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Abstract Background Heat-related illness (HRI) is commonly considered an acute condition, and its potential long-term consequences are not well understood. We conducted a population-based cohort study and an animal experiment to evaluate whether HRI is associated with dementia later in life. Methods The Taiwan National Health Insurance Research Database was used in the epidemiological study. We identified newly diagnosed HRI patients between 2001 and 2015, but excluded those with any pre-existing dementia, as the study cohort. Through matching by age, sex, and the index date with the study cohort, we selected individuals without HRI and without any pre-existing dementia as a comparison cohort at a 1:4 ratio. We followed each cohort member until the end of 2018 and compared the risk between the two cohorts using Cox proportional hazards regression models. In the animal experiment, we used a rat model to assess cognitive functions and the histopathological changes in the hippocampus after a heat stroke event. Results In the epidemiological study, the study cohort consisted of 70,721 HRI patients and the comparison cohort consisted of 282,884 individuals without HRI. After adjusting for potential confounders, the HRI patients had a higher risk of dementia (adjusted hazard ratio [AHR] = 1.24; 95% confidence interval [CI]: 1.19–1.29). Patients with heat stroke had a higher risk of dementia compared with individuals without HRI (AHR = 1.26; 95% CI: 1.18–1.34). In the animal experiment, we found cognitive dysfunction evidenced by animal behavioral tests and observed remarkable neuronal damage, degeneration, apoptosis, and amyloid plaque deposition in the hippocampus after a heat stroke event. Conclusions Our epidemiological study indicated that HRI elevated the risk of dementia. This finding was substantiated by the histopathological features observed in the hippocampus, along with the cognitive impairments detected, in the experimental heat stroke rat model.

We report two cases of traumatic iliopsoas hemorrhage, without hemoperitoneum, initially detected by ultrasound. Flexion hip contracture in the first case and incomplete femoral nerve palsy in the second case alerted the sonographer to the possibility of traumatic iliopsoas hemorrhage. The first case involved a 54-year-old man who complained of progressive right flank pain and difficulty in walking after falling to the ground. The second case involved a 34-year-old man who complained of severe lower back pain and numbness and weakness of the left leg after a motorcycle accident. In both cases, iliopsoas hemorrhage was confirmed on subsequent multidetector computed tomography.

This study adds fluoride to the electroless nickel-phosphorus (Ni–P) plating solution to prevent the deterioration of MAO-coated AZ31B Magnesium alloy after contact with an electroless plating bath. During the electroless Ni–P plating process, fluoride reacts with Ni2+ ions and the MAO coating to form interphases (NaMgF3), which exhibit good bonding and corrosion resistance. NaMgF3 buffers H+ ions formed from the initiation of Ni–P deposition, preventing the interface of materials from damaging the MAO coating with H+ ions. As immersion time increases, nickel is scattered over the coating.The fundamental data for MAO/Ni–P coated AZ31B Mg alloy determines whether there is fluoride in the electroless Ni–P plating solution. The results show that the coating for a fluoride-containing solution is more resistant to corrosion than those in fluoride-free solution. The compositions, structure and morphology of the MAO/Ni–P coatings that formed for different working parameters are determined using energy dispersive spectroscopy (EDS), X-ray diffraction (XRD), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The corrosion resistance of the MAO/Ni–P coatings is calculated in a 3.5 wt.% NaCl solution using a potentiodynamic polarization test, electrochemical impedance spectroscopy (EIS) and a salt spray test (SST).

Nanoparticles (NPs) with feature sizes ranging between 1 nm and 100 nm have increasingly gained momentum for their versatile functionality as the pharmaceutical agents in many branches of biomedical research and clinical experiments. However, NPs’ inherent material toxicity and the concomitant adverse effects of their function, such as photo-physical properties, often remain a major concern over the issues of environmental safety and human health, and require a thorough assessment before a wide-spread usage can be complied. This research herein investigates the intrinsic and photothermal toxicity of Cs0.33WO3 NPs solution in zebrafish larvae through a direct immersion method. Experimentally, the survival, hatching and malformation rates of zebrafish embryo/larvae as functions of the NP feature sizes, concentration and duration of photothermal dose were examined and analyzed. This study verified that the Cs0.33WO3 NPs has an intrinsic toxicity on a scale of a fraction of 1 mg/ml, and the phototoxicity effect of the NIR-irradiated NPs, when irradiated for 30 min, can affect the embryogenesis of zebrafish larvae and causes 60% and 50% in the survival and delayed hatching rates, respectively, as well as a severe malformation.

