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Background/aims: Anti-reflux mucosal ablation (ARMA) is a promising endoscopic intervention for proton pump inhibitor (PPI)-dependent gastroesophageal reflux disease (GERD). However, the effect of ARMA on esophageal motility remains unclear., Methods: Twenty patients with PPI-dependent GERD receiving ARMA were prospectively enrolled. Comprehensive self-report symptom questionnaires, endoscopy, 24-hour impedance-pH monitoring, and high-resolution impedance manometry were performed and analyzed before and 3 months after ARMA., Results: All ARMA procedures were performed successfully. Symptom scores, including GerdQ (11.16 ± 2.67 to 9.11 ± 2.64, P = 0.026) and reflux symptom index (11.63 ± 5.62 to 6.11 ± 3.86, P = 0.001), improved significantly, while 13 patients (65%) reported discontinuation of PPI. Total acid exposure time (5.84 ± 4.63% to 2.83 ± 3.41%, P = 0.024) and number of reflux episodes (73.05 ± 19.34 to 37.55 ± 22.71, P < 0.001) decreased significantly after ARMA. Improved esophagogastric junction (EGJ) barrier function, including increased lower esophageal sphincter resting pressure (13.89 ± 10.78 mmHg to 21.68 ± 11.5 mmHg, P = 0.034), 4-second integrated relaxation pressure (5.75 ± 6.42 mmHg to 9.99 ± 5.89 mmHg, P = 0.020), and EGJ-contractile integral (16.42 ± 16.93 mmHg·cm to 31.95 ± 21.25 mmHg·cm, P = 0.016), were observed. Esophageal body contractility also increased significantly (distal contractile integral, 966.85 ± 845.84 mmHg·s·cm to 1198.8 ± 811.74 mmHg·s·cm, P = 0.023). Patients with symptom improvement had better pre-AMRA esophageal body contractility., Conclusions: ARMA effectively improves symptoms and reflux burden, EGJ barrier function, and esophageal body contractility in patients with PPIdependent GERD during short-term evaluation. Longer follow-up to clarify the sustainability of ARMA is needed.

Introduction: Concerns have been raised that glucagon-like peptide 1 receptor agonists (GLP1-RAs) may increase the risk of thyroid cancer, but evidence remains conflicting. We therefore investigated if GLP1-RA use, compared with use of dipeptidyl peptidase-4 inhibitors (DPP-4is), was associated with thyroid cancer risk in patients with type 2 diabetes. Methods: This multisite cohort study with subsequent meta-analysis included six population-based databases from Canada (Ontario), Denmark, Norway, South Korea, Sweden, and Taiwan. Study populations comprised patients with type 2 diabetes between 2007 and 2023. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CIs) for thyroid cancer among GLP1-RA users compared with DPP-4is. Models were weighted using standardized mortality ratio weights generated from time-specific propensity scores. Site-specific HRs were pooled using a fixed-effects model. Results: We identified 98,147 users of GLP1-RA and 2,488,303 users of DPP-4i, with the median follow-up among users of GLP1-RA ranging from 1.8 to 3.0 years. Overall, use of GLP1-RA relative to use of DPP-4i was not associated with an increased risk of thyroid cancer (pooled weighted HR 0.81, CI 0.59-1.12). Similarly, we observed no increased risk in thyroid cancer with increasing cumulative dose of GLP1-RA among GLP1-RA ever-users. Subgroup analysis of types of thyroid cancer was not possible. Results remained consistent across a range of supplementary analyses. Discussion: In this large multisite study, utilizing data from six population-based databases, we found no evidence that GLP1-RA use is associated with an increased risk of thyroid cancer with follow-up ranging from 1.8 to 3.0 years, providing some reassurance to patients and clinicians about the short-term safety of these drugs. Nevertheless, evidence was insufficient to rule out excess risk with long-term use, due to the short follow-up.

Background: Hypoalbuminemia is a common complication in patients with chronic kidney disease (CKD) and is associated with various adverse clinical events. Currently, there are few studies focused on identifying risk factors and constructing models for hypoalbuminemia in patients with CKD stages 3 and 4. This study aims to identify independent risk factors for hypoalbuminemia in patients with CKD stages 3 and 4 and construct a nomogram for predicting the risk of hypoalbuminemia in these patients., Methods: A total of 237 patients with CKD stages 3 and 4 treated at Anning First People's Hospital from January to December 2023 were included. Univariate and bidirectional stepwise multivariate logistic regression analyses were used to identify independent risk factors for hypoalbuminemia in these patients. Based on the results of logistic regression analyses, a nomogram was constructed. The model performance was assessed using area under the receiver operator characteristic curve, calibration curves, and decision curve analysis., Results: Hemoglobin, red blood cells, serum sodium, and serum calcium were identified as independent risk factors for hypoalbuminemia in these patients. The contributions of each independent risk factor to hypoalbuminemia were visualized in a nomogram. The area under the receiver operator characteristic curve of the model was 0.819, indicating good discrimination. The calibration curves showed good agreement between predicted and observed outcomes. The decision curve analysis also verified that the model had the good clinical utility., Conclusion: Hemoglobin, red blood cells, serum sodium, and serum calcium were identified as independent risk factors of hypoalbuminemia in patients with CKD stages 3 and 4. The nomogram exhibits good discrimination, calibration, and clinical utility, offering a reliable tool for the early prediction and identification of hypoalbuminemia in these patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Jiang, Ma, Yuan, Liao, Duan, Wang and Duan.)

