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Goats may suffer from rumen bloat for many reasons, e.g. improperly concentrated ratio or obstruction. The disease can be caused by eating undigested items, e.g. plastic rope or bags. Since the COVID-19 pandemic, it has often become mandatory for people to wear medical masks. People are generally unaware that masks left on the ground pose a risk to goats who may eat them. This case report describes the rumen bloat caused by medical masks in a male goat reared in an elementary school. After physical examination, the goat showed a bloated rumen, anorexia, depression, and weakness. The heart rate was normal, but respiratory patterns were fast and deep. Fewer defecated feces were noted by the owner. Furthermore, the owner’s complaints and ultrasound images revealed that undigested items in the rumen were the cause. After performing a standard rumenotomy, we scooped out four medical masks, one plastic bag, and one high-density nylon rope from the rumen. We believe this was the first report describing the risk of medical masks in goats. Promoting life and animal welfare education is essential to inform others of the harm medical masks pose to animals.

Postoperative delirium in patients who have hip fractures may lead to poor outcomes. This study aimed to determine perioperative risk factors and clinical outcomes of postoperative delirium in patients undergoing hip bipolar hemiarthroplasty for displaced femoral neck fractures.Among 1,353 patients who underwent hemiarthroplasty at our institution during 2013-2021, we identified 78 patients with postoperative delirium diagnosed with the confusion assessment method. The mean delirium duration was 28 hours (range: 15-520). We also included 1:2 sex- and age-matched patients who did not have postoperative delirium after the same surgery as a matching cohort for comparison. Patient comorbidities, perioperative data, delirium occurrence, and outcomes were collected for analyses.A Charlson Comorbidity Index (CCI) score ≥6 (odds ratio (OR): 2.08, P = .017), nighttime surgery (OR: 3.47, p =.001), surgical delays (OR: 1.01, P = .012), preoperative anemia (OR: 2.1, P = .012), and blood transfusions (OR: 2.47, P = .01) may increase the risk of postoperative delirium. The presentation of delirium was associated with sepsis (OR: 3.77, P = .04), longer hospital stays (P.001), higher 1-year mortality (OR: 3.97, P = .002), and overall mortality (OR: 2.1, P = .02).Postoperative delirium predicted poor outcomes. Our results emphasized the importance of early identification of patients at risk and optimization of the medical conditions before and after surgery.

Studies have shown that elevated plasma levels of platelet-derived soluble TREM-like transcript-1 (sTLT-1) are associated with an unfavorable outcome in patients with septic shock. However, the underlying molecular mechanisms are not well defined. This research aimed to study the role of sTLT-1 in mediating immune dysfunction during the development of sepsis. Our study demonstrated that patients with septic shock have significantly higher plasma concentrations of sTLT-1, whereas sTLT-1 is not detectable in healthy subjects. Plasma concentrations of sTLT-1 were correlated with the degree of immunosuppressive parameters in monocytes from patients with septic shock. sTLT-1 can first activate monocytes by binding to the TLR4/MD2 complex but subsequently induce immunosuppressive phenotypes in monocytes. Blocking Abs against TLR4 and MD2 led to a significant decrease in sTLT-1–induced activation. Treatment with an anti–TLT-1 Ab also significantly reduces sTLT-1 binding to monocytes and proinflammatory cytokine secretion in a mouse model of endotoxemia. sTLT-1 acts as an endogenous damage-associated molecular pattern molecule, triggering the activation of monocytes through the TLR4/MD2 complex followed by sustained immune suppression. This process plays a crucial role in the development of sepsis-associated pathophysiology. Our findings outline, to our knowledge, a novel pathway whereby platelets counteract immune dynamics against infection through sTLT-1.

Two-stage exchange arthroplasty is considered the gold standard treatment for chronic periprosthetic joint infection (PJI). However, there is a scarcity of research investigating the major risk factors for infection recurrence and the prognosis after infection recurrence.This study included 203 patients who underwent 2-stage exchange arthroplasty between June 22, 2010 and January 24, 2017. The need of reoperation for infection-related or PJI-related mortality was considered treatment failure. Participant age, gender, body mass index, comorbidities, culture results, length of hospital stay, cause of treatment failure, operative procedure, and fate were analyzed.Fifty-three patients experienced treatment failure (26.1%). Mean follow-up was 63 months (range, 26-103). Based on the multivariate analyses, risk factors for treatment failure included men and positive intraoperative culture during reimplantation. Recurrent infection was most commonly caused by Staphylococcus aureus (32.1%, 17/53), and new microorganisms caused recurrent infection in 34 of 53 (64.2%) patients. In 44 patients who had treatment failure, debridement, antibiotic therapy, irrigation, and retention of prosthesis (DAIR) performed within 6 months of reimplantation and at3 weeks from symptom onset resulted in a significantly higher success rate than the use of other DAIR protocols (P = .031).Men and positive intraoperative culture are major risk factors for 2-stage exchange arthroplasty failure in patients who have knee PJI. Recurrent infection in these patients is usually caused by new microorganisms. DAIR within 6 months of reimplantation and at3 weeks from symptom onset results in good outcomes in these patients.

Burnout is highly prevalent among nurses; however, the effect of personalized music intervention on burnout remains unclear on nurses. We aimed to investigate the effects of personalized music intervention in relieving burnout among nurses. Forty-two eligible nurses were recruited for an assessor-blinded, two-arm parallel randomized controlled trial. The participants were randomly assigned to the following two groups: The personalized music group (n = 21), which listened to music of their choice for 30 min per session three times per week for 5 weeks; and the wait-list control group (n = 21), which did not listen to any music for relaxation. At baseline, nurses in the personalized music group had worse emotional exhaustion and greater depression compared with the wait-list control group. Results from an analysis of covariance using baseline emotional exhaustion and depression as covariates indicated that nurses who received personalized music intervention experienced less emotional exhaustion than the nurses in the wait-list control experienced. Personalized music intervention can be used for nurses as an adjuvant approach to reduce emotional exhaustion and then improve their well-being.

This study investigated the effects of adjuvant radiotherapy on outcomes in early-stage major salivary gland cancers.A total of 655 patients were identified, including 355 (54.2%) received adjuvant radiotherapy and 300 (45.8%) had surgery alone. The effect of adjuvant radiotherapy on 5-year locoregional recurrence and disease-specific survival (DSS) was calculated using the Kaplan-Meier method, Wilcoxon rank sum test, and Cox proportional hazards model.There were no significant differences in locoregional recurrence and DSS between patients receiving adjuvant radiotherapy and those not in both univariate and multivariable analysis. Although patients with positive margin status had a higher locoregional recurrence and those with moderate/poor differentiation had a worse DSS, stratified analysis still indicated there were no protective effects from the use of adjuvant radiotherapy.The use of adjuvant radiation therapy was not associated with improved locoregional recurrence and DSS, even for those with high-risk histopathological factors.

