = − 0.758, p < 0.01), and decreased thrombocyte (r = − 0.728, p < 0.01). Neutralizing TNF-α considerably (p < 0.05) reversed such DENV-induced effects and was further validated by immunostaining-based flow cytometry analysis on mononuclear CD14 positive monocytes. Exogenous administration of TNF-α effectively caused thrombophagocytosis accompanied by decreased monocytes and thrombocytes, probably causing monocyte activation.Conclusion: These results demonstrate the potential pathogenesis of thrombocytopenia caused by TNF-α-induced thrombophagocytosis in monocytes during DENV infection.Graphical Abstract: Keywords: dengue virus, monocyte, thrombophagocytosis, ex vivo, TNF-&#x03B1

Yu-Ting Chen,1,&ast; Chen-Pang Hou,1– 3,&ast; Horng-Heng Juang,1,4 Yu-Hsiang Lin,1,2 Pei-Shan Yang,1,4 Phei-Lang Chang,1 Chien-lun Chen,1 Shu-Chuan Weng,3 Ke-Hung Tsui1,5 1Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; 3Health and Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan; 4Department of Anatomy, School of Medicine, Chang Gung University, Tao-Yuan, Taipei, Taiwan; 5Department of Urology, Shuang Ho Hospital, TMU Research Center of Urology and Kidney, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan&ast;These authors contributed equally to this workCorrespondence: Ke-Hung Tsui, Taiwan Innovative Medical Association, Department of Urology, Shuang Ho Hospital, College of Medical, Taipei Medical University, Taipei, Taiwan, Email t2130@s.tmu.edu.tw Shu-Chuan Weng, Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taipei, Taiwan, Email scweng303@mail.ypu.edu.twBackground and Purpose: In this study, we compared patient outcomes between the 120-W thulium laser (Vela™XL) prostate enucleation (ThuLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) techniques.Methods: We excluded patients with concomitant prostate cancer and bladder cancer and prospectively analyzed patients with benign prostatic obstruction (BPO) who underwent ThuLEP and B-TUEP from October 2018 to January 2021 in our institution. Patients’ demographics, comorbidities, prostate volumes, prostate-specific antigen (PSA) levels, and International Prostate Symptoms Score (IPSS) were recorded. Perioperative outcomes including intraoperative blood loss, prostate resection percentage of the transition zone, postoperative pain score (numeric rating scale, NRS), complications, changes in postoperative uroflowmetry parameters, IPSS, and the rate of reuse of BPH medications were also evaluated.Results: The data of a total of 111 patients (ThuLEP: 49, B-TUEP: 62) met the inclusion criteria were collected and analyzed prospectively. Our results revealed no significant differences between ThuLEP and B-TUEP in terms of operation time, prostate tissue enucleated, and days of hospitalization. However, patients in the ThuLEP group reported less pain after surgery than those in the B-TUEP group, and a higher proportion of patients in the B-TUEP group returned to the emergency department due to complications within one month postoperatively, with hematuria being the main cause. No significant differences were observed between the groups in changes in uroflowmetry parameters and IPSS at 2 weeks, 3 months, and 6 months postoperatively.Conclusion: The efficacy of ThuLEP was comparable to that of B-TUEP in terms of maximal flow rate, voiding volume, IPSS, and quality of life. ThuLEP also had several advantages over B-TUEP, including less blood loss and less postoperative pain. Therefore, ThuLEP can be considered a treatment of choice for BPH/bladder outlet obstruction, specifically for patients with a bleeding tendency and fear of pain.Keywords: prostate, laser, prostatectomy, prostatic hyperplasia, quality

Tung-Wei Kao,1,2 Tao-Chun Peng,1 Wei-Liang Chen,1 Yu-Chiao Chi,2 Chi-Ling Chen,2 Wei-Shiung Yang2– 4 1Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 2Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; 3Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 4Center for Obesity, Life Style and Metabolic Surgery, National Taiwan University Hospital, Taipei, TaiwanCorrespondence: Wei-Shiung Yang Email wsyang@ntu.edu.twBackground: Leptin plays an important role in regulating the energy homeostasis of fat and muscle. Paradoxical findings existed between serum leptin levels and muscle health conditions. Here, we aimed to investigate the relationship between serum leptin levels and the risk of sarcopenia or dynapenia among older adults.Methods: Adults aged 65 and older living in the community were recruited at annual health checkups. Body composition, gait speed, and handgrip strength were examined. The cutoff values of muscle mass and strength to define sarcopenia and dynapenia were based on the consensus by the Asia Working Group of Sarcopenia in 2019. Serum leptin level was measured by an immunoassay.Results: Four hundred sixty participants (55.65% females) were enrolled. There were 16.08% and 23.91% with sarcopenia and dynapenia, respectively. Higher serum leptin levels were positively associated with muscle and fat mass but negatively associated with handgrip strength and gait speed for both sexes. In the logistic regression models adjusted for various confounders, a higher serum leptin level was associated with an increased risk of dynapenia with dose-response effects among both male and female participants (odds ratio [OR]=3.74, 95% confidence interval [CI]= 0.99– 14.17; OR= 3.32, 95% CI=1.03– 10.74, respectively), and a positive trend existed in both genders (p for trend=0.040 and 0.042, respectively). In contrast, a higher leptin level was associated with a reduced risk of sarcopenia with dose-response trends for both sexes (OR= 0.06, 95% CI=0.01– 0.48; OR= 0.26, 95% CI=0.06– 1.17, respectively) in models of multivariate logistic regression analyses, and a negative trend existed in both genders (p for trend = 0.002 and 0.023, respectively).Conclusion: A positive trend existed between the serum leptin level and the dynapenia risk, whereas it revealed a negative trend in the serum leptin level and sarcopenia risk in both male and female elderly individuals. The biological mechanisms underlying its negative association with muscle strength but its positive association with muscle mass warrants further investigation.Keywords: leptin, dynapenia, sarcopenia, elderly, muscle, strength, mass