Background: The suicide risk in patients with atrial fibrillation receiving novel oral anticoagulants or warfarin has not been evaluated in real-world practice. Moreover, reducing vitamin K levels may increase the suicide risk, underscoring the importance of selecting appropriate oral anticoagulants to prevent unintended outcomes. Therefore, we aimed to evaluate the association between different types of oral anticoagulants and the risk of attempted and completed suicide among patients with atrial fibrillation., Methods: This nationwide study retrieved data from Taiwan's National Health Insurance Research Database from 2012 to 2020. This study included patients with atrial fibrillation aged 20 years and older who newly received oral anticoagulant treatment, and who had no contraindications for NOACs and no history of suicide-related events. The main outcomes were suicide-related outcomes, including attempted suicide and completed suicide. This study employed the target trial emulation framework to improve the causal inference for the observed association.  RESULTS: A total of 103,768 (71.74%) patients taking NOACs and 40,877 (28.26%) patients taking warfarin were included in this study. Compared to those receiving warfarin, patients receiving NOACs were associated with a lower risk of suicide-related outcomes (HR, 0.82; 95% CIs, 0.69-0.96)., Conclusions: The findings of this cohort study suggested that patients receiving NOACs were associated with a lower risk of suicidal attempts but similar risk of complete suicide, compared to those receiving warfarin. Considering the risk of suicide, NOACs could be the preferred anticoagulants for patients with atrial fibrillation., (© 2024. The Author(s).)

Background: Esophageal diverticulum (ED) is an uncommon structural disorder with heterogenous manifestations and elusive pathophysiology. Our aim was to investigate esophageal motility and associated symptom profiles in patients with ED based on high-resolution impedance manometry (HRIM)., Methods: Consecutive patients with ED referred to our motility laboratory between 2015 to 2022 were identified in our electronic database. All patients were evaluated based on an upper endoscopy, HRIM, and standardized symptom questionnaires. Patients with ED were further stratified into upper, middle, and lower (epiphrenic) cases. Esophageal motility was evaluated with HRIM and the updated Chicago Classification v4.0., Results: Twenty-four patients with ED (9 upper, 4 middle, and 11 epiphrenic) were analyzed. Patients with ED were generally older (mean: 65 ± 13.3 years) and predominantly women (58.3%). Most ED cases were unilaterally located (95.8%) and left-side predominant (62.5%). Mean symptom duration was 20 months (range: 1-120) and the most common symptoms were dysphagia (70.8%) and regurgitation (37.5%). Erosive esophagitis was noted in 16 patients (69.6%), while barium stasis was noted in 5 patients (20.8%). Fourteen patients (58.3%) were diagnosed with esophageal motility disorders using HRIM, with achalasia being the most common diagnosis (n = 5, 20.8%). Patients with epiphrenic diverticulum had significantly higher symptom scores and achalasia prevalence., Conclusion: Patients with ED tended to be older and was associated with a high prevalence of EMD. A multi-disciplinary evaluation, including complete anatomical and motility surveys, may help clarify the underlying pathophysiology and tailor further treatment strategies., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This paper discusses the feasibility of a monitoring program for the quality assurance status of activity meters. We sent a questionnaire to clinical nuclear medicine departments of medical institutions, requesting information on their activity meters and quality assurance practices. On-site visits were conducted with exemption-level standard sources (Co-57, Cs-137 and Ba-133) for dose calibrators in nuclear medicine departments including physical inspection, accuracy and reproducibility. A method offering a quick check on the detection efficiency of the space dimension inside the activity meters was also introduced. For dose calibrator quality assurance, the daily checks had the highest implementation. However, annual checks and upon acceptance/after a repair check were reduced to 50% and 44%, respectively. The accuracy results of dose calibrators showed that all models exceeded the ±10% criteria with Co-57 and Cs-137 sources. The reproducibility results showed that some models exceeded the ±5% criteria with Co-57 and Cs-137 sources. The appropriate application of exemption-level standard sources considering the uncertainty that affects the measurement is discussed., (© 2023 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.)

Background: Major symptoms of depression are commonly observed in patients requiring total hip arthroplasty (THA), and this is associated with increased pain scores and opioid consumption. We aimed to investigate the analgesic effect of duloxetine in these high-risk patients., Methods: Among 263 patients scheduled for primary unilateral THA, 67 patients who scored at least 8 on the 17-item Hamilton Depression Scale (HAMD) were enrolled in this study. Patients were randomized to the duloxetine group (60 mg daily, from the day of surgery to postoperative day 6) or the placebo group. The postoperative visual analog scale (VAS) score during walking, the VAS score during hip flexion, and resting VAS score was measured. Postoperative morphine consumption, hip range of motion (ROM), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, postoperative length of stay (LOS), and adverse events were recorded., Results: The duloxetine group had significantly lower VAS scores during walking and hip flexion from postoperative day 3 to week 3 than the placebo group. With regard to the resting VAS score, duloxetine showed a better analgesic effect from postoperative day 3 to week 2 than placebo. Patients in the duloxetine group had less consumption of morphine. The duloxetine group exhibited better hip function scores, including ROM, HHS, and WOMAC function scores than the placebo group. No significant difference was observed in LOS or adverse events between groups., Conclusion: Perioperative short-term duloxetine provides advantages in decreasing pain, reducing morphine consumption, and increasing hip function in THA patients who have depressive symptoms., (Copyright © 2022. Published by Elsevier Inc.)

Competing Interests: The authors declare that they have no conflict of interest.