The endoscopic modified Lothrop procedure (EMLP) is performed to create a large frontal neostium in patients who had failed previous frontal sinus surgeries. EMLP causes obvious changes in the volume and anatomy of the sinuses, which may cause a more significant change in nasality. This study aimed to evaluate the changes in nasalance in patients who underwent EMLP by comparing their preoperative nasalance to the established normative values and postoperative nasalance.This was a prospective study. Twenty-one patients diagnosed with refractory frontal sinusitis who were indicated to undergo EMLP were enrolled. One hundred one healthy participants were enrolled as norm references. The Nasometer II Model 6400 (KayPENTAX) was used to analyze the nasalance scores. Nasalance scores were tested before surgery and 1 and 3 months after the surgery.The normative references of nasalance were (mean ± SD) 14.6% ± 6.7%, 39.4% ± 8.4%, and 55.8% ± 8.3% for the oral passage, oral-nasal passage, and nasal sentences, respectively. The mean nasalance scores pre-EMLP and 1 and 3 months post-EMLP were 23.2% ± 9.6%, 29.0% ± 9.3%, and 29.9% ± 0.4% for the oral passage; 48.7% ± 10.7%, 54.7% ± 7.7%, and 56.4% ± 7.2% for the oral-nasal passage; and 62.7% ± 10.9%, 69.8% ± 6.7%, and 70.7% ± 6.4% for the nasal sentences, respectively. Compared with the normative references, pre-EMLP nasalance was higher for all the three speech stimuli (t-test, p0.05). Post-EMLP nasalance also significantly increased for all the three stimuli at the 1- and 3-month follow-up visits (Paired t-test, p0.05).EMLP has a short-term impact on resonance; however, long-term follow-up is required for further study.

本研究目的在瞭解穴位電刺激是否能對注意力網絡功能產生影響進而提升注意力。研究招募60位研究參與者，隨機分派至穴位電刺激及偽刺激組。以多頻道銀錘點低周波治療儀在雙手合谷及內關穴進行電及偽電刺激。以注意力網絡測驗為評估工具，取得前測、中測及後測警覺性、導向性、執行控制功能分數，以混合設計二因子變異數分析統計檢定。結果顯示，穴位電刺激與偽刺激組組間注意力網絡功能未達顯著差異；但在警覺性功能中不同測量時段呈現顯著差異，穴位電刺激組警覺性功能前測低於中測、後測，偽刺激組警覺性功能前測低於中測，與後測無顯著差異。穴位電刺激與偽刺激組間未能呈現顯著差異，可能來自刺激劑量不足，未來若以療程方式累積劑量或能產生較大效果。穴位電刺激造成警覺性功能增加且能延續15分鐘，但對於警覺性的提升，來自穴位特異性或單純電刺激效果需更進一步證實。偽刺激當下警覺性顯著提升但無法延續至後測階段，可能與偽刺激當下的穴位按壓效果有關。 This study aims to explore the effect of electro-acustimulation (EA) on attention networks. Sixty participants were randomly divided into EA and sham-EA group. The acupoints LI-4 (HeGu) and PC-6 (NeiGuan) were stimulated by transcutaneous electrical nerve stimulator. Attention network test (ANT) was employed at pre-test, test and post-test phases. Mixed two-factor ANOVA was conducted. Results showed no significant difference between EA and sham-EA in ANT. The alerting function within group at three phases showed statistically significant differences. The level of alerting function at pre-test was lower than during and post-test phases in EA while it was lower than during-test phases only in sham-EA. The non-significant difference between EA and sham-EA in ANT might be due to insufficient doses of stimulation. Whether the enhancement of alerting function in EA comes from the specificity of acupoint selection or electrical stimulation effect requires further confirm. The improvement of alerting function at the during-test phase in sham-EA group might be related to the pressing effect on acupoints. &nbsp

Androgen deprivation therapy (ADT) includes bilateral orchiectomy or long-acting gonadotropin-releasing hormone (GnRH) agonists/antagonists. It remains controversial with respect to ADT associated cardiovascular outcomes. Hereby, we compared the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with prostate cancer receiving either surgical castration or GnRH therapies.Using the Taiwan Cancer Registry and Taiwan's National Health Insurance Research Database, we identified 8,413 patients receiving GnRH therapies compared with 694 receiving surgical castration from 2008 to 2017. The median followup duration was 3 years.The crude incidences of 3-year mortality and MACCEs were 19.90% vs 26.51% and 8.23% vs 8.65% in patients receiving GnRH therapies or surgical castration, respectively. After adjusting for age, cancer stage and comorbidities, despite no significant differences in MACCEs between groups there was a slight increase in the incidence of acute myocardial infarction (AMI) in patients receiving surgical castration compared with those receiving GnRH therapies. The mortality adjusted hazard ratios of MACCEs and AMI among patients receiving surgical castration were 1.11- and 1.8-fold higher than those receiving GnRH therapies. Notably, in subgroup analysis regarding cancer stage, patients with cancer stage IV showed the most significantly increasing risk of AMI in those receiving surgical castration compared with GnRH therapies.Collectively, we indicated an increased risk of AMI in patients with prostate cancer, especially in patients receiving surgical castration rather than those receiving GnRH therapies. Our findings highlight concerns regarding the cardiac safety of surgical castration compared with GnRH therapies.

ASR has been shown to achieve great performance recently. However, most of them rely on massive paired data, which is not feasible for low-resource languages worldwide. This paper investigates how to learn directly from unpaired phone sequences and speech utterances. We design a two-stage iterative framework. GAN training is adopted in the first stage to find the mapping relationship between unpaired speech and phone sequence. In the second stage, another HMM model is introduced to train from the generator's output, which boosts the performance and provides a better segmentation for the next iteration. In the experiment, we first investigate different choices of model designs. Then we compare the framework to different types of baselines: (i) supervised methods (ii) acoustic unit discovery based methods (iii) methods learning from unpaired data. Our framework performs consistently better than all acoustic unit discovery methods and previous methods learning from unpaired data based on the TIMIT dataset.

