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  • 1
    Online Resource
    Online Resource
    Clinical Efficacy of Adjuvant Chemotherapy in Advanced Upper Tract Urothelial Carcinoma (pT3-T4): Real-World Data from the Taiwan Upper Tract Urothelial Carcinoma Collaboration Group
    MDPI AG ; 2022
    In:  Journal of Personalized Medicine Vol. 12, No. 2 ( 2022-02-06), p. 226-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 12, No. 2 ( 2022-02-06), p. 226-
    Abstract: The clinical efficacy of adjuvant chemotherapy in upper tract urothelial carcinoma (UTUC) is unclear. We aimed to assess the therapeutic outcomes of adjuvant chemotherapy in patients with advanced UTUC (pT3-T4) after radical nephroureterectomy (RNU). We retrospectively reviewed the data of 2108 patients from the Taiwan UTUC Collaboration Group between 1988 and 2018. Comprehensive clinical features, pathological characteristics, and survival outcomes were recorded. Univariate and multivariate Cox proportional hazards models were used to evaluate overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Of the 533 patients with advanced UTUC included, 161 (30.2%) received adjuvant chemotherapy. In the multivariate analysis, adjuvant chemotherapy was significantly associated with a reduced risk of overall death (hazard ratio (HR), 0.599; 95% confidence interval (CI), 0.419–0.857; p = 0.005), cancer-specific mortality (HR, 0.598; 95% CI, 0.391–0.914; p = 0.018), and cancer recurrence (HR, 0.456; 95% CI, 0.310–0.673; p 〈 0.001). The Kaplan–Meier survival analysis revealed that patients receiving adjuvant chemotherapy had significantly better five-year OS (64% vs. 50%, p = 0.002), CSS (70% vs. 62%, p = 0.043), and DFS (60% vs. 48%, p = 0.002) rates compared to those who did not receive adjuvant chemotherapy. In conclusion, adjuvant chemotherapy after RNU had significant therapeutic benefits on OS, CSS, and DFS in advanced UTUC.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm12020226
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662248-8
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  • 2
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    Clinical Validation of Cardiac Arrest Hospital Prognosis (CAHP) Score and MIRACLE2 Score to Predict Neurologic Outcomes after Out-of-Hospital Cardiac Arrest
    MDPI AG ; 2022
    In:  Healthcare Vol. 10, No. 3 ( 2022-03-20), p. 578-
    Details
    In: Healthcare, MDPI AG, Vol. 10, No. 3 ( 2022-03-20), p. 578-
    Abstract: Background. Out-of-hospital cardiac arrest (OHCA) remains a challenge for emergency physicians, given the poor prognosis. In 2020, MIRACLE2, a new and easier to apply score, was established to predict the neurological outcome of OHCA. Objective. The aim of this study is to compare the discrimination of MIRACLE2 score with cardiac arrest hospital prognosis (CAHP) score for OHCA neurologic outcomes. Methods. This retrospective cohort study was conducted between January 2015 and December 2019. Adult patients ( 〉 17 years) with cardiac arrest who were brought to the hospital by an emergency medical service crew were included. Deaths due to trauma, burn, drowning, resuscitation not initiated due to pre-ordered “do not resuscitate” orders, and patients who did not achieve return of spontaneous circulation were excluded. Receiver operating characteristic curve analysis with Youden Index was performed to calculate optimal cut-off values for both scores. Results. Overall, 200 adult OHCA cases were analyzed. The threshold of the MIRACLE2 score for favorable neurologic outcomes was 5.5, with an area under the curve (AUC) value of 0.70 (0.61–0.80, p 〈 0.001); the threshold of the CAHP score was 223.4, with an AUC of 0.77 (0.68–0.86, p 〈 0.001). On setting the MIRACLE2 score cut-off value, we documented 64.7% sensitivity (95% confidence interval [CI], 56.9–71.9%), 66.7.0% specificity (95% CI, 48.2–82.0%), 90.8% positive predictive value (PPV; 95% CI, 85.6–94.2%), and 27.2% negative predictive value (NPV; 95% CI, 21.4–33.9%). On establishing a CAHP cut-off value, we observed 68.2% sensitivity (95% CI, 60.2–75.5%), 80.6% specificity (95% CI, 62.5–92.6%), 94.6% PPV (95% CI, 88.6%–98.0%), and 33.8% NPV (95% CI, 23.2–45.7%) for unfavorable neurologic outcomes. Conclusions. The CAHP score demonstrated better discrimination than the MIRACLE2 score, affording superior sensitivity, specificity, PPV, and NPV; however, the CAHP score remains relatively difficult to apply. Further studies are warranted to establish scores with better discrimination and ease of application.
