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In this study, we aimed to report our experience with the use of intraoperative transcutaneous laryngeal ultrasonography (TLUSG) to evaluate the vocal cord twitch response during predissection vagus nerve stimulation in thyroid surgeries and examine the reliability of this technique when compared with that of laryngeal twitch palpation (LTP).The prospective data collection of consecutive patients who underwent open thyroidectomy with intraoperative neuromonitoring (IONM) was reviewed retrospectively. We recorded the electromyographic activity and assessed the vocal cord twitch response on LTP, TLUSG. We compared the accessibility, sensitivity, and specificity of the techniques.A total of 110 patients (38 men and 72 women) with 134 nerves at risk were enrolled. The vocal cord was assessable by TLUSG in 103 (93.6%) patients and by LTP in 64 (59.1%) patients. Two patients showed negative predissection IONM signal but positive on TLUSG and the presence of laryngeal twitch response confirmed by laryngoscopy. Fourteen patients showed positive IONM signals and presence of the vocal cord twitch response on TLUSG but not on LTP. The sensitivity and specificity were 70.21% and 100%, respectively, for LTP, and those both were 100% for TLUSG. For patients who could be assessed using both techniques, TLUSG had better accuracy than LTP (100% vs 80.33%, p = 0.0005).The innovative intraoperative application of TLUSG is better for evaluating the laryngeal twitch response than LTP. This technique provides practical troubleshooting guidance for patients with no IONM signals during predissection vagus nerve stimulation.

Radiofrequency ablation (RFA) is a relatively safe and efficient alternative to surgery for patients with benign thyroid nodules. We investigated predictive factors associated with volume reduction using digital imaging analysis. In this retrospective study, a prospectively maintained database containing the data of patients who received treatment from April 2019 to March 2020 was analyzed. Computerized analysis for quantitative measurement of echogenicity, heterogeneity, and the proportion of cystic components was performed on ultrasonographic images. The volume reduction rate (VRR) was calculated during follow-up. Treatment efficacy was defined as a volume reduction greater than 50% of baseline volume. The median volume of 58 benign thyroid nodules before RFA was 22.7 mL. Of 53 nodules with sufficient follow-up, the median VRR was 46.4%, 61.5%, 63.4%, and 67.4% at 1, 3, 6, and 12 months, respectively. Overall, at one-year follow-up, treatment efficacy was achieved in 39 (74%) nodules. In a multivariate regression analysis, the proportion of cystic components and RFA treatment time were independently associated with treatment efficacy. A subgroup analysis focusing on solid nodules indicated a negative correlation between echogenicity and VRR. The proportion of cystic components in thyroid nodules is the main predictor of RFA treatment efficacy. In solid nodules, higher echogenicity is associated with a lower volume reduction.

This study investigated whether l-glutamine (Gln) and/or l-leucine (Leu) administration could attenuate muscle atrophy in a mouse model of cecal ligation and puncture (CLP)-induced sepsis.Septic mice were given a daily intraperitoneal injection of Gln, Leu, or Gln plus Leu, and mice were sacrificed on either day 1 or 4 after CLP. Blood and muscles were collected for analysis of amino acid contents and markers related to protein degradation, muscle regeneration, and protein synthesis.Leu treatment alone increased both muscle mass and total muscle protein content on day 4 after CLP. Gln administration reduced muscular Gln contents on day 1 and enhanced plasma Gln levels on day 4. Higher plasma branched-chain amino acid (BCAA) abundances and lower muscular BCAA levels were observed in Leu-treated mice on day 4. Gln and Leu individually suppressed muscle expressions of the E3 ubiquitin ligase genes, Trim63 and Fbxo32, on day 4 after CLP. As to muscle expressions of myogenic genes, both Gln and Leu upregulated Myog expression on day 1, but Leu alone enhanced Myf5 gene expression, whereas Gln plus Leu increased MyoD and Myog expression levels on day 4. Akt/mammalian target of rapamycin (mTOR) signaling was only activated by Gln and Leu when individually administered.Gln and/or Leu administration reduces sepsis-induced muscle degradation and promotes myogenic gene expressions. Leu treatment alone had more-pronounced effects on maintaining muscle mass during sepsis. A combination of Gln and Leu failed to show synergistic effects on alleviating sepsis-induced muscle atrophy.

