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The aerosol radiative effect can be modulated by the vertical distribution and optical properties of aerosols, particularly when aerosol layers are decoupled. Direct aerosol radiative effects over the northern South China Sea (SCS) were assessed by incorporating an observed data set of aerosol optical properties obtained from the Seven South East Asian Studies (7-SEAS)/Dongsha Experiment into a radiative transfer model. Aerosol optical properties for a two-layer structure of aerosol transport were estimated. In the radiative transfer calculations, aerosol variability (i.e., diversity of source region, aerosol type, and vertical distribution) for the complex aerosol environment was also carefully quantified. The column-integrated aerosol optical depth (AOD) at 500nm was 0.1-0.3 for near-surface aerosols and increased 1-5 times in presence of upper layer biomass-burning aerosols. A case study showed the strong aerosol absorption (single-scattering albedo (ω) ≈ 0.92 at 440nm wavelength) exhibited by the upper layer when associated with predominantly biomass-burning aerosols, and the ω (≈0.95) of near-surface aerosols was greater than that of the upper layer aerosols because of the presence of mixed type aerosols. The presence of upper level aerosol transport could enhance the radiative efficiency at the surface (i.e., cooling) and lower atmosphere (i.e., heating) by up to -13.7 and +9.6Wm-2 per AOD, respectively. Such enhancement could potentiallymodify atmospheric stability, can influence atmospheric circulation, as well as the hydrological cycle over the tropical and low-latitude marginal northern SCS.

Objectives: To investigate whether the addition of nitroglycerine to transcatheter arterial (chemo)embolization (TAE/TACE) can increase the delivery and effectiveness of TAE/TACE in patients with hepatocellular carcinoma (HCC) by dual-energy CT.Methods: HCC patients (BCLC stage A or B) were randomized to (n = 51) or not to (n = 50) receive nitroglycerine and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Dual-energy CT was performed pre- and 1 to 3 months post-embolization to assess changes in tumour diameter and Lipiodol levels in tumours.Results: Median tumour diameter decreased from baseline in both groups with and without nitroglycerine (7.11 % vs. 12.5 %, respectively), and was statistically significant in the group receiving nitroglycerine (P = 0.023). There was no difference between the two groups in disease response (P = 0.237). The concentration and percentage of Lipiodol retained in tumours were significantly greater in patients treated with nitroglycerine compared to those without (median concentration 15.05 mg/mL vs. 4.40 mg/mL, respectively, P < 0.001; median percentage 82.01 % vs. 36.75 %, respectively, P < 0.001).Conclusions: Nitroglycerine increased delivery of the Lipiodol emulsion via TAE/TACE to HCC tumours with significant tumour reduction. Dual-energy CT can accurately quantify the amount of Lipiodol deposited in tumours.Key Points: • Nitroglycerine improves delivery of tumour-targeted therapy via enhanced permeability and retention. • In hepatocellular carcinoma, nitroglycerine added to TAE/TACE showed greater tumour reduction. • Dual-energy CT can reliably quantify the amount of Lipiodol in TAE/TACE. [ABSTRACT FROM AUTHOR]

Length mismatch between aspiration catheters and microcatheters can hinder optimal thrombus engagement, particularly in tortuous vessels and cases of vascular stenosis. We present a case in which a side puncture technique was used to deploy the stent retriever when exchangeable devices were unavailable. A man in his seventies with basilar artery occlusion underwent mechanical thrombectomy. The aspiration catheter failed to advance because of the tortuosity of the vertebral artery, preventing the microcatheter from delivering the stent retriever distal to the thrombus. By puncturing the aspiration catheter, additional microcatheter length was obtained, allowing the stent to be deployed at the targeted site. Thrombus extraction was then successfully performed using the Solumbra technique. This approach is advantageous for its simplicity and eliminates the need for additional devices. However, it also has specific drawbacks, such as damaging the aspiration catheters., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The coronavirus disease (COVID-19) pandemic broke out in March 2020, causing tremendous damage to public health and more than 6 million deaths. After authorization for the emergency use of COVID-19 vaccines, various adverse events have been reported, including optic neuritis. COVID-19 vaccination was implemented in Taiwan in March 2021., Methods: We report patients who developed optic neuritis after COVID-19 vaccination at one university-affiliated tertiary hospital, between March 2021 and December 2022. We also provided a literature review of optic neuritis cases after COVID-19 vaccination., Results: Five patients who developed optic neuritis after COVID-19 vaccination have been identified. Four brands of vaccine used were as follows: Moderna, Pfizer-BioNTech, Medigen, and Oxford AstraZeneca. Optic neuritis developed after the first dose of vaccination in 4 patients, whereas in 1 patient, it developed after the second shot. In the 3 patients with poor initial visual acuity, intravenous methylprednisolone pulse therapy achieved substantial improvement., Conclusions: Optic neuritis is a rare but potentially vision-threatening adverse effect of COVID-19 vaccination. We suggest early diagnosis and treatment to maximize visual outcomes., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by North American Neuro-Ophthalmology Society.)

Background and Objectives : Left ventricular hypertrophy (LVH) represents a significant cardiovascular risk in patients undergoing chronic hemodialysis (CHD). A large inferior vena cava diameter (IVCD), potentially indicative of fluid overload and a contributing factor to elevated cardiovascular risk, has not been sufficiently explored. Therefore, our study aims to gain further insights into this aspect. Materials and Methods : A retrospective cohort study enrolled patients receiving CHD in a single medical center with available echocardiography from October to December 2018. They were categorized into four groups based on LVH geometry and IVCD. Cox proportional hazard models assessed the risk of major adverse cardiovascular effects (MACEs) and cardiovascular and overall mortality after multivariate adjustments. Kaplan-Meier analysis depicted MACE-free events and survival during the follow-up time. Results : Of the 175 CHD patients, 38, 42, 45, and 50 exhibited small IVCD with eccentric and concentric LVH and large IVCD with eccentric and concentric LVH, respectively. Compared to small IVCD and eccentric LVH, large IVCD and eccentric LVH had the highest risk of MACEs, followed by large IVCD and concentric LVH (aHR: 4.40, 3.60; 95% CI: 1.58-12.23, 1.28-10.12, respectively). As for cardiovascular mortality, large IVCD and concentric LVH had the highest risk, followed by large IVCD and eccentric LVH, and small IVCD and concentric LVH. (aHR: 14.34, 10.23, 8.87; 95% CI: 1.99-103.35, 1.41-74.33; 1.01-77.87). The trend in overall mortality risk among the groups was similar to that of cardiovascular mortality. Conclusions : LVH geometry and IVCD co-modify the risk of MACEs and cardiovascular and overall mortality in CHD patients. The highest risk of MACEs is associated with large IVCD and eccentric LVH, while the highest risk of cardiovascular and overall mortality is linked with large IVCD and concentric LVH.