Background/purpose Herpes simplex virus type 1 (HSV-1) is the pathogenic agent of human diseases, including gingivostomatitis and herpes labialis. The anti-viral activities of the tea polyphenol, epigallocatechin-3-gallate (EGCG), have been demonstrated. This study examined the combined effects of EGCG and the antiviral drug, acyclovir (ACV), on infection of HSV-1 in oral epithelial cells. Methods Cell viability was examined using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide. Viral yields were determined using the plaque assay. Viral proteins were detected using Western blotting analysis or confocal laser scanning microscopy. Viral DNA was detected using the real-time polymerase chain reaction. Results Cytotoxic effects of HSV-1 on the viability of oral epithelial cells were evidently reduced in the presence of EGCG (25 μg/ml) or/and ACV (50 μg/ml). Viral yields were also significantly reduced by treatment of cells with EGCG or/and ACV. Expression of viral immediate early protein, infected cell protein 0 (ICP0), was greatly inhibited when cells were treated with EGCG. Combined effects of EGCG and ACV were more evident for the expression of viral thymidine kinase, ICP5 and glycoprotein D. EGCG, but not ACV, significantly reduced the levels of viral particles and viral DNA during viral entry phase. However, at 20 h post infection, the intracellular viral DNA was evidently reduced in HSV-1 infected cells treated with EGCG and ACV. Moreover, the stimulatory effects of HSV-1 on phosphorylation of c-Jun N-terminal kinase could be reduced by ACV. Conclusion The results demonstrated the additive effects of EGCG and ACV on HSV-1 infection in oral epithelial cells.

Two-stage exchange arthroplasty is a feasible treatment for chronic PJI (periprosthetic joint infection) of total hip arthroplasty (THA). However, there are large numbers of patients who are unable to ultimately receive reimplantation after resection arthroplasty owing to uncontrolled infection and multiple comorbidities. The purpose of the current study was to identify patient-related risk factors and reasons for being unable to undergo revision THA. Individuals undergoing resection arthroplasty for chronic PJI treatment from 2013 to 2020 at our institution were retrospectively reviewed. A variety of patient comorbidities, laboratory data, isolated pathogens, and follow-up status were collected for analysis. A total of 84 patients (46 men and 38 women) with a 2.7 ± 2.1-year follow-up were analyzed. Thirty-eight (45.2%) patients eventually underwent revision THA, while the other 46 (54.8%) did not receive reimplantation during follow-up. The patients without receiving reimplantation had higher Charlson comorbidity index (CCI) score (3.1 ± 2.9 versus 1.2 ± 1.5; p = 0.001). Lower cumulative incidence of receiving reimplantation was observed in patients with chronic kidney disease (log-rank test, p = 0.019), anemia (p = 0.011), presence of initial fever (p = 0.030), and oxacillin-resistant strain infection (p = 0.030). The most common reasons for not receiving reimplantation were uncontrolled infection, unstable medical conditions, and death. The patients without reimplantation had a relatively higher mortality rate (log-rank test, p = 0.002). Chronic hip PJI with poor medical conditions or oxacillin-resistant strain infection decreased the chance of undergoing revision surgery. These patients had unfavourable outcomes and a higher mortality rate after resection arthroplasty.

IntroductionHyperglycemic crisis episode (HCE) suggests a poor control of diabetes, which may increase the risk of Parkinson disease (PD). This study aimed to clarify this issue since literature remains unclear.Material and methodsPatients with diabetes with and without HCE matched at a 1:1 ratio by age, sex, and index date between 2000 and 2002 from the Taiwan National Health Insurance Research Database were identified for analyses. Comparison of PD between patients with diabetes with and without HCE was performed by follow-up until 2012. Independent predictors for PD were also investigated among all patients.ResultsA total of 10,056 patients with diabetes with HCE and an identical number of patients with diabetes without HCE were included in the study. The mean age and male ratio were 62.0 years and 52.1%, respectively in both cohorts. Patients with HCE were found to have higher prevalence rates of hypertension, renal disease, hyperlipidemia, mental disorder, chronic obstructive pulmonary disease, liver disease, and head injury than those without HCE. Patients with HCE for ≥3 times had a higher risk for PD (adjusted hazard ratio [AHR]: 1.27; 95% confidence interval [CI]: 1.05-1.54) compared to those without HCE; however, patients with HCE for 1 or 2 times were not at high risk. Older age except ≥85 years, hypertension, hyperlipidemia, and mental disorder were also independent predictors for PD.ConclusionsHCE for ≥3 times is associated with PD. Close follow-up in older patients with HCE as well as control of hypertension, hyperlipidemia, and mental disorder are warranted.

Background Total hip arthroplasty (THA) is the treatment of choice for posttraumatic arthritis with failed internal fixation for hip fractures. However, the postoperative prognosis is not clear. Questions/purposes The primary aim of the study is to report the postoperative outcome, prognosis, and complication rates of total hip arthroplasty in posttraumatic hip arthritis after failed internal fixation of fractures around the hip. The secondary aim of the study is to report results among different fracture types around the hip. Patients and methods We enrolled salvage THA patients after failed internal fixation of fractures around the hip and matched control patients undergoing primary THA for hip osteoarthritis. Subgroup analysis was performed to compare the postoperative outcomes, prognosis, and complication rates of salvage THA in posttraumatic hip arthritis after failed internal fixation of different fracture types around the hip. Results A total of 315 THAs (105 salvage THAs and 210 primary THAs) were analyzed. Patients with salvage THA had a longer operative time, lower postoperative hemoglobin (Hb) level, more Hb drop (2.2 ± 1.4 vs. 1.7 ± 1.2 gm/dl, p = 0.002), and delayed ambulation. The salvage THA group also had a higher dislocation rate within 2 months after salvage THA (9.5% vs. 1.9%, p = 0.002), reoperation rate (10.5% vs. 3.8%, p = 0.019, including debridement, open and closed reduction under sedation, revision surgery, surgical fixation for periprosthetic fractures), and revision rate (5.7% vs. 0.5%, p = 0.003) than patients undergoing primary THA. Patients who had failed fixation for acetabular fractures were younger and tended to recover well. Patients with previous intertrochanteric fracture had the longest operative time, more hip pain (83.8%, p = 0.022) and more complications. Conclusion Salvage THA in posttraumatic hip arthritis after failed internal fixation required a longer operative time and led to more blood loss and postoperative complications. The dislocation, reoperation, and revision rates after salvage THA were higher than those after primary THA. Patients with salvage THA after failed internal fixation for intertrochanteric fractures were the most susceptible to more complications compared to those with femoral neck fracture or acetabular fracture. Level of Evidence level III

Background: Home healthcare (HHC) is an important care choice for elderly people with disabilities; however, the risk factors for emergency department (ED) visits, a poor outcome index, remain unclear. Therefore, we conducted this study to clarify it. Methods: We conducted a case-control study from a medical center in Taiwan by identifying HHC patients between Aug 1, 2019, and July 31, 2021. Age, sex, iatrogenesis, underlying comorbidities, and ED visit data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of ED visits. Results: We identified 240 patients, including 133 patients with and 107 patients without ED visits, for this study. The mean ages were 83.9 and 83.3 years and females accounted for 71% and 60.9% of patients without and with ED visits, respectively. Multivariable logistic regression analyses showed that urinary catheters (adjusted odds ratio [aOR]: 5.84; 95% confidence interval [CI]: 1.48−23.01, p = 0.012) and peptic ulcer disease (PUD)/gastroesophageal reflux disease (GERD) (aOR: 2.27; 95% CI: 1.12−4.61, p = 0.023) were independent predictors of ED visits. Stratified analyses according to sex and age showed that PUD/GERD and dyslipidemia were significant predictors of ED visits in female patients. Conclusions: This study identified independent predictors of ED visits in HHC patients. Our results provide an important reference for the early prevention, recognition, and adjustment of care plans for at-risk patients. Further studies recruiting more patients and external validation are warranted.