Ethnopharmacological Relevance: Licorice, as a traditional Chinese herbal medicine, possessing the efficacies of invigorating spleen and replenishing qi, heat-clearing and detoxicating, phlegm-resolving and cough suppressant, relieving spasm and pain, and hamonizing actions of various medicines., Aim of the Study: The goal of this systematic review, which includes meta-analysis and network pharmacology in preclinical studies, is to investigate the multiple efficacies of licorice on ulcerative colitis (UC)., Materials and Methods: We searched several databases, e.g., Web of Science, Elsevier ScienceDirect and PubMed until Januanry 2022 for literature collection, and the Review Manager 5.3 was used to analyze the data. To synthesize the retrieved data, the fixed and random-effects models were utilized, respectively, and network pharmacology was applied to confirm the mechanisms., Results: Based on the result of meta-analysis, it suggested that the treatments of licorice extract and its active compounds showed strong therpeutic effects, which not only reflected the declining histological score, a index of the colitis severity [SMD = -2.86, 95% CI (-3.65, -2.08); P < 0.00001], but also reversed colonic shortness [WMD = 1.67, 95% CI (1.16, 2.19); P < 0.00001] between experimental UC model and licorice-treatment groups. In addition, it suggested the significant reduction of TNF-α level [SMD = -2.70, 95% CI (-3.23, -2.16); P < 0.00001], which acted as a crucial role in inflammatory response. Furthermore, from the results of network pharmacology, it indicated that anti-inflammation, anti-oxidative stress, immunomodulatory effect and microbiota homeostasis were the predominant therapeutic mechanisms of licorice extract and its active compounds treating UC., Conclusion: This systematic review with meta-analysis and network pharmacology demonstrates an efficient role of licorice extract and its active compounds in preclinical studies of UC, which provides supporting evidence for clinical trial implementation. However, there exist some limitations, such as technique quality decificency, missed reports due to negative outcome, failure to calculate sample size, and the risk of bias., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: There is scant literature on the evaluation of dislocation after total hip arthroplasty (THA) in patients with ipsilateral valgus knee deformity. This study aimed to investigate the post-operative dislocation rate in patients with valgus knee deformity who underwent ipsilateral THA and identify whether ipsilateral valgus knee deformity increases the dislocation rate after THA., Methods: We retrospectively reviewed patients with valgus knee deformity who underwent ipsilateral THA in our institution from January 2016 to December 2018. Each hip with ipsilateral valgus knee deformity was matched with a hip without valgus knee deformity according to sex, affected side, and date of surgery. The primary outcome was the dislocation rate after THA. Univariate analyses were initially used to compare data between the dislocation group and the non-dislocation group. Independent risk factors for dislocation were determined using multivariate logistic regression., Results: There were 257 THAs with ipsilateral valgus knee deformity (valgus knee group) and 257 THAs without valgus knee deformity (control group). The valgus knee group showed a significantly higher dislocation rate than the control group (9.7% versus 1.6%, p < 0.001). Older age (p = 0.020) and malposition of the acetabular cup (p = 0.048) were independent risk factors of post-operative dislocation., Conclusion: Patients with valgus knee deformity have a higher risk of dislocation after ipsilateral THA. If ipsilateral THA and total knee arthroplasty must be performed successively, total knee arthroplasty may have an earlier priority than THA., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

Aims: Scientific evidence imply the strong correlation between diabetes and breast cancer. Glucagon-like peptide-1 (GLP-1) and its analogue liraglutide, have been widely used for diabetes treatment. However, the role of GLP-1 receptor (GLP-1R) in breast cancer requires further elucidation. This study aimed to investigate the risk and the molecular mechanisms of liraglutide using in breast cancer., Materials and Methods: Quantitative real-time polymerase chain reaction, western blot or immunohistochemistry were used to detect the expressions of GLP-1R, NADPH oxidase 4 (NOX4) and vascular endothelial growth factor (VEGF) in human triple negative breast cancer (TNBC) cells (MDA-MB-231 and MDA-MB-468) and tissues derived from BALB/cfC3H mouse bearing 4T1 cells inoculation. Cell proliferation and migration was detected using the Cell Counting Kit-8, adenosine triphosphate assay, and transwell assay, respectively. Flow cytometry was used to measure the level of reactive oxygen species (ROS)., Key Findings: We found that the expression of GLP-1R increased after liraglutide treatment in breast cancer cells and the transplanted tumors. Liraglutide, at a slightly higher concentration, accelerated breast cancer progress in vitro (100 nM) and in vivo (400μg/kg) through the NOX4/ROS/VEGF signal pathway after activating GLP-1R. The GLP-1R inhibitor, Exendin (9-39), significantly inhibited the effect of liraglutide, inducing a reversed function of GLP-1R activation., Significance: Our study illustrated that in an approximately toxicology context, liraglutide may promote the malignant progression of TNBC. The dosage and the phenotype of the breast cancer should be considered as important factors for the rational administration of antidiabetic drugs, especially that of liraglutide in breast cancer patients., (Copyright © 2022. Published by Elsevier Inc.)

Malaysia like many other developing countries is facing the challenge of poor waste management. This research was conducted to determine the effect of black soldier fly (BSF) larvae in decomposing food waste, palm oil waste, fish waste and yard waste. The development time and waste reduction efficiency of four different organic materials were evaluated. In this study, BSF larvae were fed with all four types of waste at five feeding rates of 0.25, 0.50, 1.00, 1.50 and 2.00 g larva -1 day -1 with three replicates per feeding rate until the larvae reached the pre-pupae stage. During the study, larval development time, larval mortality, pre-pupae weight and waste reduction indexes (WRI) were determined. Food waste and yard waste achieved the highest WRI of 4.43 ± 0.06 and 0.71 ± 0.01, respectively at the feeding rate of 0.50 g larva -1 day -1 while palm oil waste and fish waste attained the highest WRI values at feeding rates of 1.00 g larva -1 day -1 (1.89 ± 0.02) and 0.25 g larva -1 day -1 (3.75 ± 0.24), respectively. The results showed that both variables significantly influenced the bioconversion process, but waste reduction efficiency was the most influential element., (© Penerbit Universiti Sains Malaysia, 2022.)

Background: Robot-assisted total knee arthroplasty (TKA) has been largely studied to confirm its advantages in terms of accurate component positioning, microembolus formation, less blood loss, and so on, but is currently usually performed under tourniquet due to its longer operative time than conventional TKA. The aim of this study was to estimate the effects of tourniquet use in robot-assisted TKA on blood loss, pain, functional recovery, and complications., Methods: Patients scheduled for robot-assisted TKA were prospectively randomized into a tourniquet or non-tourniquet group (each n = 14). The primary outcome measure was blood loss. The secondary outcome measures were operation time; visual analog scale (VAS) pain scores; time to achieve the first straight-leg raise; swelling of the thigh, knee, and calf; range of motion; Hospital for Special Surgery score; length of stay; and postoperative complications., Results: There was no significant difference in total blood loss between the tourniquet and non-tourniquet groups (738.57 ± 276.158 vs. 866.85 ± 243.422 ml, P = 0.061). The tourniquet group showed significantly lower intraoperative blood loss (P < 0.001), but higher hidden blood loss (P = 0.002). The non-tourniquet group showed better knee range of motion on postoperative days (PODs) 1-3 (all P < 0.001), less thigh swelling on PODs 2 and 3 (P < 0.05), earlier straight-leg raising (P = 0.044), and shorter length of stay (P = 0.044). Thigh pain VAS score at 1 month after surgery was significantly greater in the tourniquet group (P < 0.001), as was knee pain during activity and at rest on PODs 2-3 (all P < 0.05). The tourniquet group also showed a significantly higher rate of tension blisters (28.8% vs. 7.1%, P = 0.038)., Conclusions: Tourniquet use during robot-assisted TKA does not reduce total blood loss, and it appears to increase postoperative pain, aggravate muscle injury, and prolong postoperative recovery. Trial registration ChiCTR, ChiCTR2100041800. Registered 5 January 2021, http://www.chictr.org.cn/index.aspx ., (© 2022. The Author(s).)