Abstract Background Women with endometrial cancer (EC) have favorable prognoses, leaving them vulnerable to the development of second primary cancers (SPCs). We investigated the SPC risk and survival outcomes among EC patients treated with surgery alone in order to exclude the impact of adjuvant treatment on the results. Methods Data from the Taiwan Cancer Registry from 1995 to 2013 were analyzed. Standardized incidence ratios (SIRs) of SPCs among EC survivors were calculated. Results Among 7725 women enrolled, 478 developed an SPC. The overall SIR for SPCs in EC survivors was 2.84 (95% confidence interval [CI] 2.59–3.10) compared with the general female population. Women diagnosed with EC at age

Symbolic numeracy first emerges as children learn the meanings of number words and how to use them to precisely count sets of objects. This development starts before children enter school and forms a foundation for lifelong mathematics achievement. Despite its importance, exactly how children acquire this basic knowledge is unclear. Here we test competing theories of early number learning by measuring event-related brain potentials during a novel number word-quantity comparison task in 3-4-year-old preschool children (N = 128). We find several qualitative differences in neural processing of number by conceptual stage of development. Specifically, we find differences in early attention-related parietal electrophysiology (N1), suggesting that less conceptually advanced children process arrays as individual objects and more advanced children distribute attention over the entire set. Subsequently, we find that only more conceptually advanced children show later-going frontal (N2) sensitivity to the numerical-distance relationship between the number word and visual quantity. The nature of this response suggested that exact rather than approximate numerical meanings were being associated with number words over frontal sites. No evidence of numerical distance effects was observed over posterior scalp sites. Together these results suggest that children may engage parallel individuation of objects to learn the meanings of the first few number words, but, ultimately, create new exact cardinal value representations for number words that cannot be defined in terms of core, nonverbal number systems. More broadly, these results document an interaction between attentional and general cognitive mechanisms in cognitive development.

This study analysed the content of 30 in-service primary school music teachers' lesson plans for mobile music creation during a 5-week professional development course from 2019 to 2022 in Hong Kong. During the course, the teachers were taught by the researcher on how to use the mobile application GarageBand in their instructional design for classroom music teaching. Various mobile learning pedagogies were discussed during the course to facilitate listening, performing and creating in music teaching and learning. As a learning outcome of this course, the teachers were asked to upload their lesson plans to the Knowledge Transfer website to exchange ideas for further discussion and professional sharing with other in-service teachers from their respective schools. The purpose of this study was to provide an analysis of their teaching plans based on previously published research on mobile learning and motivation. This study aimed to a) deepen the understanding of music lessons in mobile music creation, and b) analysing the lesson plans and suggesting how different teaching strategies and approaches can be used in classroom teaching. Based on the results of the study, a pedagogical model is proposed as a reference point for knowledge exchange in the research and practice of music education.

This study investigated the predictive effect of 11th grade Taiwanese students' (N = 878) self-assessed critical thinking, group participation self-efficacy, and active learning on their genuine learning interest (GLI) in socio-scientific issues (SSI). Results showed that active learning had a direct effect on GLI, while critical thinking and group participation self-efficacy had indirect effects on GLI as mediated by active learning. Critical thinking showed a significant direct effect on active learning, and a significant indirect effect on active learning that was mediated by group participation self-efficacy.

Abstract Hyperthermia is one of the most patient-friendly methods to cure cancer diseases owing to its noninvasiveness, minimally induced side-effects and toxicity, and easy implementation, prompting the development of novel therapeutic methods like photothermally triggering dose system. This research herein interrogates the variables of photothermal effects of Cs0.33WO3 nanoparticles (NPs), the duration of irradiation, optical power density and NP concentration, upon HepG2 liver cancer cell line in vitro, leading to the formulation of a near-infrared (NIR)-irradiated thermal dose. Expressly, the NPs with particulate feature sizes of 120 nm were synthesized through a series of oxidation–reduction (REDOX) reaction, thermal annealing and wet-grinding processes, and the subsequent characterization of physical, compositional, optical, photothermal properties were examined using dynamic light scattering (DLS), energy-dispersive X-ray spectroscopy (EDS), scanning and tunneling electron microscopies (SEM and TEM), X-ray diffraction (XRD) and visible-near-infrared (VIS–NIR) photospectroscopy. Cytotoxicity of the NPs and its irradiation parameters were obtained for the HepG2 cells. By incubating the cells with the NPs, the state of endocytosis was verified, and the dependence of cellular survival rate on the variable parameters of photothermal dose was determined while maintaining the medium temperature of the cell-containing culture dish at human body temperature around 36.5 °C.

A bi-layer coating is deposited on the surface of the AZ31B Mg alloy for corrosion protection of the Mg alloy. The bi-layer coating is composed of a micro-arc oxidation coating (MAO), and an electroless plated Ni-P coating. The micro-arc oxidation (MAO) treatment in the electrolyte with or without the addition of phosphate ions is carried out under unipolar power mode. The microstructure and composition of the MAO coatings are analyzed by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS). The roughness of the MAO coatings is obtained by using 3D white light interferometry. The corrosion resistances are evaluated by potentiodynamic polarization test as well as electrochemical impedance spectroscopy (EIS) in a 3.5 wt.% NaCl solution and salt spray test. The adhesion test results of the MAO/Ni-P composite coatings by drawing test machine. The results showed that the micro-pores size of the MAO coating treated in the phosphate-free bath is uniform and smaller than the phosphate-containing solution, which could decrease the roughness and enhance the corrosion resistance. The corrosion resistance of MAO coating with the phosphate-free solution for 2.8 times was better than that of phosphate-containing solution. Moreover, phosphate-free MAO/Ni-P composite coating showed the corrosion rate is more than 4 times lower than the phosphate-containing MAO/Ni-P composite coating. Furthermore, the MAO/Ni-P composite coatings prepared by the MAO coating treated in the phosphate-free bath could suppress the erosion of aggressive media during exposure after 120 h salt spray test (corrosion area is approximately 5%) and present excellent adhesion.