Chun-Yi Lai,1,2,&ast; Po-Chun Tseng,1,2,&ast; Chia-Ling Chen,3 Rahmat Dani Satria,2,4– 6 Yung-Ting Wang,2 Chiou-Feng Lin1,2,7,8 1Core Laboratory of Immune Monitoring, Office of Research & Development, Taipei Medical University, Taipei, 110, Taiwan; 2Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; 3School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; 4International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; 5Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia; 6Clinical Laboratory Installation, Dr. Sardjito Central General Hospital, Yogyakarta, 55281, Indonesia; 7Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; 8International Ph.D. Program in Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chiou-Feng LinDepartment of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, TaiwanTel +886 2 27361661 ext. 7156Email cflin2014@tmu.edu.twBackground: Phorbol 12-myristate 13-acetate (PMA)-induced differentiation of human monocytic THP-1 cells is an experimental model for preparing resting macrophages (M0) for cell polarization toward the different functional specializations of macrophages.Methods: In this study, we examined the expression of immune checkpoints by using flow cytometry following multicolor staining. The blockade of immune checkpoint by using neutralizing antibodies was performed to assess their role in PMA-induced THP-1-differentiated macrophages.Results: Upon the inducible macrophage differentiation caused by PMA, increased expression levels of CD11b and CD68 were measured and characterized according to their adherent phenotype accompanied by the generation of cellular complexity. While the cell growth rate was abolished post-differentiation, some cells underwent cell death. Notably, we found increases in the expression of programmed cell death protein 1, also known as PD-1 (CD279), and its ligand PD-L1 (CD274), mainly in differentiated M0 (CD68+CD11b+) macrophages. However, neutralizing PD-L1/PD-1 neither blocked THP-1 cell differentiation toward macrophages nor inhibited macrophage polarization in M1 and M2. In specializing macrophages, a decrease both in CD274 and CD279 was found in M2.Conclusion: These results revealed the inducible expression of PD-L1/PD-1 in PMA-induced THP-1-differentiated M0 macrophages followed by a decrease in M2 macrophages.Keywords: PMA, THP-1, macrophage, differentiation, PD-L1, PD-1

Chung-Yao Chen,1,2 Chia-Ling Chen3,4 1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan; 2School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; 4Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, TaiwanCorrespondence: Chung-Yao ChenDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, No. 200, Ln. 208, Jijin 1st Road, Anle Dist., Keelung City, 204, TaiwanTel +886-2-2432-9355 Ext 2545Fax +886-2-24315931Email jongyau2002@gmail.comBackground and Purpose: Obstructive sleep apnea (OSA) increases risk of stroke recurrence and mortality in ischemic stroke patients. However, equivocal treatment effects warrant further categorization of post-stroke OSA for risk stratification and individualized treatment planning.Methods: The study recruited 232 ischemic stroke patients with moderate-to-severe OSA admitted for inpatient rehabilitation consecutively. Latent class analysis was performed based on sex, age, smoking, daytime sleepiness, depression, obesity, sedative use, atrial fibrillation, diabetes, dyslipidemia, hypertension, recurrent stroke and dysphagia. The augmentation index, a marker of arterial stiffness, was measured by applanation tonometry.Results: A three-cluster model provided the best fit. Cluster 1 (n=84, 36.2%) was older in age, predominantly female, with the highest hypopnea index and prevalence of atrial fibrillation. Moreover, patients in Cluster 1 had significantly higher augmentation index than those in Cluster 2. Cluster 2 patients (N=80, 34.5%) were of older age, predominantly male, with the highest prevalence of depression, the lowest prevalence of hypertension and had the most normal body mass index (BMI). Additionally, Cluster 2 had less nocturnal hypoxia as compared to Cluster 3. Cluster 3 (n=68, 29.3%) was the youngest in age, predominantly male, with the highest BMI, cumulative risk score, and prevalence of dyslipidemia of the three clusters.Conclusion: Post-stroke OSA can be categorized into three clinical phenotypes. Patients in Clusters 1 and 3 both had elevated cardiovascular risk and treatment can be based on their distinct characteristics. Patients in Cluster 2 had relatively lower risk of cardiovascular events and the benefits of OSA treatment requires further study.Keywords: obstructive sleep apnea, ischemic stroke, cluster analysis, latent class analysis

Chung-Yao Chen,1,2 Wen-Chun Tseng,1 Yao-Hung Yang,1 Chia-Ling Chen,3,4 Lain-Li Lin,5 Fang-Ping Chen,2,6,7 Alice MK Wong2,3,8 1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung 204, Taiwan; 2Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 333, Taiwan; 4Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; 5Department of Tourism Leisure and Health, Ching Kuo Institute of Management and Health, Keelung 204, Taiwan; 6Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan; 7Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; 8Healthy Aging Research Center, Chang Gung University, Taoyuan 333, TaiwanCorrespondence: Chung-Yao ChenDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, No. 200, Ln. 208, Jijin 1st Road, Anle District, Keelung City 204, TaiwanTel +886-2-2432-9292 #2725Email jongyau2002@gmail.comIntroduction: Sarcopenia is highly prevalent among residents of assisted-living facilities. However, the optimal screening tools are not clear. Therefore, we compared the performance of four recommended screening tools for predicting sarcopenia.Methods: The study recruited 177 people over 65 years of age in assisted-living facilities. Appendicular muscle mass index was measured using bioelectrical impedance analysis. Calf circumference (CC), handgrip, six-meters walking speed, and screening questionnaires including SARC-CalF, SARC-F and 5-item Mini Sarcopenia Risk Assessment (MSRA-5) were evaluated. The diagnosis criteria for sarcopenia were based on the Asian Working Group for Sarcopenia 2019 consensus. The area under the receiver operating characteristic curves (AUC) was used to contrast the diagnostic accuracy of screening tools.Results: The prevalence of sarcopenia was 52.7% among men and 51.2% among women. After adjusting for age, sex, body mass index and SARC-CalF score, CC remained significantly associated with sarcopenia in logistic regression analysis. The prediction model for sarcopenia based on CC alone had the highest accuracy compared to SARC-CalF, MSRA-5 and SARC-F (AUC, 0.819 vs 0.734 vs 0.600 vs 0.576; sensitivity/specificity, 80.4%/71.8% vs 38.0%/80.0% vs 60.7%/54.2% vs 10.9%/91.8%). Differences in AUCs between the prediction models were statistically significant (CC vs. SARC-CalF, P = 0.0181; SARC-CalF vs. MSRA-5, P = 0.0042). Optimal cutoff values for predicting sarcopenia were CC < 34 cm in men and < 33 cm in women.Conclusion: To predict sarcopenia based on low CC alone is accurate, easy and inexpensive for use in assisted-living facility settings. Further validation studies in different populations are suggested.Keywords: sarcopenia, calf circumference, SARC-F, SARC-CalF, MSRA, assisted-living