This study compared the efficacies of enteral cholecalciferol and/or intravenous (IV) calcitriol administration on mesenteric lymph node (MLN) cluster-of-differentiation-4-positive (CD4+) T cell distribution and intestinal barrier damage in obese mice complicated with sepsis. Mice were fed a high-fat diet for 16 weeks and then sepsis was induced by cecal ligation and puncture (CLP). Mice were divided into the following sepsis groups: without vitamin D (VD) (S); with oral cholecalciferol 1 day before CLP (G); with IV calcitriol 1 h after CLP (V); and with both cholecalciferol before and IV calcitriol after CLP (GV). All mice were sacrificed at 12 or 24 h after CLP. The findings show that the S group had a higher T helper (Th)17 percentage than the VD-treated groups at 12 h after CLP. The V group exhibited a higher Th1 percentage and Th1/Th2 ratio than the other groups at 24 h, whereas the V and GV groups had a lower Th17/regulatory T (Treg) ratio 12 h post-CLP in MLNs. In ileum tissues, the VD-treated groups had higher tight junction protein and cathelicidin levels, and higher mucin gene expression than the S group at 24 h post-CLP. Also, aryl hydrocarbon receptor (AhR) and its associated cytochrome P450 1A1 and interleukin 22 gene expressions were upregulated. In contrast, levels of lipid peroxides and inflammatory mediators in ileum tissues were lower in the groups with VD treatment after CLP. These results suggest that IV calcitriol seemed to have a more-pronounced effect on modulating the homeostasis of Th/Treg subsets in MLNs. Both oral cholecalciferol before and IV calcitriol after CLP promoted cathelicidin secretion, alleviated intestinal inflammation, and ameliorated the epithelial integrity in obese mice complicated with sepsis possibly via VD receptor and AhR signaling pathways.

This study investigated the impacts of enteral cholecalciferol and/or intravenous calcitriol administration on the balance of cluster of differentiation 4-positive T cell subsets, the renin-angiotensin system (RAS), and the severity of acute lung injury (ALI) in obese mice with sepsis. Mice were fed a high-fat diet and then cecal ligation and puncture (CLP) was performed. Obese mice were divided into four sepsis groups: without vitamin D (VD) (S), with oral cholecalciferol 1 d before CLP (G), with intravenous calcitriol 1 h after CLP (V), and with both cholecalciferol before and intravenous calcitriol after CLP (GV). Mice were euthanized after CLP. The V and GV groups showed higher blood T helper (Th)1/Th2 and lower Th17/T regulatory (Treg) ratios than did the S and G groups. In the lungs, The V group had the lowest nuclear factor-κB and interleukin-1β gene expressions among all groups 24 h post-CLP. In parallel, gene expressions of angiotensin type 2 receptor (AT2R), angiotensin-converting enzyme 2 (ACE2), and Mas receptor (MasR) were highest in the V group compared to other groups. The protein levels of MasR in the GV group and the AT2R/AT1R ratio in the V group were higher than those in the G and/or S groups. All of the VD-treated groups had lower injury scores than the S group. These findings suggest that calcitriol administration had more-pronounced impacts on regulating the homeostasis of Th/Treg cells and is prone to RAS-associated anti-inflammatory pathway in the lungs. However, both forms of VD attenuated sepsis-induced ALI in obese animals.