BackgroundPrevious studies have identified three single nucleotide polymorphisms (SNPs): GALNT14-rs9679162, WWOX-rs13338697 and rs6025211. Their genotypes are associated with therapeutic outcomes in hepatocellular carcinoma (HCC). Herein, we examined whether these SNP genotypes could predict the clinical outcome of HCC patients treated with ADI-PEG 20.MethodsTotally 160 patients with advanced HCC, who had previously been enrolled in clinical trials, including 113 receiving ADI-PEG 20 monotherapy (cohort-1) and 47 receiving FOLFOX/ADI-PEG 20 combination treatment (cohort-2), were included retrospectively.ResultsThe WWOX-rs13338697-GG genotype was associated with favorable overall survival in cohort-1 patients (P = 0.025), whereas the rs6025211-TT genotype was associated with unfavorable time-to-tumor progression in cohort-1 (P = 0.021) and cohort-1 plus 2 patients (P = 0.008). As ADI-PEG 20 can reduce plasma arginine levels, we examined its pretreatment levels in relation to the WWOX-rs13338697 genotypes. Pretreatment plasma arginine levels were found to be significantly higher in patients carrying the WWOX-rs13338697-GG genotype (P = 0.006). We next examined the association of the WWOX-rs13338697 genotypes with WWOX tissue protein levels in 214 paired (cancerous/noncancerous) surgically resected HCC tissues (cohort-3). The WWOX-rs13338697-GG genotype was associated with decreased tissue levels of WWOX and ASS1. Mechanistic studies showed that WWOX and ASS1 levels were downregulated in hypoxic HCC cells. Silencing WWOX to mimic low WWOX protein expression in HCC in patients with the WWOX-rs13338697-GG genotype, enhanced HIF1A increment under hypoxia, further decreased ASS1, and increased cell susceptibility to ADI-PEG 20.ComclusionIn summary, the WWOX-rs13338697 and rs6025211 genotypes predicted treatment outcomes in ADI-PEG 20-treated advanced HCC patients. The WWOX-rs13338697-GG genotype was associated with lower tissue WWOX and ASS1 levels and higher pretreatment plasma arginine levels, resembling an arginine auxotrophic phenotype requires excessive extracellular arginine supply. Silencing WWOX to mimic HCC with the WWOX-rs13338697-GG genotype further stimulated HCC cell response to hypoxia through increased HIF1A expression, leading to further reduction of ASS1 and thus increased cell susceptibility to ADI-PEG 20.

This study aimed to compare survival of patients with advanced major salivary gland cancers treated with adjuvant chemoradiation therapy (CRT) versus radiotherapy (RT) alone, after surgical resection. The Taiwan Cancer Registry database was used to identify patients (2009–2017) with advanced (T3–4 or nodal positivity) major salivary gland cancers, treated post-surgically with adjuvant CRT or RT alone. Overall survival (OS) and disease-specific survival (DSS) evaluated using Kaplan–Meier. Stratified analyses conducted on clinicopathological features. A total of 395 patients were analyzed: 178 (45.1%) received adjuvant CRT; 217 (54.9%) received adjuvant RT alone. Median radiation dose was 66 Gy in 33 fractions. Cisplatin was most common chemotherapy regimen. After a median follow-up of 3.37 years, there was no significant difference in OS or DSS (p = 0.1354 and 0.3361, respectively) between groups. Adding chemotherapy to adjuvant RT was not significantly associated with improved OS (adjusted hazard ratio [aHR] 0.94; 95% CI 0.72–1.23) and DSS (aHR 0.96; 95% CI 0.72–1.28). Stratified analysis of clinicopathological features found no significant advantages for improved OS or DSS from adding chemotherapy to adjuvant RT. Thus, in this population database, the use of chemotherapy provided limited survival benefits in advanced major salivary gland cancers after surgical resection.

BackgroundFor rectal cancer, it remains unclear how to incorporate tumor response to neoadjuvant chemoradiotherapy (nCRT) when deciding whether to give adjuvant chemotherapy. In this study, we aim to determinate the survival benefit of adjuvant chemotherapy for rectal cancer patients with good response (ypT0-2N0) after nCRT and surgery.MethodsThe study cohort included 720 rectal cancer patients who had good response (ypT0-2N0) after nCRT and surgery, who did or did not receive adjuvant chemotherapy between January 2007 and December 2017, from the Taiwan Cancer Registry and National Health Insurance Research database. The Kaplan–Meier method, log-rank tests, and Cox regression analysis were performed to investigate the effect of adjuvant chemotherapy on 5-year overall survival (OS) and disease-free survival (DFS).ResultsOf 720 patients, 368 (51.1%) received adjuvant chemotherapy and 352 (48.9%) did not. Patients who received adjuvant chemotherapy were more likely to be female, younger (≤ 65), with advanced clinical T (3-4)/N (1-2) classification and ypT2 classification. No significant difference in 5-year OS (p=0.681) or DFS (p=0.942) were observed by receipt of adjuvant chemotherapy or not. Multivariable analysis revealed adjuvant chemotherapy was not associated with better OS (adjusted hazard ratio [aHR], 1.03; 95% Confidence Interval [CI], 0.88-1.21) or DFS (aHR, 1.05; 95% CI, 0.89-1.24). Stratified analysis for OS and DFS found no significant protective effect in the use of adjuvant chemotherapy, even for those with advanced clinical T or N classification.ConclusionAdjuvant chemotherapy may be omitted in rectal cancer patients with good response (ypT0-2N0) after nCRT and surgery.