Quantum summation is one of the various applications in secure multi-party computation. However, most of the existing quantum summation protocols assume that the participants possess all the quantum devices. Considering future applications, the capability of the participants must be adjusted before it can be put into practical use. Although Boyer et al. proposed that the semi-quantum environment could be used to solve this problem; another practical problem is the interference by noise. In 2022, Ye et al. proposed a two-party semi-quantum summation (SQS) protocol resistant to the interference of collective noise, in which two classical participants can accomplish the summation of their private binary sequences with the assistance of a quantum semi-honest third party. They proved that their SQS protocol is resistant to various eavesdropping attacks. This paper unveils two risks of information leakage in Ye et al.’s SQS protocol. If the aforementioned security issues are not resolved, Ye et al.’s SQS protocol may not be able to perform private quantum computations securely. Fortunately, the SQS protocol against the collective-dephasing noise proposed in this study is free from the issue of information leakage as well as resistant to various quantum attacks. In addition, the quantum efficiency of the SQS protocol proposed in this study is four times higher than that of Ye et al.’s SQS protocol, which can effectively improve the quantum utilization rate.

Abstract Background The standard treatment for epithelial ovarian carcinoma (EOC) is surgery followed by platinum/paclitaxel-based chemotherapy, but the overall survival rate is poor. The purpose of this study was to investigate the therapeutic potential of chemotherapy combined with inhibition of B and T lymphocyte attenuator (BTLA) for clinical use to treat EOC. Methods Initially, we evaluated the potential application of chemotherapy combined with anti-BTLA antibody in an animal model. We then analyzed the distribution and regulation of BTLA expression on immunocytes in vitro. Finally, we examined the correlation between BTLA expression levels in cancerous tissues and prognosis in 254 EOC cases. Results The combination of chemotherapy and anti-BTLA antibody for inhibiting BTLA significantly reduced peritoneal tumor volume and extended survival in tumor-bearing mice. In addition, BTLA could be identified mostly on B lymphocytes, especially on CD19hi B cells, rather than on T lymphocytes and natural killer cells. Under regulation of interleukins 6 and 10, more BTLA+CD19hi B lymphocytes could be induced through AKT and STAT3 signaling pathways. Detectable BTLA expression in ovarian cancerous tissues was associated with worse disease-free and overall survivals of EOC patients. Conclusions BTLA detected in cancerous tissues can predict poor outcome of EOC patients. Inhibition of BTLA combined with chemotherapy can elevate immune activation and generate potent anti-tumor effects. Thus, the combination of chemotherapy and anti-BTLA antibody may hold potential clinical application for the treatment of EOC patients. Trial registration The Trial Registration Number was NCT00854399.

Background: Intravascular leiomyomatosis (IVL) is relatively rare. The optimal surgical method and long-term outcomes are not completely understood. Methods: Medical records between 2007 and 2017 in our hospital were analyzed to identify IVL cases with surgical intervention. Their medical records, operative details, and follow-up were collected by chart review and telephone communication. Results: Eight patients with IVL were included in the study, accounting for 0.26% of all uterine leiomyoma cases. Primary IVL was confined to pelvic cavity in three patients, extended to the inferior vena cava (IVC) below renal vein in one, reached IVC and right atrium in three, and reached main pulmonary artery in one. One-stage operation was performed for seven patients. Cardiopulmonary bypass was done in four patients, and aortic cross-clamp and temporary circulatory arrest was performed in two patients. None of the four patients with intrapulmonary tumors received concomitant pulmonary tumor resection. There was no operative mortality and four morbidities, including ureter injury (2), bladder injury (1), and femoral vein thrombosis (1). During follow-up, two patients exhibited local recurrence of the tumor in the pelvis, and one patient had rapidly growing intrapulmonary tumor three months post-operatively. Intrapulmonary tumors in the other three patients remained stationary at 6, 84, and 120 months post-operatively. Conclusion: One-stage operation to completely remove IVL is feasible and with good long-term outcomes, which is recommended if the patient can tolerate the operation. Concomitant intrapulmonary tumors can be followed up watchfully except when associated with pleural effusion or the pathology indicating trend of increasing malignancy. Keywords: Intravascular leiomyomatosis, Intracardiac leiomyomatosis, Cardiac tumor, Surgery, Cardiopulmonary bypass, Follow-up