Chao-Lei Chen,1,* Lin Liu,1,* Jia-Yi Huang,1 Yu-Ling Yu,1 Kenneth Lo,1,2 Yu-Qing Huang,1 Ying-Qing Feng1 1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People’s Republic of China; 2Centre for Global Cardiometabolic Health, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA*These authors contributed equally to this workCorrespondence: Yu-Qing Huang; Ying-Qing FengDepartment of Cardiology,Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou 510080, People’s Republic of ChinaTel/ Fax +86-20-83827812Email hyq513@126.com; 651792209@qq.comBackground: The optimal blood pressure (BP) level for diabetic patients remains controversial, while studies provided limited evidence on BP management for individuals with normoglycemia or prediabetes. We aimed to investigate the associations between systolic blood pressure (SBP) and all-cause and cardiovascular (CVD) mortality among US adults with different glycemic profiles.Methods: We used data from the 1999– 2014 National Health and Nutrition Examination Survey (NHANES, n=40,046) with comprehensive baseline examination and follow-up assessment. Restricted cubic spline analysis was performed to examine dose–response relationship between SBP and mortality risk. Cox regression models were used to estimate hazard ratios of all-cause mortality and CVD mortality for SBP categories.Results: U-shaped associations between SBP and all-cause mortality were observed regardless of glucose status. The relationship between SBP and CVD mortality was found to be U-shaped only in normoglycemic participants. The lowest mortality risk of optimal SBP (mmHg) by group was 115– 120 (normoglycemia), 120– 130 (prediabetes), and 125– 135 (diabetes). When compared with the reference group, SBP < 100 mmHg was significantly associated with 49% (HR=1.49, 95% CI: 1.13– 1.96), 57% (1.57, 1.07– 2.3), and 59% (1.59, 1.12– 2.25) higher all-cause mortality risk in people with normoglycemia, prediabetes, and diabetes, respectively. The multivariable-adjusted HRs of all-cause mortality for SBP ≥ 150 mmHg were 1.51 (1.25– 1.82), 1.56 (1.27– 1.93), and 1.33 (1.08– 1.64), respectively. As for CVD mortality, the multivariable-adjusted HRs were 2.85 (1.29– 6.33) for SBP < 100 mmHg and 2.71 (1.56– 4.69) for SBP ≥ 150 mmHg in normoglycemia; HR was 1.66 (1.05– 2.63) for SBP ≥ 150 mmHg in diabetic patients.Conclusion: U-shaped relationships between SBP and all-cause mortality were observed regardless of diabetes status. The optimal SBP range was gradually higher with worsening glucose status.Keywords: systolic blood pressure, mortality, normoglycemia, prediabetes, diabetes mellitus

Jing-Jing Zhao,1,2,* Zi-Qi Zhou,1,2,* Peng Wang,3,4,* Chang-Long Chen,1,2 Yuan Liu,1,2 Qiu-Zhong Pan,1,2 Qian Zhu,1,2 Yan Tang,1,2 De-Sheng Weng,1,2 Jian-Chuan Xia1,2 1Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; 2Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China; 3Department of Emergency Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; 4Department of Medical Research, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China *These authors contributed equally to this work Introduction: Esophageal squamous cell carcinoma (ESCC) develops in a background of chronic inflammation; therefore, it is a promising candidate for treatment by immunotherapy. Although tumor immunity is critically involved in tumor growth and metastasis in ESCC, important gaps exist in our understanding of its immune microenvironment. This study aimed to investigate the expression and prognostic significance of immune checkpoint proteins in ESCC and the associated T-cell densities.Materials and methods: We investigated the infiltration of CD8+ T cells and the expressions of immune checkpoint proteins (PD-1, TIGIT, PD-L1, and PD-L2) in 154 primary ESCC patients by immunohistochemistry. The correlation of immune checkpoint proteins’ expression and clinical outcomes was determined by Kaplan–Meier test and multivariate Cox regression analysis.Results: PD-L1 and PD-L2 expression were detected in 45.5 and 59.7% of the ESCC samples, respectively. The high densities of PD-1+ and TIGIT+ tumor-infiltrating lymphocytes (TILs) were expressed in 47.4 and 49.4% of the ESCC patients, respectively. The number of PD-1+ TILs was significantly positively correlated with CD8+ TILs (P

