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Dedifferentiated liposarcoma is a high-grade entity developed from a preexisting or recurrent well-differentiated liposarcoma, and rarely, it may contain divergent differentiation. We presented the case of a 39-year-old woman with retroperitoneal dedifferentiated liposarcoma with heterologous low-grade osteosarcoma, possessing a special pattern of tumoral calcification.

Abstract Purpose Currently, there are no accurate markers for predicting potentially lethal prostate cancer (PC) before biopsy. This study aimed to develop urine tests to predict clinically significant PC (sPC) in men at risk. Methods Urine samples from 928 men, namely, 660 PC patients and 268 benign subjects, were analyzed by gas chromatography/quadrupole time-of-flight mass spectrophotometry (GC/Q-TOF MS) metabolomic profiling to construct four predictive models. Model I discriminated between PC and benign cases. Models II, III, and GS, respectively, predicted sPC in those classified as having favorable intermediate risk or higher, unfavorable intermediate risk or higher (according to the National Comprehensive Cancer Network risk groupings), and a Gleason sum (GS) of ≥ 7. Multivariable logistic regression was used to evaluate the area under the receiver operating characteristic curves (AUC). Results In Models I, II, III, and GS, the best AUCs (0.94, 0.85, 0.82, and 0.80, respectively; training cohort, N = 603) involved 26, 24, 26, and 22 metabolites, respectively. The addition of five clinical risk factors (serum prostate-specific antigen, patient age, previous negative biopsy, digital rectal examination, and family history) significantly improved the AUCs of the models (0.95, 0.92, 0.92, and 0.87, respectively). At 90% sensitivity, 48%, 47%, 50%, and 36% of unnecessary biopsies could be avoided. These models were successfully validated against an independent validation cohort (N = 325). Decision curve analysis showed a significant clinical net benefit with each combined model at low threshold probabilities. Models II and III were more robust and clinically relevant than Model GS. Conclusion This urine test, which combines urine metabolic markers and clinical factors, may be used to predict sPC and thereby inform the necessity of biopsy in men with an elevated PC risk.

Abstract Background No clear consensus has been reached on the reconstruction of long-segment or total ureter discontinuation. Here we present our experience using the Yang–Monti technique in total ureter reconstruction. Methods This study was a single-center retrospective study of patients who underwent Yang–Monti ileal whole ureter reconstruction (from the ureteropelvic junction[UPJ] to the ureterovesical junction). Data were collected on patients’ baseline characteristics, stricture etiology, the time interval between insult and surgical repair, pre/postoperative serum creatinine, estimated glomerular filtration rate (eGFR), split renal function, complications during admission and follow-ups, and the indwelling durations of JJ tubes and nephrostomy tubes, if presented. Results Seven patients underwent Yang–Monti ileal ureter reconstruction in 2010–2020 at our hospital. One of the patients underwent single-session bilateral ureter repair. Radiation therapy-related fibrosis and degloving injury were the most common etiologies for ureter injury. The median interval between ureter insult and operation was 8 months. The median follow-up was 36.7 months. The average operation time was 11.4 h, and the average blood loss was 273 ml. Postoperatively, no significant differences were found in serum creatinine, eGFR, or split renal function. As for postoperative complications, two patients experienced ileus and were treated conservatively. One patient had UPJ stenosis, which resolved after re-anastomosis surgery 11 months later. Metabolic acidosis or electrolyte imbalance was not reported. Conclusion We found that ileal replacement of total ureteral loss using the Yang–Monti principle is effective and durable. This is the largest cohort study conducted with more than 2 years of follow-up.

Objectives: This study aimed to characterize the plasmid-mediated quinolone resistance (PMQR) in fluoroquinolone nonsusceptible E. coli (FQNSEC) isolated from patients with urinary tract infections (UTIs) in 2019–2010 and 2020. Methods: A total of 844 E. coli isolates were collected from UTI patients at National Cheng Kung University Hospital. The antimicrobial susceptibility of E. coli isolates to 21 antibiotics was determined by disk diffusion tests. The distribution of phylogenetic groups, virulence factor, and PMQR genes was determined by PCR. Conjugation assays were performed to investigate the transferability of qnr genes from FQNSEC isolates to E. coli C600. Results: We found 211 (41.9%) and 152 (44.7%) E. coli isolates were FQNSEC in 2009–2010 and 2020, respectively. Phylogenetic group B2 was dominant in FQNSEC isolates (52.34%), followed by group F (10.47%), group B1 (9.64%), and group D (9.64%). FQNSEC isolates were more resistant to 17 of 19 tested antimicrobial agents, compared to the fluoroquinolone susceptible E. coli. PMQR screening results showed 34, 22, and 10 FQNSEC isolates containing aac(6′)-Ib-cr, qnr genes, and efflux pump genes (qepA or oqxAB), respectively. PMQR E. coli isolates were more nonsusceptible to gentamicin, amoxicillin, ampicillin/sulbactam, imipenem, cefazolin, cefuroxime, cefmetazole, ceftriaxone, ceftazidime, and cefepime compared to non-PMQR FQNSEC. Moreover, 16 of 22 qnr-carrying plasmids were transferrable to the recipient C600. Conclusion: Here, we reported the high prevalence of MDR- and XDR-E. coli in FQNSEC isolates. Moreover, qnr-carrying plasmids were highly transferable and led to the resistance to other classes of antibiotics in the transconjugants.