    Type of Medium: Online Resource
    ISSN: 2227-9032
    URL: Article
    DOI: 10.3390/healthcare10030578
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2721009-1
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  • 3
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    Online Resource
    Curved Planar Reformation: A Useful Method for Screening Dental Pathologies in Chronic Rhinosinusitis via Paranasal Sinus Computed Tomography
    MDPI AG ; 2022
    In:  Tomography Vol. 8, No. 5 ( 2022-09-16), p. 2330-2338
    Details
    In: Tomography, MDPI AG, Vol. 8, No. 5 ( 2022-09-16), p. 2330-2338
    Abstract: (1) Background: Curved planar reformation (CPR) is a multiplanar reformatting technique of computed tomography (CT) commonly used during dental cone-beam CT (CBCT) to generate panorex-like images for dental evaluation. Here, we evaluated the utility of an additional CPR sequence in detecting dental pathologies in patients with chronic rhinosinusitis (CRS). (2) Methods: CRS patients who underwent paranasal sinus CT were enrolled retrospectively. The CT images featured three orthogonal sequences and a reconstructed CPR sequence. Additional dental CBCT was performed in patients with pathologies with a strongly suspected odontogenic origin. Dental pathologies detected by CT, CPR, and CBCT were analyzed. (3) Results: A total of 82 CRS patients (37 females and 45 males; mean age 47.3 ± 13.7 years) were included, of whom 23 underwent dental CBCT. In total, 1058 maxillary teeth were evaluated. Compared with paranasal sinus CT, CPR identified greater frequencies of dental pathologies, particularly caries (p 〈 0.001), periapical lesions (p 〈 0.001), and fistulae (p = 0.014). CBCT identified greater frequencies of periodontal dental pathologies (p = 0.046) and premolar caries (p = 0.002) compared with CPR. CBCT and CPR detected molar dental pathologies at similar frequencies. (4) Conclusions: CPR could increase the diagnostic rate of odontogenic pathologies compared with standard CT orthogonal views, especially when the sinusitis is caused by caries, periapical lesions, or fistulae. The addition of a CPR sequence allows for simple screening of dental pathologies in CRS patients without a need for additional radiation.
    Type of Medium: Online Resource
    ISSN: 2379-139X
    URL: Article
    DOI: 10.3390/tomography8050194
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2857000-5
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  • 4
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    Online Resource
    Nasal Methicillin-Resistant Staphylococcus aureus Colonization in Patients with Type 1 Diabetes in Taiwan
    MDPI AG ; 2021
    In:  Microorganisms Vol. 9, No. 6 ( 2021-06-15), p. 1296-
    Details
    In: Microorganisms, MDPI AG, Vol. 9, No. 6 ( 2021-06-15), p. 1296-
    Abstract: Nasal methicillin-resistant Staphylococcus aureus (MRSA) colonies are an essential reservoir of infection, especially for patients with diabetes. However, data on MRSA colonization in patients with type 1 diabetes are limited. We investigated the epidemiology of MRSA colonization in patients with type 1 diabetes. This prospective cross-sectional study was conducted in a medical center (Chang Gung Memorial Hospital) in Taiwan from 1 July to 31 December 2020. Nasal sampling and MRSA detection were performed. The molecular characteristics of MRSA isolates were tested, and factors associated with MRSA colonization were analyzed. We included 245 patients with type 1 diabetes; nasal MRSA colonization was identified in 13 (5.3%) patients. All isolates belonged to community-associated MRSA genetic strains; the most frequent strain was clonal complex 45 (53.8%), followed by ST59 (30.8%) (a local community strain). MRSA colonization was positively associated with age ≤ 10 years, body mass index 〈 18 kg/m2, and diabetes duration 〈 10 years; moreover, it was negatively associated with serum low-density lipoprotein cholesterol ≥ 100 mg/dL. No independent factor was reported. The nasal MRSA colonization rate in type 1 diabetes is approximately 5% in Taiwan. Most of these colonizing strains are community strains, namely clonal complex 45 and ST59.