Yu-Min Lin,1 Chia-Lin Chou,2,3 Yu-Hsuan Kuo,4,5 Hung-Chang Wu,4,6 Chia-Jen Tsai,7 Chung-Han Ho,8,9 Yi-Chen Chen,8 Ching-Chieh Yang,6,7,&ast; Cheng‐Wei Lin10– 12,&ast; 1Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Division of Colorectal Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan; 4Division of Hematology and Oncology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 5Department of Cosmetic Science, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan; 6Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan; 7Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan; 8Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 9Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 10Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 11Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; 12Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan&ast;These authors contributed equally to this workCorrespondence: Ching-Chieh YangDepartment of Radiation Oncology Chi-Mei Medical Center, No. 901, Zhonghua Road, Yung Kang District, Tainan City, 701, Taiwan, Republic of ChinaTel +88662812811Email cleanclear0905@gmail.comCheng‐Wei LinDepartment of Biochemistry and Molecular Biology, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu ‐ Xing Street, Taipei, 11031, Taiwan, Republic of ChinaEmail cwlin@tmu.edu.twPurpose: A lymph node (LN) yield ≥ 12 is required to for accurate determination of nodal status for colorectal cancer but cannot always be achieved after neoadjuvant therapy. This study aims to determine the difference in LN yield from rectal cancer patients treated with and without neoadjuvant therapy and the effects of specific LN yields on survival.Patients and Methods: The study cohort included a total of 4344 rectal cancer patients treated between January 2007 and December 2015, 2260 (52.03%) of whom received neoadjuvant therapy. Data were retrieved from the Taiwan nationwide cancer registry database. The minimum acceptable LN yield below 12 was investigated using the maximum area under the ROC curve.Results: The median LN yield was 12 (8– 17) for patients who received neoadjuvant therapy and 17 (13– 24) for those who did not. The recommended LN yield ≥ 12 was achieved in 82.73% of patients without and 57.96% of those with neoadjuvant therapy (p < 0.0001). Patients with LN yield ≥ 12 had a higher OS probability than did those with LN < 12 (OR, 1.33; 95% CI, 1.06– 1.66; p = 0.0124). However, the predictive accuracy for survival was greater for LN yield ≥ 10 (AUC, 0.7767) than cut-offs of 12, 8, or 6, especially in patients with pathologically-negative nodes (AUC, 0.7660).Conclusion: Neoadjuvant therapy significantly reduces the LN yield in subsequent surgery. A lower yield (LN ≥ 10) may be adequate for nodal evaluation in rectal cancer patients after neoadjuvant therapy.Keywords: rectal cancer, neoadjuvant therapy, lymph node yield, quality, survival

ObjectivesPatients with rheumatoid arthritis (RA) may have an increased risk for gastrointestinal perforation (GIP) caused by medications or chronic inflammation. However, the risk of GIP between patients with and without RA remains unclear. Therefore, we conducted this study to clarify it.MethodsUsing the Taiwan National Health Insurance Research Database, we identified patients with and without RA matched at 1:1 ratio by age, sex, and index date between 2000 and 2013 for this study. Comparison of the risk of GIP between the two cohorts was performed by following up until 2014 using Cox proportional hazard regression analyses.ResultsIn total, 11,666 patients with RA and an identical number of patients without RA were identified for this study. The mean age (±standard deviation) and female ratio were 55.3 (±15.2) years and 67.6% in both cohorts. Patients with RA had a trend of increased risk for GIP than patients without RA after adjusting for underlying comorbidities, medications, and monthly income [adjusted hazard ratio (AHR) 1.42; 95% confidence interval (CI) 0.99–2.04, p = 0.055]. Stratified analyses showed that the increased risk was significant in the female population (AHR 2.06; 95% CI 1.24–3.42, p = 0.005). Older age, malignancy, chronic obstructive pulmonary disease, and alcohol abuse were independent predictors of GIP; however, NSAIDs, systemic steroids, and DMARDs were not.ConclusionRA may increase the risk of GIP, particularly in female patients. More attention should be paid in female population and those with independent predictors above for prevention of GIP.

Carbon monoxide poisoning may damage the brain and adrenal glands, but it is unclear whether it is associated with adrenal insufficiency. We identified all COP patients diagnosed between 1999 and 2012 in Taiwan using the Nationwide Poisoning Database and selected a reference cohort (participants without COP) from the same database by exact matching of age and index date at a 1:2 ratio. Participants with a history of adrenal insufficiency or steroid use of more than 14 days were excluded. We followed up participants until 2013 and compared the risk of developing adrenal insufficiency between the two cohorts. The 21,842 COP patients had a higher risk for adrenal insufficiency than the 43,684 reference participants (adjusted hazard ratio [AHR] = 2.5; 95% confidence interval [CI]: 1.8–3.5) after adjustment for sex and underlying comorbidities (liver disease, thyroid disease, mental disorder). The risk continued to elevate even after 1 year (AHR = 2.1; 95% CI: 1.4–3.4). The COP patients who had acute respiratory failure had an even higher risk for adrenal insufficiency than those without acute respiratory failure, which may indicate a dose–response relationship. Stratified analyses showed that female patients had an elevated risk (AHR = 3.5; 95% CI: 2.1–6.0), but not male patients. Younger patients (

Gonadotropin-releasing hormone (GnRH) therapy has been known to increase risks of major adverse cardiovascular and cerebrovascular events (MACCEs). Herein, we aim to estimate whether regular use of aspirin attenuates risks of MACCEs in prostate cancer patients receiving GnRHs. Using Taiwanese National Health Insurance Research Database (NHIRD), we identified 7719 patients diagnosed with prostate cancer who were either aspirin-naïve, received irregular or regular aspirin from 2008 to 2015. Through a multivariable logistic regression model, we investigated the impact of aspirin on MACCEs. Compared with nonusers and irregular users, most patients receiving regular aspirin were older and had more comorbidities. The crude incidence of one-year MACCEs was lowest in aspirin nonusers but highest in irregular users of aspirin compared with regular users of aspirin (2.65% vs. 4.41% vs. 2.85%, p=0.0099). After adjusting for age, cancer stage and comorbidities, irregular aspirin users had a higher risk of one-year MACCEs (adjusted OR: 1.33; 95% CI: 0.93-1.90, p=0.1139) than aspirin nonusers, but conversely, there was a trend of reducing the risk of MACCEs among those who received regular aspirin (adjusted OR: 0.79; 95% CI: 0.44-1.42, p=0.4256). In the subgroup analysis, there were age- and cancer stage-independent higher risks of MACCEs in patients who took aspirin irregularly compared to those in patients who did not take aspirin. The risks were attenuated in patients receiving regular aspirin. Collectively, regular use of aspirin presented a trend of reducing risks of MACCEs in prostate cancer patients receiving GnRHs. However, irregular use of aspirin diminished the benefits.