Ming-Kung Wu,1 Li-Wen Hsu,2 Kuang-Tzu Huang,3 Chih-Che Lin,2 Chih-Chi Wang,2 Ting-Lung Lin,2 Wei-Feng Li,2 Shigeru Goto,2 Chao-Long Chen,2 Chien-Chih Chen1 1Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Background: Living donor liver transplantation (LDLT) has been developed as one of gold standard treatments for end-stage liver disease. Mental health is a required selection criterion for adult living liver donors and may influence the quality of life after operation. Patients and methods: A total of 1,210 potential living donor candidates for liver transplantation (LT) underwent psychosocial evaluation that included a semi-structured interview, multi-choice self-reported inventory (Beck Depression Inventory-2nd edition [BDI-II], Beck Anxiety Inventory [BAI]), and the family APGAR (Adaptability, Partnership, Growth, Affection, Resolve) index. The test results were compared by family relationships, and subgroups were classified based on the donation type: 1) parents to children, 2) grown children to parents, 3) siblings to siblings, 4) spouses to spouses, and 5) other relatives to other relatives. Results: The BDI-II (P < 0.001) and BAI differed considerably according to the donation type in potential donor candidates. Compared with other subgroups, parents donating to their children suffered the most severe psychological stress before LDLT and exhibited more depressive (P < 0.001) and anxiety symptoms. However, the stress associated with grown children donating to their parents, siblings, and spouses was not significantly higher than it was for other relatives. Furthermore, a significant negative correlation existed between family APGAR scores and the severity of depression and anxiety (P < 0.001) among potential donor candidates. Conclusion: These results indicate the importance of understanding potential donor candidates’ psychological characteristics before LT. Greater anxiety and depression may be exhibited by parent donors due to the distress from fears of death or illness of the recipients, or their guilty feeling for their child. Additionally, family dysfunction also revealed more depression and anxiety. Such donor candidates should be given more extensive pre-donation counseling for minimizing pre-LDLT psychological stress. Keywords: living donor candidates, psychosocial evaluation, depression, anxiety, family function, family relationship

Wei-Jie Guan,1,2 Jing-Jing Yuan,1 Hui-Min Li,1 Yong-Hua Gao,3 Chun-Lan Chen,1 Yan Huang,1 Rong-Chang Chen,1 Nan-Shan Zhong1,2 1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Sino-French Hoffmann Institute, Guangzhou Medical University, Guangzhou, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China Background: Bronchiectasis is a debilitating disease with chronic airway infection. Proteobacteria, the dominant phylum, can be detected with high-throughput sequencing.Objective: To stratify Proteobacteria compositions according to culture findings in bronchiectasis.Patients and methods: We sampled sputum, split for culture and 16srRNA sequencing, from 106 patients with stable bronchiectasis and 17 healthy subjects. Paired sputa from 22 bronchiectasis patients were collected during exacerbations and convalescence.Results: Forty-five, 41, and 20 patients with clinically stable bronchiectasis had isolated Pseudomonas aeruginosa (PA), other potentially pathogenic microorganisms, and commensals at the initial visit, respectively. The PA group (but not other groups) demonstrated significantly greater relative abundance of Proteobacteria, and lower Shannon–Wiener Diversity Index, Simpson Diversity Index, and richness compared with healthy subjects. Pseudomonas was the dominant genus that discriminated bronchiectasis patients (particularly in the PA group) from healthy subjects. Compared with baseline levels, Proteobacteria community compositions in the PA group, but not in other groups, were more resilient during exacerbations and convalescence.Conclusion: Proteobacteria community compositions could be partially reflected by conventional sputum bacterial culture. Significantly altered Proteobacteria community compositions – particularly, the increased relative abundance of Pseudomonas and diminished community diversity – represent critical targets for novel interventions to restore normal airway microenvironment in patients with bronchiectasis. Keywords: bronchiectasis, Proteobacteria, Pseudomonas aeruginosa, culture, exacerbation

Pei-Shan Yang,1 Chien-Lun Chen,1 Chen-Pang Hou,1 Yu-Hsiang Lin,1 Ke-Hung Tsui1,2 1Department of Urology, 2Prostate Health Laser Center, Chang Gung Memorial Hospital-Linkou, Chang Gung University, College of Medicine, Taipei, Taiwan, Republic of China Purpose: The aim of this study was to investigate the efficacy and tolerability of switching from 0.2 mg tamsulosin to 0.4 mg tamsulosin oral controlled absorption system (OCAS) over a 12-week period in Taiwanese men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Patients and methods: Taiwanese male patients who were dissatisfied with treatment with 0.2 mg tamsulosin were enrolled in this clinical study and switched to 0.4 mg tamsulosin OCAS. Efficacy was assessed over a 12-week period by an International Prostate Symptom Score (IPSS) questionnaire and analysis of urinary flow by uroflowmetry. Results: A statistically significant improvement was observed in total IPSS scores from baseline (14.94±7.41, moderate) to 12 weeks (7.36±5.77, mild) in 81 patients who were switched from 0.2 to 0.4 mg tamsulosin OCAS (P

Yu-Hsiang Lin,1–3,* Chen-Pang Hou,1,2,* Tien-Hsing Chen,2,4 Horng-Heng Juang,5 Phei-Lang Chang,1,2 Pei-Shan Yang,1,2 Yu-Sheng Lin,2,6 Chien-Lun Chen,1,2 Ke-Hung Tsui1,2 1Department of Urology, Chang Gung Memorial Hospital – Linkou, 2School of Medicine, 3Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 4Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, 5Department of Anatomy, School of Medicine, Chang Gung University, Kwei-shan, Tao-Yuan, 6Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, Republic of China *These authors contributed equally to this work Purpose: We assessed the lower urinary tract symptoms (LUTSs) and clinical outcomes between diabetes mellitus (DM) patients and non-diabetic (non-DM) patients receiving transurethral resection of prostate (TUR-P). Methods: This analysis was a retrospective cohort study using 13 years (2000–2012) of claims data from Taiwan’s National Health Insurance Research Database (NHIRD). A total of 4,887 patients who had persistent LUTSs and underwent TUR-P for prostate enlargement (benign prostate enlargement [BPE]) were enrolled and divided into two groups: DM and non-DM groups. The patients’ characteristics, postoperative clinical outcomes, and the medication records after TUR-P were compared. Chi-square test was used for categorical variables and independent samples t-test for continuous variables. Multivariable logistic regression analysis was used to compare the risk of postoperative outcomes. Finally, we estimated the medication-free survival rate after TUR-P using Kaplan–Meier method and compared it between study groups using log-rank test. Results: DM group patients had a higher prevalence of comorbidities. Postoperatively, the DM group had lower rates of urinary tract infection (UTI; odds ratio [OR], 0.78; P=0.009) and higher rates of urinary retention requiring catheterization (OR, 1.35; P=0.01) within 1 month after TUR-P. A higher proportion of patients with DM took anti-muscarinics (OR, 1.23; P=0.032) within the first 3 months and α-blockers (OR, 1.18; P=0.049) during 3–12 months after receiving TUR-P. Overall, the DM group patients had a worse postoperative medication-free survival compared to that of non-DM group patients (95% confidence interval [95% CI], 1.14; P=0.005). Conclusion: DM patients require higher rates of continuing medication after TUR-P, especially anti-muscarinics in 3 months postoperatively and alpha-blocker after 3 months postoperatively. DM patients also had higher incidence of urine retention after surgery. DM patients had relatively poor treatment outcomes compared to DM-free patients. Keywords: benign prostate hyperplasia, infection, overactive bladder, prostatectomy, urinary tract infection, lower urinary tract symptoms