Objective: To evaluate the clinical presentations, diagnosis, management, and outcomes of torsion of the pedunculated subserous uterine leiomyoma. Materials and methods: We retrospectively reviewed medical records of patients with subserous uterine leiomyomas undergoing surgeries at National Taiwan University Hospital from January 2001 to December 2015. Results: Five cases of torsion of pedunculated subserous uterine leiomyoma were identified. All presented with sudden onset abdominal pain. Two patients received emergent surgeries, the other three cases received scheduled surgeries. The postoperative courses of these five women were uneventful without sequelae. Conclusions: Torsion of pedunculated subserous uterine leiomyoma is rare. Accurately diagnosing it prior to surgery is a major challenge. It should be one of the differential diagnosis in patients with uterine leiomyoma presenting with acute abdomen. Keywords: Abdominal pain, Emergency, Myomectomy, Subserous leiomyoma, Torsion

Objective: To report a case and review published cases of large cell neuroendocrine carcinoma (LCNEC) of the endometrium. Case report: A 51-year-old female presented with postmenopausal bleeding and a palpable pelvic mass. An endometrial biopsy showed a malignant mixed Mullerian tumor (MMMT). Suboptimal debulking surgery was performed. The final pathology revealed stage IVB endometrial LCNEC. Post-operative adjuvant chemotherapy with cisplatin and etoposide was administered. Two months after discontinuing adjuvant chemotherapy, salvage chemotherapy with cisplatin and ifosfamide was administered due to tumor progression; however, obstructive ileus was noted 2 months later. A segmental small bowel resection and palliative colostomy were performed. She died secondary to a post-operative infection 8 days after the operation. Conclusion: Endometrial LCNEC is a rare but aggressive disease. If diagnosed, combined therapies, including staging surgery, following by adjuvant radiotherapy and chemotherapy, should be performed.

Objective: Radical trachelectomy (RT) is an alternative treatment for preserving fertility in patients with cervical cancer. Because women with operable cervical cancer opting for fertility preservation are scarce, few cases have been reported in Taiwan. Here we report our cases series. Materials and Methods: We retrospectively evaluated seven patients who underwent vaginal RT and three patients who underwent abdominal RT in a single medical institute for a median follow-up period of 5 years. Results: The oncological outcome was highly satisfactory. All patients survived and are currently disease-free, except for two who had recurrence and received additional concurrent chemoradiation therapy. Other complications included urinary tract infection, cervical stenosis, and unilateral hydronephrosis. All complications were manageable with little long-term effects. However, no pregnancy was observed during the 5-year follow-up period. Conclusion: RT is considered a complicated surgical procedure among gynecological operations. Here we review the literature and describe several factors associated with higher pregnancy rates.

DNA damage response (DDR) is important for maintaining genomic integrity of the cell. Aberrant DDR pathways lead to accumulation of DNA damage, genomic instability and malignant transformations. Gene mutations have been proven to be associated with epithelial ovarian cancer, and the majority of the literature has focused on BRCA. In this study, we investigated the somatic mutation of DNA damage response genes in epithelial ovarian cancer patients using a multiple-gene panel with next-generation sequencing. In all, 69 serous, 39 endometrioid and 64 clear cell carcinoma patients were enrolled. Serous carcinoma patients (69.6%) had higher percentages of DDR gene mutations compared with patients with endometrioid (33.3%) and clear cell carcinoma (26.6%) (p < 0.001, chi-squared test). The percentages of DDR gene mutations in patients with recurrence (53.9 vs. 32.9% p = 0.006, chi-squared test) or cancer-related death (59.2 vs. 34.4% p = 0.001, chi-squared test) were higher than those without recurrence or living patients. In endometrioid carcinoma, patients with ≥2 DDR gene mutations had shorter PFS (p = 0.0035, log-rank test) and OS (p = 0.015, log-rank test) than those with one mutation or none. In clear cell carcinoma, patients with ≥2 DDR gene mutations had significantly shorter PFS (p = 0.0056, log-rank test) and OS (p = 0.0046, log-rank test) than those with 1 DDR mutation or none. In the EOC patients, somatic DDR gene mutations were associated with advanced-stage tumor recurrence and tumor-related death. Type I EOC patients with DDR mutations had an unfavorable prognosis, especially for clear cell carcinoma.

Objective: To evaluate the influence of age, screening interval, and histologic type on the effect of Pap smears in cervical cancer screening. Materials and methods: Data were retrieved from the Taiwan National Cancer Registry and Cervical Cancer Screening Registration System for the period from 2002 to 2010. Age, Pap smear interval, FIGO stage, and histology were further analyzed. Results: A total of 12,294 women with cervical cancer were enrolled, including 10,040 with squamous cell carcinoma (SCC), 1720 with adenocarcinoma (ADC), 401 with adenosquamous carcinoma (ASC), and 133 with small cell neuroendocrine carcinoma (SMC). Women who had a Pap smear at an interval of

