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The direction of individual B8 solar neutrinos has been reconstructed using the SNO+ liquid scintillator detector. Prompt, directional Cherenkov light was separated from the slower, isotropic scintillation light using time information, and a maximum likelihood method was used to reconstruct the direction of individual scattered electrons. A clear directional signal was observed, correlated with the solar angle. The observation was aided by a period of low primary fluor concentration that resulted in a slower scintillator decay time. This is the first time that event-by-event direction reconstruction in high light-yield liquid scintillator has been demonstrated in a large-scale detector.

Yu-Yang Hua,1 Ming-Chun Kuo,1 Yen-Hao Chen,1 Hung-I Lu,2 Chien-Ming Lo,2 Yu Chen,2 Yu-Ming Wang,3 Yun-Hsuan Lin,3 Shau-Hsuan Li,1 Shih-Yu Huang1 1Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanCorrespondence: Shau-Hsuan Li; Shih-Yu Huang, Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong Dist, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 ext. 8303, Email lee0624@cgmh.org.tw; a724057@cgmh.org.twBackground: Liver cirrhosis (LC) is common among patients with esophageal squamous cell carcinoma (ESCC) due to shared etiologic factor, alcohol. For non-metastatic ESCC (nmESCC) patients with cirrhosis, surgery is often contraindicated or associated with high morbidity, therefore radiotherapy-based therapy was commonly applied. This study aims to investigate prognosticators for overall survival (OS) in nmESCC and cirrhotic patients receiving radiotherapy-based therapy. Furthermore, we will also evaluate the predictors for the 90-day mortality rate to reduce avoidable treatment-related toxic effects, and prevent medical waste.Methods: Between January 2001 and December 2021, we retrospectively reviewed medical records of 1298 ESCC patients. Total 78 patients with nmESCC and liver cirrhosis identified based on abdominal ultrasonography, computerized tomography, or liver biopsy were enrolled. Clinicopathologic parameters were collected and correlated with OS and 90-day mortality.Results: Univariate analysis revealed that Child-Pugh classification B/C (P< 0.001, versus A), radiotherapy alone (P=0.03, versus chemoradiotherapy), prothrombin time (PT) prolonged≧2 seconds (P=0.024), albumin≦3.5g/dl (P< 0.001), controlled/refractory ascites (P=0.01, versus none of ascites), and total bilirubin≧1.5mg/dl (P=0.004) were significantly associated with inferior OS. In multivariate analyses, albumin≦3.5g/dl (P=0.001, odds ratio (OR): 2.500) and total bilirubin≧1.5mg/dl (P=0.019, OR: 2.012) were independent adverse prognosticators. The 90-day mortality in these 78 patients receiving radiotherapy-based therapy was 10.3% (n=8), including ESCC progression in 4 patients, liver failure in 1 patient, and others in 3. Clinical 8th American Joint Committee on Cancer (AJCC) stage IVA (P=0.02), clinical T classification T3/4 (P=0.049), PT prolonged≧4 seconds (P=0.009), and albumin≦3.5g/dl (P=0.027) were significantly correlated with higher 90-day mortality. Logistic model showed albumin≦3.5g/dl (P=0.015, OR: 16.129) and clinical 8th AJCC stage IVA (P=0.012, OR: 17.544) were independently correlated with higher 90-day mortality.Conclusion: Hypoalbuminemia is associated with higher 90-day mortality and poor prognosis in nmESCC and liver cirrhosis patients receiving radiotherapy-based therapy.Keywords: radiotherapy, esophageal cancer, liver cirrhosis, prognosis, albumin, nutrition

Xiaoqing Wei,1,&ast; Junying Zhang,2,&ast; Youwen Mei,3 Eqiong Li,4 Qianling Dai,1 Xiaoli Yang,1 Dan Luo,5 Biao Li,6 Ping Hua,7 Jian Cai,7 Hua Lai,8 Dongfeng Qi,9 Sha Lai,10 Mi Qin,11 Yonghong Lin4 1Department of Cervical Disease and Cervical Cancer Prevention and Treatment, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 2Clinical Laboratory Department, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 3Department of Reproduction and Infertility, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 4Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 5Department of Obstetrics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 6Department of Neonatal Intensive Care Unit, Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 7Department of Pathology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 8Department of Radiation and Interventional Therapy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 9Department of Ultrasonics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 10Dermatology Department, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China; 11Department of Pediatric Surgery, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yonghong Lin; Xiaoqing Wei, Email linyhcd2011@163.com; xqcherry@163.comObjective: We report a case of Carmi Syndrome in a neonate.Aim: To share our lessons in diagnosis of the case of Carmi Syndrome.Case Report: Carmi Syndrome is an extremely rare autosomal recessive genetic disorder characterized the coexistence of pyloric atresia and junctional epidermolysis bullosa, and with aplasia cutis congenita in approximately 28% patients. In this case, a full-term male neonate was born to a G4P2+1L1 multipara through cesarean section delivery in hospital in a non-consanguineous marriage with 4000mL of II°meconium-stained amniotic fluid. He was found extensive skin loss over lower legs and other parts, with scattered blisters and bilateral microtia. Plain abdominal X-ray revealed a large gastric air bubble with no gas distally. The mother had an intrauterine fetal loss previously for reasons unknown. The dermatologist diagnosed the newborn with Bart Syndrome, while the pediatric surgeon diagnosed congenital pyloric atresia(CPA). The parents refused further treatment and the neonate passed away about 30 hours after birth.Outcome: The neonate passed away about 30 hours after birth.Conclusion: Lessons from this case:①.Rule out Carmi Syndrome in patients with PA, and differentiate Bart syndrome and Carmi Syndrome in patients with abnormal skin manifestations. ②. For rare and/or severe diseases, multidisciplinary teams(MDTs) should be establish. ③. Genetic counseling and prenatal diagnosis are necessary prior to subsequent childbearings. ④.Termination of pregnancy might be contemplated if certain indicators are revealed.Keywords: Carmi syndrome, bart syndrome, epidermolysis bullosa, EB, junctional epidermolysis bullosa, JEB, congenital pyloric atresia, CPA, aplasia cutis congenita, ACC, congenital localized absence of skin, CLAS, pyloric atresia, PA, epidermolysis bullosa with pyloric atresia, EB-PA, multidisciplinary teams, MDT

The SNO+ Collaboration reports the first evidence of reactor antineutrinos in a Cherenkov detector. The nearest nuclear reactors are located 240 km away in Ontario, Canada. This analysis uses events with energies lower than in any previous analysis with a large water Cherenkov detector. Two analytical methods are used to distinguish reactor antineutrinos from background events in 190 days of data and yield consistent evidence for antineutrinos with a combined significance of 3.5σ.

This paper reports results from a search for single and multinucleon disappearance from the O16 nucleus in water within the SNO+ detector using all of the available data. These so-called "invisible"decays do not directly deposit energy within the detector but are instead detected through their subsequent nuclear deexcitation and gamma-ray emission. New limits are given for the partial lifetimes: τ(n→inv)>9.0×1029 years, τ(p→inv)>9.6×1029 years, τ(nn→inv)>1.5×1028 years, τ(np→inv)>6.0×1028 years, and τ(pp→inv)>1.1×1029 years at 90% Bayesian credibility level (with a prior uniform in rate). All but the (nn→inv) results improve on existing limits by a factor of about 3.