Shape is one of the most important features in the diagnosis of malignant thyroid nodules. This characteristic has been described qualitatively, but only shapes that appear markedly different can be easily differentiated at first interpretation. This study sought to clarify whether software-based shape indexes are useful for the detection of thyroid cancers. In the final analysis, 200 participants with 231 pathologically proven nodules participated in the study. Ultrasound features were assessed by clinicians. The tumor contour was auto-defined, and shape indexes were calculated using commercial software. Of the 231 nodules, 134 were benign and 97 were malignant. The presence of taller-than-wide (TTW) dimensions differed significantly between the benign and malignant thyroid tumors. Designation of TTW assessed by the software had a higher kappa value and proportional agreement than TTW assessed by clinicians. Disagreement between the clinician and software in designating nodules as TTW occurred for 28 nodules. The presence of other ultrasonic characteristics and small differences in the height and width measurements were causes for the incorrect interpretation of the TTW feature. The proposed software-based quantitative analysis of tumor shape seems to be promising as an important advance compared with conventional TTW features evaluated by operators because it allows for a more reliable and consistent distinction and is less influenced by other ultrasonic features.

Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.

High-speed schlieren visualizations show that a composite reaction-shock cluster structure is formed in the last flame acceleration stage prior to detonation transition for ethylene/oxygen mixture in a narrow channel. The composite structure is bounded by a normal shock at the leading edge of the structure, and series of parallel oblique shocks interweave with reaction front on the other end in the cluster. Propagating velocity of the reaction front at the inception of the cluster is ∼ 45–50% of Chapman-Jouguet detonation velocity of the mixture. Reaction front accelerates rapidly after the formation of the reaction-shock cluster, and run into detonation in tens of microseconds except for very lean mixtures. The angle between the parallel oblique shocks in the cluster and the side wall, defined as ω-angle, is found to be constant for a specific mixture as the reaction wave propagates. Dependence of ω-angle on mixture equivalence ratio and channel size are investigated in the study. Analysis shows that DDT distance is linearly proportional to ω-angle, and an empirical correlation is derived.

For ultrasound imaging of thyroid nodules, medical guidelines are all based on findings of sonographic features to provide clinicians management recommendations. Due to the recent development of artificial intelligence and machine learning (AI/ML) technologies, there have been computer-assisted detection (CAD) software devices available for clinical use to detect and quantify the sonographic features of thyroid nodules. This study is to validate the accuracy of the computerized sonographic features (CSF) by a CAD software device, namely, AmCAD-UT, and then to assess how the reading performance of clinicians (readers) can be improved providing the computerized features. The feature detection accuracy is tested against the ground truth established by a panel of thyroid specialists and a multiple-reader multiple-case (MRMC) study is performed to assess the sequential reading performance with the assistance of the CSF. Five computerized features, including anechoic area, hyperechoic foci, hypoechoic pattern, heterogeneous texture, and indistinct margin, were tested, with AUCs ranging from 0.888~0.946, 0.825~0.913, 0.812~0.847, 0.627~0.77, and 0.676~0.766, respectively. With the five CSFs, the sequential reading performance of 18 clinicians is found significantly improved, with the AUC increasing from 0.720 without CSF to 0.776 with CSF. Our studies show that the computerized features are consistent with the clinicians’ findings and provide additional value in assisting sonographic diagnosis.

Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.

Summary: Background: Preoperative differentiation of follicular thyroid carcinoma (FTC) from follicular adenoma (FA) remains an unsolved puzzle. Patients sometimes undergo unnecessary lobectomy for histology confirmation inevitably. Objective: In this retrospective study, we propose new gray-scale ultrasonographic (US) features that may help to differentiate FTC from FA. Method: Medical charts and US images of follicular thyroid neoplasms were collected prospectively. Gray-scale US features including conventional parameters adding tubercle-in-nodule and trabecular formation were recorded. Results: The histopathologic diagnosis was FA in 139 and FTC in 49 patients. In patients with FTC, minimally invasive follicular carcinoma (MIFC) was seen in 36 patients and widely invasive follicular carcinoma (WIFC) in 13. The incidences of calcifications (p