Objective: To evaluate the association between radiation exposure from repeated nuclear medicine (NM) examinations and the subsequent risk of neoplasm in pediatric patients. Methods: From 2000 to 2017, participants under 18 years of age who underwent NM scanning were identified using the Health and Welfare Data Science Center (HWDC) dataset, which was extracted from the Taiwan National Health Insurance Research Database (NHIRD). Both the exposed cohort and unexposed subjects were followed up with until the presence of any malignancy arose, including malignant brain, lymphoid and hematopoietic tumors and benign brain or other central nervous tumors. Results: There were 35,292 patients in the exposed cohort and 141,152 matched subjects in the non-exposed group. The exposed cohort had an overall higher IR (IR: incidence rate, per 100,000 person-years) of any malignancy and benign central nervous tumor than the non-exposed group [IR, 16.9 vs. 1.54; adjusted hazard ratio (HR), 10.9; 95% CI, 6.53-18.2]. Further stratifying the number of NM examinations into 1-2, 3-4, and 5 or more times revealed that the IR of pediatric neoplasms increased gradually with the increased frequency of NM examinations (IR, 11.5; adjusted HR, 7.5; 95% CI, 4.29-13.1; IR, 25.8; adjusted HR, 15.9; 95% CI, 7.00-36.1; IR, 93.8; adjusted HR, 56.4; 95% CI, 28.8-110.3). Conclusion: NM examination is significantly associated with a higher risk of pediatric neoplasms, according to our population-based data. Thorough radiation protection and dose reduction in pediatric NM procedures should be an issue of concern., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Yuan, Chang, Yuan, Foo, Chan, Wang, Lin, Hsu and Kao.)

Background: Previous studies have demonstrated the efficacy of duloxetine in reducing postoperative pain and opioid consumption. However, the effect of duloxetine on total hip arthroplasty (THA) remains unclear. The objective of this study was to assess the efficacy of oral duloxetine in THA., Methods: We enrolled 96 patients in this randomized controlled trial. These patients were randomized (1,1) to either the duloxetine group or the placebo group and received daily doses of 60 mg duloxetine or placebo, respectively, from 2 d pre-operation to 14 d after surgery. The primary outcome was pain severity upon movement measured by a visual analogue scale (VAS). The secondary outcomes included VAS scores for resting pain, morphine consumption, Harris Hip Score, patient satisfaction at discharge, length of postoperative hospital stay, and adverse events., Results: Patients in the duloxetine group had significantly lower pain severity scores upon movement within 3 postoperative weeks (p < 0.05) while none of the differences met the minimum clinically important difference (MCID). Moreover, patients in the duloxetine group performed better in terms of resting pain (in 3 weeks after surgery), morphine requirements, and satisfaction level at discharge (all p < 0.05). There was no difference between groups in the prevalence of adverse events., Conclusions: Although it did not result in a clinically meaning reduction in pain after total hip arthroplasty, perioperative administration of 60 mg of duloxetine daily significantly alleviated pain in the postoperative 3 weeks and morphine requirements during the postoperative 48 h. Therefore, duloxetine still shows promise in optimizing the multimodal pain-management protocols in total hip arthroplasty., Trial Registration: Chinese Clinical Trial Registry, ChiCTR2000033606 , 06/06/2020.

Objective: The effect of patellar denervation with electrocautery (PD) on anterior knee pain (AKP) after total knee arthroplasty (TKA) is still debated. The aim of this meta-analysis was to evaluate the current evidence regarding the use of PD in TKA without patellar resurfacing., Methods: A computerized search of published studies was performed in the PubMed, Embase and Cochrane Library databases in December 2019. Eligible studies were randomized controlled trials (RCTs) comparing clinical outcomes of the PD group and the non-PD group. Subgroup analyses were carried out according to the follow-up time (3, 12 months, and over 12 months) to evaluate whether the clinical effect of PD changed with time., Results: Ten RCTs were included in this meta-analysis. Pooled results showed a lower rate of AKP (Risk Ratio [RR] = 0.70; 95% confidence interval [CI], 0.50 to 0.97; P = 0.03) and a reduction in visual analogue scale (VAS) for AKP (mean difference, -0.37; 95% CI, -0.69 to -0.05; P = 0.02) in the PD group when compared to the non-PD group. Subgroup analyses found the differences in AKP incidence and VAS for AKP were significant at 3- and 12-month follow-up but not after 12-month follow-up. No significant difference was observed in functional scores between the two groups. No specific complication directly or indirectly related to PD was found., Conclusion: PD can decrease the incidence and severity of AKP within 12 months after TKA, but the effect cannot be maintained after 12-month follow-up. Without significant associated complication and reoperation, the use of PD is still recommended in TKA without patellar resurfacing., (© 2020 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Purpose: The dicentric chromosome assay (DCA), the gold standard for radiation biodosimetry, evaluates an individual absorbed radiation dose by the analysis of DNA damage in human lymphocytes. The conventional (C-DCA) and QuickScan (QS-DCA) scoring methods are sensitive for estimating radiation dose. The Biodosimetry Laboratory at Institute of Nuclear Energy Research (INER), Taiwan, participated in intercomparison exercises conducted by Health Canada (HC) in 2014, 2015 and 2018 to validate the laboratory's accuracy and performance., Material and Methods: Blood samples for the conventional dose response curve for Taiwan were irradiated with 0, 0.25, 0.5, 1, 2, 3, 4 and 5 Gy. Ten blind blood samples were provided by HC. Either or both of two methods of conventional (C) or QuickScan (QS) scoring could be chosen for the HC's intercomparison. For C-DCA triage scoring, only cells with 46 centromeres were counted and each scorer recorded the number of dicentrics in the first 50 metaphases or stopped scoring when 30 dicentrics were reached. Scorers also recorded how much time it took to analyze 10, 20, and 50 cells. Subsequently, the data were entered into the Dose Estimate software (DoseEstimate&#95;v5.1) and dose estimates were calculated. With QS-DCA scoring, a minimum of 50 metaphase cells (or 30 dicentrics) were scored in apparently complete metaphases without verification of exactly 46 centromeres., Results: For the blinded blood samples irradiated at HC and shipped to INER, the mean absolute deviation (MAD) derived after scoring 50 cells for C-DCA and QS-DCA was <0.5 Gy for all three intercomparisons, meeting the criteria for acceptance., Conclusion: The results indicated that the Biodosimetry Laboratory at INER can provide reliable dose estimates in the case of a large-scale radiation accident.