A search for Majoron-emitting modes of the neutrinoless double beta decay of Xe136 is performed with the full EXO-200 dataset. This dataset consists of a total Xe136 exposure of 234.1 kg·yr, and includes data with detector upgrades that have improved the energy threshold relative to previous searches. A lower limit of T1/2Xe136>4.3×1024 yr at 90% C.L. on the half-life of the spectral index n=1 Majoron decay was obtained, a factor of 3.6 more stringent than the previous limit from EXO-200 and a factor of 1.6 more stringent than the previous best limit from KamLAND-Zen. This limit corresponds to a constraint on the Majoron-neutrino coupling constant of |geeM|

SNO+ is a large-scale liquid scintillator experiment with the primary goal of searching for neutrinoless double beta decay, and is located approximately 2 km underground in SNOLAB, Sudbury, Canada. The detector acquired data for two years as a pure water Cherenkov detector, starting in May 2017. During this period, the optical properties of the detector were measured in situ using a deployed light diffusing sphere, with the goal of improving the detector model and the energy response systematic uncertainties. The measured parameters included the water attenuation coefficients, effective attenuation coefficients for the acrylic vessel, and the angular response of the photomultiplier tubes and their surrounding light concentrators, all across different wavelengths. The calibrated detector model was validated using a deployed tagged gamma source, which showed a 0.6% variation in energy scale across the primary target volume.

Hsuan Huang,1 Hsiao-Ling Su,2 Chih-Hsung Huang,2 Yi-Hsin Lin2 1Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, TaiwanCorrespondence: Yi-Hsin Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan, Tel +886-2-2771-8151, Email slimesin0709@gmail.comBackground: During the COVID-19 pandemic, the national lockdown had a significant impact on healthcare systems and diabetes management. The results of relevant studies were inconsistent. The aim of the study was to investigate the impact of lockdown on glycemic control among patients with type 2 diabetes mellitus(T2D) in Taiwan.Methods: This was a retrospective study conducted in a single regional hospital in Northern Taiwan. The clinic characteristics of the patients were summarized. Anthropometric and biochemical data before and after the lockdown were collected and analyzed. Stepwise multiple regression analysis was performed to identify the independent determinants of variables, including baseline characteristics and laboratory parameters, for the changes in glycated hemoglobin(HbA1c).Results: A total of 943 (females 48.5%) patients with T2D were enrolled. The mean age of the patients was 60.6± 12.3years, with a mean HbA1c of 7.0± 1.0%, a mean diabetes duration of 7.3± 4.6years, and a mean body mass index(BMI) of 26.5± 4.5kg/m2. The overall means of HbA1c and fasting blood glucose were significantly improved after the lockdown compared to before (7.0± 1.0 vs 6.8± 0.9, p< 0.001 and 132.2± 33.3 vs 124.4± 30.0, p< 0.001, respectively). The proportion of patients achieving HbA1c target (≤ 7%) was higher after the lockdown compared to before (61.5% vs 68.9%, p< 0.001). Stepwise multiple regression analysis revealed that baseline HbA1c before the lockdown was a positive contributor to the change in HbA1c after the lockdown, whereas BMI and co-morbidity with dyslipidemia were negative contributors (standardized coefficient +0.16, p< 0.001; − 0.07, p=0.025; − 0.12, p=0.001, respectively).Conclusion: Our study highlights the benefits of lockdown measures on diabetic control in Northern Taiwan as a single-center experience with the improvement of HbA1c and fasting blood glucose. Understanding these consequences of national lockdown can help healthcare providers to improve diabetes care during the pandemic.Keywords: COVID-19 lockdown, type 2 diabetes mellitus, glycemic control

Xue Ke,1 Li He,2 Jia-Feng Zheng,1 Yong-Hong Lin,1 Fang Wang1 1Department of Reproductive Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China; 2Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of ChinaCorrespondence: Fang Wang, Department of Reproductive Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China, Email wangfcd2022@163.comPurpose: Ectopic pregnancy (EP) is rare among patients having received tubal ligation; in these cases, a fertilized ovum is implanted in the proximal tube stump. Distal tubal EP cases in patients having undergone ipsilateral tubal ligation and who have relatively intact contralateral adnexa are extremely rare. Here, we report a case of pregnancy in the distal stump of the ipsilateral fallopian tube following fallopian tubal isthmus ligation.Case Presentation: A 28-year-old woman was admitted after having experienced lower abdominal pain for 10 days and amenorrhea for 1 week and receiving a transvaginal color ultrasonography finding of a heterogeneous echo (2.1 × 1.2 × 1.4 cm) near the left ovary. The patient had a medical history of transvaginal left tubal ligation under single-port laparoscopy for a left hydrosalpinx. Postoperatively, the patient had undergone in vitro fertilization for assisted reproduction. After ovum retrieval, whole-embryo cryopreservation had been performed due to the ovarian hyperstimulation syndrome trend. This pregnancy was natural after embryo cryopreservation. After the patient was admitted, laparoscopic exploration revealed an elevated ampulla in the distal stump of the left fallopian tube. Left salpingectomy with removal of the ectopic pregnancy in the distal remnant tube was performed under the guidance of transvaginal single-port laparoscopy. Serum β-human chorionic gonadotropin levels gradually decreased. Thereafter, the patient underwent two cycles of frozen embryo transfer, both of which resulted in chemical pregnancies.Conclusion: This case suggests that gynecologists should pay attention to the possibility of fallopian tube ectopic pregnancy in the distal tubal segment post-tubal ligation.Keywords: distal stump, ectopic pregnancy, tubal ligation, unilateral salpingectomy, in vitro fertilization

The SNO+ experiment collected data as a low-threshold water Cherenkov detector from September 2017 to July 2019. Measurements of the 2.2-MeV γ's produced by neutron capture on hydrogen were made using an Am-Be calibration source, for which a large fraction of emitted neutrons are produced simultaneously with a 4.4-MeV γ. Analysis of the delayed coincidence between the 4.4-MeV γ and the 2.2-MeV capture γ revealed a neutron detection efficiency that is centered around 50% and varies at the level of 1% across the inner region of the detector, which to our knowledge is the highest efficiency achieved among pure water Cherenkov detectors. In addition, the neutron capture time constant was measured and converted to a thermal neutron-proton capture cross section of 336.3-1.5+1.2mb.