In this retrospective study, we investigated adverse events and outcomes in patients treated with bevacizumab for ovarian, fallopian tube, or primary peritoneal cancers at a single hospital. We determined the cumulative incidences of various bevacizumab-related adverse events and the correlation between dose and adverse event incidences. We analyzed data from 154 patients that received 251 rounds of bevacizumab as first-line, first salvage, >2 salvage treatments. Adverse events of any grade were observed in 121 (78.6%) patients; at least one grade 3 or 4 adverse event occurred in 32 (20.8%) patients. The two most common events were proteinuria (38.3%) and hypertension (33.8%). The first-line treatment group displayed significantly higher frequencies of hypertension (52.7% vs. 18.9% vs. 15.5%, p < 0.001), wound complications (9.1% vs. 0% vs. 1.2%, p = 0.010), arthralgia (29.1% vs. 11.3% vs. 8.3%, p = 0.003), and reduced range of joint motion (14.5% vs. 5.7% vs. 3.6%, p = 0.046), compared to those in the first and >2 lines salvage groups, respectively (Kruskal–Wallis test). The cumulative incidences of all grades and grades 3/4 of hypertension cumulative incidence plateaued at around 30% for all grades and 10% for grades 3 and 4, at bevacizumab doses above 8080 and 3510 mg, respectively. The proteinuria cumulative incidence plateaued at around 35% for all grades and 3% for grades 3 and 4, at bevacizumab doses above 11,190 and 4530 mg, respectively. We concluded that, in this realistic clinical population, different kinds and higher cumulative incidences of adverse events were observed compared to those reported in previous clinical trials. Moreover, bevacizumab doses showed cumulative toxicity and plateau effects on hypertension and proteinuria.

Abstract Background Weight control behaviors are commonly observed among adolescents and emerging adults. However, the high prevalence of overweight and obesity in both these age groups remains an imperative health concern. Adolescents and emerging adults represent the most vulnerable groups facing the health burden of obesity. Methods This study was designed to articulate the underlying beliefs concerning weight control behaviors among adolescents and emerging adults living with obesity by an elicitation qualitative study based on the integrated behavioral model (IBM). Semi-structured and individual interviewing was utilized. Eligible participants were recruited during September and November 2020. All interviews were audio-recorded, transcribed verbatim, and analyzed using a hybrid inductive and deductive content analysis approach. Results Twenty-seven participants, comprising 12 adolescents and 15 emerging adults living with obesity, were interviewed to explore their beliefs and strategies regarding weight control behaviors. Emerging adults were more likely to engage in extreme weight control methods. Three overarching themes emerged across both age groups: eating-centered concerns, focus on physical appearance, and social interference. Significant differences were noted while adolescents and emerging adults shared some common beliefs. Emerging adults expressed more economic concerns about weight control, whereas adolescents identified food restriction as the primary barrier to their weight management efforts. These findings highlight the nuanced differences in beliefs about the weight control practice of these two developmental groups. Conclusion More beliefs-tailored and theoretically driven interventions are needed for these two unique age groups. Healthcare providers should address dietary and economic concerns while engaging adolescents and emerging adults in weight management. Future obesity interventions should incorporate shared and unique beliefs identified in each group to promote healthy weight management effectively.

This study utilised the instant semantic analysis and feedback system (ISAFS) to assist learners in the online discussion learning activities of socio-scientific issues (SSIs) and to document their learning process behaviours for behavioural analyses. The aim was to understand the learners' discussion behaviours during the ISAFS assisted learning process and to guide them in exhibiting more effective discussion behaviours in order to facilitate the learning effectiveness of online asynchronous discussions. The research participants were 55 eleventh-grade students from a senior high school in northeastern Taiwan. A single pre-experimental group design was adopted to collect the learning process data. Eventually, 34 effective samples were considered following the online discussions. The results showed that learners with distinct computer-mediated communication competences and personality traits have different behaviour patterns. Overall, the behavioural analyses reveal that different learning behaviours would result in distinct learning effectiveness, and that learners with different computer-mediated communication competences and personality traits would present various learning behaviours. Based on the research results, suggestions for the application of ISAFS in teaching and implications for future developments are proposed. The findings could be instrumental in the improvement of the teaching process through online discussions.

The purpose of civic education is to prepare students to become 'good citizens' aligned with the policies and political purposes of the regime to which they belong. This exploratory study employed a mixed methods design to construct a typology of 'good citizens' to understand university students' perceptions of citizenship in Taiwan, Hong Kong, Macau and Mainland China. It found that the university students' perceptions of 'good citizens' is constructed from two components: internal political efficacy and the connection between 'good citizens' and the regime. Students in these societies share a similar understanding of the first component but have significant divergences in the second component. These findings demonstrate a correlation between regime type and the perceptions of 'good citizens' and our typology could provide a conceptual framework to guide researchers in organising and conducting further comparative studies.