Background: To evaluate the effectiveness and safety of radiofrequency ablation (RFA) treatment for benign thyroid nodules (BTNs) in five medical centers in Taiwan. Methods: From April 2016 to July 2020, 762 patients underwent ultrasound guided RFA treatment of 826 benign thyroid nodules at five medical centers in Taiwan. The RFA procedure was performed by radiologists, otolaryngologists, or surgeons. Patients were grouped into three subgroups according to the initial volume of BTNs. The volume reduction ratio (VRR) of each nodule, and complications were analyzed at 1, 3, and 6 months after RFA treatment and the three groups compared. Results: The large nodular group showed greater VRR compared to the other two groups at first 1-month follow-up. At 6-months follow-up, there was no significant difference of VRR among the three groups. Goiters with difference in size can attain a successful VRR (>50%) although different specialists demonstrated variable VRR after 6-months follow-up. A total of 40 (4.8%) complications were reported. All patients recovered spontaneously without surgery intervention. Conclusions: The reliability and safety of RFA for benign thyroid nodules had been established. RFA has gradually become an alternative to surgery in the treatment of benign thyroid nodules in Taiwan.

Radiofrequency ablation (RFA) is a relatively safe and efficient alternative to surgery for patients with benign thyroid nodules. We investigated predictive factors associated with volume reduction using digital imaging analysis.In this retrospective study, a prospectively maintained database containing the data of patients who received treatment from April 2019 to March 2020 was analyzed. Computerized analysis for quantitative measurement of echogenicity, heterogeneity, and the proportion of cystic components was performed on ultrasonographic images. The volume reduction rate (VRR) was calculated during follow-up. Treatment efficacy was defined as a volume reduction greater than 50% of baseline volume.The median volume of 58 benign thyroid nodules before RFA was 22.7 mL. Of 53 nodules with sufficient follow-up, the median VRR was 46.4%, 61.5%, 63.4%, and 67.4% at 1, 3, 6, and 12 months, respectively. Overall, at one-year follow-up, treatment efficacy was achieved in 39 (74%) nodules. In a multivariate regression analysis, the proportion of cystic components and RFA treatment time were independently associated with treatment efficacy. A subgroup analysis focusing on solid nodules indicated a negative correlation between echogenicity and VRR.The proportion of cystic components in thyroid nodules is the main predictor of RFA treatment efficacy. In solid nodules, higher echogenicity is associated with a lower volume reduction.

Surgical treatment for autoimmune thyroid disease is theoretically risky due to its chronic inflammatory status. This study aimed to investigate the correlation between preoperative serum migration inhibitory factor (MIF) levels and the difficulty of thyroidectomy in patients with autoimmune thyroiditis. Forty-four patients (average age: 54 years) were prospectively recruited: 30 with autoimmune thyroiditis and 14 with nodular goiter. Preoperative serum samples were collected to measure MIF levels. The difficulty of thyroidectomy was evaluated using a 20-point thyroidectomy difficulty scale (TDS) scoring system. The potential correlations between MIF levels and clinicopathological features as well as postoperative complications were analyzed. Preoperative serum thyroid-stimulating hormone (TSH), TSH receptor antibody, thyroid peroxidase antibodies levels, TDS score, and serum MIF levels were significantly higher in the autoimmune thyroiditis group than those in the goiter group. MIF levels were significantly associated with postoperative transient recurrent laryngeal nerve injury and hypoparathyroidism. MIF levels were positively correlated with TDS score, operation time, and blood loss in the autoimmune thyroiditis group. Increased preoperative serum MIF levels are associated with higher TDS scores, operation time, blood loss, and postoperative complications. Preoperative serum MIF level may be a useful predictor of difficult thyroidectomy and help surgeons provide better preoperative management.