Chao-Jen Li,1,&ast; Hung-Wen Tsai,2,&ast; Yi-Li Chen,3 Chun-I Wang,4 Yang-Hsiang Lin,5 Pei-Ming Chu,6,7 Hsiang-Cheng Chi,8,9 Yi-Ching Huang,3 Cheng-Yi Chen3 1Department of General & Gastroenterological Surgery, An Nan Hospital, China Medical University, Tainan, Taiwan; 2Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan; 5Liver Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 6Department of Anatomy, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 7Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan; 8Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; 9Chinese Medicine Research Center, China Medical University, Taichung, Taiwan&ast;These authors contributed equally to this workCorrespondence: Cheng-Yi Chen, Tel/Fax +886-6-2353535&num;5329, Email cychen@gs.ncku.edu.twIntroduction: Hepatocellular carcinoma (HCC) accounts for 80% of all liver cancers and is the 2nd leading cause of cancer-related death in Taiwan. Various factors, including rapid cell growth, a high recurrence rate and drug resistance, make HCC difficult to cure. Moreover, the survival rate of advanced HCC patients treated with systemic chemotherapy remains unsatisfactory. Hence, the identification of novel molecular targets and the underlying mechanisms of chemoresistance in HCC and the development more effective therapeutic regimens are desperately needed.Methods: An MTT assay was used to determine the cell viability after cisplatin or doxorubicin treatment. Western blotting, qRT‒PCR and immunohistochemistry were utilized to examine the protein tyrosine phosphatase IVA3 (PTP4A3) level and associated signaling pathways. ELISA was utilized to analyze the levels of the inflammatory cytokine IL-6 influenced by cisplatin, doxorubicin and PTP4A3 silencing.Results: In this study, we found that PTP4A3 in the cisplatin/doxorubicin-resistant microarray was closely associated with the overall and recurrence-free survival rates of HCC patients. Cisplatin or doxorubicin significantly reduced cell viability and decreased PTP4A3 expression in hepatoma cells. IL-6 secretion increased with cisplatin or doxorubicin treatment and after PTP4A3 silencing. Furthermore, PTP4A3 was highly expressed in tumor tissues versus adjacent normal tissues from HCC patients. In addition, we evaluated the IL-6-associated signaling pathway involving STAT3 and JAK2, and the levels of p-STAT3, p-JAK2, STAT3 and JAK2 were obviously reduced with cisplatin or doxorubicin treatment in HCC cells using Western blotting and were also decreased after silencing PTP4A3. Collectively, we suggest that cisplatin or doxorubicin decreases HCC cell viability via downregulation of PTP4A3 expression through the IL-6R-JAK2-STAT3 cascade.Discussion: Therefore, emerging evidence provides a deep understanding of the roles of PTP4A3 in HCC cisplatin/doxorubicin chemoresistance, which can be applied to develop early diagnosis strategies and reveal prognostic factors to establish novel targeted therapeutics to specifically treat HCC.Keywords: hepatocellular carcinoma, chemoresistance, cisplatin, doxorubicin, PTP4A3, IL-6

Hsiao-Ping Huang,1 Kee-Hsin Chen,2– 6 Chen-Liang Tsai,7 Wen-Pei Chang,8,9 Sherry Yueh-Hsia Chiu,10,11 Shin-Rou Lin,10,11 Yu-Huei Lin2 1Nursing Department, Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 2Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; 3Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; 4Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 5Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 6Evidence-Based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 8Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 9School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; 10Department of Health Care Management, College of Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; 11Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, TaiwanCorrespondence: Yu-Huei Lin, Tel +886 2 27361661 Ext 3620, Fax +886 2 23772842, Email gracelin@tmu.edu.twPurpose: This study aimed to evaluate the efficacy of high-frequency chest wall oscillation for sputum expectoration and hospital length of stay in patients with acute exacerbations of chronic obstructive pulmonary disease. The improvements in pulmonary function and oxygenation were also investigated.Patients and Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Automated literature database searches were conducted from the earliest records to March 31, 2022. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB 2.0), and meta-analysis software (RevMan 5.4) was used to analyze the data.Results: From 5439 identified articles, 13 studies (with 756 patients) were included in this meta-analysis. Compared to other airway clearance techniques, HFCWO significantly increased expectorated sputum volume by 6.18 mL (95% CI: 1.71 to 10.64; I2 = 87%), shortened hospital stay by 4.37 days (95% CI: − 7.70 to − 1.05; I2 = 84%). However, FEV1 (%), PaO2, and PaCO2 did not improve significantly.Conclusion: AECOPD patients may benefit from HFCWO therapy. HFCWO enables AECOPD patients to excrete more sputum and shorten their hospital stays. However, due to heterogeneity among the included research, these results should be interpreted with caution.Keywords: acute exacerbation of chronic obstructive pulmonary disease, AECOPD, high-frequency chest wall oscillation, HFCWO, sputum expectoration, length of hospital stay

The search for neutrinoless double beta decay probes the fundamentalproperties of neutrinos, including whether or not the neutrino and antineutrinoare distinct. Double beta detectors are large and expensive, so backgroundreduction is essential for extracting the highest sensitivity. Theidentification, or 'tagging', of the $^{136}$Ba daughter atom from double betadecay of $^{136}$Xe provides a technique for eliminating backgrounds in thenEXO neutrinoless double beta decay experiment. The tagging scheme studied inthis work utilizes a cryogenic probe to trap the barium atom in solid xenon,where the barium atom is tagged via fluorescence imaging in the solid xenonmatrix. Here we demonstrate imaging and counting of individual atoms of bariumin solid xenon by scanning a focused laser across a solid xenon matrixdeposited on a sapphire window. When the laser sits on an individual atom, thefluorescence persists for $\sim$30~s before dropping abruptly to the backgroundlevel, a clear confirmation of one-atom imaging. No barium fluorescencepersists following evaporation of a barium deposit to a limit of $\leq$0.16\%.This is the first time that single atoms have been imaged in solid nobleelement. It establishes the basic principle of a barium tagging technique fornEXO.

Shang-Yu Chou,1 Hung-I Lu,2 Yen-Hao Chen,3 Chien-Ming Lo,2 Yun-Hsuan Lin,1 Tzu-Ting Huang,1 Fu-Min Fang,1 Li-Chun Chen,2 Yu Chen,2 Yi-Chun Chiu,4 Yeh-Pin Chou,4 Shau-Hsuan Li,3,&ast; Yu-Ming Wang1,5,&ast; 1Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 4Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 5School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Yu-Ming Wang, Department of Radiation Oncology & Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 129, Ta-Pei Road, Niaosong Dist., Kaohsiung, 833, Taiwan, Tel +886-7-7317123 ext. 7000, Fax +886-7-7322813, Email scorpion@cgmh.org.tw Shau-Hsuan Li, Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niaosong Dist., Kaohsiung, 833, Taiwan, Tel +886-7-7317123 ext. 8303, Fax +886-7-7322813, Email lee0624@cgmh.org.twPurpose: For locally advanced esophageal cancer, definitive concurrent chemoradiotherapy (CCRT) with a radiation dose of 50– 50.4 Gy/25-28 Fx is prescribed, followed by adjuvant esophagectomy for better local control or salvage treatment if locoregional recurrence occurs. However, radiation injury before surgery may delay wound healing. We performed cervical anastomosis directly inside the left supraclavicular fossa (SCF), the irradiation target for esophageal cancer. The significance of radiation injury in patients with cervical anastomotic leak (AL) remains unclear. Thus, we assessed the influence of radiation on cervical AL in patients undergoing preoperative CCRT followed by esophagectomy.Patients and Methods: We defined the SYC zone, a portion of the region overlapping the left SCF. The radiation dose to the SYC zone was analyzed and correlated with AL in patients with locally advanced esophageal squamous cell carcinoma (ESCC) who were administered preoperative CCRT (radiation dose with 50– 50.4 Gy/25-28 Fx to the primary esophageal tumor) followed by esophagectomy between October 2009 and January 2018. Receiver operating characteristic curve analysis and logistic regression were used to identify the optimal radiation factor to predict AL and the cutoff value.Results: The optimal radiation factor to predict AL was the mean dose to the SYC zone (area under the curve (AUC)=0.642), and the cutoff point of the mean dose was 48.55 Gray (Gy). For a mean SYC zone dose ≥ 48.55 Gy, the AL risk was sevenfold greater than that for < 48.55 Gy (OR = 7.805; 95% CI: 1.184 to 51.446; P value = 0.033).Conclusion: Recognizing the SYC zone as an organ at risk and performing radiation evaluation are meaningful. A reduced mean dose of the SYC zone below 48.55 Gy results in a lower cervical AL rate following esophagectomy.Keywords: esophageal squamous cell carcinoma, preoperative concurrent chemoradiotherapy, radiation therapy