Ching-Long Chen,1,2 Yi-Hao Chen,1,2 Ming-Cheng Tai,2 Chang-Min Liang,2 Da-Wen Lu,1,2 Jiann-Torng Chen1,2 1Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan; 2Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Abstract: Proliferative vitreoretinopathy (PVR) is the main cause of failure following retinal detachment surgery. Transforming growth factor (TGF)-β2-induced epithelial-to-mesenchymal transition (EMT) plays an important role in the development of PVR, and EMT inhibition decreases collagen gel contraction and fibrotic membrane formation, resulting in prevention of PVR. Resveratrol is naturally found in red wine and has inhibitory effects on EMT. Resveratrol is widely used in cardioprotection, neuroprotection, chemotherapy, and antiaging therapy. The purpose of this study was to investigate the effects of resveratrol on TGF-β2-induced EMT in ARPE-19 cells in vitro. We found that resveratrol suppressed the decrease of zona occludens-1 (ZO-1) and caused an increase of alpha-smooth muscle actin expression in TGF-β2-treated ARPE-19 cells, assessed using Western blots; moreover, it also suppressed the decrease in ZO-1 and the increase of vimentin expression, observed using immunocytochemistry. Resveratrol attenuated TGF-β2-induced wound closure and cell migration in ARPE-19 cells in a scratch wound test and modified Boyden chamber assay, respectively. We also found that resveratrol reduced collagen gel contraction – assessed by collagen matrix contraction assay – and suppressed the phosphorylation of Smad2 and Smad3 in TGF-β2-treated ARPE-19 cells. These results suggest that resveratrol mediates anti-EMT effects, which could be used in the prevention of PVR. Keywords: resveratrol, epithelial-to-mesenchymal transition, proliferative vitreoretinopathy, transforming growth factor-β2, retinal pigment epithelial cells

Hsin-Yao Chen,1 Chiu-Liang Chen,1,2 Wei-Liang Chen3 1Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua City, 2Liberal Arts Center of Da Yeh University, Dacun Township, Changhua County, Taiwan; 3Department of Clinical Image, Changhua Christian Hospital, Changhua City, Changhua County, Taiwan Background: Pedicle screw instrumentation for treating spinal disorder is becoming increasingly widespread. Many studies have advocated its use to facilitate rigid fixation for spine; however, adjacent segmental disease is a known complication. Instrumented fusion for osteoporotic spines remains a significant challenge for spine surgeons. Prophylactic vertebroplasty for adjacent vertebra has been reported to reduce the complications of junctional compression fractures but has raised a new problem of vertebral subluxation. This case report is a rare and an extreme example with many surgical complications caused by repeated instrumented fusion for osteoporotic spine in a single patient. This patient had various complications including adjacent segmental disease, vertebral subluxation, and junctional fractures on radiographs and magnetic resonance images.Case presentation: An 81-year-old Taiwanese woman underwent decompression and instrumented fusion of L4-L5 in Taiwan 10 years ago. Due to degenerative spinal stenosis of L3-L4 and L2-L3, she had decompression with instrumented fusion from L5 to L1 at the previous hospital. However, catastrophic vertebral subluxations with severe neurologic compromise occurred, and she underwent salvage surgeries twice with prolonged instrumented fusion from L5 to T2. The surgeries did not resolve her problems of spinal instability and neurologic complications. Eventually, the patient remained with a Frankel Grade C spinal cord injury.Conclusion: Adjacent segmental disease, junctional fracture, and vertebral subluxation are familiar complications following instrumented spinal fusion surgeries for osteoporotic spines. Neurologic injuries following long instrumentation are often serious and difficult to address with surgery alone. Conservative treatments should always be contemplated as an alternative method for patients with poor bone stock. Keywords: osteoporotic spine, vertebral subluxation, junctional fracture, instrumented fusion, complication

Chen-Pang Hou,1,2 Yu-Hsiang Lin,1,2 Meng-Chiao Hsieh,3 Chien-Lun Chen,1,2 Phei-Lang Chang,1,2 Ying-Chen Huang,2 Ke-Hung Tsui1,21Department of Urology, Chang Gung Memorial Hospital at Linkou, 2School of Medicine, Chang Gung University, 3Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan Objective: The purpose of this study was to prospectively investigate the degree of pain experienced by the patients receiving transrectal ultrasonography (TRUS) of the prostate by applying a visual analog scale. We also identified the clinical parameters influencing pain during the TRUS examination.Materials and methods: Records were obtained from a prospective database for male patients who received TRUS of prostate in the outpatient department of Chang Gung Memorial Hospital, Taiwan, from January 2014 to June 2014. The patients underwent a detailed physical examination and medical history review. Immediately after the TRUS examination, the patients completed questionnaires based on a ten-point visual analog pain scale. The variables of interest were age, body mass index, prostate volume, prostate sagittal length, prostate-specific antigen, previous TRUS experience, external hemorrhoids, anal surgical history, prostate calcification, and image artifact caused by stool in the rectum. All variables were correlated to the visual analog scale by applying multivariate regression analysis.Results: By using linear regression analysis, we identified the independent factors that affected the pain score during the TRUS examination. The patients who received the examination for the first time or had longer prostate sagittal lengths, external hemorrhoids, anal surgical history, or stool stored in the rectum experienced more pain during the TRUS examination. Furthermore, the pain was reduced when we provided the patients with a detailed explanation before the procedure and allowed them to observe the real-time images during the examination.Conclusion: Although a TRUS examination is uncomfortable for patients, after having identified the factors affecting pain, physicians can assist patients in reducing pain during the procedure, thus providing higher quality examinations. Keywords: VAS, TRUS, ultrasound, pain score, transrectal, benign prostate hyperplasia, digital examination