CONTEXT Radiofrequency ablation (RFA) is a well-tolerated approach to treating benign thyroid nodules (TNs), but no index can predict its success. Other than size decrease, little is known about TN appearance on ultrasonography (US) after RFA. OBJECTIVE This study aimed to (a) assess the effectiveness of single-session RFA treatment, (b) determine whether pre-ablation US characteristics correlate with its effectiveness, and (c) demonstrate TN characteristics on baseline and follow-up US. DESIGN Retrospective cohort study among the patients who underwent single-session RFA for the treatment of benign TNs at a referral medical center between January 2018 and April 2019. PATIENTS A total of 116 patients (137 nodules) were included in the study. MEASUREMENTS Characteristics were quantified using commercial software. TNs were classified into 2015 American Thyroid Association (ATA) sonographic patterns and American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TI-RADS) categories. RESULTS The average volume reduction ratio (VRR) was 74.51% in 1 year (95% confidence interval, 70.63%-78.39%). The only pre-ablation US feature significantly different between nodules with VRR 50% was the cyst composition (0.05 vs. 0.02, p-value = .02). The VRR and margin change in the first 3 months after ablation were found to be leading indicators significantly correlated to the VRR in 6 months with correlation coefficients (r) = .72 and -.28 (p-value

ObjectivesDifferentiating thyroid nodules with a cytological diagnosis of follicular neoplasm remains an issue. The goal of this study was to determine whether ultrasonographic (US) findings obtained preoperatively from the computer-aided detection (CAD) system are sufficient to further stratify the risk of malignancy for this diagnostic cytological category.MethodsFrom September 2016 to September 2018 in our hospital, patients diagnosed with Bethesda category IV (follicular neoplasm or suspicion of follicular neoplasm) thyroid nodules and underwent surgical excisions were include in the study. Quantification and analysis of tumor features were performed using CAD software. The US findings of the region of interest, including index of composition, margin, echogenicity, texture, echogenic dots indicative of calcifications, tall and wide orientation, and margin were calculated into computerized values. The nodules were further classified into American Thyroid Association (ATA) and American College of Radiology Thyroid Imaging Reporting & Data System (TI-RADS) categories.Results92 (10.1%) of 913 patients were diagnosed with Bethesda category IV thyroid nodules. In 65 patients, the histological type of the nodule was identified. The quantitative features between patients with benign and malignant conditions differed significantly. The presence of heterogeneous echotexture, blurred margins, or irregular margins was shown to have the highest diagnostic value. The risks of malignancy for nodules classified as having very low to intermediate suspicion ATA, non-ATA, and high suspicion ATA patterns were 9%, 35.7%, and 51.7%, respectively. Meanwhile, the risks of malignancy were 12.5%, 26.1%, and 53.8% for nodules classified as TIRADS 3, 4, and 5, respectively. When compared to human observers, among whom poor agreement was noticeable, the CAD software has shown a higher average accuracy.ConclusionsFor patients with nodules diagnosed as Bethesda category IV, the software-based characterizations of US features, along with the associated ATA patterns and TIRADS system, were shown helpful in the risk stratification of malignancy.

Pancreatic adenocarcinoma (PDAC) is a leading cause of cancer-related death. Altered glycosylation contributes to tumor progression and chemoresistance in many cancers. C1GALT1 is the key enzyme controlling the elongation of GalNAc-type O-glycosylation. Here we showed that C1GALT1 was overexpressed in 85% (107/126) of PDAC tumors compared with adjacent non-tumor tissues. High expression of C1GALT1 was associated with poor disease-free and overall survival (n = 99). C1GALT1 knockdown using siRNA suppressed cell viability, migration, and invasion as well as increased gemcitabine sensitivity in PDAC cells. In contrast, C1GALT1 overexpression enhanced cell migration and invasion. In subcutaneous and pancreatic orthotopic injection models, C1GALT1 knockdown decreased tumor growth and metastasis of PDAC cells in NOD/SCID mice. Mechanistically, C1GALT1 knockdown dramatically suppressed cell-extracellular matrix (ECM) adhesion, which was associated with decreased phosphorylation of FAK at Y397/Y925 and changes in O-glycans on integrins including the β1, αv, and α5 subunits. Using functional blocking antibodies, we identified integrin αv as a critical factor in C1GALT1-mediated invasiveness of PDAC cells. In conclusion, this study not only reveals that C1GALT1 could be a potential therapeutic target for PDAC but also provides novel insights into the role of O-glycosylation in the α subunits of integrins.