Background: With the use of tranexamic acid and control of the blood pressure during the operation, total knee arthroplasty (TKA) without tourniquet can be achieved. There is no exact standard for the control level of blood pressure during no tourniquet TKA. We explored the optimal level of blood pressure control during no tourniquet TKA surgery with the use of tranexamic acid in this study., Methods: Patients underwent TKA were divided into three groups: the mean intraoperative systolic blood pressure in group A was < 90 mmHg, 90-100 mmHg in group B, > 100 mmHg in group C. Total blood loss (TBL), intraoperative blood loss, hidden blood loss, transfusion rate, maximum hemoglobin drop, operation time, and postoperative hospitalization days were recorded., Results: Two hundred seventy-eight patients were enrolled, 82 in group A, 105 in group B, and 91 in group C. Group A (663.3 ± 46.0 ml) and group B (679.9 ± 57.1 ml) had significantly lower TBL than group C (751.7 ± 56.2 ml). Group A (120.2 ± 18.7 ml) had the lowest intraoperative blood loss than groups B and C. Group C (26.0 ± 4.1 g/l) had the largest Hb change than groups A and B. Group A (62.3 ± 4.7 min) had the shortest operation time. The incidence rate of postoperative hypotension in group A (8, 9.8%) was significantly greater than groups B and C. No significant differences were found in other outcomes., Conclusion: The systolic blood pressure from 90 to 100 mmHg was the optimal strategy for no tourniquet primary TKA with tranexamic acid.

Several brain tumors is closely related to the disorder of chromatin histone modification, whereas the epigenetic mechanisms of the incidence of highly malignant adult glioma is not yet deeply studied. Deletion or mutation of the MEN1 gene, which encodes the epigenetic regulator menin, specifically induces poorly differentiated neuroendocrine tumors; however, the biological and clinical importance of MEN1 in the nervous system remains poorly understood. Menin expression was robustly activated in 44.4% of adult gliomas. Abnormally high expression of menin was closely related to a shorter median survival time of 20 months, a larger tumor volume and a higher percentage of Ki67 staining. Interestingly, menin expression was also activated in the cytoplasm of tumor cells (38.8%) and was also closely related to the poor prognosis of patients with glioma. Importantly, in a screening of 96 types of small-molecule targeted histone modification regulators, menin inhibitors were found to significantly block the proliferation of adult glioma cells. Our findings confirm that menin is a potential biomarker of poor prognosis in adult gliomas, independent of the WHO grade. Targeting menin may effectively inhibit certain gliomas, and this information provides novel insight into therapeutic strategies for glioma.

Background: Revision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. The purpose of this study is to report the minimum 8-year clinical and radiographic results of revision THA with severe femoral bone defects treated with extensively porous-coated stems and cortical strut allografts., Methods: We retrospectively identified 44 patients diagnosed with Paprosky type III and IV femoral bone defects between January 2006 and July 2011. The exclusion criteria were patients not eligible for surgery, revised with extensively porous-coated stems alone, lost to follow-up and deceased. A total of 31 patients treated with extensively porous-coated stems and cortical strut allografts were finally included in this study. The degree of femoral bone defects was categorized as Paprosky type IIIA in 19 patients, type IIIB in 9 patients and type IV in 3 patients. The mean duration of follow-up was 11.0 ± 1.5 (range, 8.1-13.5) years., Results: The mean Harris Hip Score improved significantly from 43.4 ± 10.5 points to 85.2 ± 6.6 points (P < 0.001). Similarly, WOMAC and SF-12 scores also significantly improved. Twenty-eight stems achieved stable bone ingrowth, two stems showed stable fibrous ingrowth, and one stem was radiologically unstable. Complete union and bridging between cortical strut allografts and host bone was achieved in all 31 patients. The femoral width was augmented with cortical strut allografts after revision surgery (an increase of 10.5 ± 0.5 mm) and showed a slight decrease of 2.5 ± 4.8 mm after the 10-year follow-up. Using re-revision for any reason as an endpoint, the Kaplan-Meier cumulative survival rate of the stem was 96.2% (95% confidence interval, 75.7-99.5%) at 10 years., Conclusion: Our data demonstrate that the use of extensively porous-coated stems combined with cortical strut allografts in revision THA with Paprosky type III and IV femoral bone defects can provide satisfactory clinical and radiographic outcomes with a minimum follow-up of 8 years.