East Asian continental outflows with PM 2.5 , O 3 , and other species may determine the baseline conditions and affect the air quality in downwind areas via long-range transport (LRT). To gain insight into the impact and spatiotemporal characteristics of airborne pollutants in East Asian continental outflows, a versatile multicopter drone sounding platform was used to simultaneously observe PM 2.5 , O 3 , CO 2 , and meteorological variables (temperature, specific humidity, pressure, and wind vector) above the northern tip of Taiwan, Cape Fuiguei, which often encounters continental outflows during winter monsoon periods. By coordinating hourly high-spatial-resolution profiles provided by drone soundings, WRF/CMAQ model air quality predictions, HYSPLIT-simulated backward trajectories, and MERRA-2 reanalysis data, we analyzed two prominent phenomena of airborne pollutants in continental outflows to better understand their physical/chemical characteristics. First, we found that pollutants were well mixed within a sounding height of 500 m when continental outflows passed through and completely enveloped Cape Fuiguei. Eddies induced by significant fluctuations in wind speeds coupled with minimal temperature inversion and LRT facilitated vertical mixing, possibly resulting in high homogeneity of pollutants within the outflow layer. Second, the drone soundings indicated exceptionally high O 3 concentrations (70-100 ppbv) but relatively low concentrations of PM 2.5 (10-20 μg/m 3 ), CO 2 (420-425 ppmv), and VOCs in some air masses. The low levels of PM 2.5 , CO 2 , and VOCs ruled out photochemistry as the cause of the formation of high-level O 3 . Further coordination of spatiotemporal data with air mass trajectories and O 3 cross sections provided by MERRA-2 suggested that the high O 3 concentrations could be attributed to stratospheric intrusion and advection via continental outflows. High-level O 3 concentrations persisted in the lower troposphere, even reaching the surface, suggesting that stratospheric intrusion O 3 may be involved in the rising trend in O 3 concentrations in parts of East Asia in recent years in addition to surface photochemical factors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) has gained much attention in recent years. However, unintended embolization may occur when employing liquid embolic agents or particles. We present our clinical experience in simple coiling of MMAE to manage CSDH., Methods: Patients underwent either surgical evacuation or MMAE with simple coiling for CSDH were reviewed. Clinical and radiographic outcomes were assessed at admission, 1-month, and 6-month intervals. Two treatment groups were matched with inverse probability of treatment weighting., Results: One hundred twelve patients were included, with 27 patients in MMAE group and 87 patients in surgery group. In MMAE group, significant reductions were observed in hematoma width (admission vs. 1-month, 2.04 [1.44-2.60] cm vs. 0.62 [0.37-0.95] cm, p  < 0.001). The adjusted odds ratio (aOR) of surgical rescue rate (0.77 95%CI 0.13-4.47, p  = 0.77), hematoma reduction (>50%) (0.21 95%CI 0.04-1.07, p  = 0.06), and midline shift improvement rate (3.22, 95%CI 0.84-12.4, p  = 0.09) had no substantial disparities between two groups at 1-month follow-up. In addition, no significant difference was noted between two groups in terms of hematoma reduction (>50%) at 6-month follow-up (aOR 1.09 95%CI 0.32-3.70, p  = 0.89). No procedure-related complications were found in MMA embolization group., Conclusion: Simple coiling for MMA had comparable outcomes with surgical evacuation for CSDH. Our findings suggest that simple coiling can be an alternative choice for liquid agents or particles in MMA embolization for CSDH with acceptable safety., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Contrast-induced nephropathy has become increasingly prevalent as the age and prevalence of comorbidities in the general population have increased. Most cases of contrast-induced nephropathy are reversible; however, some may progress to acute kidney disease, and subsequently, to chronic kidney disease. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are known for their renoprotective effects. However, whether the use of these inhibitors affects the risk of contrast-induced kidney injury remains unclear., Methods: Data were collected from the Taipei Medical University Clinical Research Database. We included patients with diabetes who had contrast exposure between 2016 and 2020 because of computed tomography or coronary angiography. The primary outcome was the risk of a major adverse kidney event (MAKE), which encompassed acute kidney disease, chronic kidney disease progression, and the need for renal replacement therapy. Overlap weighting was performed to reduce the effects of potential confounders., Results: This study included 12 421 patients, who were divided into two groups: SGLT2i users (n = 920) and nonusers (n = 11 501). The follow-up period after contrast exposure was 6 months. The risk of a MAKE was lower in SGLT2i users than in nonusers (incidence, 36.9 vs. 49.9 per 1000 person-months, respectively; P = .0011). Furthermore, the incidence of acute kidney disease or chronic kidney disease progression was significantly lower in the SGLT2i users than in nonusers. However, no significant between-group difference was noted in the incidence of other MAKEs., Conclusions: SGLT2i may be safely used in diabetic patients needing contrast exposure. The risk of a MAKE may be lower in SGLT2i users than in nonusers., (© The Author(s) 2023. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Paxlovid is an oral drug composed of nirmatrelvir and ritonavir that has been demonstrated to be effective in decreasing the risk of severe coronavirus disease 2019 (COVID-19). Here, we report the use of paxlovid in pregnant women with COVID-19., Methods: Pregnant women attending a tertiary referral hospital in Taiwan from 29 April to 30 July 2022 were enrolled in the study. We compared baseline characteristics, clinical manifestations, and adverse events between paxlovid-treated women and those without paxlovid use. Maternal and neonatal outcomes were analysed in women who delivered during the study period., Results: A total of 30 paxlovid-treated pregnant women and 55 women without paxlovid use were included in the analysis. The mean duration of COVID-19-associated symptoms in the paxlovid-treated women was shorter than that in the control group (10.10 days versus 15.59 days, p = 0.04). No severe adverse events due to paxlovid use were observed. Dysgeusia and diarrhoea were the most common adverse effects. Thirteen paxlovid-treated and 28 untreated women delivered during the study period. More pregnant women in the paxlovid group who delivered during the study period underwent caesarean delivery compared to the group without antiviral treatment (10 of 13 [76.92%] versus 12 of 28 [42.86%], p = 0.042), and insignificantly more newborns were born small for gestational age in the paxlovid group compared to the control group (3 of 13 [23.08%] versus 1 of 28 [3.57%], p = 0.086)., Conclusion: Our study showed that paxlovid was effective and safe for pregnant women during the Omicron wave of the COVID-19 pandemic. A higher proportion of caesarean delivery rates was observed among paxlovid-treated women. Long-term follow-up of pregnant women exposed to paxlovid and their offspring is needed., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: The COVID-19 pandemic has had an enormous impact on society and the medical environment in Taiwan in 2022. As pregnant women with COVID-19 are at higher risk for multiple complications, Taiwan needs a COVID-19 specialized maternity unit to improve the quality of maternal and neonatal care., Materials and Methods: We share our experience with specialized maternity unit for pregnant women with COVID-19 at the National Cheng Kung University Hospital, where we can have careful evaluation, safe birth, and comprehensive postpartum care., Results: Our COVID-19 specialized maternity unit enrolled 253 pregnant women with COVID-19, 90 (35.6%) pregnant women were admitted to the specialized maternity unit, and 71 (28.1%) pregnant women gave birth during hospitalization in two months. All pregnant women recovery well and real-time polymerase chain reaction tests on all infants were negative for COVID-19., Conclusion: A specialized maternity unit can provide pregnant women with a safe birth environment, immediate maternity care, and high medical quality. It can also help health workers in non-specialized maternity units deal with COVID-19-related psychological stress. Therefore, setting up one specialized maternity unit in the city during the pandemic should be guardedly considered., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2023. Published by Elsevier B.V.)