Internet-related issues have influenced how civic knowledge is educated and measured. The International Civic and Citizenship Education Study (ICCS) is a well-known large-scale assessment concerning how civic knowledge is educated and measured globally. Regardless of the emerging roles of internet access and usage, the influences of internet access on civic knowledge have yet to be investigated in ICCS research. Hence, this study aims to study whether the multiple-choice items in the civic knowledge test of ICCS 2016 are affected by internet access, what causes the effect, and to what degree Internet access influences the measurement. Results indicated that the ICCS civic knowledge test included six differential item functioning (DIF) items on internet access, of which five favored families with internet access, and one favored families without internet access. In addition, the primary source of DIF items was highly related to socioeconomic status. Overall, the students in families where the internet was available possessed higher civic knowledge than the students who were not. In conclusion, this study provides evidence of item inequivalence and identifies suspicious sources. These results can be used as a basis to investigate related research on digital learning, online teaching, and social media engagement in civic literacy.

We aimed to identify factors predicting parametrial invasion in early-stage cervical cancer patients undergoing radical hysterectomy. We recruited women with invasive cervical cancer who underwent radical hysterectomy at a single medical institute from 2000-2011. The clinical and pathological characteristics and outcomes were retrospectively recorded, and the risk factors for parametrial invasion were analyzed. We enrolled 339 patients, including 7 with stage IA1 carcinomas, 10 with stage IA2, 266 with stage IB1, 39 with stage IB2, 14 with stage IIA1, and 3 with stage IIA2. The majority (237/339, 69.9%) had squamous cell carcinoma, while 32 (12.4%) had parametrial invasion. The 16 patients with stage IB1 tumors and parametrial invasion were older (55.9±9.5vs. 49.0±9.9 years, p = 0.005, Mann-Whitney U test), and had deeper cervical stromal invasion (9.59±4.87 vs. 7.47±5.48 mm, p = 0.048, Mann-Whitney U test), larger tumor size (2.32±1.15 vs. 1.74±1.14cm, p = 0.043, Mann-Whitney U test), higher incidences of lymphovascular space invasion (87.5% vs. 28.8%, p2 cm,10% had parametrial invasion and 24.2% had lymph node metastasis compared with only 4% and 9.4% of stage IB1 patients with a tumor size

We evaluated the prevalence of and risk factors for hypersensitivity reactions related to carboplatin, which is commonly used to treat gynecological malignancies. All women with pathologically documented ovarian, fallopian tube, or primary peritoneal cancer treated with carboplatin alone or a carboplatin-based combination chemotherapy regimen at a single hospital between January 2006 and December 2013 were retrospectively recruited. We analyzed the incidence, characteristics, risk factors, management, and outcomes of carboplatin-related hypersensitivity reactions among these patients. Among 735 eligible women, 75 (10.2%) experienced a total of 215 carboplatin-related hypersensitivity reaction events. The annual incidence of carboplatin-related hypersensitivity reactions gradually increased from 0.88% in 2006 to 5.42% in 2013. The incidence of carboplatin-related hypersensitivity was higher in patients with advanced stage disease (P < 0.001, Kruskal-Wallis test), serous and mixed histological types (P = 0.003, Kruskal-Wallis test), malignant ascites (P = 0.009, chi-square test), and history of other drug allergy (P < 0.001, chi-square test). Compared to women without hypersensitivity reactions, women who experienced hypersensitivity reactions had a significantly greater median cycle number (12 vs. 6, P < 0.001, independent sample t-test) and dose (6,816 vs. 3,844 mg, P < 0.001, independent sample t-test). The cumulative incidence of carboplatin-related hypersensitivity reactions dramatically increased with >8 cycles or dose >3,500 mg. Therefore, disease severity, histological type, malignant ascites, past drug allergies, and cumulative carboplatin dose are risk factors for carboplatin-related hypersensitivity reactions. Such reactions could potentially be reduced or prevented by slowing the infusion rate and using a desensitization protocol involving anti-allergy medications.

We analyzed the management and risk of subsequent cervical intraepithelial neoplasm 3 (CIN3) and invasive cervical cancer in women with low-grade squamous intraepithelial lesion (LSIL) cytology. A total of 53,293 women with a new diagnosis of cytologic LSIL were identified in Taiwan's national cervical screening registration database. Based on the retrieved clinical management data, the incidence of subsequent CIN3+ lesions was determined, and the hazard ratios (HRs) were estimated using a Cox proportional hazards model. The average follow-up was 5.02 years. A total of 988 women developed CIN3+ lesions during this period, with an overall incidence of 369.3 women per 100,000 person-years. Cryotherapy and conization/loop electrosurgical excision procedure (LEEP) decreased the subsequent risk of CIN3+ lesions in women younger than 50 years (HR 0.49, 95% confidence interval [CI] 0.37-0.64, p

Objective: To report a case of isolated omental peritoneal carcinoma without peritoneal carcinomatosis. Case report: A 60-year-old female with abdominal distention was found to have a pelvic mass. Under the impression of ovarian cancer, laparotomy was performed only to show one isolated mass over omentum. Serial examination and pathology study including immunochemical staining indicated primary peritoneal serous carcinoma. Conclusion: Isolated omental peritoneal carcinoma without peritoneal carcinomatosis and ascites is rare, and whether this represented a unique entity with different chemotherapy response and treatment outcome from the disseminated form of primary peritoneal carcinoma needs to be reviewed in the future.