I-Hung Shao,1,2,* Yu-Hsiang Lin,1,* Chen-Pang Hou,1 Horng-Heng Juang,3,4 Chien-Lun Chen,1 Phei-Lang Chang,1,4 Ke-Hung Tsui, 1,41Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, 2Department of Urology, Lotung Poh-Ai Hospital, 3Department of Anatomy, Chang Gung University, 4Bioinformation Center, Chang Gung Memory Hospital, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China*These authors contributed equally to this workPurpose: Radical nephroureterectomy (RNU) is a standard treatment for upper urinary tract urothelial carcinoma. However, RNU can result in decreased renal function and cannot be treated with adjuvant chemotherapy. We performed a risk group stratification analysis to determine the preoperative factors that are predictive of diminished renal function after RNU.Materials and methods: We retrospectively evaluated the medical records of all patients who underwent nephroureterectomy for upper urinary tract urothelial carcinoma at the Chang Gung Memorial Hospital from 2001 to 2008. We analyzed the association between perioperative glomerular filtration rate and preoperative parameters including cancer characteristics, serum creatinine level, and kidney size measured on computed tomographic images.Results: A total of 242 patients fulfilled the inclusion criteria. The average decrease in renal function 1 month after RNU was 19.7%. Using 60 mL/min/1.73 m2 as the eligibility cutoff for cisplatin-based chemotherapy, 42.1% of the population was eligible prior to nephroureterectomy, whereas following surgery only 15.2% remained eligible. Using a cutoff of 45 mL/min/1.73 m2, 59.9% of the cohort was eligible for fractionated cisplatin dosing preoperatively, whereas only 32.6% remained above the cutoff postoperatively. The most significant predictors of poor postoperative renal function were body mass index >25 kg/m2, age >65 years, contralateral kidney length less than 10 cm, and absence of ipsilateral hydronephrosis.Conclusion: Our results suggest that older age, higher body mass index, smaller contralateral renal length, and absence of ipsilateral hydronephrosis are predictive of decreased renal function after RNU.Keywords: transitional cell, carcinoma, kidney, adjuvant chemotherapy, upper tract urothelial carcinoma

Wei-Hsiu Hsu,1–3 Chi-lung Chen,2 Liang Tseng Kuo,2 Chun-Hao Fan,1 Mel S Lee,2 Robert Wen-Wei Hsu2 1Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan; 2Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan; 3Department of Medicine, Chang Gung University, Tao Yuan, Taiwan Background: Health-related fitness has been reported to be associated with improved quality of life (QoL) in the elderly. Health-related fitness is comprised of several dimensions that could be enhanced by specific training regimens. It has remained unclear how various dimensions of health-related fitness interact with QoL in postmenopausal women.Objective: The purpose of the current study was to investigate the relationship between the dimensions of health-related fitness and QoL in elderly women.Methods: A cohort of 408 postmenopausal women in a rural area of Taiwan was prospectively collected. Dimensions of health-related fitness, consisting of muscular strength, balance, cardiorespiratory endurance, flexibility, muscle endurance, and agility, were assessed. QoL was determined using the Short Form Health Survey (SF-36). Differences between age groups (stratified by decades) were calculated using a one-way analysis of variance (ANOVA) and multiple comparisons using a Scheffé test. A Spearman’s correlation analysis was performed to examine differences between QoL and each dimension of fitness. Multiple linear regression with forced-entry procedure was performed to evaluate the effects of health-related fitness. A P-value of

Chen-Pang Hou,1 Chien-Lun Chen,1 Yu-Hsiang Lin,1 Yu-Lun Tsai,1 Phei-Lang Chang,1 Horng-Heng Juang,2 Ke-Hung Tsui11Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 2Department of Anatomy, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of ChinaPurpose: We investigated the association of the prostatic urethral angle (PUA) with peak urinary flow rate (Qmax) and the severity of lower urinary tract symptoms (LUTS) on the aging male. We also evaluated the effect of the PUA on the treatment efficacy of tamsulosin on men with LUTS.Materials and methods: The records were obtained from a prospective database for first-visit male patients with LUTS in the outpatient department of our institution. These patients underwent a detailed physical examination and taking of medical history. A transrectal ultrasound was performed on these patients. The prostate size, length of intravesical prostatic protrusion (IPP), PUA, and International Prostate Symptom Score (IPSS) of the patients were evaluated. Uroflowmetry and a bladder scan for residual urine were also performed on every patient. Tamsulosin 0.2 mg per day was prescribed. The IPSS and uroflowmetry were reevaluated after they had received treatment for 3 months.Results: A total of 178 patients were included, and 149 of them completed this cohort study. The mean PUA was 48.32°±13.74°. The mean prostate volume was 39.19±20.87 mL, and the mean IPP was 5.67±7.85 mm. On multivariate linear regression analysis, the PUA was independently associated with the IPSS (P