    Type of Medium: Online Resource
    ISSN: 2076-2607
    URL: Article
    DOI: 10.3390/microorganisms9061296
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2720891-6
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  • 5
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    Sinus Plain Film Can Predict a Risky Distance from the Lacrimal Sac to the Anterior Skull Base: An Anatomic Study of Dacryocystorhinostomy
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 4 ( 2022-04-08), p. 930-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 4 ( 2022-04-08), p. 930-
    Abstract: Background: Removal of the surrounding bone during dacryocystorhinostomy may present a higher risk of skull base injury in patients with frontal sinus aplasia. We used sinus plain films to predict cases with a greater risk of a reduced skull base distance in dacryocystorhinostomy. Methods: Sinus plain films and computed tomography data from patients were retrospectively evaluated. The frontal sinus was classified as normal, hypoplastic, or aplastic according to Waters’ view. Correlations of the frontal sinus roof-supraorbital margin (F-O) and the frontal sinus roof-nasion (F-N) distances on plain film with the closest lacrimal sac-anterior skull base (LS-ASB) distance measured on computed tomography images were assessed. Results: We evaluated 110 patients. In total, 16 (11.8%) patients had frontal sinus aplasia, of whom 6 (2.7%) had bilateral and 10 (9.1%) had unilateral aplasia. Sides with frontal sinus aplasia based on Waters’ view had a shorter median LS-ASB distance than normal or hypoplastic sides. The F-O and F-N distances in Waters’ view were significantly positively correlated with the computed tomographic LS-ASB distance. The F-O margin and F-N distance thresholds for predicting an LS-ASB distance 〈 10 mm, considered a risky distance, were 11.6 and 14.4 mm, respectively, with sensitivities of 100% and 91.7%, and specificities of 76% and 82.7%, respectively. Conclusions: The LS-ASB distance is closer on aplastic frontal sinus sides. Waters’ view on plain sinus films can provide a fast and inexpensive method for evaluating the skull base distance and sinonasal condition during planning for dacryocystorhinostomy.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12040930
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662336-5
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  • 6
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    Lower Limb Lymphedema Patients Can Still Benefit from Supermicrosurgical Lymphaticovenous Anastomosis (LVA) after Vascularized Lymph Node Flap Transfer (VLNT) as Delayed Lymphatic Reconstruction—A Retrospective Cohort Study
    MDPI AG ; 2021
    In:  Journal of Clinical Medicine Vol. 10, No. 14 ( 2021-07-15), p. 3121-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 10, No. 14 ( 2021-07-15), p. 3121-
    Abstract: Background: For lymphedema patients who received a vascularized lymph node flap transfer (VLNT) as their primary treatment, what are the treatment options when they seek further improvement? With recent publications supporting the use of lymphaticovenous anastomosis (LVA) for treating severe lymphedema, we examined whether LVA could benefit post-VLNT patients seeking further improvement. Methods: This retrospective cohort study enrolled eight lymphedema patients with nine lymphedematous limbs (one patient suffered from bilateral lower limb lymphedema) who had received VLNT as their primary surgery. Patients with previous LVA, liposuction, excisional therapy, or incomplete data were excluded. LVA was performed on nine lower lymphedematous limbs. Demographic data and intraoperative findings were recorded. Preoperative and postoperative limb volumes were measured with magnetic resonance volumetry. The primary outcome was the limb volume measured 6 months post-LVA. Results: The median duration of lymphedema before LVA was 10.5 (4.9–15.3) years. The median waiting time between VLNT and LVA was 41.4 (22.3–97.9) months. The median volume gained in the lymphedematous limb was 3836 (2505–4584) milliliters (mL). The median post-LVA follow-up period was 18 (6–30) months. Significant 6-month and 1-year post-LVA percentage volume reductions were found compared to pre-LVA volume (both p 〈 0.001). Conclusion: Based on the results from this study, the authors recommend the use of LVA as a secondary procedure for post-VLNT patients seeking further improvement.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm10143121
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662592-1
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  • 7
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    Online Resource
    Effects of Asymmetric Quantum Wells on the Structural and Optical Properties of InGaN-Based Light-Emitting Diodes
    MDPI AG ; 2014
    In:  Materials Vol. 7, No. 5 ( 2014-05-12), p. 3758-3771
    Details
    In: Materials, MDPI AG, Vol. 7, No. 5 ( 2014-05-12), p. 3758-3771