Objective: To investigate the various genotypes of human papillomavirus (HPV) in Taiwanese women patients with abnormal cervical cytology and analyze the associations between HPV types, cervical preinvasive lesions, and the medical characteristics of these patients. Materials and Methods: We performed HPV genotyping GeneChip procedures and colposcopies for 784 women with abnormal Papanicolaou smears. The characteristics of the patients and the status of the HPV infection were correlated. Results: A total of 706 (90.1%) of the 784 women were positive for HPV infection, including 641 patients with high-risk HPV (HR-HPV). Among the patients with high-grade squamous intraepithelial lesions (HSILs), the average age of the 273 patients with other HR-HPV types (48.6 ± 13.8 years) was significantly older than the 222 patients infected with HPV 16/18 (39.8 ± 11.8 years) (p

Background: E. coli ST8346 is a unique strain associated with the potential carriage of multiple carbapenemases. Three unique E. coli ST8346 isolates were identified, each concurrently harboring multiple carbapenemases, including blaNDM-5, blaKPC-2, and/or blaOXA-181. This study aimed to characterize the genetic and plasmid structures of these isolates to understand their transmission and resistance mechanisms. Methods: Antibiotic resistance profiles, genetic relatedness, and plasmid structures were determined using antibiotic susceptibility testing, multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), S1 nuclease PFGE, and long-read sequencing. Results: All the strains were carbapenem resistant. PFGE revealed close genetic relationships among the isolates, despite the lack of geographical or epidemiological connections. blaNDM-5, blaKPC-2, and blaOXA-181 were located on separate plasmids. Plasmids harboring blaNDM-5 showed genetic similarities to blaNDM-5-bearing IncF plasmids in the United Kingdom. The IncA/C plasmids harboring blaKPC-2 had identical sequences resembling a plasmid from a K. pneumoniae strain in Taiwan, except for the blaKPC-2 region, which matched a strain from China, indicating a hybrid plasmid. Conclusion: This study is the first to identify and characterize the coexistence of blaNDM-5, blaKPC-2, and blaOXA-181 in E. coli ST8346 isolates. The spread appears to be due to independent acquisition events. We identified the putative origins of these plasmids and detected a possible recombination event in a novel IncA/C plasmid. These findings emphasize the importance of ongoing surveillance and further investigations.

Background: The roles of endogenous stress hormones (norepinephrine, epinephrine, and cortisol) in cardiovascular diseases have been discussed. However, the higher versus lower level of stress hormones in relation to cardiovascular risks remained uncertain. Methods: We searched databases from their inception to 31, March 2023. We conducted a meta-analysis to estimate the effect of higher to lower level of stress hormones with random effect model. Subgroup and meta-regression analysis were done to clarify the heterogeneity. Results: In total, 33 studies involving 43641 participants were included. With regard to cardiovascular disease risks, a higher risk for individuals with higher level of all stress hormones (risk ratio (RR), 1.63; 95 % Confidence intervals (CIs): 1.36, 1.97) was noted compared with lower level of all stress hormones. The meta-regression showed that as the follow-up year increased per year, the impact of higher level of all stress hormones on the risk of cardiovascular disease declined significantly (RR, −0.09; 95 % CIs: 0.15, −0.03, p = 0.006). A significantly higher risk of cardiovascular diseases for individuals with higher level of norepinephrine (RR, 1.68; 95 % CIs: 1.37, 2.06), with higher level of epinephrine (RR, 1.58; 95 % CIs: 1.10, 2.26), and with higher level of cortisol (RR, 1.60; 95 % CIs: 1.04, 2.26) were noted compared with a lower level of each stress hormone. Conclusion: Higher levels of stress hormones were significantly associated with higher risks of cardiovascular diseases compared with lower levels of stress hormones.

Objective: Signal transducer and activator of transcription (STAT)1 is a key tumor suppressor, which is always methylated in a variety of human cancers. However, nonspecific primers for the detection of specific promoter hypermethylation of STAT1 gene can lead to false-positive or false-negative results for gene methylation. Materials and Methods: We designed new primers for the detection of STAT1 methylation and compared the sensitivities and specificities of these new primers with prior published primers by methylation-specific polymerase chain reaction (PCR) from ovarian clear cell carcinomas. The mRNA expression levels of STAT1 in these cancerous tissues were also evaluated by reverse-transcriptase PCR and correlated with the results of promoter methylation of STAT1 gene. Results: Nine (39%) of the 23 samples detected by the new primers and 13 samples (56%) detected by prior published primers showed STAT1 methylation. A direct DNA sequencing test revealed that four of the 13 samples (30.8%) showed false positivity for STAT1 methylation using the prior published primers. In contrast, none of the nine samples was false-positive for the detection of STAT1 methylation using the new primers. The new primers for the detection of STAT1 methylation showed 100% specificity and 100% sensitivity without false positivity. Conclusion: Specific primers for methylation-specific PCR are mandatory for the accurate detection of STAT1 gene methylation. Besides, specific primers can generate correct interpretation of STAT1 gene methylation, and its correlation with the clinicopathological characteristics and outcome of cancer patients.