109 Cd is quite a useful nuclide for the calibration of X-ray spectroscopy, gamma-ray spectroscopy or as an excitation source in X-ray fluorescence. In this work, 4π(PC)e-X coincidence counting and 4π(LS)ce counting were used to determine the activity of the 109 Cd solution. The two methods showed good agreement in their counting results. On the other hand, the mean value came from the results of the two methods was used to calibrate the well type ionization chambers to maintain the radioactivity measurement standard of 109 Cd at INER., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

An international key comparison, identifier CCRI(II)-K2.Ge-68, has been performed. The National Institute of Standards and Technology (NIST) served as the pilot laboratory, distributing aliquots of a 68 Ge/ 68 Ga solution. Results for the activity concentration, C A , of 68 Ge at a reference date of 12h00 UTC 14 November 2014 were submitted by 17 laboratories, encompassing many variants of coincidence methods and liquid-scintillation counting methods. The first use of 4π(Cherenkov)β-γ coincidence and anticoincidence methods in an international comparison is reported. One participant reported results by secondary methods only. Two results, both utilizing pure liquid-scintillation methods, were identified as outliers. Evaluation using the Power-Moderated Mean method results in a proposed Comparison Reference Value (CRV) of 621.7(11)kBqg -1 , based on 14 results. The degrees of equivalence and their associated uncertainties are evaluated for each participant. Several participants submitted 3.6mL ampoules to the BIPM to link the comparison to the International Reference System (SIR) which may lead to the evaluation of a Key Comparison Reference Value and associated degrees of equivalence., (Published by Elsevier Ltd.)

Treatment of hyperglycemia with drugs that block renal glucose reabsorption via inhibition of sodium-dependent glucose cotransporter 2 (SGLT2) is a novel approach to diabetes management. In this study, twenty-seven aryl C-glycosides bearing a C=N/C-N linkage at the glucosyl C6 position were designed, synthesized and evaluated for their inhibitory activity against human SGLT2 (hSGLT2). Compounds with good hSGLT2 inhibition were further investigated to determine their selectivity over hSGLT1. Of these, five representative aryl C-glycosides were chosen for pharmacokinetic analysis. Oxime 2a was determined to have the most promising pharmacokinetic properties and was selected for in vivo glucosuria and plasma glucose level studies, which found it to exhibit comparable efficacy to dapagliflozin (1). Furthermore, 2a was not found to exhibit either significant cytotoxicity (CC 50  > 50 μM) or human ether-a-go-go related gene (hERG) inhibition (2% inhibition at 10 μM). Taken together, these efforts culminated in the discovery of oxime 2a as a potential SGLT2 inhibitor., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

We performed real-time myocardial contrast echocardiography on a patient with cardiac amyloidosis and previous normal coronary angiography presenting with atypical chest pain to assess myocardial blood flow reserve (MBFR). Myocardial contrast echocardiography was performed and flash microbubble destruction and replenishment analysis was used to calculate myocardial blood flow. Dipyridamole was used to achieve hyperemia. MBFR was derived from the ratio of peak myocardial blood flow at hyperemia and rest. The results show a marked reduction in MBFR in our patient. Previous reports of luminal obstruction of intramyocardial rather than epicardial vessels by amyloid deposition may be causing microvascular dysfunction.

The National Radiation Standard Laboratory of Taiwan organized in 2014 a comparison exercise by distributing 210 L drum-typed samples to seven radioactive waste analysis laboratories in Taiwan. Four drums were filled with uniformly distributed active carbon, water, resin and concrete, respectively and five drums were filled with cracked metals and heterogeneously distributed radioactive sources. Measurement uncertainties of participants results are in the range 3–40% (k=2) and about 96% of the reported results produced En values (ISO, 1997) smaller than one for drums with activity uniformly distributed. The minimum discrepancies, expressed as Bi values (ISO, 1997), of drums with heterogeneously distributed 137Cs and 60Co were 0.34 and 0.17, respectively.

In this study, two kinds of reference drums were developed. One type was constructed with nine layers of large-area sources filled with different materials having five different densities. The other type of reference drums was constructed with nine rod sources filled with the same materials of different densities. The efficiency calibration of a plastic scintillation counter in 4π counting geometry using these two kinds of drums showed that rod-source drums resulted in higher counting efficiency than layered source drums. The counting rates obtained from rod-source drums were closer to those obtained from a standard drum with water solution than counting rates from drums with layered sources. The results of this study recommend to use reference drums with rod-sources to compensate the drawbacks of standard drums with water solution of not being able to adjust the density of material. The proposed reference drums improve the accuracy of radioactivity analysis for waste drums of different densities., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Standard Bonner spheres and proposed high-sensitivity Bonner cylinders were calibrated in a neutron calibration room, using a (252)Cf source. The Bonner sphere system consists of 11 polyethylene (PE) spheres of various diameters and 4 extended spheres that comprise embedded metal shells. Similar to the design of Bonner spheres, a set of Bonner cylinders was assembled using a large cylindrical (3)He tube as the central probe, which was wrapped using various thicknesses of PE. A layer of lead was employed inside one of the PE cylinders to increase the detection efficiency of high-energy neutrons. The central neutron probe used in the Bonner cylinders exhibited an efficiency of ∼17.9 times higher than that of the Bonner spheres. However, compared with the Bonner spheres, the Bonner cylinders are not fully symmetric in their geometry, exhibiting angular dependence in their responses to incoming neutrons. Using a series of calculations and measurements, this study presents a systematic comparison between Bonner spheres and cylinders in terms of their response functions, detection efficiencies, angular dependences and spectrum unfolding., (© The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

This report described a radioactive waste reference drum which was established with large-area sources and metal slices. This reference drum could be applied in calibration or testing of drum counting systems having 4π counting geometry and being made with plastic scintillators. This metal reference drum has the advantages of easy operation, low natural background and it also has agreeable measurement efficiency calibration curves for the drum counting system as the non-metal reference drum studied previously. On the other hand, this study explored the counting efficiency variations of the drum counting system by simulations of the metal reference drum being filled with wastes up to different heights within the drum. With the exploration, it is feasible to correct the measurement errors caused by different quantities of waste filling., (© 2013 Published by Elsevier Ltd.)