Executive functions (EF) were the critical neuropsychological functions linked to long-term adaptation. Given the heterogeneous prognosis trajectories of mild traumatic brain jury (mTBI), the mildest TBI may not always be benign in the chronic stage. The present study explored the long-term EF in patients with chronic complicated mTBI and a Glasgow Coma Scale (GCS) score of 15. Fifty patients with complicated mTBI and GCS scores of 15 and 35 control participants were recruited in this study. Medical records were retrospectively analyzed, and neuropsychological assessments and subjective measures examined the neuropsychological functions. Compared with healthy controls, complicated mTBI patients with a GCS score of 15 performed significantly worse on most EF assessments, including longer reaction time (RT) and poor cognitive flexibility and abstract reasoning performances. Patients also reported more EF problems and lower quality of life (QoL) than healthy controls. Females and those with subdural hematoma (SDH) had significantly longer reaction times (RT) on executive attention tests. This study found that complicated mTBI with a GCS score of 15 had incomplete recovery of EF, even in the chronic stage. We suggest that early neuropsychological assessment and rehabilitation should be arranged for such patients.

The immense impacts of coal-fired power plant plumes on the atmospheric environment have caused great concern linked to climate and health issues. However, studies on the field observations of aerial plumes are relatively limited, mainly due to the lack of suitable plume observation tools and techniques. In this study, we use a multicopter unmanned aerial vehicle (UAV) sounding technique to study the influences of the aerial plumes of the world's fourth-largest coal-fired power plant on the atmospheric physical/chemical conditions and air quality. A set of species, including 106 volatile organic compounds (VOCs), CO, CO 2 , CH 4 , PM 2.5 , and O 3 , and meteorological variables of temperature (T), specific humidity (SH), and wind data, are collected by the UAV sounding technique. The results reveal that the large-scale plumes of the coal-fired power plant cause local temperature inversion and humidity changes, and even affect the dispersion of pollutants below. The chemical compositions of coal-fired power plant plumes are significantly different from those of another ubiquitous vehicular source. High fractions of ethane, ethene, and benzene and low fractions of n-butane and isopentane found in plumes could serve as the key features to help distinguish the influences of coal-fired power plant plumes from other pollution sources in a particular area. By taking the ratios of pollutants (e.g., PM 2.5 , CO, CH 4 , and VOCs) to CO 2 in plumes and the CO 2 emission amounts of the power plant into calculation, we enable the easy quantification of the specific pollutant emissions released from power plant plumes to the atmosphere. In summary, observation by using drone soundings dissecting the aerial plumes provides a new methodology that allows aerial plumes to be readily detected and characterized. Furthermore, the influences of the plumes on the atmospheric physical/chemical conditions and air quality can be assessed rather straightforwardly, which was not easily achievable in the past., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Postoperative nerve palsy is a major complication following resection of neck peripheral nerve sheath tumours (PNSTs). Accurate preoperative identification of the nerve origin (NO) can improve surgical outcomes and patient counselling., Material and Methods: This study was a retrospective cohort and quantitative analysis of the literature. The authors introduced a parameter, the carotid-jugular angle (CJA), to differentiate the NO. A literature review of neck PNST cases from 2010 to 2022 was conducted. The CJA was measured from eligible imaging data, and quantitative analysis was performed to evaluate the ability of the CJA to predict the NO. External validation was performed using a single-centre cohort from 2008 to 2021., Results: In total, 17 patients from our single-centre cohort and 88 patients from the literature were analyzed. Among them, 53, 45, and 7 patients had sympathetic, vagus, and cervical nerve PNSTs, respectively. Vagus nerve tumours had the largest CJA, followed by sympathetic tumours, whereas cervical nerve tumours had the smallest CJA ( P <0.001). Multivariate logistic regression identified a larger CJA as a predictor of vagus NO ( P <0.001), and receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.907 (0.831-0.951) for the CJA to predict vagus NO ( P <0.001). External validation showed an AUC of 0.928 (0.727-0.988) ( P <0.001). Compared with the AUC of the previously proposed qualitative method (AUC=0.764, 0.673-0.839), that of the CJA was greater ( P =0.011). The cut-off value identified to predict vagus NO was greater than or equal to 100°. Receiver operating characteristic analysis showed an AUC of 0.909 (0.837-0.956) for the CJA to predict cervical NO ( P <0.001), with a cut-off value less than 38.5°., Conclusions: A CJA greater than or equal to 100° predicted a vagus NO and a CJA less than 100° predicted a non-vagus NO. Moreover, a CJA less than 38.5 was associated with an increased likelihood of cervical NO., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Much attention has been found to the long-range transport (LRT) of air pollutants and their adverse effects on downwind air qualities resulting from the Chinese haze, which frequently occurs in association with winter monsoon. This study integrates ground-based measurements, unmanned aerial vehicles (UAVs), and model simulations to characterize the meteorological, chemical, and particulate matter (PM) properties comprehensively for the events that were LRT or local pollution (LP) dominated in northern Taiwan during the wintertime of 2017. During the two types of episodes, various approaches were made to investigate the vertical mixing conditions and PM properties with UAV flights. A confined and PM accumulated feature near ground level with a temperature inversion was found during the LP event. In contrast, a vertically homogeneous atmospheric structure with strong winds was suggested during the LRT event. Independent measurements of criteria air pollutants, meteorological variables, volatile organic compounds (VOCs), and micropulse lidar (MPL) made at the ground level were closely supported by the vertical measurements. When synchronizing all these observational and numerical tools in a three-dimensional manner, the characterization of air masses and possible origins of pollution, such as LP vs. LRT, has now become more versatile and capable of gaining a complete picture of atmospheric conditions that define air quality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose of the Study: The risk of bone fracture is high in patients with chronic kidney disease (CKD), and aggressive treatment to reduce fragility fracture risk is the major strategy. However, the outcomes of osteoporosis medications in patients with CKD remain unclear., Study Design: Patients with stage 3-5 CKD during 2011-2019 were enrolled. Patients were divided into two groups based on receiving osteoporosis medications (bisphosphonates, raloxifene, teriparatide or denosumab) or not. Two groups were matched at a 1:1 ratio by using propensity scores. The outcomes of interest were bone fractures, cardiovascular (CV) events and all-cause mortality. Cox proportional hazard regression models were applied to identify the risk factors. Additional stratified analyses by cumulative dose, treatment length and menopause condition were performed., Results and Conclusions: 67 650 patients were included. After propensity score matching, 1654 patients were included in the study and control group, respectively. The mean age was 70.2±12.4 years, and 32.0% of patients were men. After a mean follow-up of 3.9 years, the incidence rates of bone fracture, CV events and all-cause mortality were 2.0, 1.7 and 6.5 per 1000 person-months, respectively. Multivariate analysis results showed that osteoporosis medications reduced the risk of CV events (HR, 0.35; 95% CI, 0.18 to 0.71; p = 0.004), but did not alleviate the risks of bone fracture (HR, 1.48; 95% CI, 0.73 to 2.98; p = 0.28) and all-cause mortality (HR, 0.93; 95% CI, 0.67 to 1.28; p = 0.65). Stratified analysis showed that bisphosphonates users have most benefits in the reduction of CV events (HR, 0.26; 95% CI, 0.11 to 0.64; p = 0.003). In conclusion, osteoporosis medications did not reduce the risk of bone fractures, or mortality, but improved CV outcomes in patients with CKD., (© The Author(s) 2022. Published by Oxford University Press on behalf of Postgraduate Medical Journal. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purposes: This study aimed to evaluate the diagnostic capacity of apparent diffusion coefficient (ADC) in predicting pathological Masaoka and T stages in patients with thymic epithelial tumors (TETs)., Methods: Medical records of 62 patients who were diagnosed with TET and underwent diffusion-weighted imaging (DWI) prior to surgery between August 2017 and July 2021 were retrospectively analyzed. ADC values were calculated from DWI images using b values of 0, 400, and 800 s/mm 2 . Pathological stages were determined by histological examination of surgical specimens. Cut-off points of ADC values were calculated via receiver operating characteristic (ROC) analysis., Results: Patients had a mean age of 56.3 years. Mean ADC values were negatively correlated with pathological Masaoka and T stages. Higher values of the area under the ROC curve suggested that mean ADC values more accurately predicated pathological T stages than pathological Masaoka stages. The optimal cut-off points of mean ADC were 1.62, 1.31, and 1.48 × 10 -3 mm 2 /sec for distinguishing pathological T2-T4 from pathological T1, pathological T4 from pathological T1-T3, and pathological T3-T4 from pathological T2, respectively., Conclusion: ADC seems to more precisely predict pathological T stages, compared to pathological Masaoka stage. The cut-off values of ADC identified may be used to preoperatively predict pathological T stages of TETs., (© 2022. The Author(s).)