Background: Osteoarthritis (OA) may increase urinary tract infection (UTI) in older adults. However, this issue remains unclear.Methods: We identified 8599 older patients (≥65 years) with OA, and an equal number of older patients without OA, matched by age, sex, and index date from the Taiwan National Health Insurance Research Database between 2001 and 2005. Past histories, including UTI and underlying comorbidities, were included in the analyses. Comparisons for any UTI, ≥1 hospitalization for UTI, and ≥3 hospitalizations for UTI between the two cohorts by following up until 2015 were performed.Results: In both cohorts, the percentages of age subgroups were 65–74 years (65.7%), 75–84 years (30.1%), and ≥85 years (4.2%). The male sex was 42.4%. Patients with OA had an increased risk of any UTI compared with those without OA after adjusting for all past histories (adjusted hazard ratio [AHR]: 1.72; 95% confidence interval [CI]: 1.64–1.80). The Kaplan–Meier curve and log-rank test showed that OA increased any UTI (p Conclusions: OA increased UTI in older adults. We suggest appropriately managing OA and controlling underlying comorbidities to prevent subsequent UTI.

Despite the advances in coronary reperfusion in acute myocardial infarction (MI), post-MI heart failure is still a large burden of public health. Transmural infarction and extended fibrosis contribute largely to post-MI systolic dysfunction and heart failure, and thus cardioprotective strategies are crucial. Human amniotic membrane-derived mesenchymal stem cells (hAMSCs) have been shown with properties of immunomodulation, anti-inflammation, and low immunogenicity, which make them good candidates for cell therapies. In this study, a myocardial ischemia/reperfusion (I/R) model was established in rats, and hAMSCs were administered via the tail vein during coronary reperfusion. Compared to the control group, the rats receiving hAMSCs during the I/R procedure (hAMSC group) exhibited significantly better left ventricular ejection fractions after MI. Histological examinations of the hearts in hAMSC group showed minimal transmural infarction 4 weeks after the I/R procedure. Compared to the control group, hAMSC group had reduced size of cardiac fibrosis and less thinning of myocardial wall. In conclusion, intravenous hAMSCs limit transmural infarction, reduce fibrosis size, and improve left ventricular systolic function after MI in the animal model.

The Chelonid herpesvirus 5 (ChHV5) infection possibly associated to the fibropapillomatosis (FP) disease in sea turtles worldwide remains largely unknown and limited studies have used serological approaches to detection of antibodies against ChHV5 in sea turtles with or without FP. We aimed to develop diagnostic platforms based on the viral glycoprotein B (gB) for ChHV5 infection. In this study, five recombinant sub-fragments of the gB protein were successfully expressed and subsequently served as antigens for both seroprevalence and antibody production. The results indicated that the five expressed proteins harbored antigenicity, shown by the results of using sera from sea turtles that were PCR-positive for ChHV5. Moreover, seropositive sea turtles were significantly associated with FP (p

A common strategy to improve the sensitivity of a biosensor for the detection of a low abundance analyte is to preconcentrate the analyte molecules before detection. A dual-functional gold–iron oxide core–satellite hybrid nanoparticle structure is proposed in this work to overcome the drawbacks of traditional sample pretreatment methods and the methods using non-magnetic nanomaterials for sample pretreatment. The new dual-functional hybrid nanoparticle structure can simultaneously serve as a signal reporter of a biorecognition event and a preconcentrator of a target at an extremely low concentration in a nanoplasmonic biosensor. By utilizing a fiber optic nanogold-linked sorbent assay in the fiber optic particle plasmon resonance (FOPPR) biosensor and an arbitrary DNA sequence as a target, we have demonstrated that the use of the new hybrid nanoparticle structure with magnetic preconcentration improves the limit of detection (LOD) for the DNA by 18 times as compared to the same method without magnetic preconcentration, so that the LOD for detecting the DNA can be as low as 2.6 fM. The new hybrid nanoparticle structure is easy to prepare and its use in the high-sensitivity and low-cost FOPPR biosensor provides vast opportunities in point-of-care applications.

An admittance-to-digital-impedance converter (ADIC) for impedance measurement is proposed. The ADIC was integrated in a chip with a programmable sinusoidal frequency synthesizer, allowing an operating range from 0.1 Hz to 10 kHz. The frequency synthesizer generates sinusoidal voltage signals to a sample under test (SUT), and the resulting current signal from the SUT is sensed and sent to the ADIC for postprocessing. In fact, this sensed signal is proportional to the SUT admittance, rather than to its impedance. Hence, the proposed ADIC has two functions: taking the reciprocal of the sensed signal to make it proportional to impedance and converting it into a digital signal. Furthermore, two novel circuits are also proposed: a low-leakage magnitude detector that makes it possible to measure at sub-1-Hz frequencies and a stepped-pulse divider that performs an accurate dividing function. The chip was fabricated by using a 0.35- $\mu \text{m}$ 2P4M mixed-signal process. According to the measured results, the maximum errors in the magnitude and phase measurements were 1.6% and 1.8°, respectively, and the proposed system was verified by measuring the concentrations of albumin solutions.

Background: This study aimed to assess the efficacy of acupuncture for treating attention deficit hyperactivity disorder (ADHD) in children and adolescents. Patients and Methods: Systematic review and meta-analysis including randomized controlled trials that compared the effects of acupuncture treatment (AT) with pharmacotherapy (methylphenidate hydrochloride, MPH) among patients with ADHD. A total of 12 electronic databases were searched from inception until February 3, 2020. The main outcomes were the effective rate and post-treatment hyperactivity scores. We also assessed the incidence of adverse events and follow-up course. Results: A total of 10 studies involving 876 patients were included in this study. The meta-analysis revealed that AT yielded a significantly higher effective rate than MPH (odds ratio 2.239, 95% CI 1.438–3.487, p < 0.001, 8 studies), and that AT can reduce the hyperactivity scores to a lesser degree than MPH (standardized mean difference = –0.882, 95% CI –1.295 to –0.469, p < 0.001, 3 studies). Two studies reported no adverse events in the AT group, while one study suggested that AT can reduce adverse drug reactions. Furthermore, 3 studies concluded that the effects of AT were maintained, even after completion of treatment. Conclusion: This study suggests that AT may be more beneficial than MPH therapy for ADHD patients. However, the evidence may be highly limited, especially considering the outcome of hyperactivity scores with the high risk of bias, very low GRADE, and small number of studies. Thus, further studies of rigorous design and high quality are needed to confirm and strengthen the results, especially in the Western part of the world. Additionally, well-designed randomized controlled trials that evaluate adverse events and include a long-term follow-up should be conducted to determine the efficacy, safety, and side effects of AT for ADHD in children and adolescents.