Yi-Hsiu Lin Master Program of Sport Facility Management and Health Promotion, National Taiwan University, Taipei City, Taiwan, Republic of ChinaCorrespondence: Yi-Hsiu Lin Email shulin909@gmail.comPurpose: The empirical paper aimed to develop a theoretical model of social capital in professional spectating sports by investigating the antecedents and outcomes related to social capital from the spectator’s viewpoint.Participant and Method: Brothers Elephants, a professional baseball franchise in the Chinese Professional Baseball League, provided the research setting. The study’s participants consisted of 422 spectators of a Brothers Elephants game at its home field, Taichung Intercontinental Baseball Field. Around half of the participants were male; 46.4% of them aged between 30 and 39 years old. Data analysis was conducted through structural equation modeling.Results: Results revealed that social interactions positively correlated with social capital, prosocial behavior, and spectator intention to re-attend the sporting event. Corporate social responsibility (CSR) also positively predicted intention to re-attend the sporting event, social capital, and prosocial behavior. Social capital significantly correlated with prosocial behavior and subjective well-being, and prosocial behavior significantly correlated with subjective well-being and intention to re-attend the sporting event.Conclusion: The results suggest that social capital can be developed through social interactions and perceived CSR in the context of professional spectator sporting events, with such social capital increasing, in turn, prosocial behavior, subjective well-being, and intention to re-attend the sporting event. From perspective of practical implication, professional sports franchise can develop more campaigns that boost sports spectators’ perceived social interactions and CSR, which can increase their social capital, prosocial behavior, subjective well-being, and their intention to re-attend the sporting event.Keywords: sports event, prosocial behavior, subjective well-being, corporate social responsibility

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

Chordoid glioma is a rare brain tumor thought to arise from specialized glial cells of the lamina terminalis along the anterior wall of the third ventricle. Despite being histologically low-grade, chordoid gliomas are often associated with poor outcome, as their stereotypic location in the third ventricle makes resection challenging and efficacious adjuvant therapies have not been developed. Here we performed genomic profiling on 13 chordoid gliomas and identified a recurrent D463H missense mutation in PRKCA in all tumors, which localizes in the kinase domain of the encoded protein kinase C alpha (PKCα). Expression of mutant PRKCA in immortalized human astrocytes led to increased phospho-ERK and anchorage-independent growth that could be blocked by MEK inhibition. These studies define PRKCA as a recurrently mutated oncogene in human cancer and identify a potential therapeutic vulnerability in this uncommon brain tumor.

Traffic-related particulate matter (PM) is a major source of outdoor air pollution worldwide. It has been recently hypothesized to cause cardiometabolic syndrome, including cardiovascular dysfunction, obesity, and diabetes. The environmental and toxicological factors involved in the processes, and the detailed mechanisms remain to be explored. The objective of this study is to assess the current scientific evidence of traffic-related PM-induced cardiometabolic syndrome. We conducted a literature review by searching the keywords of "traffic related air pollution", "particulate matter", "human health", and "metabolic syndrome" from 1980 to 2018. This resulted in 25 independent research studies for the final review. Both epidemiological and toxicological findings reveal consistent correlations between traffic-related PM exposure and the measured cardiometabolic health endpoints. Smaller sizes of PM, particularly ultrafine particles, are shown to be more harmful due to their greater concentrations, reactive compositions, longer lung retention, and bioavailability. The active components in traffic-related PM could be attributed to metals, black carbon, elemental carbon, polyaromatic hydrocarbons, and diesel exhaust particles. Existing evidence points out that the development of cardiometabolic symptoms can occur through chronic systemic inflammation and increased oxidative stress. The elderly (especially for women), children, genetically susceptible individuals, and people with pre-existing conditions are identified as vulnerable groups. To advance the characterization of the potential health risks of traffic-related PM, additional research is needed to investigate the detailed chemical compositions of PM constituents, atmospheric transformations, and the mode of action to induce adverse health effects. Furthermore, we recommend that future studies could explore the roles of genetic and epigenetic factors in influencing cardiometabolic health outcomes by integrating multi-omics approaches (e.g., genomics, epigenomics, and transcriptomics) to provide a comprehensive assessment of biological perturbations caused by traffic-related PM.

Hao Lin,1 Wen-Hsin Chen,1 Chen-Hsuan Wu,1,2 Yu-Che Ou,3 Yu-Jen Chen,3 Ying-Yi Chen,1 Yu-Han Lin,4 Hung-Chun Fu1– 3 1Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Graduate Institute of Clinical Medical Sciences, Chang Gung University, Lin-Kou, Taiwan; 3Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan; 4Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, Tainan, TaiwanCorrespondence: Hung-Chun FuDepartment of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta Pei Road, Niao Sung District, Kaohsiung City, Taiwan, Republic of ChinaTel +886 7 731712Fax +886 7 7322915Email allen133@adm.cgmh.org.twAim: To investigate whether the time interval between primary debulking surgery (PDS) and initiating adjuvant chemotherapy affects survival in patients with epithelial ovarian cancer (EOC).Methods: We retrospectively reviewed FIGO stage IIB to IV EOC patients who received PDS followed by adjuvant chemotherapy in our hospital between January 2008 and December 2016. The optimal cut-off time interval to chemotherapy related to survival was determined using the Contal and O’Quigley method and Cox hazard models. Cox regression analysis was used to identify the independent effect of time interval on survival.Results: A total of 152 patients were identified and divided into three groups based on the time interval between PDS and initiating adjuvant chemotherapy: early (< 23 days), intermediate (23– 43 days) and late (> 43 days). The intermediate group had a significantly better median progression-free survival (PFS, 35.5 months) compared to the early (20 months) and late (22.6 months) groups. After adjustments for confounding factors, time interval was still an independent variable affecting PFS. The intermediate group was associated with a better PFS compared with the early and late groups (hazard ratio 0.27, 95% CI 0.10– 0.83, p=0.002). There was no statistical significance in overall survival (OS) in univariate or multivariate analysis, although there was a trend towards better OS in the intermediate group.Conclusion: Our results provide evidence that the time interval from PDS to chemotherapy influences PFS in patients with advanced EOC. The optimal time to initiate chemotherapy was between 23 and 43 days, within 3– 6 weeks post-operatively. Initiating chemotherapy early (< 23 days) did not appear to benefit PFS.Keywords: time interval, chemotherapy, ovarian cancer