Abstract Background Urinary tract infection (UTI) is one of the most common outpatient bacterial infections. In this study, we isolated and characterized an extensively-drug resistant (XDR) NDM-5-producing Escherichia coli EC1390 from a UTI patient by using whole-genome sequencing (WGS) in combination with phenotypic assays. Methods Antimicrobial susceptibility to 23 drugs was determined by disk diffusion method. The genome sequence of EC1390 was determined by Nanopore MinION MK1C platform. Conjugation assays were performed to test the transferability of EC1390 plasmids to E. coli recipient C600. Phenotypic assays, including growth curve, biofilm formation, iron acquisition ability, and cell adhesion, were performed to characterize the function of EC1390 plasmids. Results Our results showed that EC1390 was only susceptible to tigecycline and colistin, and thus was classified as XDR E. coli. A de novo genome assembly was generated using Nanopore 73,050 reads with an N 50 value of 20,936 bp and an N 90 value of 7,624 bp. WGS analysis showed that EC1390 belonged to the O101-H10 serotype and phylogenetic group A E. coli. Moreover, EC1390 contained 2 conjugative plasmids with a replicon IncFIA (pEC1390-1 with 156,286 bp) and IncFII (pEC1390-2 with 71,840 bp), respectively. No significant difference was observed in the bacterial growth rate in LB broth and iron acquisition ability between C600, C600 containing pEC1390-1, C600 containing pEC1390-2, and C600 containing pEC1390-1 and pEC1390-2. However, the bacterial growth rate in nutrition-limited M9 broth was increased in C600 containing pEC1390-2, and the cell adhesion ability was increased in C600 containing both pEC1390-1 and pEC1390-2. Moreover, these plasmids modulated the biofilm formation under different conditions. Conclusions In summary, we characterized the genome of XDR-E. coli EC1390 and identified two plasmids contributing to the antimicrobial resistance, growth of bacteria in a nutrition-limited medium, biofilm formation, and cell adhesion.

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

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

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

Whether epidural anesthesia and analgesia (EA) is beneficial for postoperative cancer outcomes remains controversial and we conducted this historical cohort study to evaluate the association between EA and long-term outcomes following surgery for renal cell carcinoma (RCC). We collected patients receiving RCC surgery from 2011 to 2017 and followed up them until February 2020. Patient attributes, surgical factors and pathological features were gathered through electronic medical chart review. The association between EA and recurrence-free and overall survival after surgery was evaluated using Cox regression models with inverse probability of treatment weighting (IPTW) to balance the observed covariates. The median follow-up time for the 725 included patients was 50 months (interquartile range: 25.3–66.5) and 145 of them (20%) received perioperative EA. We demonstrated EA use was associated with better recurrence-free survival [IPTW adjusted hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.49–0.83, p < 0.001] and overall survival [IPTW adjusted HR: 0.66, 95% CI: 0.49–0.89, p = 0.006] in patients receiving surgical resection for RCC. More prospective studies are needed to verify this connection between EA and superior cancer outcomes after RCC surgery.

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

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

Summary: Neuroendocrine prostate cancer (NEPC) is a lethal prostate cancer subtype arising as a consequence of more potent androgen receptor (AR) targeting in castration-resistant prostate cancer (CRPC). Its molecular pathogenesis remains elusive. Here, we report that the Wnt secretion mediator Wntless (WLS) is a major driver of NEPC and aggressive tumor growth in vitro and in vivo. Mechanistic studies showed that WLS is a transcriptional target suppressed by AR that activates the ROR2/PKCδ/ERK signaling pathway to support the neuroendocrine (NE) traits and proliferative capacity of NEPC cells. Analysis of clinical samples and datasets revealed that WLS was highly expressed in CRPC and NEPC tumors. Finally, treatment with the Wnt secretion inhibitor LGK974 restricted NE prostate tumor xenograft growth in mice. These findings collectively characterize the contribution of WLS to NEPC pathogenesis and suggest that WLS is a potential therapeutic target in NEPC.