Background In addition to hypoxia, oxidative stress and inflammation due to carbon monoxide (CO) poisoning cause adverse health effects. These mechanisms are related to the occurrence of autoimmune connective tissue disease, but studies on the association between CO poisoning and autoimmune connective tissue disease are limited. We conducted a study to evaluate the occurrence of autoimmune connective tissue disease following CO poisoning. Methods We identified participants with CO poisoning diagnosed between 1999 and 2012 from the Nationwide Poisoning Database and selected participants without CO poisoning from the Taiwan National Health Insurance Research Database with matching age and index dates at a 1:3 ratio. Sex, underlying comorbidities, and monthly income were also included in the analyses. We followed up the participants until 2013 and made comparison of the risk of autoimmune connective tissue disease between participants with and without CO poisoning. Results The 23,877 participants with CO poisoning had a higher risk for autoimmune connective tissue disease than the 71,631 participants without CO poisoning (adjusted hazard ratio [AHR], 3.5; 95% confidence interval [CI], 3.1-3.9) after adjustment for sex, diabetes, Lyme disease, herpes zoster, infectious mononucleosis, hepatitis, HIV infection, liver disease, renal disease, non-CO poisoning or drug abuse, malignancy, hypertension, hyperlipidemia, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and monthly income. An increased risk was observed even after 4 years of follow-up (AHR, 3.6; 95% CI, 3.0-4.4). Conclusion The risk of autoimmune connective tissue disease increased following CO poisoning. Close follow-up of the patients with CO poisoning for the development of connective tissue disease is recommended, and further investigation of the detailed mechanisms is warranted.

Background Lung cancer contributes to high cancer mortality worldwide with 80% of total cases diagnosed as non-small cell lung cancer (NSCLC). Epidermal growth factor receptor (EGFR) tyrosine kinase (TK) domain serves as a druggable target in NSCLC patients with exon 19 deletion and L858R mutation. However, patients eventually succumbed to resistance to first- and second-generation EGFR-TK inhibitors through activation of T790M mutation. Third-generation EGFR-TKI, Osimertinib exhibits high efficacy in patients with exon 19 deletion/L858R/T790M mutation but they experienced acquired resistance thereafter. Available treatment options in NSCLC patients remains a challenge due to unknown molecular heterogeneity responsible for acquired resistance to EGFR-TKI. In this study, we aim to generate Osimertinib-resistant (OR) cells from H1975 carrying L858R/T790M double mutation which can be used as a model to elucidate mechanism of resistance. Methods OR cells were established via stepwise-dose escalation and limiting single-cell dilution method. We then evaluated Osimertinib resistance potential via cell viability assay. Proteins expression related to EGFR-signalling, epithelial to mesenchymal transition (EMT), and autophagy were analyzed via western blot. Results OR cell lines exhibited increased drug resistance potential compared to H1975. Distinguishable mesenchymal-like features were observed in OR cells. Protein expression analysis revealed EGFR-independent signaling involved in the derived OR cells as well as EMT and autophagy activity. Conclusion We generated OR cell lines in-vitro as evidenced by increased drug resistance potential, increased mesenchymal features, and enhanced autophagy activity. Development of Osimertinib resistance cells may serve as in-vitro model facilitating discovery of molecular aberration present during acquired mechanism of resistance.

BACKGROUND An imbalanced fat or excess energy intake always results in obesity and increased serum/liver lipids, thus leading to metabolic syndromes. Given the bioactive components in black vinegar (BV), such as branched amino acids, phenolic profile, and mineral contents, we investigated the antiobesity effects of BV-based supplements in rats fed a high-fat diet (HFD). RESULTS HFD (30% fat, w/w) feeding increased (P

The present study aims to evaluate the reliability and validity of the Mandarin version of the Singing Voice Handicap Index-10 (MSVHI-10).One hundred and fifteen singers, aged from 21 to 65, participated in this study. All the subjects completed the Mandarin version of the SVHI-10 and the Voice Handicap Index-10 (VHI-10). Other gathered information include sex, age, type of singing performance, and the accumulated years of singing. We also asked the participants to self-report the presence of singing voice complaint. Statistical analyses were performed to evaluate the validity, reliability, and the Receiver Operating Characteristic (ROC) curve of MSVHI-10.The results showed high internal consistency (Cronbach's α =0.96), with the scores of each question ranged from 0.57 to 0.90. Forty-three singers re-filled the MSVHI-10 with an interval of 12.7 ± 9.3 days (mean ± standard deviation), and the results showed a high test-retest reliability (r = 0.98, P0.01). The SVHI-10 scores were significantly correlated with the VHI-10 (r = 0.54-0.72, P0.01). ROC analysis revealed a high differentiating accuracy for distinguishing between the subjects with or without singing voice complaints, with an area under the curve (AUC) of 0.97. At the cut-off score of 21.5, the sensitivity and specificity were 85.7% and 95.9%, respectively.The Mandarin version of the SVHI-10 has been shown to be a reliable and valid instrument for evaluating the self-perception of singing voice complaints.

Chien-An Chen,1,2,&ast; Chung-Han Ho,3– 5,&ast; Yu-Cih Wu,3 Yi-Chen Chen,3 Jhi-Joung Wang,3 Kuang-Ming Liao6 1Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, 71004, Taiwan; 2Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, 71004, Taiwan; 3Department of Medical Research, Chi Mei Medical Center, Tainan, 71004, Taiwan; 4Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, 71005, Taiwan; 5Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, 11696, Taiwan; 6Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, 72263, Taiwan&ast;These authors contributed equally to this workCorrespondence: Kuang-Ming Liao, Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, 72263, Taiwan, Tel +886 6 726 3333, Email abc8870@yahoo.com.twPurpose: The incidence of aspergillosis is increasing, and the risk factors for infection include cancer, admission to the intensive care unit, chronic pulmonary diseases, immunocompromised status, and taking immunomodulatory drugs. There are limited data about the incidence of aspergillosis in patients with different types of cancer. The aim of our study was to survey the incidence of aspergillosis in different cancer types from 2006 to 2017.Patients and Methods: Data were collected from the Taiwan Cancer Registry database and International Classification of Diseases, 9th, 10th Revision, and Clinical Modification codes for diagnosing aspergillosis. Patients with a history of aspergillosis before cancer were excluded, and the secondary outcome was the risk of mortality in cancer patients with and without aspergillosis after 1 year.Results: Among 951 cancer patients with a diagnosis of aspergillosis, there were 614 hematopoietic and reticuloendothelial system patients, 100 lung cancer patients, and 73 lymphoma cancer patients. The overall incidence rates of aspergillosis tended to increase significantly from 2006 to 2017 (from 3.50 to 13.37 per 10,000 person-years, p value: < 0.0001). Regarding sex, the incidence rates of aspergillosis in males and females were 12.52 and 7.53 per 10,000 person-years, respectively. Patients with a diagnosis of aspergillosis had a 2.30-fold (95% CI: 2.14– 2.48, p value: < 0.0001) higher risk of mortality than those without aspergillosis.Conclusion: The incidence of aspergillosis was increased in cancer patients, and cancer patients with aspergillosis had a significantly higher risk of mortality than those without aspergillosis.Keywords: aspergillosis, cancer patients, Taiwan Cancer Registry, incidence rate