Tsung-Lun Li,1 Tai-Hua Chan,2 Cheng-Hui Wang,3– 5 Ruwen Jou,2,6 Ming-Chih Yu,1,3,7 Denise Utami Putri,3,* Chih-Hsin Lee,1,3,8,* Yi-Hsien Lin3 1Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; 2Taiwan Centers for Disease Control, Taipei, Taiwan; 3Pulmonary Research Center, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; 4Department of Laboratory Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; 5School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; 6Institute of Microbiology and Immunology, National Yang-Ming Chiao Tung University, Taipei, Taiwan; 7Schools of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; 8Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Chih-Hsin Lee; Denise Utami PutriPulmonary Research Center, Wanfang Hospital, Taipei Medical University, 111 Sec. 3, Xinglong Road Wenshan District, Taipei, 116, TaiwanTel +886-2930-7930Email chleetw@tmu.edu.tw; 108336@w.tmu.edu.twAbstract: Appropriate treatment is the key element in eliminating tuberculosis (TB), and requires prompt diagnosis. We presented a case of a household contact of rifampicin-resistant TB revealing reactive IFN-gamma release assay with unsuspicious clinical and radiologic examinations. She was diagnosed with latent tuberculosis infection (LTBI) and treated with isoniazid monotherapy. On the ninth month, she developed a progressive cough and was found to harbor active TB disease with added resistance to isoniazid. An individualized anti-TB regimen consisting of moxifloxacin, kanamycin, prothionamide, ethambutol, and pyrazinamide was prescribed for 20 months, leading to sputum culture conversion and improvement of the reported symptom. No recurrence was observed on one-year follow-up. Assuming high compliance to therapy, we propose that the patient may have been underdiagnosed and received sub-optimal treatment leading to acquired-drug resistance. Conventional diagnosis methods based on immunological assay and radiographical findings may be insufficient to distinguish the incipient and subclinical states of TB from LTBI.Keywords: latent tuberculosis infection, LTBI, treatment, acquired drug resistance, drug-resistant TB, subclinical TB, case report

Junjie Bi,1,* Yuhua Lin,1,* Yipeng Sun,1,* Mengzhe Zhang,2,* Qingge Chen,1 Xiayi Miu,1 Lingling Tang,1 Jinjin Liu,1 Linyun Zhu,1 Zhenhua Ni,3 Xiongbiao Wang1 1Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China; 2Department of Laboratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China; 3Central Laboratory, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhenhua Ni; Xiongbiao Wang Email zhenhuani@yeah.net; xiongbiao6@yahoo.comBackground: Polygonum cuspidatum is a Chinese medicine commonly used to treat phlegm-heat asthma. However, its anti-asthmatic active ingredients and mechanism are still unknown. The aim of this study was to predict the active ingredients and pathways of Polygonum cuspidatum and to further explore the potential molecular mechanism in asthma by using network pharmacology.Methods: The active ingredients and their targets related to Polygonum cuspidatum were seeked out with the TCM systematic pharmacology analysis platform (TCMSP), and the ingredient-target network was constructed. The GeneCards, DrugBank and OMIM databases were used to collect and screen asthma targets, and then the drug-target-disease interaction network was constructed with Cytoscape software. A target protein-protein interaction (PPI) network was constructed using the STRING database to screen key targets. Finally, GO and KEGG analyses were used to identify biological processes and signaling pathways. The anti-asthmatic effects of Polygonum cuspidatum and its active ingredients were tested in vitro for regulating airway smooth muscle (ASM) cells proliferation and MUC5AC expression, two main symptoms of asthma, by using Real-time PCR, Western blotting, CCK-8 assays and annexin V-FITC staining.Results: Twelve active ingredients in Polygonum cuspidatum and 479 related target proteins were screened in the relevant databases. Among these target proteins, 191 genes had been found to be differentially expressed in asthma. PPI network analysis and KEGG pathway enrichment analysis predicted that the Polygonum cuspidatum could regulate the AKT, MAPK and apoptosis signaling pathways. Consistently, further in vitro experiments demonstrated that Polygonum cuspidatum and resveratrol (one active ingredient of Polygonum cuspidatum) were shown to inhibit ASM cells proliferation and promoted apoptosis of ASM cells. Furthermore, Polygonum cuspidatum and resveratrol inhibited PDGF-induced AKT/mTOR activation in ASM cells. In addition, Polygonum cuspidatum decreased H2O2 induced MUC5AC overexpression in airway epithelial NCI-H292 cells.Conclusion: Polygonum cuspidatum could alleviate the symptoms of asthma including ASM cells proliferation and MUC5AC expression through the mechanisms predicted by network pharmacology, which provides a basis for further understanding of Polygonum cuspidatum in the treatment of asthma.Keywords: Polygonum cuspidatum, asthma, ASM cells, MUC5AC, network pharmacology

Li-Li Yang,1,2,* Ping Peng,1,3,* Yun-Hong Lin,3 Ting Zhou,4 Xiao-Xue Ren,1,3 Wei-Qi Wang,1 Xing-Xing Li1,3 1Department of Dental Research, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, 650100, People’s Republic of China; 2Department of Periodontics, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, 650100, People’s Republic of China; 3Department of Prosthodontics, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, 650100, People’s Republic of China; 4Department of Orthodontics, The Affiliated Stomatological Hospital of Kunming Medical University, Kunming, Yunnan, 650100, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xing-Xing LiDepartment of Prosthodontics, The Affiliated Stomatological Hospital of Kunming Medical University, No. 1088 Haiyuan Road, Wuhua District, Kunming, Yunnan, 650100, People’s Republic of ChinaTel +86 13759581696Fax +86 87165330099Email lxx_drli1862@163.comObjective: This study aims to measure and analyze the lip and tooth dynamic esthetic characteristics at rest and during speech in order to provide a reference for its esthetic design and restoration among the Hani and Han populations in Yunnan Province, China.Methods: Subjects of Hani and Han ethnicity in Yunnan were selected using multistage stratified sampling and inclusive criteria. The lip and tooth dynamic esthetic characteristics of the subjects at rest and during the pinyin pronunciation of “me”, “yi”, “fu”, and “si” were recorded using digital photography and analyzed with computer software.Results: No statistical difference was detected between the Hani and Han groups in the upper central-incisor display, when pronouncing the pinyin “yi”. Furthermore, there were no statistical differences in lip dynamic esthetic parameters between the Hani and Han groups, except for the distance between the upper and lower lips when pronouncing “si”. There were three kinds of correlation between the upper central-incisor edge and lower lip: separation, contact, and overlap.Conclusion: The display of upper central incisors and the mouth width of Hani people are larger than those of Han people when at rest. When the pinyin “si” is pronounced, the display of upper central incisors and the upper–lower lip distance of Hani people is less than that of Han people due to labial muscle movement.Keywords: Hani, Han, pronunciation, lip and tooth aesthetics, digital videography

The electronic properties of organic semiconductors are strongly influenced by intermolecular packing. When cast as thin films, crystalline π-conjugated molecules are strongly textured, potentially leading to anisotropic charge transport. Consequently, it is hypothesized that the orientation of crystallites in the active layer plays an important role in charge extraction and organic photovoltaic device performance. Here we demonstrate orientation control of molecular packing from mostly face-on to edge-on configurations in the active layer of P3HT-b-PFTBT block copolymer photovoltaics using 1-chloronaphthalene as a solvent additive. The effect of molecular orientations in P3HT crystals on charge transport and solar cell performance is examined. We find that optimized photovoltaic device performance is independent of the crystalline texture of P3HT. Our observations provide further insights into the molecular organization required for efficient charge transport and overall device efficiencies. The dominant crystal orientation, whether face-on or edge-on, is not critical to block copolymer solar cells. Instead, a broad distribution of crystallite orientations ensures pathways for charge transport in any direction and enables efficient charge extraction in photovoltaic devices.