    Type of Medium: Online Resource
    ISSN: 1996-1944
    URL: Article
    DOI: 10.3390/ma7053758
    Language: English
    Publisher: MDPI AG
    Publication Date: 2014
    detail.hit.zdb_id: 2487261-1
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  • 8
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    Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors
    MDPI AG ; 2020
    In:  Journal of Clinical Medicine Vol. 9, No. 11 ( 2020-11-13), p. 3658-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 9, No. 11 ( 2020-11-13), p. 3658-
    Abstract: Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p 〈 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage ( 〉 200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm9113658
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
    detail.hit.zdb_id: 2662592-1
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  • 9
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    Multicenter Study of Benign Thyroid Nodules with Radiofrequency Ablation: Results of 762 Cases over 4 Years in Taiwan
    MDPI AG ; 2022
    In:  Journal of Personalized Medicine Vol. 12, No. 1 ( 2022-01-06), p. 63-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 12, No. 1 ( 2022-01-06), p. 63-
    Abstract: Background: To evaluate the effectiveness and safety of radiofrequency ablation (RFA) treatment for benign thyroid nodules (BTNs) in five medical centers in Taiwan. Methods: From April 2016 to July 2020, 762 patients underwent ultrasound guided RFA treatment of 826 benign thyroid nodules at five medical centers in Taiwan. The RFA procedure was performed by radiologists, otolaryngologists, or surgeons. Patients were grouped into three subgroups according to the initial volume of BTNs. The volume reduction ratio (VRR) of each nodule, and complications were analyzed at 1, 3, and 6 months after RFA treatment and the three groups compared. Results: The large nodular group showed greater VRR compared to the other two groups at first 1-month follow-up. At 6-months follow-up, there was no significant difference of VRR among the three groups. Goiters with difference in size can attain a successful VRR ( 〉 50%) although different specialists demonstrated variable VRR after 6-months follow-up. A total of 40 (4.8%) complications were reported. All patients recovered spontaneously without surgery intervention. Conclusions: The reliability and safety of RFA for benign thyroid nodules had been established. RFA has gradually become an alternative to surgery in the treatment of benign thyroid nodules in Taiwan.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm12010063
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662248-8
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  • 10
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    Lymphaticovenous Anastomosis for Treating Secondary Lower Limb Lymphedema in Older Patients—A Retrospective Cohort Study
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 11 ( 2022-05-30), p. 3089-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 11 ( 2022-05-30), p. 3089-
    Abstract: Despite an increased incidence of secondary lower limb lymphedema (LLL) and severity of comorbidities with age, the impact of age on the effectiveness of lymphaticovenous anastomosis (LVA) in the older patients remains unclear. Methods: This retrospective cohort study enrolled older patients (age 〉 65 years) with secondary unilateral LLL. All patients underwent supermicrosurgical LVA. Demographic data and intraoperative findings including lymphatic vessel (LV) diameter, LV functionality (indocyanine green-enhanced and Flow positivity), and lymphosclerosis classification were recorded. Magnetic resonance volumetry was used for measuring preoperative and postoperative volume changes at 6 months and one year after LVA as primary and secondary endpoints. Results: Thirty-two patients (29 females/3 males) with a median age of 71.0 years [range, 68.0 to 76.3] were enrolled. The median duration of lymphedema was 6.4 [1.0 to 11.7] years. The median LV diameter was 0.7 [0.5 to 0.8] mm. The percentage of ICG-e nhanced and Flow-positive LVs were 89.5% and 85.8%, respectively. The total percentage of suitable LVs (s0 and s1) for LVA based on lymphosclerosis classification was 75.9%. There were significant six-month and one-year post-LVA percentage volume reductions compared to pre-LVA volume (both p 〈 0.001). A significant reduction in cellulitis incidence was also noted after LVA (p 〈 0.001). No surgical or postoperative complications were found. Conclusion: Relief of secondary LLL was achievable through LVA in older patients who still possessed favorable LV characteristics, including larger LV diameters as well as a high proportion of functional LVs with a low grade of lymphosclerosis.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm11113089
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662592-1
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