Wei-Chang Lee,1,* Yu-Hsiang Lin,1,* Chen-Pang Hou,1 Phei-Lang Chang,1 Chien-Lun Chen,1 Horng-Heng Juang,2 Ke-Hung Tsui1 1Department of Urology, Chang Gung Memorial Hospital-Linko and Chang Gung University, College of Medicine, Taiwan, 2Department of Anatomy, College of Medicine, Chang Gung University, Kweishan-Shan, Taoyuan, Taiwan, Republic of China *These authors contributed equally to this work Purpose: Endoscopic lasers have become a treatment option for benign prostate hyperplasia (BPH). The study reported here sought to elucidate the benefits and drawbacks of different laser systems in the treatment of patients with BPH. Methods: The study enrolled 741 patients diagnosed with lower urinary tract symptoms secondary to BPH during the period January 2005 to December 2011. The techniques used in the study were photoselective vaporization of the prostate, thulium laser prostatectomy, and diode laser prostatectomy. Patients were assigned to one of three groups according to the type of laser treatment they received. Outcomes were evaluated using the International Prostate Symptom Score (IPSS), quality of life, maximal urinary flow rate, post-voiding residual urine volume, and prostate-specific antigen (PSA) level. Results: The baseline characteristics of patients who received diode laser prostatectomy show a significant elevated risk and high American Society of Anesthesiology score (P=0.001). Operative time and catheter removal time differed significantly between the three groups (P=0.001). No cases were converted to transurethral resection of the prostate intraoperatively due to bleeding (P=0.142). Among the three groups, there were no significant differences in maximal flow rate, lower post-void residual urine, and postoperative PSA level during the entire follow-up period (P

Chen-Pang Hou,1,* Tzu-Yu Chen,2,* Chia-Chi Chang,3 Yu-Hsiang Lin,1 Phei-Lang Chang,1 Chien-Lun Chen,1 Yu-Chao Hsu,1 Ke-Hung Tsui1 1Department of Urology, Chang Gung Memorial Hospital Linko, Chang Gung University, Taiwan, Republic of China; 2Department of Nursing, Chang Gung Memorial Hospital, Taipei, Republic of China; 3College of Nursing, Taipei Medical University, Taipei, Republic of China *These authors contributed equally to this work Purpose: We used the Short Form (SF)-36® Health Survey scale to assess the effect of pelvic floor muscle exercise (PFE) on aging males who received transurethral resection of the prostate (TUR-P). Methods: From April 2010 to December 2010, a total of 66 patients who underwent TUR-P were enrolled in this study. They were randomized into two groups (with 33 patients in each group) – an experimental group who performed postoperative PFE every day and a control groups. Data, including the International Prostate Symptom Score (IPSS), uroflowmetry study, and the SF-36 quality of life measure, were collected before the operation, and at 1, 4, 8, and 12 weeks after the operation. We analyzed the differences between the two groups with respect to their IPSS scores, maximal urinary flow rate, residual urine amount, and life quality. Results: A total of 61 patients (experimental group: 32 patients, and control group: 29 patients) completed this study. We found that at 12 weeks postop, patients who performed PFE every day had a better maximal urinary flow rate (16.41 ± 6.20 vs 12.41 ± 7.28 mL/min) (P = 0.026) compared with patients in the control group. The experimental group had a much greater decrease in IPSS score (P < 0.001). As for the SF-36 scale, the experimental group had higher scores than did the control group on both the physiological domain (54.86 vs 49.86) (P = 0.029) and the psychological domain (61.88 vs 52.69) (P = 0.005). However, there were no significant differences with respect to the postvoiding residual urine between the two groups (57.24 ± 52.95 vs 64.68 ± 50.63 mL) (P = 0.618). Conclusion: Compared with the control group, patients who performed PFE for 12 weeks after TUR-P showed improvement in their maximal urinary flow rate and lower urinary tract symptoms, and had a better quality of life. The immediate initiation of PFE is suggested for patients who undergo TUR-P. Keywords: benign prostatic hyperplasia, SF-36, pelvic floor exercise, prostatectomy, quality of life

Ching-Yen Chen,1,4,5 Chin-Pang Lee,1,4 Yu Chen,2,4,5 Jun-Ran Jiang,3,4,5 Chun-Lin Chu,1,4,5 Chun-Liang Chen3,4,5 1Department of Psychiatry, 2Department of Urology, 3Department of Traditional Chinese Medicine, 4Men’s Health Center, Chang Gung Memorial Hospital at Linkou, Taiwan; 5School of Medicine, Chang Gung University, Taoyuan, Taiwan Background: Andropause and psychiatric disorders are associated with various symptoms in aging males and are part of the differential diagnosis of depression and anxiety. This study was designed to investigate the relationship between symptoms of aging, anxiety, and depression, and to determine if sexual dysfunction could be a differentiating characteristic in the psychiatric outpatient clinic. Methods: One hundred seventy-six male psychiatric outpatients participated in the study and completed self-reported measures assessing symptoms of aging, depression, and anxiety. Symptoms of aging were assessed by the Aging Males’ Symptoms scale. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale. Erectile dysfunction was considered if a response to item 15 on the Aging Males’ Symptoms scale (impaired sexual potency) was rated with 4 or 5 points. Affective disturbance was assessed by the total scores of the Hospital Anxiety and Depression Scale. Results: Age was correlated with less anxiety and more sexual symptoms. Anxiety and depression were associated with more severe symptoms of aging, and depression was associated with more sexual symptoms than was anxiety. Impaired sexual potency was the only sexual symptom not significantly associated with depression and anxiety. Depression was associated with an interspousal age gap of ≥6 years. The point prevalence of erectile dysfunction was 28.4%, and age and affective disturbance were associated with the risk of erectile dysfunction. Conclusion: Impaired sexual potency should raise the suspicion of androgen deficiency rather than depression and anxiety among middle-aged or older male psychiatric outpatients. Keywords: androgen deficiency, depression, anxiety, erectile dysfunction

