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Therapeutic options for metastatic CRC (mCRC) have changed significantly in recent years, greatly increasing the complexity of therapeutic decision-making. Although oncology guidelines have helped improve the care process, guidelines may also limit the flexibility to individualize in-clinic decision-making. This consensus paper addresses specific gaps in the current international guidelines to assist Taiwanese colon and rectal experts make specific therapeutic choices. Over 3 years and three meetings with selected experts on “real-world” Taiwanese practice patterns for mCRC, consensus was achieved. The experts also discussed specific questions during in-depth one-on-one consultation. Outcomes of the discussion were then correlated with published evidence by an independent medical writer. The final consensus includes clinically implementable recommendations to provide guidance in treating Taiwanese mCRC patients. The consensus includes criteria for defining fit and unfit intensive treatment patients, treatment goals, treatment considerations of molecular profiles, treatment consideration, and optimal treatment choices between different patient archetypes, including optimal treatment options based on RAS, BRAF, and microsatellite instability (MSI) status. This consensus paper is the second in the Taiwan Society of Colon and Rectal Surgeons (TSCRS) Consensus series to address unmet gaps in guideline recommendations in lieu of Taiwanese mCRC management. Meticulous discussions with experts, the multidisciplinary nature of the working group, and the final drafting of the consensus by independent medical professionals have contributed to the strong scientific value of this consensus.

Background There is limited research examining gait and inter-segmental coordination in patients with Ehlers-Danlos syndrome. The objective was to compare lower extremity inter-segmental coordination amplitude and variability during gait between patients with Ehlers-Danlos syndrome and healthy adults. Methods This cross-sectional study included participants with Ehlers-Danlos syndrome (n = 13) and healthy adults (n = 14). Gait data were acquired using a motion capture system and force plates. Participants ambulated at self-selected speeds for five trials. Inter-segmental coordination was quantified using continuous relative phase, which examined the dynamic interaction between the thigh-shank and shank-foot paired segments (i.e. phase space relation). A 2-way mixed analysis of variance examined the effects of groups (Ehlers-Danlos and healthy) and gait phases (stance and swing phase) on inter-segmental coordination amplitude and between-trial variability. Effect sizes were calculated using Cohen's d. Findings The Ehlers-Danlos group had greater inter-segmental coordination variability compared to the healthy group for foot-shank and shank-thigh segment pairs in the sagittal plane over stance and swing phases (P = 0.04; small to large effect sizes). The Ehlers-Danlos group also had greater variability in the frontal plane at the foot-shank segment pair during stance phase (P = 0.03; large effect). There were no differences in inter-segmental coordination amplitude between groups (P = 0.06 to 0.85). Interpretation Patients with Ehlers-Danlos syndrome have more variability between gait trials in lower limb motor coordination than healthy adults. This may be related to the impaired proprioception, reduced strength, pain, or slower gait speed seen in this population.

Background/Purpose Over the past two decades, ulcerative colitis (UC) has emerged in the Asia Pacific area, and its treatment goal has shifted from symptom relief to endoscopic remission. Endoscopy is the gold standard for the assessment of mucosal healing; however, it is an invasive method. Fecal calprotectin (FC) is a non-invasive stool-based inflammatory marker which has been used to monitor mucosal healing status, but it is expensive. By contrast, the immune fecal occult blood test (iFOBT) is a widely utilized stool-based screening tool for colorectal cancer. In this study, we compared the predictive values of iFOBT and FC for mucosal healing in Taiwanese patients with UC. Methods A total of 50 patients with UC identified via the electronic clinical database of Changhua Christian Hospital, Taiwan, were retrospectively enrolled from January 2018 to July 2019. Results of iFOBT, FC level, and blood tests as well as Mayo scores were reviewed and analyzed. Colonic mucosa was evaluated using the endoscopic Mayo subscore. Results The average age of the patients was 46 years, and 62% of the patients were men. Disease distribution was as follows: E1 (26%), E2 (40%), and E3 (34%). Complete mucosal healing (Mayo score = 0) was observed in 30% of patients. Endoscopic mucosal healing with a Mayo score of 0 or 1 was observed in 62% of the patients. Results of FC and iFOBT were compared among patients with and without mucosal healing. Predictive cutoff values were analyzed using receiver operating characteristics curves. iFOBT and FC had similar area under the curve for both complete mucosal healing (0.813 vs. 0.769, respectively, p = 0.5581) and endoscopic mucosal healing (0.906 vs. 0.812, respectively, p = 0.1207). Conclusion In daily clinical practice, FC and iFOBT do not differ in terms of predictive values for mucosal healing among Taiwanese patients with UC.

This work develops a cloud-fog computing architecture for information-centric Internet-of-Things (IoT) applications with job classification and resource scheduling functions. The two designed functions support quality of service (QoS) by classifying IoT applications and scheduling computing resources. An innovative scheduling mechanism is developed to optimize the dispatch of cloud and fog resources at minimum cost in a cloud-fog computing environment. One cloud, three fogs, four types of IoT application and 2500 IoT tasks are designed in the cloud-fog simulation environment. The simulation results reveal that the proposed computing architecture outperforms computing without scheduling by reducing the cloud computing load by approximately 20.47%. The QoS of real-time IoT applications is guaranteed in the proposed mechanism.