Background: Little is known about the association of inferior vena cava diameter (IVCD) and left ventricular end-systolic diameter (LVESD) with mortality in patients undergoing hemodialysis (HD). Methods: The single medical center observational cohort study enrolled 241 adult chronic HD patients from 1 October 2018 to 31 December 2018. Echocardiography results of IVCD and LVESD prior to dialysis were retrieved and patients were divided into high IVCD and low IVCD groups. Patients who received HD via a tunneled cuffed catheter were excluded. Study outcomes included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Subgroup analyses of HD patients with high and low LVESD were also performed. Results: The incidence of all-cause mortality, cardiovascular mortality, and MACE were higher in chronic HD patients with high IVCD (p < 0.01). High IVCD patients had significantly greater all-cause mortality, cardiovascular mortality, and MACE (log-rank test; p < 0.05). High IVCD patients are also associated with an increased risk of all-cause mortality and MACE relative to low IVCD patients (aHRs, 2.88 and 3.42; 95% CIs, 1.06−7.86 and 1.73−6.77, respectively; all p < 0.05). In the subgroup analysis of patients with high or low LVESD, the high IVCD remained a significant risk factor for all-cause mortality and MACE, and the HR is especially high in the high LVESD group. Conclusions: Dilated IVCD is a risk factor for all-cause mortality and MACE in chronic HD patients. In addition, these patients with high LVESD also have a significantly higher HR of all-cause mortality and MACE.

Since the 24-hr PM 2.5 (particle aerodynamic diameter less than 2.5 μm) concentration standard was regulated in Taiwan in 2012, the PM 2.5 concentration has been decreasing year by year, but the ozone (O 3 ) concentration remains almost the same. In particular, the daily maximum 8-hr average O 3 (MDA8 O 3 ) concentration frequently exceeds the standard. The goal of this study is to find a solution for reducing PM 2.5 and O 3 simultaneously by numerical modeling. After the Volatile Organic Compounds (VOC S )-limited and nitrogen oxides (NO X )-limited areas were defined in Taiwan, then, in total, 50 scenarios are simulated in this study. In terms of the average in Taiwan, the effect of VOC S emission reduction is better than that of NO X on the decrease in PM 2.5 concentration, when the same reduction proportion (20%, 40%) is implemented. While the effect of further NO X emission reduction (60%) will exceed that of VOC S . The decrease in PM 2.5 is proportional to the reduction in precursor emissions such as NO X , VOC S , sulfur dioxides (SO 2 ), and ammonia (NH 3 ). The lower reduction of NO X emission for whole Taiwan caused O 3 increases on average but higher reduction can ease the increase, which suggests the implement of NO X emission reductions must be cautious. When comparing administrative jurisdictions in terms of grids, districts/towns, and cities/counties, it was found that controlling NO X and VOC S at a finer spatial resolution of control units did not benefit the decrease in PM 2.5 but did benefit the decrease in O 3 . The enhanced O 3 control strategies obviously cause a higher decrease of O 3 throughout Taiwan due to NO X and VOC S emission changes when they are implemented in the right places. Finally, three sets of short-term and long-term goals of controlling PM 2.5 and O 3 simultaneously are drawn from the comprehensive rankings for all simulated scenarios, depending on whether PM 2.5 or O 3 control is more urgent. In principle, the short-term scenarios could be ordinary or enhanced version of O 3 decrease with lower NO X /VOC S emissions, while the long-term scenario is enhanced version of O 3 decrease plus high emission reductions for all precursors., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