Yi-Hsin Lin,1 Di-An Chen,2 Chemin Lin,3 Hsuan Huang4 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan (R.O.C.); 2Department of Clinic Psychology, Fu Jen Catholic University, Taipei, Taiwan (R.O.C.); 3Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan (R.O.C.); 4Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan (R.O.C.)Correspondence: Hsuan HuangDepartment of Surgery, Mackay Memorial Hospital, Taipei, Taiwan (R.O.C.)Tel +886-2-2562-7200Email smilefortw@hotmail.comPurpose: Type D personality (TDP) has been recognized as a risk factor for many diseases. The aims of our study were to estimate the prevalence of TDP and glycemic control on the patients with type 2 diabetes mellitus (T2DM) and to assess their relationship between TDP and socio-psychological factors, such as perceived stress, self-efficacy, self-care behaviors, and psychological distress.Patients and Methods: A total of 198 T2DM patients (male 62.6%, mean age 51.2± 11.0, mean HbA1c 7.3± 1.8%) were recruited consecutively from the Department of Endocrinology of a regional hospital in Taipei, Taiwan, from December 2017 to April 2018. They completed questionnaires that contain questions about sociodemographic characteristics, TDP, illness-related stress, self-efficacy, execution of diabetes management and emotional distress. Their medical records were reviewed for biomedical data.Results: Of the 198 patients, 82 (41.4%) had TDP. Controlling for sociodemographic factors, patients with TDP were reported significantly poorer on glycemic control than those without TDP (mean HbA1c (%) 7.6± 1.9 vs 7.1± 1.8, P< 0.05). Compared to those without TDP, the results showed significantly higher levels of perceived stress (P< 0.001) and psychological distress (anxiety and depression) (P< 0.001), as well as significantly lower levels of self-efficacy (P< 0.001) and self-care behaviors (P< 0.001) on patients with TDP. TDP was positively correlated with perceived stress and psychological distress and negatively correlated with self-efficacy and self-care behaviors scores.Discussion: This study provides the evidence linking TDP with poor glycemic control, low levels of self-efficacy and self-care behaviors, as well as high levels of perceived stress and psychological distress, which highlights the screening of TDP and the tailored needs for the care among T2DM patients with TDP.Keywords: Type D personality, type 2 diabetes mellitus, perceived stress, self-efficacy, self-care behaviors, psychological distress

Yi-Hsin Lin,1 Hsuan Huang2 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan (R.O.C.); 2Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan (R.O.C.)Correspondence: Hsuan HuangDivision of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan (R.O.C.)Email slimesin0709@gmail.comBackground/purpose: Dipeptidyl peptidase-4 (DPP-4) inhibitors are the most popular oral antidiabetic drugs (OADs) in recent 20 years because of the low risk of hypoglycemia, intermediate efficacy to lower glycated hemoglobin (△HbA1c): 0.5–0.9%, neutral effect on body weight change, convenience for usage (mostly once daily), and rare occurrence of major side effects. The purpose of this study was to determine the important predictors of the efficacy of naïve use of DPP-4 inhibitors in Taiwanese patients with type 2 diabetes mellitus (T2D).Methods: A retrospective observational study was conducted. Of the T2D patients, 193 (122 men) naïve DPP-4 inhibitor users with an age of 58.0 ± 12.6 years, disease duration 5.4 ± 4.7 years, body mass index (BMI) 26.1 ± 4.3 kg/m2, and estimated glomerular filtration rate 95.9 ± 27.0 mL/min/1.73M2 were assessed for △HbA1c in 6 months.Results: After 6 months of DPP-4 inhibitors use, mostly second or third line of OADs (2.8 ± 0.7 kinds of OADs), 193 T2D patients (mean baseline HbA1c: 8.4 ± 1.4%) had △HbA1c 1.1 ± 1.2% on average (P < 0.01). The group with a higher baseline HbA1c level had more effective efficacy (△HbA1c ≥0.5%) in lowering HbA1c. Single regression analysis showed that the change in HbA1c after 6 months of treatment was positively associated with the baseline HbA1c level (R = 0.71, P < 0.001). In addition, multiple regression analysis showed that contributors to decrease HbA1c level after 6 months were high baseline HbA1c level, low BMI, short T2D duration, and fewer kinds of OADs.Conclusion: Our study suggested that high baseline HbA1c level, low BMI, short T2D duration, and fewer kinds of OADs are the predictors of the efficacy of DPP-4 inhibitors in Taiwanese patients with T2D. The baseline HbA1c level, in particular, played the most important role in effective efficacy (△HbA1c ≥0.5%).Keywords: dipeptidyl peptidase-4 inhibitor, type 2 diabetes, HbA1c, predictor of efficacy

Yun-Hsuan Lin,1,2 Jong-Long Guo,3 Hsiao-Pei Hsu,2 Li-Shu Yang,4 Ya-Lin Fu,2,4 Chiu-Mieh Huang51Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan; 2Department of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan; 3Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan; 4Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; 5Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, TaiwanPurpose: This study aimed to explore the association between hospital loyalty, perceived usefulness of a mobile app, perceived ease of use of that mobile app, and satisfaction with the app’s use as well as predicting patients’ intended use of the app.Patients and methods: Purposive sampling was adopted in a cross-sectional survey. The participants were outpatients at the traditional Chinese medicine departments of three hospitals in northern Taiwan (n=125). The self-report questionnaire comprised information about sociodemographics and scales related to hospital loyalty, perceived usefulness of the mobile app, its perceived ease of use, satisfaction with its use, and its usage intention. The data were analyzed using structural equation modeling.Results: The four factors explained 70% variance in usage intention. The perceived usefulness of the mobile app directly and indirectly affects their usage intention, but its perceived ease of use had only indirect effects on the usage intention. Perceived usefulness and perceived ease of use influence the usage intention through satisfaction. The women’s hospital loyalty does not directly affect the usage intention of the mobile app, but indirectly affects it through perceived usefulness and perceived ease of use of the mobile app.Conclusion: Intended use of the app by women is mainly related to their experience of which is usefulness, ease of use and satisfaction of service are the most important factors contributing to continuous use. Hospital loyalty does not directly affect intention to use as expected. The influence of loyalty must be related to the patients’ perception of the product, in terms of usefulness, ease to use, and satisfaction. The finding is helpful to understand patients’ preference and support their behavioral adherence.Keywords: usage intention, patient engagement, hospital loyalty, technology acceptance model, mobile application

Yi-Hsin Lin,1 Hsuan Huang21Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan; 2Department of Surgery, Mackay Memorial Hospital, Taipei, TaiwanPurpose: Improvements in insulin resistance have been observed by following lifestyle modification (LM) for adults with metabolic syndrome (MetS). However, these improvements are associated with relatively intensive and long-term duration LM, which is unlikely to be a part of routine practice for most people. This study examined the impact of a short-term (eight-week) low-intensive LM program on anthropomorphic parameters and insulin resistance in a community-based population.Patients and methods: A total of 174 adults (67 with MetS) were enrolled in this retrospective observational study. The effects of the eight-week LM program on anthropomorphic parameters and glucose homeostasis were investigated.Results: After the LM program, most anthropomorphic parameters in both groups were significantly improved (P