Although most thyroid nodules (TNs) are benign and require only serial observation, some may need treatment for symptoms. Radiofrequency ablation (RFA) has been used and shown to be a promising and well-tolerated new approach. The efficacy of RFA is evaluated by using parameters such as volume reduction ratio (VRR), and cosmetic or symptomatic improvement. However, no index is now available to predict the therapeutic success before RFA. And apart from size reduction, little is known about their ultrasonography (US) appearances after RFA. The purpose of this study was to 1) assess the effectiveness of single session RFA treatment on volume reduction 2) determine if quantitative US characteristics are correlated to the VRR 3) demonstrate the US characteristics from the baseline and during the follow-up. Quantification of characteristics was performed using commercial software. The CAD software classified nodules into the 2015 ATA sonographic patterns and TIRADS categories. All patients underwent a single treatment session and with significant improvement in cosmetic and pressure symptoms. It shows that there is a direct correlation between the initial tumor size/cyst component percentage and VRR. The US characteristics are significant different after RFA, and the tumors were categorized to more suspicious ATA patterns and had higher TIRAD scores. In conclusion, RFA is effective on volume reduction and US characteristics correlated with therapeutic success. Post RFA US features may potentially mislead and clinicians should always keep in mind.

Physicians use sonographic characteristics as a reference for the possible diagnosis of thyroid cancers. The purpose of this study was to investigate whether physicians were more effective in their tentative diagnosis based on the information provided by a computer-aided detection (CAD) system. A computer compared software-defined and physician-adjusted tumor loci. A multicenter, multireader, and multicase (MRMC) study was designed to compare clinician performance without and with the use of CAD. Interobserver variability was also analyzed. Excellent, satisfactory, and poor segmentations were observed in 25.3%, 58.9%, and 15.8% of nodules, respectively. There were 200 patients with 265 nodules in the study set. Nineteen physicians scored the malignancy potential of the nodules. The average area under the curve (AUC) of all readers was 0.728 without CAD and significantly increased to 0.792 with CAD. The average standard deviation of the malignant potential score significantly decreased from 18.97 to 16.29. The mean malignant potential score significantly decreased from 35.01 to 31.24 for benign cases. With the CAD system, an additional 7.6% of malignant nodules would be suggested for further evaluation, and biopsy would not be recommended for an additional 10.8% of benign nodules. The results demonstrated that applying a CAD system would improve clinicians&rsquo, interpretations and lessen the variability in diagnosis. However, more studies are needed to explore the use of the CAD system in an actual ultrasound diagnostic situation where much more benign thyroid nodules would be seen.

A novel approach for assembling Al/CuO thermite consists of aluminum nanoparticles and cupric oxide nanowires has been successfully developed in this study. Aluminum nanoparticles were driven into gaps in the cupric oxide nanowires layer on a copper wire through electrophoretic deposition in this method. The cupric oxide nanowires along with oxide layers were grown on the copper wire via thermal oxidation, and the remaining copper core was the negative electrode that attracted aluminum particles carrying positive surface charges in the ethanol/water solution during electrophoretic deposition. A nanothermite shell enclosing the copper wire was obtained after the process. Considerable heat release from the thermite wire was observed starting from ∼400 °C in differential scanning calorimetry measurements. Exothermic solid–solid thermite reactions were fully ignited at 529 °C, and the heat release peaked at 566 °C. Above the melting temperature of aluminum, another heat release peak, which could be associated with reactions between liquid aluminum and the remaining oxides, was detected at 760 °C. Overall heat release of the nanothermite wire assembled with 80 V and 10 s electrophoretic deposition was 3108 J/g. Reaction propagation speed along the nanothermite wire with 10 s electrophoretic deposition was the highest at 43.8 cm/s, and longer deposition durations resulted in slower burning speeds.