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

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

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

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

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

It is quite difficult to investigate thermal comfort in hot–humid regions, and there have not been many real case studies or research related to this issue. In this article, four running events held in nearby popular travel spots in Kaohsiung, the largest city in southern Taiwan, were selected to analyze the influence of thermal environment and air quality on thermal comfort. Mostly real time environmental monitoring data were applied for estimating thermal indicators, along with Sky View Factor (SVF) data taken at the sites of the running scheduled routes, to analyze the thermal performance of participants at running events. Compared with runners, walkers (local residents, fans, and staff of the events) would be exposed to a greater risk of thermal discomfort with increasing time spent on the routes. With the integrated analysis, mPET (modified physiologically equivalent temperature) can be viewed as a relatively comprehensive indicator in considering both environmental thermal conditions and the biometrical differences of activities and clothing types. From the results, a good correlation between mPET and solar radiation/SVF was obtained, which indicated that mPET could be sufficiently sensible in revealing the thermal condition variation from one site to another during the route with time. Based on the discomfort risk assessment, for runners, the event held in autumn with lower SVF at the route sites would be less risky of thermal discomfort, while the event held in spring with lower solar radiation would be more comfortable for walkers. As for air quality condition, the inappropriateness of holding winter outdoor activities in Kaohsiung was obviously shown in both real time monitoring data and long term analysis.

Numerous studies have examined the correlation between the number of attendants in a given outdoor environment and thermal indices to understand how the environmental planning has an impact on the users. However, extensive observations should be conducted to examine the detailed static and dynamic behavior patterns of users. We conducted dynamic observations at a stepped plaza to perform on-site measurements of the physical environment and observations of users behaviors, including their resting positions, movements, and stay durations. The results indicated that more people rested on the steps during the cool season than hot season. Compared to neutral temperatures, people demonstrated higher heat tolerance to the hot season. The results indicated that more than 75% of users preferred to remain in shaded areas and stayed longer than in the sunlight. The people tended to engage in static activities in environments that exhibit sufficient shading. The shaded areas were conducive to static activities as the summer grew hotter. The results verified that the people of Taiwan would avoid sunlight and desire shaded spaces based on their previous climate experiences and expectations, which can serve as a reference for outdoor space design to improve the usability and quality of open urban spaces.

Roughness length is a critical parameter for estimation of wind conditions, and it is therefore also relevant for the estimation of human thermal conditions in urban areas. The high density of buildings in urban areas causes large changes in land coverage, thereby increasing surface roughness. This influence atmospheric flow and also leads to a reduction in urban air ventilation, thus increasing the risk of human thermal stress. In this study, a digital building model of Tainan city was used to calculate roughness length using an approach based on Voronoi cells by applying the microclimate model, SkyHelios. The model was also used to estimate the wind conditions, including the wind speed and wind direction. For estimation of the thermal conditions, this study obtained meteorological data for air temperature, relative humidity, globe temperature, wind speed, and wind direction on two specific days (31 July 2015 and 21 January 2016). To quantify the thermal stress, the physiologically equivalent temperature (PET) was used to represent the thermal conditions. The wind conditions results obtained from the model indicate that even microscale conditions with vortices and corner flow can be represented with high precision and resolution. The thermal conditions results demonstrate that different created environments and microclimate conditions affect the thermal environment. The difference in PET can be up to 3 °C. This study confirmed that comparison of microclimate thermal conditions based on measurements and obtained from modeling using SkyHelios are in sufficient agreement and can be used in urban planning in the future.

People living in different climatic regions have adapted to specific weatherconditions and their tolerance to high temperatures and wind speeds is diverse. This studyanalyses the effect of thermal adaptations on the thermal perception of users of outdoorspaces in two different regions: Taichung (Taiwan) and Lisbon (Portugal), by means of fieldsurveys and measurements of weather parameters. The thermal acceptable range, representingthe satisfaction of people with thermal conditions, was calculated based on the PhysiologicalEquivalent Temperature (PET) and the results obtained for each region were compared.People in Lisbon are less satisfied with higher values of PET than in Taiwan, due tothe adaptation of local people to higher values of air temperature and relative humidity inTaiwan. On the contrary, people in Lisbon showed a higher tolerance to strong wind, as aresult of their exposure to higher average wind speeds than those in Taiwan. The resultsdemonstrated that people’s thermal perceptions vary with different climatic and culturalbackground. The influence of thermal adaptations in the use of outdoor spaces can contributeto improve the quality of these spaces, adapting them to the preferences of local users.

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