Endometrial hyperplasia is considered a precursor of endometrial carcinoma, but concurrent endometrial carcinoma in patients with endometrial hyperplasia is seen frequently. Our aim was to examine the risk factors for coexisting endometrial carcinoma in patients with endometrial hyperplasia. Methods: Between January 1996 and September 2006, 77 patients who underwent hysterectomy for endometrial hyperplasia were enrolled retrospectively. We divided the patients into non-endometrial carcinoma and endometrial carcinoma groups, depending on the final pathology of hysterectomy and analyzed the clinical variables of these patients. Results: The prevalence rate of concurrent endometrial carcinoma in patients with endometrial hyperplasia was 26%. Those with atypical endometrial hyperplasia had a higher rate of coexisting endometrial carcinoma (54%). In addition to cytologic atypia, body mass index (BMI) was another risk factor. All the patients with concomitant endometrial carcinoma had at least one risk factor, but almost 50% of the cases in the non-endometrial group had no risk factors. Half of the women with cytological atypia and BMI > 25 had coexisting endometrial carcinoma. Conclusion: When patients are diagnosed with endometrial hyperplasia, surgical intervention should be performed in those with cytological atypia and higher BMI because of the possibility of coexisting endometrial carcinoma.

The formation of pseudoaneurysms in patients with gynecologic malignancies is rare. We describe a patient with locally advanced cervical cancer who had life-threatening rectal bleeding due to a ruptured pseudoaneurysm of the right external iliac artery, which was successfully treated by emergent endovascular covered stent placement. This 56-year-old woman had received concurrent chemoradiation, salvage hysterectomy and systemic chemotherapy for advanced cervical cancer. About 25 months after her diagnosis of cervical cancer, she suffered from acute life-threatening rectal bleeding. Angiography revealed active extravasation from a pseudoaneurysm of the right external iliac artery. A covered stent was placed across the pseudoaneurysm via an endovascular approach to stop the bleeding. The patient recovered well without any sequelae. We believe that this technique might also be useful in other irradiated gynecologic cancer patients, especially when direct surgical repair is difficult to perform due to pelvic irradiation or tumor recurrence.

Extraperitoneal cesarean section was once used for the prevention of infection and postoperative adhesion. However, we report an unusual complication after this procedure. A 29-year-old woman had pus discharge from the anterior vaginal wall after extraperitoneal cesarean section. Broad-spectrum antibiotics failed to relieve her symptoms and vaginal culture yielded Morganella morganii. Magnetic resonance imaging, sagittal view, showed a cervical abscess measuring 5 × 5 cm with a tract extending to the anterior vagina. After performing dilation and abscess drainage via the cervical ostium, the symptoms gradually subsided with adequate antibiotic treatment. Cervical abscess may develop after extraperitoneal cesarean section and present initially as vaginal fistula. Detailed imaging study provides comprehensive anatomic information for effective management.

BACKGROUND: Associations of obesity and obesity-related metabolic factors (adiposity factors) with uterine corpus cancer (UCC) and ovarian cancer (OVC) risk have been described. Still, a cause-effect relationship and the underlying mediators remain unclear, particularly for low-incidence populations. We aimed to prospectively determine whether adiposity factors could predict the development of UCC and OVC in Taiwanese women. To explore the biological mediators linking adiposity factors to cancer risk, we examined the association of two adipokines, leptin and adiponectin, with the gynecological cancers. METHODS: Totally, 11,258 women, aged 30-65, were recruited into the Community-Based Cancer Screening Program (CBCSP) study during 1991-1993, and were followed for UCC and OVC cases until December 31, 2011. Cox proportional hazard models were used to estimate hazard ratios (HRs). Adiposity factors and risk covariates were assessed at recruitment. Newly-developed cancer cases were determined from data in the government's National Cancer Registry and Death Certification System. For adipokienes study, a nested case-control study was conducted within the cohort. Baseline plasma samples of 40 incident gynecological cancer cases and 240 age-menopause-matched controls were assayed for adipokines levels. FINDINGS: There were 38 and 30 incident cases of UCC and OVC, respectively, diagnosed during a median 19.9 years of follow-up. Multivariate analysis showed that alcohol intake (HR = 16.00, 95% = 4.83-53.00), high triglyceride levels (HR = 2.58, 95% = 1.28-5.17), and years of endogenous estrogen exposure per 5-year increment (HR = 1.91, 95% = 1.08-3.38) were associated with increased UCC risk. High body mass index (BMI ≥ 27 kg/m(2), HR = 2.90, 95% = 1.30-6.46) was associated with increased OVC risk. Analysis further showed an independent effect of adipokines on UCC and OVC risk after adjustment of the risk covariates. CONCLUSION: We provided evidence that alcohol intake, high triglyceride levels and long endogenous estrogen exposure increase UCC risk, whereas obesity positively predicts OVC risk. Circulating adipokines may mediate the link of adiposity factors to gynecological cancer risk.