I-Hung Shao,1,* Chen-Pang Hou,1,* Shao-Ming Chen,3 Chien-Lun Chen,1,2 Yu-Hsiang Lin,1 Phei-Lang Chang,1,2 Ke-Hung Tsui1,2 1Department of Urology, 2Bioinformation Center, Chang Gung Memorial Hospital-Linko and Chang Gung University College of Medicine, 3Department of Urology, Taipei City Hospital, Heping Campus, Taipei, Taiwan, People's Republic of China *These authors contributed equally to this work Abstract: Endoscopic surgical treatment has become an option to treat benign prostate hyperplasia. We evaluated the safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients. We evaluated preoperative and perioperative parameters, functional outcomes, and adverse events up to 12 months postoperatively of patients on oral anticoagulation therapy undergoing PVP, and compared the results with patients who did not take anticoagulation therapy. A total of 89 patients who received photoselective vaporization laser for benign prostate hyperplasia from May 2006 to February 2011 in our hospital were enrolled in our study. The patients were divided into two groups based on whether or not they were taking oral aspirin; 23 (25.8%) patients were taking aspirin derivatives (aspirin group), and 66 (74.2%) were not taking aspirin derivatives (control group). The mean prostate volume (58.8 mL vs 51 mL; P = 0.16) and mean energy consumption (235,268 J vs 289,793 J; P = 0.097) were comparable between the aspirin group and control group. The average postoperative results of hemoglobin were 13.4 mg/dL for the aspirin group versus 13.9 mg/dL for the control group (P = 0.327). A significantly higher maximum flow rates and 80% improved post-void residual urine were noted during the followup. Postoperatively all variable showed significant improvement starting at month 1 of followup and remained improved for the 12 month followup. Postoperative complications were low and comparable between groups. PVP was characterized by excellent hemostatic properties and a very low intraoperative complication rate, even in the patients who were taking aspirin. On the basis of our perioperative results, we recommend PVP as a safe and effective procedure for patients with symptomatic benign prostate hyperplasia when taking an aspirin derivative. Keywords: prostate gland, benign prostatic hyperplasia, laser, elderly, green light laser Corrigendum for this paper has been published

IntroductionEnhanced recovery after surgery (ERAS) pathways have emerged as a promising strategy to reduce postoperative opioid use and decrease the risk of developing new persistent opioid use in surgical patients. However, the association between ERAS implementation and discharge opioid prescribing practices is unclear.Study designWe conducted a retrospective observational quasi-experimental study of opioid-naïve patients aged 18+ undergoing cesarean delivery between February 2015 and December 2019 at a large academic center. An interrupted time series analysis (ITSA) was used to model the changes in pain medication prescribing associated with the implementation of ERAS to account for pre-existing temporal trends.ResultsAmong the 1473 patients (out of 2249 total) who underwent cesarean delivery after ERAS implementation, 80.72% received a discharge opioid prescription vs. 95.36% at baseline. Pre-ERAS daily oral morphine equivalents (OME) on the discharge prescription decreased by 0.48 OME each month (p

This study investigates the evolution of superconductivity in K2-xFe4+ySe5 using temperature-dependent X-ray absorption and resonant inelastic X-ray scattering techniques. Magnetization measurements show that polycrystalline superconducting (SC) K1.9Fe4.2Se5 has a critical temperature (T c) of ∼31 K with a varying superconducting volume fraction, which strongly depends on its synthesis temperature. An increase in Fe-structural/vacancy disorder in SC samples with more Fe atoms occupying vacant 4d sites is found to be closely related to the decrease in the spin magnetic moment of Fe. Moreover, the nearest-neighbor Fe-Se bond length in SC samples exceeds that in the non-SC (NS) sample, K2Fe4Se5, which indicates a weaker hybridization between the Fe 3d and Se 4p states in SC samples. These results clearly demonstrate the correlations among the local electronic and atomic structures and the magnetic properties of K2-xFe4+ySe5 superconductors, providing deeper insight into the electron pairing mechanisms of superconductivity.

This study investigates the evolution of superconductivity in K2-xFe4+ySe5 using temperature-dependent X-ray absorption and resonant inelastic X-ray scattering techniques. Magnetization measurements show that polycrystalline superconducting (SC) K1.9Fe4.2Se5 has a critical temperature (T c) of ∼31 K with a varying superconducting volume fraction, which strongly depends on its synthesis temperature. An increase in Fe-structural/vacancy disorder in SC samples with more Fe atoms occupying vacant 4d sites is found to be closely related to the decrease in the spin magnetic moment of Fe. Moreover, the nearest-neighbor Fe-Se bond length in SC samples exceeds that in the non-SC (NS) sample, K2Fe4Se5, which indicates a weaker hybridization between the Fe 3d and Se 4p states in SC samples. These results clearly demonstrate the correlations among the local electronic and atomic structures and the magnetic properties of K2-xFe4+ySe5 superconductors, providing deeper insight into the electron pairing mechanisms of superconductivity.

Observations from a wintertime and summertime field campaign are used to assess the relationship between black and brown carbon (BC and BrC, respectively) optical properties and particle composition and coating state. The wintertime campaign, in Fresno, CA, was impacted by primary emissions from residential wood burning, secondary organic and inorganic particle formation, and BC from motor vehicles. Two major types of BrC were observed in wintertime. One occurred primarily at night—the result of primary biomass burning emissions. The second was enhanced in daytime and strongly associated with particulate nitrate and the occurrence of fog. The biomass-burning-derived BrC absorbed more strongly than the nitrate-associated BrC but had a weaker wavelength dependence. The wintertime BC-specific mass absorption coefficient (MAC BC ) exhibited limited dependence on the ensemble-average coating-to-BC mass ratio (R coat-rBC ) at all wavelengths, even up to R coat-rBC of ~5. For the summertime campaign, in Fontana, CA, BC dominated the light absorption, with negligible BrC contribution even after substantial photochemical processing. The summertime MAC BC exhibited limited dependence on R coat-rBC , even up to ratios of >10. Based on the four classes of BC-containing particles identified by Lee et al. (2017, https://doi.org/10.5194/acp-17-15055-2017) for the summertime measurements, the general lack of an absorption enhancement can be partly—although not entirely—attributed to an unequal distribution of coating materials between the BC-containing particle types. These observations demonstrate that in relatively near-source environments, even those impacted by strong secondary aerosol production, the ensemble-average, mixing-induced absorption enhancement for BC due to coatings can be quite small.