Objective: To study the drainage proportions from the corpora cavernosa in defrosted human cadavers, as the veins related to penile erection were recently depicted to comprise the deep dorsal vein (DDV), a pair of cavernous veins (CVs) and two pairs of para-arterial veins (PAVs), as opposed to a single DDV between Buck's fascia and the tunica albuginea of the human penis., Materials and Methods: With no formalin fixation, 10 defrosted male human cadavers were used for this study. After injecting a 10% solution of colloid, and with the intracavernous pressure (ICP) fixed at 90 mmHg, the perfusion rate was recorded before and after the DDV, CVs and PAVs were removed, respectively. Finally, measurements were again recorded after penile arterial ligation. Cavernosography was used if required., Results: The mean (range) perfusion rate for maintaining the ICP at 90 mmHg was 30.2 (15.5-90.8) mL/min, whereas the arterial perfusion rate was 2.8 (0.3-3.9) mL/min. The mean (range) drainage proportion of the corpora cavernosa was 60.5 (50.3-69.7)%, 11.9 (5.8-22.9)% and 11.4 (5.2-15.0)% via the DDV, CVs and PAVs, respectively. The remaining drainage proportion was 15.6 (14.1-18.1)%. This study shows the separate drainage contributions of the DDV, CVs and PAVs to the corpora cavernosa of the human penis., Conclusion: We conclude that the venous drainage system of the corpora cavernosa is much more complex than the previous depictions of it, and the consequent focus on a single DDV. This also shows the independent role of each venous system.

Objective: Medical radiation-induced cataracts, especially those resulting from head and neck CT studies, are an issue of concern. The current study aimed to determine the risk of cataract associated with repeated radiation exposure from head and neck CT., Materials and Methods: This study used information from a random sample of 2 million persons enrolled in the nationally representative Taiwan National Health Insurance Research Database. Exposed cases consisted of patients with head and neck tumor 10-50 years old who underwent at least one CT between 2000 and 2009. The nonexposed control group was composed of subjects who were never exposed to CT studies but who were matched by time of enrollment, age, sex, history of coronary artery disease, hypertension, and diabetes., Results: There were 2776 patients in the exposed group and 27,761 matched subjects in the nonexposed group. The exposed group had higher overall incidence of cataracts (0.97% vs 0.72%; adjusted hazard ratio [HR], 1.76; 95% CI, 1.18-2.63). Further stratifying the number of CT studies in the exposed group into one or two, three or four, and five or more revealed that cataract incidence increased gradually with increasing frequency of CT studies (0.79%, 0.93%, and 1.45%, respectively) (p=0.001, adjusted for trend). Radiation exposure due to repeated head and neck CT studies was independently associated with an increased risk of developing cataracts when the cumulative CT exposure frequency involved more than four studies (adjusted HR, 2.12; 95% CI, 1.09-4.14)., Conclusion: Repeated exposure to head and neck CT is significantly associated with increased risk of cataract.

In 2010, the National Radiation Standard Laboratory held a proficiency test for measurement and analysis of clearance mixed-nuclide samples. Two types of samples, box-shape and drum-shape, containing (60)Co and (137)Cs mixed solutions were measured by the participating laboratories and their results were then compared with the reference values. Seven participants used plastic scintillator counting systems and two participants used HPGe spectrometer systems to join in this study, obtaining 40 measurement results. The evaluation results showed that all the participants passed the requirements of this proficiency test, E(n)≦1, and the discrepancy was between -25% and 50%., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

A procedure using liquid scintillation counting for the monitoring of gross alpha and beta activities in environmental water was implemented to improve the conventional procedure using GFPC adopted in Taiwan. The new procedure was acquired through calibration and validation, and then was applied to the monitoring of surface water in Taiwan. This procedure can improve 2-4 times of detection efficiencies and takes only 70-80% of analysis time with reliable accuracy. With these features, the newly developed procedure is favorable during emergency situations., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Performance tests of a movable gamma-ray waste drum scanning system were carried out in this study. The scanner consists of a single HPGe detector on a movable cart with a 90° collimation angle to the observed item. The detection efficiency for (137)Cs was determined using the ISOTOPIC software. The activities of 35 low-level radioactive waste drums were measured using this system and compared with the results of two other measurement systems. This movable scanning system gave the same result as the other two systems with a relative spread (one standard deviation) of about 7.2%., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

This study reports the preparation of four varieties of water extract from sweet potato leaves from Taiwan, including TNG10, TNG57, TNG66 and YSP, and evaluates their antioxidative activity. The EC50 values (scavenging DPPH radicals) of TNG10, TNG57, TNG66 and YSP were 0.27±0.01, 0.19±0.01, 0.41±0.02, and 0.31±0.02mg/ml, respectively, on a freeze-dry weight basis. The total phenolic contents of these water extracts were in the order: TNG57>TNG10>TNG66>YSP. The TNG10 and TNG57 extracts exhibited better reducing power and scavenging effects of superoxide radicals than did TNG66 and YSP. At a concentration of 1mg/ml, TNG10 and TNG57 significantly protected HaCaT cells from H2O2-induced cytotoxicity. The water extracts of YSP had more flavonoids than had those of TNG66 which may have contributed to their higher activity in many antioxidative assays. These results suggest that the water extracts of all four varieties of sweet potato leaves, and especially TNG10 and TNG57, display potent antioxidative effects., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

A novel series of N-linked β-D-xylosides were synthesized and evaluated for inhibitory activity against sodium-dependent glucose cotransporter 2 (SGLT2) in a cell-based assay. Of these, the 4-chloro-3-(4-cyclopropylbenzyl)-1-(β-D-xylopyranosyl)-1H-indole 19m was found to be the most potent inhibitor, with an EC(50) value similar to that of the natural SGLT2 inhibitor phlorizin. Further studies in Sprague-Dawley (SD) rats indicated that 19m significantly increased urine glucose excretion in a dose-dependent manner with oral administration. The antihyperglycemic effect of 19m was also observed in streptozotocin (STZ) induced diabetic SD rats. These results described here are a good starting point for further investigations into N-glycoside SGLT2 inhibitors.