Adjuvant chemotherapy use in stage II colorectal cancer (CRC) is debated. We evaluated the prognostic significance of clinicopathological features recommended by most guidelines for identifying high-risk stage II CRC and adjuvant chemotherapeutic response.We enrolled 1,039 stage II CRC patients who underwent curative surgery at Taipei Veterans General Hospital from January 2005 to December 2010. Seventy-seven patients who received radiotherapy were excluded. The endpoint was disease-free survival.Of 962 patients, 37 had stage T4 tumors; 50, lymphovascular invasion; 39, poor differentiation; 249, preoperative carcinoembryonic antigen (CEA) levels5 ng/mL; and 53 underwent emergent operations. One hundred ninety-four patients received 5-fluorouracil-based adjuvant chemotherapy. During a median follow-up period of 60.2 months, recurrence developed in 110 patients (11.4 %). The 5-year disease-free survival (DFS) was 87.6 %. In multivariate analysis, preoperative CEA5 ng/ml (p = 0.001), emergent operation for obstruction/perforation (p = 0.008), lymphovascular invasion (p = 0.014), and T4 disease (p = 0.030) were significantly associated with poor DFS. High-risk stage II patients (n = 484) benefited from adjuvant chemotherapy (5-year DFS with and without adjuvant chemotherapy, 87.3 vs. 78.9 %; p = 0.028).Adjuvant chemotherapy improved DFS in high-risk stage II CRC patients, but not in low-risk patients.

Because of the coefficient of thermal expansion and the hygroscopic swelling mismatches on plastic packaging materials, stress and reliability issues on microelectronic packaging structures are extremely important for the packaging industry. Through the self-design test chips with the piezoresistive microstress sensors, this paper presents the experimental methodologies for stress and reliability monitoring on typical plastic ball-grid-array packaging. To this end, coefficients of the sensors are first calibrated, and stress monitoring is next performed with simultaneously thermal and hygroscopic loadings under steady-state and cyclic environments, respectively. The Weibull reliability model is next applied based on the experimental data and the parameters of the model are extracted. After real-time monitoring on stress variations during the reliability test, about 0.8 MPa of stress decrease is measured on each reliability cycle.

The prognosis for colorectal cancer (CRC) patients with unresectable metastases is dismal. This study compared outcomes of different metastatic treatments. We collected 653 CRC cases with unresectable metastases including 490 cases receiving primary tumor resection then chemotherapy (surgery group) and 163 patients receiving neoadjuvant chemotherapy then did or did not receive operations (chemotherapy (C/T) group) from 2004 to 2010. The statistical endpoint was overall survival from the date of diagnosis. In the C/T group, 124 (76 %) patients received an operation after 9.0 ± 6.2 months of chemotherapy, including 57 (34.9 %) patients with curative surgery. The C/T group had a higher proportion of T4 lesions (37.4 %) than the surgery group (26.9 %). Survival of the C/T group was longer than that of the surgery group (28.8 ± 8.8 vs. 24.3 ± 7.5 months; p = 0.043). Survival of 57 patients receiving curative surgery was 36.0 ± 6.3 months, which was significantly better than that of the 67 patients receiving palliative resection (25.2 ± 5.6, p

Recently cloud computing technology has gained its popularity on research and development for petroleum explorations. The advances of cloud computing offer flexibility of computing power and storage capacity, provides beneficial technology for this application domain. For instance, the cloud computing technology can effectively reduce the complexity of information collection and control time in the petroleum production process. This research encounters various methods in literature reviews, distant interviews, case studies, results analysis in information pattern and production system bottlenecks as research and evaluation for cloud computing technology implementation in petroleum exploration. Therefore it allows comprehensive analysis result in a specific recommendation for domestic petroleum companies to exploit cloud computing capability. In this research, 200 questionnaires were distributed to gather information and data analysis. 135 questionnaires are collected determines 67.5% sampling degree. This study is not only discussing about how to implement cloud computing for gas reserves exploration, but also comparing results and gaining understanding of unique methodology taken by different petroleum companies in each country. By leveraging cloud computing capabilities, this research technologically aims for gas layer exploration, gas manufacturing, cost calculation, data recording, real-time data update and hazard prediction. It is expected in the future that petroleum companies will create innovative management methods with the results of cloud computing implementation to achieve efficient and high quality gas reverses and exploration management.