East Asian dust episodes have a multitude of impacts, including on human health, environment, and climate over near-source and receptor regions. However, the mechanistic understanding of the synoptic conditions of these outbreaks at different altitude layers, and their eventual environmental impacts are less studied. The present study analyzed the synoptic transport patterns of East Asian dust during multiple dust generation episodes that occurred over only a few days apart in northern China, and which eventually delivered high PM 10 concentrations to surface level and high-altitude locations in Taiwan. Whether the dust plume was uplifted ahead of or behind the 700 hPa trough over East Asia determined its trajectory and eventual impact on the environment downwind. The total dust (iron) deposition over the ocean surface preceding arrival to Taiwan was 2.4 mg m -2 (0.95 μg m -2 ) for the episode impacting the surface level and 5.0 mg m -2 (4.6 μg m -2 ) for the episode impacting high-altitude Taiwan. Dust deposition in marine areas east of China was more intense for the higher altitude transport event that was uplifted behind the 700 hPa trough and resulted in twice higher marine Chl-a concentrations. Furthermore, we estimated a dust-induced direct radiative effect over a high mountainous region in Taiwan of -6.2 to -8.2 W m -2 at the surface, -1.9 to -2.9 W m -2 at the top of the atmosphere and +3.9 to +5.3 W m -2 in the atmosphere. This dust-induced atmospheric warming and surface cooling are non-negligible influences on the atmospheric thermal structure and biogeochemical cycle over the western North Pacific. Overall, this study highlights the significant impacts of dust particles on the marine ecosystem and atmospheric radiation budget over the downwind region, thus lays the foundation for linking these impacts to the initial synoptic conditions in the source area., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

East Asian continental outflows containing with pollutants may deteriorate air quality in the downwind region via long-range transport (LRT). In particular, cold fronts with high wind speeds generally promote the LRT of air pollutants to further downwind areas, including Taiwan. To gain an insightful understanding of the characteristics and vertical homogeneity of trace gases in East Asian continental outflows, as well as their relation with atmospheric meteorological conditions, whole air samples were collected above a cape at the northern tip of the island of Taiwan during frontal passages. Aerial samples were collected at multiple altitudes from the surface to a maximum height of 700 m with a multicopter sounding platform carrying a robotic whole air sampling device. Simultaneously, aerial meteorological variables of temperature and wind vector from near the surface to a maximum height of 1000 m were also measured during the whole air sampling periods. An array of 106 volatile organic compounds (VOCs) as well as CO, CO 2 , and CH 4 were analyzed to characterize the air composition and vertical homogeneity of trace gases. The results revealed rather homogeneous vertical distributions of most VOCs, CO, CO 2 , and CH 4 in the frontal passages, indicating well-mixed conditions of trace gases in the East Asian continental outflows. The strong wind shear and minimal temperature inversion associated with the frontal passage likely induced turbulence and increased vertical mixing. Furthermore, higher levels of species characteristic of the East Asian continent were observed from the surface up to hundreds of meters above the cape, revealing a strong inflow of polluted air masses from the East Asian continent brought by cold frontal passages., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study aims to explore the effects of noise and music types on nurses' anxiety, mental workload and situation awareness during an operation. Participants included 20 circulating nurses (CNs) and 16 nurse anesthetists (NAs) who completed a total of 70 operations in which each operation required one CN and one NA. The experiment was separated into a control group (operating noise only) vs. an experimental group (3 different music types-between subjects and 2 music volume levels-within-subjects). Results showed that all participants had excellent situation awareness performance despite their mental workload showing significant differences in various phases of the surgery. Music at 55-60 dB caused lower mental workloads and anxiousness for nurses than those exposed to levels of 75-80 dB. When Mozart's music was played, the participants' mental workload and situation anxiety were lower than when exposed to other music types. Music played at 60 dB during an operation may be a feasible solution to mitigate the negative effects of extra noise and thus improve the nurses' performance., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose of the Study: The risk of bone fracture is high in patients with chronic kidney disease (CKD), and aggressive treatment to reduce fragility fracture risk is the major strategy. However, the outcomes of osteoporosis medications in patients with CKD remain unclear., Study Design: Patients with stage 3-5 CKD during 2011-2019 were enrolled. Patients were divided into two groups based on receiving osteoporosis medications (bisphosphonates, raloxifene, teriparatide or denosumab) or not. Two groups were matched at a 1:1 ratio by using propensity scores. The outcomes of interest were bone fractures, cardiovascular (CV) events and all-cause mortality. Cox proportional hazard regression models were applied to identify the risk factors. Additional stratified analyses by cumulative dose, treatment length and menopause condition were performed., Results and Conclusions: 67 650 patients were included. After propensity score matching, 1654 patients were included in the study and control group, respectively. The mean age was 70.2±12.4 years, and 32.0% of patients were men. After a mean follow-up of 3.9 years, the incidence rates of bone fracture, CV events and all-cause mortality were 2.0, 1.7 and 6.5 per 1000 person-months, respectively. Multivariate analysis results showed that osteoporosis medications reduced the risk of CV events (HR, 0.35; 95% CI, 0.18 to 0.71; p = 0.004), but did not alleviate the risks of bone fracture (HR, 1.48; 95% CI, 0.73 to 2.98; p = 0.28) and all-cause mortality (HR, 0.93; 95% CI, 0.67 to 1.28; p = 0.65). Stratified analysis showed that bisphosphonates users have most benefits in the reduction of CV events (HR, 0.26; 95% CI, 0.11 to 0.64; p = 0.003). In conclusion, osteoporosis medications did not reduce the risk of bone fractures, or mortality, but improved CV outcomes in patients with CKD., (© The Author(s) 2022. Published by Oxford University Press on behalf of Postgraduate Medical Journal. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Bowel perforation during pregnancy is a rare but life-threatening situation, and the management remained uncertain. We presented a case in our hospital and reviewed literatures to provide a guidance to deal with this challenging situation., Case Report: A case at gestational age 26 weeks and 4 days, who had bowel perforation over previous ileo-colonic anastomosis site. The fetus was delivered via cesarean section after 1 week of operation and both were discharged without major complication at 35 days after delivery. We searched Pubmed and reviewed 15 English literatures and make a discussion., Conclusion: A simultaneous cesarean section could be considered if the gestational age was large enough to avoid the comorbidity of preterm birth or the maternal risk of sepsis outweigh the risk of preterm birth. Otherwise, tocolysis should be used in an attempt to delay delivery until the antenatal corticosteroids have worked., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2021. Published by Elsevier B.V.)