A proficiency testing feasibility study program was proposed by the National Radiation Standard Laboratory (NRSL) of Taiwan to understand the capabilities of laboratories dealing with clearance measurements, and to issue related technical criteria for radioactive waste assay. In this program, twelve blind test samples with different levels of radioactivity, radionuclides and different packing densities were prepared. Seven laboratories participated in this program and fourteen instruments were tested. Participants were required to report their raw data to NRSL, which would evaluate the effects of the background, geometry and the packing density to obtain the final results of the participants. In this study, the typical uncertainties of the participants were around 24%, and about 70% of the measured results produced E(n) values, which were smaller than one., (Copyright 2009 Elsevier Ltd. All rights reserved.)

The drum counting system was calibrated in this study. For (137)Cs, the counting efficiencies were around 14-1% when the density of the waste of the drum was changed from 0.15 to 2.3 g cm(-3). The effects of the background, hot spot, system linearity, sample density and weighing were also evaluated in this work. The combined standard uncertainty of the drum counting system for the (137)Cs in the density of 1g cm(-3) was around 12%. To verify the counting system, the drums containing radioactive solution were prepared by the NMI as the blind samples. A discrepancy below 15% was shown between the counting results and the reference values of the NMI.

The two-dimensional extrapolation technique and dead time extrapolation technique of 4pibeta-gamma-coincidence counting were used to standardize the activity of (67)Ga. The counting results of the two absolute counting techniques showed good agreement while the two-dimensional extrapolation technique could save about 50% of the total counting time in this study. The accuracy of the Capintec CRC-15R radionuclide calibrator used by the radiopharmacy of INER was studied in this research. A new calibration setting number, 99, was recommended to the radiopharmacy of INER in the Bayer 10mL sterile empty vial geometry.

Objective: To study the clinical pathological features and immunophenotype of follicular dendritic cell sarcoma (FDCS) with discussion on its diagnostic clues to improve diagnostic level., Methods: Five cases of FDCS were analyzed by clinical, pathologic and immunohistochemistry methods., Results: Five cases of FDCS were located in the cervical lymph node. Microscopically, the normal architectures were effaced by ovoid, spindle-shaped with fascicular, diffuse or whorled patterns and with rich lightly eosinophilic cytoplasm, syncytial appearance. Nuclei tend to show irregular clustering, scattered multinucleated giant cell. Nucleoli often distinct, sometimes prominent. Mitotic count variable, may show significant cellular pleomorphism. Immunohistochemical studies show that the tumor cells were positive for CD21, CD35, but negative for CD1a, CD34, CK and HMB45. Under electron microscopy, the tumor cells possessed long villus cytoplasmic processes and desmosome-like junctions, Birbeck granules were absent., Conclusions: FDCS is a rare malignant tumor and differential diagnosis includes Langerhans cell sarcoma, interdigitating dentric cell sarcoma, malignant fibrous histocytoma, melanoma, metastatic spindle cell carcinoma and others. Immunohistochemistry and electron microscopy are necessary for a correct diagnosis.

The Institute of Nuclear Energy Research (INER) has provided 188Re radiopharmaceuticals for hospitals in Taiwan. To enhance the accuracy of commercial radionuclide calibrators used by radiopharmacies and hospitals, and to ensure that patients receive proper doses of these radiopharmaceuticals, it is very important to standardize this nuclide. The 4pibeta-gamma coincidence counting method was used to standardize the mass activities of 188Re in this study. At the same time, three well type ionization chambers, Centronic IG11-N20, Centronic IG11-A20, and ISOCAL-IV, were calibrated by the standardized solutions of the nuclide. In this research, the calibration figures of ISOCAL-IV for the nuclide were consistent with the results of National Physical Laboratory (NPL, UK). The outcome implied that the results of coincidence counting did mutually agree. On the other hand, the radionuclide calibrator in the radiopharmacy was producing measurement errors of about 20% when using the manufacturers recommended calibration setting: an accurate correction factor has now been determined in this study.

[reaction: see text] A series of carbazole/fluorene (CBZm-Fn) hybrids were effectively synthesized through Friedel-Crafts-type substitution of the carbazole rings. These compounds were thermally and morphologically stable host materials for OLED applications. Efficient blue phosphorescent OLEDs were obtained when employing CBZ1-F2 as the host and FIrpic as the guest.

An alpha/beta emitter measurement system used to calibrate surface sources following the guidelines of ISO 8769 has been established in Institute of Nuclear Energy Research (INER) around the year 2000. This system consists of a windowless proportional counter with a uniformity of 0.28% when measuring the emission rate of a source on a centered area of 100 mm x 150 mm, and a uniformity of 0.62% when the source area was 150 mm x 200 mm. Four 100 mm x 150 mm sources (90Sr + 90Y, 36Cl, 14C and 241Am) had been measured by this system. The measurement results of the above four sources when compared with those of National Physical Laboratory, UK (NPL) showed difference between the two laboratories of < 1%.

In this study, absolute 4pi beta-gamma-coincidence counting was used to measure the mass activity of 166mHo, 58Co and 88Y. For 166mHo and 88Y, three gamma windows were set to study the systematic error caused by the different gamma window settings. To eliminate the effect arising from the large difference in counting efficiency of the 4pi beta counter between electron capture events and beta+ particles, the two-dimensional extrapolation method was used to measure 58Co. The measurement results for the three nuclides were linked with the BIPM SIR through two APMP regional comparisons, APMP.RI(II)-K2, Ho-166m and APMP.RI(II)K2.Co-58, Y-88. Results are presented.

The Institute of Nuclear Energy Research (INER) participated in a comparison of activity organized by the Electrotechnical Laboratory (ETL, Japan). At this occasion, 125I was measured. Seven laboratories of the Asia Pacific region carried out measurements and ETL, at the same time, took part in BIPM SIR measurements. Two measurement methods developed by INER, the sum-peak coincidence counting with two 76 x 76 mm NaI(Tl) detectors and the 4pie-X coincidence counting technique with efficiency extrapolation, were used to standardize the activity of 125I. The results from the two methods are 2.6% different. INER's results agree with the results of the regional comparison and the BIPM SIR.