Organic aerosols (OA) in Pasadena are characterized using multiple measurements from the California Research at the Nexus of Air Quality and Climate Change (CalNex) campaign. Five OA components are identified using positive matrix factorization including hydrocarbon-like OA (HOA) and two types of oxygenated OA (OOA). The Pasadena OA elemental composition when plotted as H:C versus O:C follows a line less steep than that observed for Riverside, CA. The OOA components from both locations follow a common line, however, indicating similar secondary organic aerosol (SOA) oxidation chemistry at the two sites such as fragmentation reactions leading to acid formation. In addition to the similar evolution of elemental composition, the dependence of SOA concentration on photochemical age displays quantitatively the same trends across several North American urban sites. First, the OA/ΔCO values for Pasadena increase with photochemical age exhibiting a slope identical to or slightly higher than those for Mexico City and the northeastern United States. Second, the ratios of OOA to odd-oxygen (a photochemical oxidation marker) for Pasadena, Mexico City, and Riverside are similar, suggesting a proportional relationship between SOA and odd-oxygen formation rates. Weekly cycles of the OA components are examined as well. HOA exhibits lower concentrations on Sundays versus weekdays, and the decrease in HOA matches that predicted for primary vehicle emissions using fuel sales data, traffic counts, and vehicle emission ratios. OOA does not display a weekly cycle - after accounting for differences in photochemical aging - which suggests the dominance of gasoline emissions in SOA formation under the assumption that most urban SOA precursors are from motor vehicles. © 2013. Her Majesty the Queen in Right of Canada. American Geophysical Union.

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

Yang-Yang He,1,2,* Yu Yan,1,3,* Hui-Fang Zhang,1,3 Yi-Huang Lin,3 Yu-Cai Chen,1,3 Yi Yan,4 Ping Wu,1,3 Jian-Song Fang,5 Shu-Hui Yang,2 Guan-Hua Du1,3 1Beijing Key Laboratory of Drug Target Identification and Drug Screening, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 2State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 3State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 4Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 5Institute of Clinical Pharmacology, Guangzhou University of Traditional Chinese Medicine, Guangzhou, People’s Republic of China *These authors contributed equally to this work Abstract: Systemic lupus erythematosus (SLE), with a high incidence rate and insufficient therapy worldwide, is a complex disease involving multiple organs characterized primarily by inflammation due to deposition of immunocomplexes formed by production of autoantibodies. The mechanism of SLE remains unclear, and the disease still cannot be cured. We used pristane to induce SLE in female BALB/c mice. Methyl salicylate 2-O-β-D-lactoside (MSL; 200, 400, and 800 mg/kg) was orally administered 45 days after pristane injection for 4.5 months. The results showed that MSL antagonized the increasing levels of multiple types of antibodies and cytokines in lupus mice. MSL was found to suppress joint swelling and have potent inhibitory effect on arthritis-like symptoms. MSL also significantly decreased the spleen index and expression of inflammatory markers in the lupus mice. MSL protected the kidneys of lupus mice from injury through inhibiting the expression of inflammatory cytokines and reducing the IgG and C3 immunocomplex deposits. Further Western blot assays revealed that the downregulation of the intracellular inflammatory signals of NFκB and JAK/STAT3 might be the potential molecular mechanisms of the pharmacological activity of MSL against SLE in vivo. These findings may demonstrate that MSL has the potential to be a useful and highly effective treatment for SLE. Keywords: methyl salicylate 2-O-β-D-lactoside, systemic lupus erythematosus, inflammatory response, lupus nephritis, signal transduction

I-Hung Shao,1,* Chia-Chen Wu,2,* Hsiao-Jung Tseng,3 Ta-Jen Lee,2 Yu-Hsiang Lin,4 Yuan-Yun Tam5 1Division of Urology, Department of Surgery, Lotung Poh-Ai Hospital, Yilan County, 2Department of Otorhinolaryngology – Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, 3Biostatistical Center for Clinical Research, Chang-Gung Memorial Hospital, Taoyuan City, 4Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, 5Department of Otorhinolaryngology – Head and Neck Surgery, Lotung Poh-Ai Hospital, Yilan County, Taiwan *These authors contributed equally to this work Background: Pseudoephedrine is a sympathomimetic drug widely used as a nasal decongestant. However, it can cause adverse effects, such as voiding dysfunction. The risk of voiding dysfunction remains uncertain in patients without subjective voiding problems.Methodology: We prospectively enrolled patients with nasal congestion who required treatment with pseudoephedrine from May to August 2015. All patients denied concomitant subjective voiding problem. The International Prostate Symptom Score (IPSS) questionnaire was used to evaluate voiding function before and 1 week after the pseudoephedrine treatment. The results of the IPSS questionnaire were analyzed as the total (IPSS-T), voiding (IPSS-V), storage (IPSS-S), and quality of life due to urinary symptom scores.Results: We enrolled 131 males with a mean age of 42.0±14.3 years. The IPSS-T, IPSS-V, and IPSS-S scores slightly increased after the medication (IPSS-T increased from 6.49 to 6.77, IPSS-V from 3.33 to 3.53, and IPSS-S from 3.17 to 3.24). The quality of life due to urinary symptom score nonsignificantly decreased from 2.02 to 1.87. We observed that older age and a higher premedication IPSS-V score yielded significant differences (P50 years, even without subjective voiding symptoms. Keywords: pseudoephedrine, nasal congestion, voiding dysfunction, IPSS

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

Chao-Pen Chen,1 Chi-Cheng Wu,2 Li-Ren Chang,3 Yu-Hsuan Lin4 1Department of Education, National Taiwan University Hospital, 2Department of Family Medicine, Min-Sheng General Hospital, Taoyuan City, 3Department of Psychiatry, National Taiwan University, College of Medicine, 4Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan Background: Phantom vibration syndrome (PVS) and phantom ringing syndrome (PRS) occur in many cell phone users. Previous studies have indicated an association between PVS/PRS and job stress. The aim of this study was to determine if PVS/PRS were also associated with occupational burnout.Methods: This was a cross-sectional study of 384 employees of a high-tech company in northern Taiwan. They all completed a phantom vibration and ringing questionnaire, the Hospital Anxiety and Depression Scale, and the Chinese version of the Occupational Burnout Inventory.Results: Significantly more women and people with at least a college education were in the population with PRS and PVS, respectively. Anxiety and depression had no associations with PVS/PRS. Higher scores for personal fatigue, job fatigue, and service target fatigue had an independent impact on the presence of PVS, but only a higher score for service target fatigue had an independent impact on the presence of PRS.Conclusion: The independent association between work-related burnout and PVS/PRS suggests that PVS/PRS may be a harbinger of mental stress or a component of the clinical burnout syndrome, and may even be a more convenient and accurate predictor of occupational burnout. Keywords: phantom vibration syndrome, phantom ringing syndrome, occupational burnout