Background: Dual antiplatelet therapy (DAPT) is currently the standard treatment for the prevention of ischemic events after stent implantation. However, the optimal DAPT duration remains elusive for patients with chronic kidney disease (CKD). Therefore, we aimed to compare the effectiveness and safety between long-term and short-term DAPT after coronary stenting in patients with CKD., Methods: This retrospective cohort study analyze data from the Taipei Medical University (TMU) Institutional and Clinical Database, which include anonymized electronic health data of 3 million patients that visited TMU Hospital, Wan Fang Hospital, and Shuang Ho Hospital. We enrolled patients with CKD after coronary stenting between 2008 and 2019. The patients were divided into the long-term (>6 months) and short-term DAPT group (≤ 6 months). The primary end point was major adverse cardiovascular events (MACE) from 6 months after the index date. The secondary outcomes were all-cause mortality and Thrombolysis in Myocardial Infarction (TIMI) bleeding., Results: A total of 1899 patients were enrolled; of them, 1112 and 787 were assigned to the long-term and short-term DAPT groups, respectively. Long-term DAPT was associated with similar risk of MACE (HR: 1.05, 95% CI: 0.65-1.70, P = 0.83) compare with short-term DAPT. Different CKD risk did not modify the risk of MACE. There was also no significant difference in all-cause mortality (HR: 1.10, 95% CI: 0.75-1.61, P = 0.63) and TIMI bleeding (HR 1.19, 95% CI: 0.86-1.63, P = 0.30) between groups., Conclusions: Among patients with CKD and coronary stenting, we found that long-term and short-term DAPT tied on the risk of MACE, all-cause mortality and TIMI bleeding., Competing Interests: The authors have declared that no competing interests exist.

Background: Recent advance in tissue characterization with parametric mapping imaging has the potential to be a novel biomarker for histopathologic correlation with thymic epithelial tumors (TETs). The purpose of our study is to evaluate MRI T1 mapping with the calculation of extracellular volume (ECV) fraction for histologic correlation with thymic epithelial tumor based on lymphocyte abundance., Methods: A retrospective study including 31 consecutive patients (14 men and 17 women, median age, 56 years; interquartile range, 12 years) with TETs was performed. The T1 values and ECV were assessed by using quantitative MRI mapping techniques. Mann-Whitney U test, Kruskal-Wallis H test, and receiver operating characteristic curve analyses were used to assess discrimination between different types of TETs based on lymphocyte abundance., Results: Extracellular volume was significantly higher in TETs with sparse lymphocyte, including type A, type B3, and thymic carcinoma, compared with those with abundant lymphocyte, including type B1, B2, and AB thymomas (42.5% vs 26.9%, respectively; p < 0.001). Extracellular volume was significantly higher in thymic carcinoma compared with low grade and high grade thymomas (48.6% vs 31.1% vs 27.6%, respectively; p = 0.002)., Conclusions: T1 mapping with the calculation of extracellular volume (ECV) fraction correlate with the WHO histologic classification of thymic epithelial tumor based on lymphocyte abundance.

This study examined the long-term trends in chemical components in PM 2.5 (particulate matter with aerodynamic diameter ≤2.5 μm) samples collected at Lulin Atmospheric Background Station (LABS) located on the summit of Mt. Lulin (2862 m above mean sea level) in Taiwan in the western North Pacific during 2003-2018. High ambient concentrations of PM 2.5 and its chemical components were observed during March and April every year. This enhancement was primarily associated with the long-range transport of biomass burning (BB) smoke emissions from Indochina, as revealed from cluster analysis of backward air mass trajectories. The decreasing trends in ambient concentrations of organic carbon (-0.67% yr -1 ; p = 0.01), elemental carbon (-0.48% yr -1 ; p = 0.18), and non-sea-salt (nss) K + (-0.71% yr -1 ; p = 0.04) during 2003-2018 indicated a declining effect of transported BB aerosol over the western North Pacific. These findings were supported by the decreasing trend in levoglucosan (-0.26% yr -1 ; p = 0.20) during the period affected by the long-range transport of BB aerosol. However, NO 3 - displayed an increasing trend (0.71% yr -1 ; p = 0.003) with considerable enhancement resulting from the air masses transported from the Asian continent. Given that the decreasing trends were for the majority of the chemical components, the columnar aerosol optical depth (AOD) also demonstrated a decreasing trend (-1.04% yr -1 ; p = 0.0001) during 2006-2018. Overall decreasing trends in ambient (carbonaceous aerosol and nss-K + ) as well as columnar (e.g., AOD) aerosol loadings at the LABS may influence the regional climate, which warrants further investigations. This study provides an improved understanding of the long-term trends in PM 2.5 chemical components over the western North Pacific, and the results would be highly useful in model simulations for evaluating the effects of BB transport on an area., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interests regarding financial funding and the content of this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Transarterial chemoembolization (TACE) delivers cytotoxic drugs intra-arterially and induces ischemic necrosis by arterial embolization. Embolization is achieved using a variety of agents that differ widely in particle size and range, deformation, and in vivo arterial distribution. The clinical significance of these differences has not been thoroughly characterized. The present study is to compare the efficacy of Embosphere and Embozene microspheres in TACE therapy for hepatocellular carcinoma., Materials and Methods: This retrospective study includes 108 hepatocellular carcinoma (HCC) patients who received TACE/doxorubicin with Embozene (70 patients) or Embosphere (38 patients) at a single medical center. Patient outcomes, including liver function, tumor size, tumor response, and complications after treatment, were analyzed. The change in total target lesion size and tumor response was evaluated according to embolization agent and clinical characteristics., Results: The postoperative glutamate oxaloacetate transaminase (mean, 194.5 vs. 147.5; p=0.032) and bilirubin (mean, 1.11 mg/dL vs. 0.73 mg/dL; p=0.016) were higher among patients treated with Embozene, the decrease in the number (55.86±25.55% vs. 41.81±38.51%, p=0.027) and size (56.37±25.91 mm vs. 43.44±37.89 mm, p=0.001) of liver tumors relative to baseline was greater in these patients than in those treated with Embosphere. These greater antitumor effects were achieved using lower doses of doxorubicin than for treatment with Embozene. Minor complications were more common among patients treated with Embosphere than with Embozene., Conclusion: These results suggest that Embozene is more efficacious than Embosphere for HCC treatment using TACE/doxorubicin.