BACKGROUND Breast cancer has a high incidence rate among women in Taiwan and worldwide. Advanced surgery and medical therapies have improved survival rates. Today, smartphones are popular and can be used to develop ubiquitous technology for disease self-management and to maintain patients’ quality of life. In Taiwan, a mobile health self-management support app with eight main features was developed to address breast cancer women’s information needs based on prior research using a design thinking approach. OBJECTIVE The aim of this study was to pilot test Taiwan breast cancer women’s acceptance of the app. METHODS An instrument with confirmed reliability and validity based on the modified technology acceptance model for mobile services and aesthetics preference of interface icons was used. Women with breast cancer were recruited to participate in the pilot test workshop and then answer survey questionnaires. Descriptive statistics and Spearman’s rank correlation coefficient method was used to analyze the data. RESULTS A total of 45 women participated the study. They were mostly aged 41-50(40%, 18/45), bachelor’s degree or equivalent (54.4%, 29/45), married (66.7%, 30/45), stage II breast cancer (37.8%, 17/45), had completed treatment (55.6%, 25/45) and received surgical treatment (93.3%, 42/45). The highest mean scores of user acceptance factors rated on the 5-point Likert scale was perceived ease of use (4.14, SD=0.42), followed by actual use (4.12, SD=0.57), perceived value (4.07, SD=0.62), user satisfaction (4.01, SD=0.51), intention to use (3.89, SD=0.58), and the lowest mean score was trust (3.89, SD=0.58). The Spearman’s rank correlation coefficient indicated positive associations between each factor and statistically significant correlations (p value CONCLUSIONS This study developed a smartphone app to predict Taiwan breast cancer women’s acceptance of mobile health technology for supporting disease self-management. The results suggest that patients positively accepted the app and would like it to be available in the future. However, data security and individual privacy protection features should be enhanced to increase users’ trust. In addition, the design of most interface icons was accepted by the participants which is consistent with their perceived ease of use of the app.

Background: There are very limited published data regarding the experience of extracorporeal membrane oxygenation (ECMO) after abdominal surgery. Our objective was to examine the clinical application and outcome of ECMO in patients deteriorating early after abdominal surgery. Methods: Between 1998 and 2018, patients who had ECMO implantation within 30 days after abdominal surgery were enrolled. Clinical outcomes, patient demographics, ECMO types and indications, laboratory findings and other relevant aspects of their medical histories were reviewed. Results: Sixteen patients aged between 20 and 77 years were enrolled, including 11 patients who underwent elective surgery and 5 who underwent emergency laparotomies. Six veno-arterial ECMO (VA-ECMO) and 10 veno-venous ECMO (VV-ECMO) devices were implanted for refractory hypotension or acute respiratory distress syndrome (ARDS) based on the clinical discretion of the attending physician. After timely diagnosis of the aetiology underlying the deterioration, 4 additional salvage interventions were allowed under ECMO support. Three VA-ECMO and 5 VV-ECMO patients were successfully weaned, while 5 patients (31.25%) survived to hospital discharge without significant sequelae. Patients who survived to discharge had a significant inotropic dose taper on day two after ECMO implantation (59.4 versus 1.3 mcg/kg/min, p = 0.0487). ECMO-related complications included 3 implantation wound haematomas, limb ischaemia requiring wound debridement and reperfusion catheter insertion. There was no intra-abdominal bleeding or major thromboembolic event in our series. Conclusions: ECMO gave surgeons additional chances to treat reversible cause of sudden patient collapse after the timely diagnosis of the cause. No patients in our cohort encountered serious ECMO-related complications. Our study demonstrated that ECMO may be used as a final back-up for sudden deterioration after abdominal surgery.