Forests have high economic and ecological importance. Forest fires and insects (bark beetles in particular) are important disturbance agents putting at risk forest health (resilience). Accurate tree structure metrics and species information are important parameters for forest resources and inventory management. Yet, in many cases this information is not available with adequate spatial and temporal resolution.The 4Map4Health project aims to explore the future multitemporal and multispectral laser scanning data in terms of forest application, especially for mapping of the forest health status, tree species, and forest fire risk. Recent studies indicate that multispectral airborne lidar is a useful and meaningful tool to assess moisture of canopies, which is correlated to forest health and susceptibility to disturbance. By means of multitemporal remote sensing data and machine learning, tree species information at individual tree level will be retrieved. During 2021 and Silvilaser 2021 benchmark event, laser scanning data from various platforms, as well as in situ data, have been collected at one of the test sites in eastern Austria. The preliminary outcomes show the high potential for deriving various forest structure parameters valuable for bark beetle risk assessment in addition to topographic and meteorological parameters. Furthermore, first tests show the high potential of ALS data as reference to train various regression models for the assessment of forest structural parameters from Sentinel-1 time series data with high temporal resolution, which can serve as essential input data within a bark beetle risk assessment framework.

Although androgen deprivation therapy (ADT) has been proposed to be associated with a higher risk of venous thromboembolisms (VTEs), whether gonadotropin-releasing hormones (GnRHs), such as both agonists and antagonists, are also associated with VTEs remain unclear. Using the Taiwan Cancer Registry (TCR) linked with the National Health Insurance Research Database, we identified patients diagnosed with prostate cancer from 2008 to 2015. Patients who received GnRH were 1:1 propensity score matched with non-GnRH users by age and cancer stage at diagnosis and clinical stage. Cox regression analysis was applied to estimate the incidences of VTEs with death as a competing event at the 5-year follow-up. The VTE incidence among GnRH users was 1.13% compared with 0.98% among non-users. After adjusting with potential confounding factors, the risk of VTEs showed borderline statistical significance among GnRH users and non-users. Notably, in the subgroup analysis among patients receiving GnRH therapy, those younger than 70 years old or at an earlier stage (stage I/II) were at a higher risk of VTEs. Different from previous studies, our findings highlighted critical concerns regarding the cardiac safety of GnRH therapies in prostate cancer patients at a relatively younger age or at an earlier stage.

IntroductionThe burden of cancer-related mortality of common malignancies has been reported worldwide. However, whether bone cancer (BC), as a highly aggressive and heterogeneous group of rare cancers, followed a similar or distinct epidemiological pattern during such process remains largely unknown. We aimed to analyze the mortality and the temporal trends of BC in relation to gender, age, and premature death in Shanghai, China.MethodsWe conducted a population-based analysis of the mortality data of BC in Shanghai Pudong New Area (PNA) from 2005 to 2020. The epidemiological characteristics and long-term trends in crude mortality rates (CMRs), age-standardized mortality rates worldwide (ASMRWs), and rate of years of life lost (YLL) was analyzed using the Joinpoint regression program. The demographic and non-demographic factors affecting the mortality rate were evaluated by the decomposition method.ResultsThere are 519 BC-specific deaths accounting for 0.15% of all 336,823 deaths and 0.49% of cancer-specific death in PNA. The CMR and ASMRW of BC were 1.15/105 person-year and 0.61/105 person-year, respectively. The YLL due to premature death from BC was 6,539.39 years, with the age group of 60–69 years having the highest YLL of 1,440.79 years. The long-term trend of CMR, ASMRW, and YLL rate significantly decreased by −5.14%, −7.64%, and −7.27%, respectively, per year (all p < 0.05) in the past 16 years. However, the proportion of BC-specific death within the total cancer-specific death dropped to a plateau without further improvement since 2016, and a remarkable gender and age disparity was noticed in the observed reduction in mortality. Specifically, the elderly benefited less but accounted for a larger percentage of BC population in the last decades. Although the overall mortality of BC decreased, there was still a significant upward trend toward an increased mortality rate caused by the aging of the BC patients.ConclusionOur study provides novel insights on the epidemiological characteristics and longitudinal dynamics of BC in a fast urbanization and transitioning city. As a rare disease affecting all ages, the burden of BC among the elderly emerged to form an understudied and unmet medical need in an aging society.

In children–robot interactions, an impression of a robot’s “social presence” (i.e., an interactive agent that feels like a person) links positively to an improved relationship with the robot. However, building relationships takes many exposures, and there is an intellectual gap in how social presence and familiarity collaborate in modulating children–robot relationships. We investigated whether social presence altered over time, how repeated exposure and social presence affected rapport, and how social presence would modulate children’s attitudes toward the robot. Fourteen children (four female, age = 10.79 ± 1.12) interacted with a companion robot for four days in spontaneous interactions. The findings revealed that children who perceived the robot as having a higher social presence developed a stronger rapport than those who perceived a lower social presence. However, repeated encounters did not change the children’s perceptions of the robot’s social presence. Children rated higher rapport after repeated interactions regardless of social presence levels. This suggests that while a higher social presence initially elevated the positive relationship between children and the robot, it was the repeated interactions that continued solidifying the rapport. Additionally, children who perceived a higher social presence from the robot felt less relational uneasiness about their relationship with robots. These findings highlight the importance of robots’ social presence and familiarity in promoting positive relationships in children–robot interaction.

Background Literature suggests that nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion, prematurity, and a higher cesarean section rate, but the direct impact on fetal outcomes is still unclear. In this study, we aimed to investigate whether nonobstetric surgery during pregnancy is associated with negative fetal outcomes by analysing a nation-wide database in Taiwan. Methods This population-based retrospective observational case–control study was based on the linkage of Taiwan’s National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database between 2004 and 2014. For every pregnancy with nonobstetric surgery during gestation, four controls were randomly matched according to maternal age and delivery year. We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of adverse fetal outcomes with the non-surgery group as the reference. The primary outcomes involved stillbirth, prematurity, low birth weight, low Apgar scores, and neonatal and infant death. Results Among 23,721 identified pregnancies, 4,747 underwent nonobstetric surgery. Pregnancies with nonobstetric surgery had significantly higher risks of prematurity (aOR: 1.46; 95% CI: 1.31–1.62), lower birth weight (aOR: 1.49; 95% CI: 1.33–1.67), Apgar scores th minute (aOR: 0.2; 95% CI: 0.05–0.82), than surgery performed in the first trimester. Conclusions Pregnancies with nonobstetric surgery during gestation were associated with increased risks of prematurity, low birth weight, low Apgar scores, neonatal and infant death, longer admission, and higher medical expenses than those without surgery. Furthermore, surgery in the third trimester was associated with a higher rate of prematurity than surgery performed in the first trimester. Trial registration Not applicable.