Background The clinicopathologic features and frequency of KRAS mutations in colorectal cancer (CRC) patients have been reported; however, the characteristics and impact of NRAS and HRAS mutations on the survival of CRC patients have seldom been addressed. Methods Under institutional review board approval, 1,519 CRC patients who underwent surgery were enrolled. Mutation status of RAS was determined by polymerase chain reaction and mass spectrophotometry. Results The frequency of KRAS , NRAS , and HRAS mutations was 39.6%, 4.3%, and 1.7%, respectively. The KRAS mutation was associated with fewer left-sided tumors, fewer poor differentiated tumors, more mucin component, and less lymphovascular invasion. The NRAS or HRAS mutations were not associated with any of the clinicopathologic features examined. After univariate analysis, only NRAS mutation was associated with patients' overall and disease-free survival. However, the association of NRAS with patients' overall and disease-free survival disappeared after stepwise elimination. Conclusions This study demonstrates the clinicopathologic characteristics of CRC patients with RAS mutations. Patients with NRAS mutation tended to have worse outcomes.

Dear Editor: Malignant colonic obstruction is an emergency condition requiring prompt bowel decompression. Surgical treatment for this condition has a perioperative morbidity rate of 77.6 % and mortality rate of 11.9 %. The use of colonic metallic stenting has evolved as a noninvasive alternative to surgical treatment for malignant colonic obstruction either as a bridge to surgery or palliation only with a high clinical success rate and an improved short-term outcome. Here, we report a 92-year-old man presenting with acute colonic obstruction from transverse colon cancer. Despite successful decompression of the colonic obstruction by emergent colonic stenting, a rare complication requiring further surgery with delayed cecal perforation developed on the fifth hospital day. Case report

56-year-old woman presented with a 1-week hisAtory of progressive abdominal distension and pain. She was afebrile and normotensive. An abdominal examination showed periumbilical tenderness without muscle guarding. Laboratory tests showed a normal leukocyte count but an increased C-reactive protein level (23.2 mg/L). Abdominal radiography showed a dilated ascending colon and small-bowel loops (Figure A, red arrows). Multiple tortuous thread-like calcifications were noted throughout the ascending colon (Figure A, green arrows), as well as along the mesenteric veins (Figure A, yellow arrows). An abdominal computed tomography showed numerous serpiginous calcifications in the tributaries of the superior mesenteric vein (Figure B, yellow arrows; Figure C, yellow arrows). Mural thickening with calcification in the right colon (Figure B, red arrows) and obstruction at the midtransverse colon also were found (Figure C, red arrows). Under the impression of colonic obstruction, an exploratory laparotomy was performed. During surgery, the colonic mucosa was edematous and dark purple (Figure D). The patient underwent an extended right hemicolectomy followed by primary anastomosis and was discharged uneventfully 2 weeks later. The histopathologic examination showed narrowing vessel lumens with fibrous wall thickening (Figure E, red arrows; Figure F, red arrows). Multiple calcifications also were found in the vascular wall (Figure E, yellow arrows; Figure F, yellow arrows).

fi g 6 ( t f m s H ( ( T n A 78-year-old woman visited the gastroenterology clinic for right lower-quadrant abdominal pain of 3 days’ duration. he pain was persistent and cramping in nature, but without ssociated fever, chills, nausea, vomiting, or change in bowel abit. Physical examination revealed localized right lower-quadrant bdominal tenderness with mild muscle guarding. White blood ell count was 6500/mm3, hemoglobin level was 11.6 g/dL, and latelet count was 191,000/mm3. Her C-reactive protein level as 0.87 mg/dL, but serum alanine aminotransferase, alkaline hosphatase, and carcinoembryonic antigen levels were all ithin normal range. Abdominal sonography revealed a heterogeneous echogenic esion about 3 cm in size in the right middle abdomen, associted with a fish bone–like structure within the lesion (Figure A, rrows). Abdominal computed tomography scan revealed an ovalhaped soft-tissue mass, about 38 20 22 mm in size, with nterior linear-shaped hyperdensity and adjacent localized illefined infiltrates in the small-bowel mesentery and focal irreglarity of the ileum (Figure B, arrows).

The presentations of cardiac myxoma are diverse, from asymptomatic to a variety of symptoms due to embolization. Occlusion of abdominal aortic bifurcation by straddled myxoma is not common; however, obstructive level above renal artery is very rare. We present a patient with cardiac myxoma who presented with acute onset of paraplegia. The aorta was occluded from the level of the liver dome to the renal arteries, and catastrophic outcome (ischemia/reperfusion) following its removal.

The through silicon via (TSV) technology brings a key to 3D integration on wafer level packaging (WLP) by stacking chips to generate direct electrical interconnecting paths. Most of the related literatures employed the daisy chain test patterns to measure the electrical continuity and to evaluate the single via resistance. However, the single via resistance is actually the contact resistance between the two metal layers at the via bottom. In this paper, we developed new test patterns with suitable electrical measurement methodologies to evaluate several typical performance, including the contact resistance, on TSV with better accuracy.

This paper examines the effect of American humorous advertising on consumers in Taiwan. Several American print advertisements for brands familiar in Taiwan were shown to Taiwanese consumers in a field study. Three distinct perceptual appealshumor, quality and positivityin the processing of the advertisements by Taiwanese consumers were identified. It was found that all of these three types of appeals positively impacted the perceived image of and the motivation to purchase the brands featured in the advertisements. This paper also discusses the managerial implications and future research avenues stemming from the results of the study.