Background: Weight-reduction therapies, including bariatric surgery (BS), are standard treatments for severely obese patients with type 2 diabetes; however, the outcomes of these therapies are inconclusive for obese patients with chronic kidney disease (CKD). This study aimed to investigate the effects of BS or non-surgical interventions on the estimated glomerular filtration rate (eGFR) and to determine whether BS can be recommended for renal function preservation based on body mass index (BMI) and eGFR changes in obese patients with CKD., Methods: This study used data from the weight Reduction Intervention on GFR in Obese Patients with Renal Impairment-Taipei Medical University (TMU) study, which was a large, long-term, propensity score-matched cohort study based on clinical data from patients who registered at weight-reduction centres at TMU and its affiliated hospitals from 2008 to 2016. The patients were stratified according to whether they had undergone BS and into the mild, moderate, and high CKD risk groups using the Kidney Disease: Improving Global Outcomes guidelines. The primary outcome was the eGFR calculated using the Taiwan Chronic Kidney Disease-Epidemiology Collaboration equation. Cox regression models were used to determine hazard ratios (HRs) for eGFR decreases ≥25%., Results: A total of 4332 obese patients were enrolled in this study. After propensity score matching, 1620 patients, including 60.2% women, with a mean age of 36.5 (9.9) years were divided into BS or non-surgery groups (n = 810 per group). The overall mean eGFRs increased by 4.4 (14) mL/min·1.73 m 2 and decreased by 6.4 (16.0) mL/min·1.73 m 2 in the BS and non-surgery groups, respectively. The decrease in BMI in the BS and non-surgery groups were 2.5 and 1.3 kg/m 2 , respectively. In the moderate/high CKD risk BS group, a significant correlation was evident between an increased eGFR and a reduced BMI (Spearman's correlation -0.229, P < 0.001). The Cox regression analysis showed that the BS group had a significantly lower risk of an eGFR decline ≥25% at 12 months [adjusted HR (aHR) 0.47, P = 0.03). After BS, obese patients with hypertension or albuminuria had significantly lower risks of eGFR declines ≥25% (aHR 0.37, P = 0.02 and aHR 0.13, P = 0.0018, respectively)., Conclusions: Bariatric surgery was associated with eGFR preservation in all obese patients and, particularly, in those with moderate-to-high CKD risks. A longer term outcome study is warranted to determine the benefits of BS for CKD patients., (© 2019 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.)

Aims: To identify the optimal transarterial chemoembolisation (TACE) approach in patients with large hepatocellular carcinoma (HCC; >5 cm) by comparing conventional TACE (cTACE) and drug-eluting-bead (DEB)-TACE., Materials and Methods: This retrospective study included 63 consecutive HCC patients who received TACE at a single medical centre from September 2009 to October 2015. Primary endpoints were 3-year overall survival (OS) rate and time-to-progression (TTP). Hazard ratios (HRs) from Kaplan-Meier curves were calculated to compare survival estimates., Results: The median OS was shorter in the cTACE group, but was not significantly different from the DEB-TACE group (33.9 versus 35.6 months, respectively; p=0.52). The mean TTP was shorter in the cTACE group than in the DEB-TACE group (13.9 versus 17.5 months, respectively; p=0.01). There was no difference in 3-year survival (HR=0.95, 95% confidence interval [CI]: 0.51-1.78; p=0.880) and TTP (HR=0.70, 95% CI: 0.42-1.16; p=0.147) between the groups; however, patients treated with DEB-TACE were more likely to have longer TTP in the first 2 years following treatment (HR=0.51, 95% CI: 0.29-0.88; p=0.009)., Conclusion: Although DEB-TACE is not superior in terms of TTP or OS in patients with large HCC, it may have greater efficacy in the first 24 months following therapy., (Copyright © 2019 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

The impact of diabetes on perioperative outcomes remains incompletely understood. Our purpose is to evaluate post-operative complications and mortality in patients with diabetes. Using the institutional and clinical databases of three university hospitals from 2009⁻2015, we conducted a matched study of 16,539 diabetes patients, aged >20 years, who underwent major surgery. Using a propensity score matching procedure, 16,539 surgical patients without diabetes who underwent surgery were also selected. Logistic regressions were used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for post-operative complications and in-hospital mortality associated with diabetes. Patients with diabetes had a higher risk of postoperative septicemia (OR 1.33, 95% CI 1.01⁻1.74), necrotizing fasciitis (OR 3.98, 95% CI 1.12⁻14.2), cellulitis (OR 2.10, 95% CI 1.46⁻3.03), acute pyelonephritis (OR 1.86, 95% CI 1.01⁻3.41), infectious arthritis (OR 3.89, 95% CI 1.19⁻12.7), and in-hospital mortality (OR 1.51, 95% CI 1.07⁻2.13) compared to people without diabetes. Previous admission for diabetes (OR 2.33, 95% CI 1.85⁻2.93), HbA1c >8% (OR 1.96, 95% CI 1.64⁻2.33) and fasting glucose >180 mg/dL (OR 1.90, 95% CI 1.68⁻2.16) were predictors for post-operative adverse events. Diabetes patients who underwent surgery had higher risks of infectious complications and in-hospital mortality compared with patients without diabetes who underwent similar major surgeries.

From autumn to the following spring, annually, the northeast monsoon transports PM 2.5 (particles less than 2.5 μm in aerodynamic diameter) from the Asian continent to downstream areas. Naturally, this triggered a question: What are the contributions of PM 2.5 from long-range transport (LRT) and local pollution (LP) at any downstream location? To answer that question, the present study developed an economical and efficient method that can easily estimate the contribution of PM 2.5 from LRT (LRT-PM 2.5 ) and PM 2.5 from LP (LP-PM 2.5 ). The method used PM 2.5 and meteorological observation data in Taiwan from 2006 to 2015 and a short-term simulation from January to May in 2010. The analysis classified the data into three types of PM 2.5 source patterns: LRT-Event (high concentration plume at the front edge of southward moving anticyclones/strong northeast wind), LRT-Ordinary (less concentration in common strong northeast wind), and LRT/LP Mix or Pure LP (PM 2.5 was from both LRT and LP or from only LP under weak northeast wind). During the ten-year period, the average LRT-PM 2.5 values at the northern tip of Taiwan were 31-39 μg m -3 , 12-16 μg m -3 , and 4-13 μg m -3 for the LRT-Event, LRT-Ordinary, and LRT/LP Mix or Pure LP patterns, respectively. The 10-year average LRT-PM 2.5 and LP-PM 2.5 contributions were approximately 70:30 in northern Taiwan, 50:50 in central Taiwan, and 30:70 in southern Taiwan for the LRT-Event pattern; 60:40 in northern and 40:60 in central and southern Taiwan for the LRT-Ordinary pattern; and 30:70 in northern and 25:75 in central and southern Taiwan for the LRT/LP Mix or Pure LP pattern. Interestingly, LRT-PM 2.5 peaked in 2013 but has decreased annually since then, whereas LP-PM 2.5 has roughly decreased in the past ten years., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Addition of nitroglycerine (NTG) to transcatheter arterial embolization/transarterial chemoembolization (TAE/TACE) has been shown to increase deposition of Lipiodol emulsion in hepatocellular carcinoma (HCC) tumors. The aim of this retrospective study was to evaluate if the addition of nitroglycerin (NTG) to TAE/TACE improved treatment response in HCC., Methods: Patients with HCC either received (n=42) or did not receive (non-NTG) (n=111) NTG and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Treatment response was monitored using dual-energy computer tomography (CT). Disease progression and overall survival (OS) were monitored., Results: The rate of disease progression in the NTG group was 86.5% and in the non-NTG group was 88.6%. Median time to disease progression was 12 months (95% CI; 9.0, 15.0) for the NTG group and 12 months (95% CI; 10.4, 13.6) for the non-NTG groups (P=0.040). No difference was observed in OS between the NTG (60 months) and the non-NTG groups (41 months) (P=0.117). Multivariate analysis found that in the NTG group, OS was associated with Cancer of the Liver Italian Program (CLIP) stage I and Barcelona Clinic Liver Cancer (BCLC) stage B., Conclusions: Addition of NTG to TAE/TACE did not result in improved OS or disease progression., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Currently, no standard of care or therapies have been established for patients with advanced HCC. We evaluated the efficacy and safety of conventional transarterial chemoembolization using gelatin sponges or microspheres plus lipiodol-doxorubicin (cTACE) and TACE with doxorubicin-loaded drug eluting beads (DEB-TACE)., Methods: This retrospective study included 273 patients who received cTACE (n = 201) or DEB-TACE. Tumor response, survival, and adverse events were evaluated over a 5-year follow-up period., Results: During 5-year follow-up, a greater percentage of patients treated with cTACE died than those treated with DEB-TACE (76.1% vs. 66.7%) (P = 0.045). At the last evaluation, all surviving patients had disease progression and no differences were seen between treatment groups. However, the time to disease progression differed between groups; median time to disease progression was 11.0 months for cTACE and 16.0 months for DEB-TACE (P = 0.019). The median survival time was 37 months in both treatment groups. No significant differences were observed between cTACE and DEB-TACE therapies in subgroups of patients with BCLC stage A or stage B + C either in survival time or time to disease progression (P values > 0.05). No significant differences were observed in survival status or disease progression between cTACE and DEB-TACE in patient subgroups with either tumor number > 5 or with the sum of the diameter of largest five HCC tumors being > 7 cm., Conclusions: DEB-TACE demonstrates greater long-term benefits than cTACE in treating treatment-naïve patients with HCC. Results of this long-term study support the use of DEB-TACE in treating HCC.