BACKGROUND Elevated cord blood IgE (cIgE), a predictor of atopic diseases, is influenced by genetic and environmental factors. However, gene-environment interactions on cIgE elevation and their difference by sex remain largely unexplored. OBJECTIVE This study aimed to determine whether there are sex-moderated interactions between genetic variants in the IL4/IL13 pathway and prenatal environments on cIgE elevation. METHODS Comprehensive information on environmental tobacco smoke (ETS), home dampness (indexed by combining mildewy odour, visible mould and water stamp on the wall) and other household environments was obtained using a structured questionnaire during the third trimester of pregnancy in 1107 full-term newborns. The cord blood was collected for measuring cIgE levels, with elevation defined as ≥0.5 IU/mL, and for genotyping of five single nucleotide polymorphisms of three candidate genes (IL-13 rs1800925, rs20541, rs848, IL-4 rs2243250 and STAT6 rs324011). RESULTS Gene-environment interactions on cIgE elevation were observed in male but not female newborns, including those between ETS and IL13 rs20541, between home dampness and STAT6 rs324011, and between composite environmental exposure (combined ETS and the three home dampness indices) and STAT6 rs324011 (P for interaction = 0.03, 0.006, and 0.001, respectively). Male newborns carrying STAT6 rs324011 CT or TT genotype manifested with a significant dose-response association of the composite environmental exposure with cIgE elevation. CONCLUSION AND CLINICAL RELEVANCE Sex moderates the gene-environment interactions involving IL4/IL13 pathway genes and prenatal household environments on cIgE elevation. The absence of prenatal exposure to ETS and home dampness in male neonates carrying the STAT6 rs324011 CT or TT genotype is least likely associated with cIgE elevation.

An adequate and continuous monitoring of operational variations can effectively reduce the uncertainty and enhance the quality of laboratory reports. This study applied the evaluation rule of the measurement system analysis (MSA) method to estimate the quality of work conducted in a biochemistry laboratory. Using the gauge repeatability & reproducibility (GR&R) approach, variations in quality control (QC) data among medical technicians in conducting measurements of five biochemical items, namely, serum glucose (GLU), aspartate aminotransferase (AST), uric acid (UA), sodium (Na) and chloride (Cl), were evaluated. The measurements of the five biochemical items showed different levels of variance among the different technicians, with the variances in GLU measurements being higher than those for the other four items. The ratios of precision-to-tolerance (P/T) for Na, Cl and GLU were all above 0.5, implying inadequate gauge capability. The product variation contribution of Na was large (75.45% and 31.24% in normal and abnormal QC levels, respectively), which showed that the impact of insufficient usage of reagents could not be excluded. With regard to reproducibility, high contributions (of more than 30%) of variation for the selected items were found. These high operator variation levels implied that the possibility of inadequate gauge capacity could not be excluded. The analysis of variance (ANOVA) of GR&R showed that the operator variations in GLU measurements were significant (F=5.296, P=0.001 in the normal level and F=3.399, P=0.015 in the abnormal level, respectively). In addition to operator variations, product variations of Na were also significant for both QC levels. The heterogeneity of variance for the five technicians showed significant differences for the Na and Cl measurements in the normal QC level. The accuracy of QC for five technicians was identified for further operational improvement. This study revealed that MSA can be used to evaluate product and personnel errors and to improve the quality of work in a biochemical laboratory through proper corrective actions.

Background In response to the problem of erroneous readings due to miscoding when performing self-monitoring blood glucose (SMBG), this study introduces a user-friendly SMBG biosensor with an innovative auto-coding module on the meter and strip. Actual users characterized the performance of the SMBG systems. Methods A total of 105 patients were incorporated in the study and Clarke error grid analysis (EGA) was administered to evaluate the clinical accuracy of the results obtained by the patients versus the technicians. All patients used the questionnaires to comment on the use of the auto-coding sensor. Results In the imprecision test, the total CV of the 5 BG levels was 2.1%. In the EGA plot, the results of the auto-coding sensor were 96.2%, both lots A and B, in zone A for the patients and 99.0% and 97.1% for the technician. The paired t-test demonstrated no statistically significant difference between the patient and technician measurements. Regression analysis also demonstrated that the measurements taken by the patients agreed with those obtained using the laboratory method. Conclusions The patients achieved satisfactory performance using the auto-coding SMBG sensor and derived similar results with both laboratory reference and operation by a technician.