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

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

Cheng-Hung Lee,1,2 Yu-Huang Lin,3 Shang-Hung Chang,1 Chun-Der Tai,3 Shih-Jung Liu,2 Yen Chu,4 Chao-Jan Wang,5 Ming-Yi Hsu,5 Hung Chang,6 Gwo-Jyh Chang,7 Kuo-Chun Hung,1 Ming-Jer Hsieh,1 Fen-Chiung Lin,1 I-Chang Hsieh,1 Ming-Shien Wen,1 Yenlin Huang81Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, 2Department of Mechanical Engineering, 3Graduate Institute of Medical Mechatronics, Chang Gung University, 4Laboratory of Cardiovascular Physiology, Division of Thoracic and Cardiovascular Surgery, 5Department of Medical Imaging and Intervention, 6Hematology-Oncology Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, 7Graduate Institute of Clinical Medicinal Sciences, Chang Gung University College of Medicine, Linkou, 8Department of Anatomical Pathology, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, TaiwanAbstract: Incomplete endothelialization, blood cell adhesion to vascular stents, and inflammation of arteries can result in acute stent thromboses. The systemic administration of acetylsalicylic acid decreases endothelial dysfunction, potentially reducing thrombus, enhancing vasodilatation, and inhibiting the progression of atherosclerosis; but, this is weakened by upper gastrointestinal bleeding. This study proposes a hybrid stent with biodegradable nanofibers, for the local, sustained delivery of acetylsalicylic acid to injured artery walls. Biodegradable nanofibers are prepared by first dissolving poly(D,L)-lactide-co-glycolide and acetylsalicylic acid in 1,1,1,3,3,3-hexafluoro-2-propanol. The solution is then electrospun into nanofibrous tubes, which are then mounted onto commercially available bare-metal stents. In vitro release rates of pharmaceuticals from nanofibers are characterized using an elution method, and a high-performance liquid chromatography assay. The experimental results suggest that biodegradable nanofibers release high concentrations of acetylsalicylic acid for three weeks. The in vivo efficacy of local delivery of acetylsalicylic acid in reducing platelet and monocyte adhesion, and the minimum tissue inflammatory reaction caused by the hybrid stents in treating denuded rabbit arteries, are documented. The proposed hybrid stent, with biodegradable acetylsalicylic acid-loaded nanofibers, substantially contributed to local, sustained delivery of drugs to promote re-endothelialization and reduce thrombogenicity in the injured artery. The stents may have potential applications in the local delivery of cardiovascular drugs. Furthermore, the use of hybrid stents with acetylsalicylic acid-loaded nanofibers that have high drug loadings may provide insight into the treatment of patients with high risk of acute stent thromboses.Keywords: biodegradable drug-eluting nanofibers, acetylsalicylic acid, release characteristics, cell adhesion to vascular stents

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

Chi-Te Huang,1 Ming-Jun Tsai,2,3 Yu-Hsuan Lin,1 Yaw-Sya Fu,4 Yaw-Bin Huang,5 Yi-Hung Tsai,5 Pao-Chu Wu11School of Pharmacy, Kaohsiung Medical University, Kaohsiung City, 2Department of Neurology, China Medical University Hospital, Taichung, 3School of Medicine, Medical College, China Medical University, Taichung, 4Faculty of Biomedical Science and Environmental Biology, 5Graduate Institute of Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung City, Taiwan, Republic of ChinaAbstract: The aim of this study was to evaluate the potential of microemulsions as a drug vehicle for transdermal delivery of citalopram. A computerized statistical technique of response surface methodology with mixture design was used to investigate and optimize the influence of the formulation compositions including a mixture of Brij 30/Brij 35 surfactants (at a ratio of 4:1, 20%–30%), isopropyl alcohol (20%–30%), and distilled water (40%–50%) on the properties of the drug-loaded microemulsions, including permeation rate (flux) and lag time. When microemulsions were used as a vehicle, the drug permeation rate increased significantly and the lag time shortened significantly when compared with the aqueous control of 40% isopropyl alcohol solution containing 3% citalopram, demonstrating that microemulsions are a promising vehicle for transdermal application. With regard to the pharmacokinetic parameters of citalopram, the flux required for the transdermal delivery system was about 1280 µg per hour. The microemulsions loaded with citalopram 3% and 10% showed respective flux rates of 179.6 µg/cm2 and 513.8 µg/cm2 per hour, indicating that the study formulation could provide effective therapeutic concentrations over a practical application area. The animal study showed that the optimized formulation (F15) containing 3% citalopram with an application area of 3.46 cm2 is able to reach a minimum effective therapeutic concentration with no erythematous reaction.Keywords: citalopram, microemulsion, transdermal delivery systems

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

Ying-Zai Chen,1 Wei-Lieh Huang,1,2,5 Jia-Chi Shan,4,5 Yu-Hsuan Lin,1–3,5 Hung-Chieh Wu Chang,1 Li-Ren Chang1,61Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, 2Institute of Brain Science, National Yang-Ming University, 3Sleep Research Center, National Yang-Ming University, 4Department of Psychiatry, Cathay General Hospital, Taipei, 5Department of Psychiatry, National Taiwan University Hospital, 6Department of Psychiatry, Medical College, National Taiwan University, Taipei, TaiwanBackground: Health-related quality of life (HRQoL) remains poor among heroin users, even after being treated with methadone. Evidence regarding self-reported psychopathology and HRQoL in heroin users is also limited. The present study aimed to investigate the association between self-reported psychopathology and HRQoL in Asian heroin users treated with methadone.Methods: Thirty-nine heroin users treated with methadone and 39 healthy controls were recruited. Both groups self-reported on demographic data, the Brief Symptom Rating Scale, EuroQoL-5D, and World Health Organization Questionnaire on Quality of Life: Short Form. We compared clinical characteristics, psychopathology, and HRQoL between the two study groups. Correlation and regression analyses were conducted to explore the association between psychopathology and HRQoL in the heroin user group.Results: Heroin users had more psychopathology and worse HRQoL than healthy controls. The HRQoL of heroin users had significant correlations with Brief Symptom Rating Scale scores. HRQoL could be predicted by depression, anxiety, paranoia, and additional symptoms (ie, poor appetite and sleep difficulties) independently.Conclusion: Self-reported psychopathology, depression, anxiety, paranoia, poor appetite, and sleep difficulties had a negative impact on each domain of HRQoL among heroin users treated with methadone. The importance of the environmental domain of HRQoL is discussed. Clinicians should recognize comorbid psychiatric symptoms early on to improve HRQoL in heroin users.Keywords: heroin abuse, Brief Symptom Rating Scale, World Health Organization questionnaire on quality of life

Yi-Hui Lin,1 Li-Min Liou,2,3 Chiou-Lian Lai,1,2 Yang-Pei Chang1,2 1Department of Neurology, Kaohsiung Medical University Hospital, 2Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 3Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Purpose: The purpose of this report is to demonstrate a rare clinical manifestation of apraxia eyelid opening related to a basal ganglia lesion. Case report: In this study, we report a 91-year-old woman suffering from difficulty in eyelid opening after being treated for myocardial ischemia with dual antiplatelet medications. She could open her eyelid with fingers touching her forehead. Brain computed tomography revealed a right putamen hemorrhage. Surface electromyography revealed persistent frontalis muscle contraction during relaxation of orbicularis oculi muscles. Apraxia of eyelid opening was diagnosed. Her eyelid symptom resolved 2 months later. Conclusion: Apraxia of eyelid opening may be caused by subcortical hemorrhage of the basal ganglia. In addition to the primary motor cortex and supplemental motor area, the basal ganglia may also play a role in eyelid opening. Keywords: intracranial hemorrhage, basal ganglia, orbicularis oculi muscle, frontalis muscle