Purpose: To examine outcomes and complications of percutaneous transhepatic biliary drainage (PTBD) performed via the right or left lobe and different entry levels (lobar, segmental, subsegmental, sub-subsegmental)., Methods: The records of patients who underwent PTBD for obstructive jaundice from 2008 to 2015 were retrospectively reviewed. Logistic regression analysis was performed to determine factors associated with outcomes and complications based on entry side and entry level. PTBD success was defined as a total bilirubin decrease after catheter placement., Results: The data of 446 patients (mean age 68.4 years) were included. Multivariate logistic regression revealed a decrease of bilirubin level was associated with left lobe (vs. right) entry [adjusted odds ratio (aOR) = 2.657, 95% confidence interval (CI) 1.160, 6.087], external drainage (aOR = 2.908, 95% CI 1.226, 6.897), and liver volume undrained <50% (aOR = 2.623, 95% CI 1.045, 6.581). PTBD success was increased with left lobe entry (aOR = 1.853, 95% CI 1.167, 2.940) and associated with entry level (subsegmental vs. lobar, aOR = 2.992, 95% CI 1.258, 7.114; sub-subsegmental vs. lobar, aOR = 3.711, 95% CI 1.383, 9.956). Complications were significantly decreased with left lobe entry (aOR = 0.450, 95% CI 0.263, 0.769) and associated with entry level (segmental vs. lobar, aOR = 0.359, 95% CI 0.148, 0.873; subsegmental vs. lobar, aOR = 0.248, 95% CI 0.10, 0.615; sub-subsegmental vs. lobar, aOR = 0.129, 95% CI 0.041, 0.411)., Conclusions: The success and complications of PTBD vary with entry side and level.

Aims: The aim of this study was to investigate the association between early percutaneous coronary intervention (PCI) and pneumonia risk in patients with acute myocardial infarction (AMI) by using Taiwan's National Health Insurance Research Database (NHIRD)., Methods and Results: In total, 4,732 patients with non-ST-elevation myocardial infarction (NSTEMI) and 5,465 with ST-elevation myocardial infarction (STEMI) who had received PCI during AMI hospitalisation (early PCI) were evaluated. Patients who did not receive PCI during AMI hospitalisation (deferred PCI) were matched through propensity score matching. The incidence rates (per 100 person-months) of pneumonia hospitalisation, pneumonia-related respiratory failure, and pneumonia-related death associated with early PCI in patients with NSTEMI were 0.36 (95% confidence interval [CI]: 0.32-0.42), 0.12 (95% CI: 0.10-0.16), and 0.08 (95% CI: 0.06-0.11), respectively. In patients with STEMI, the incidence rates (per 100 person-months) of the aforementioned adverse events were 0.16 (95% CI: 0.13-0.20), 0.04 (95% CI: 0.03-0.06), and 0.02 (95% CI: 0.01-0.04), respectively. After adjustment for patients' clinical variables, early PCI was associated with reduced risks of pneumonia hospitalisation (adjusted hazard ratio [aHR] 0.54, 95% CI: 0.43-0.68, p<0.001), pneumonia-related respiratory failure (aHR 0.54, 95% CI: 0.35-0.84, p=0.006), and pneumonia-related death (aHR 0.29, 95% CI: 0.17-0.52, p<0.001) in patients with NSTEMI. In patients with STEMI, early PCI was beneficial for pneumonia hospitalisation (aHR 0.62, 95% CI: 0.45- 0.86, p=0.004)., Conclusions: Early PCI might reduce the risk of pneumonia hospitalisation in patients with AMI.

Background/aims: The purpose of this study is to report our results using a computed tomography (CT)-guided fat transversing coaxial biopsy technique for pancreatic lesion biopsy that avoids major organs and vessels. We retrospectively reviewed the records of patients referred to our department for pancreatic mass biopsy., Patients and Methods: The records of patients (from June 2008 to August 2014) in whom biopsy was performed under CT guidance with a coaxial needle using a fat transversing technique were reviewed. Patient demographic data and biopsy outcomes were collected. We aimed to compare differences between lesion size and biopsy outcome, the independent two-samples t-test was used., Results: A total of 122 patients who underwent 17-G coaxial needle biopsy were included. The mean pancreatic lesion size was 3.2 cm, and in 30 patients it was more than 4 cm. The majority of lesions were located in the head of the pancreas (44.3%). No transorgan biopsies were performed. In most patients, the biopsy was performed via a fat traversing detour route (93.4%), and a successful diagnosis was made based on the biopsy outcome in 96.7% patients. Complications occurred in five patients (4.1%); three of the patients developed a fever, and two developed pancreatitis. All patients recovered with symptomatic treatment., Conclusion: CT-guided coaxial core biopsy of pancreatic lesions using a fat detour route appears to be a safe and effective method for obtaining pancreatic lesion biopsies with a high success rate and low complication rate.