Preoperative hydronephrosis is an independent protective factor of renal function decline after nephroureterectomy for upper tract urothelial carcinoma.

Objectives: To evaluate the predictive role of pre-nephroureterectomy (NU) hydronephrosis on post-NU renal function (RF) change and preserved eligibility rate for adjuvant therapy in patients with upper tract urothelial carcinoma (UTUC). Patients and methods: This retrospective study collected data of 1018 patients from the Taiwan UTUC Collaboration Group registry of 26 institutions. The patients were divided into two groups based on the absence or presence of pre-NU hydronephrosis. Estimated glomerular filtration rate (eGFR) was calculated pre- and post-NU respectively. The one month post-NU RF change, chronic kidney disease (CKD) progression, and the preserved eligibility rate for adjuvant therapy were compared for each CKD stage. Results: 404 (39.2%) patients without and 614 (60.8%) patients with pre-NU hydronephrosis were enrolled. The median post-NU change in the eGFR was significantly lower in the hydronephrosis group (-3.84 versus -12.88, p<0.001). Pre-NU hydronephrosis was associated with a lower post-NU CKD progression rate (33.1% versus 50.7%, p< 0.001) and was an independent protective factor for RF decline after covariate adjustment (OR=0.46, p<0.001). Patients with pre-NU hydronephrosis had a higher preserved eligibility rate for either adjuvant cisplatin-based chemotherapy (OR=3.09, 95%CI 1.95-4.69) or immune-oncology therapy (OR=2.31, 95%CI 1.23-4.34). Conclusion: Pre-NU hydronephrosis is an independent protective predictor for post-NU RF decline, CKD progression, and eligibility for adjuvant therapy. With cautious selection for those unfavorably prognostic, non-metastatic UTUC patients with preoperative hydronephrosis, adjuvant rather than neoadjuvant therapy could be considered due to higher chance of preserving eligibility.

The effect of electromagnetic field on sleep of patients with nocturia.

INTRODUCTION: Accumulated studies revealed that electromagnetic field can affect human brain and sleep. We explored the effectiveness of electromagnetic field [Schumann resonance (SR)] on nocturia symptoms, quality of life, and sleep in patients with nocturia. METHODS: This is a randomized, open-label, and active-controlled study, in which 35 participants were randomized into 2 groups. Group A received oxybutynin and the SR device for 12 weeks, while the active-control group received only the medication. We followed these patients every 4 weeks with a number of questionnaires, including the Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) for sleep, the American Urological Association Symptom Score (AUASS) for nocturia symptoms, and the Nocturia-Quality-of-Life-questionnaire (N-QOL) for quality of life. Descriptive statistics, pair t-tests, Chi-squared tests, and repeated measures were applied for data analysis. RESULTS: No significant difference was found in the demographic data between the 2 groups. The AUASS, N-QOL, PSQI, and ESS total scores were significantly improved in the SR-sleep-device group (P < .001, P = .005, P < .001, P = .001) after treatment, but no significant change was found in the active-control group. Several variables of AUASS in the SR-sleep-device group were significantly improved, especially streaming and sleeping (both P = .001), and subjective sleep quality and sleep efficiency also demonstrated significant improvement (both P < .001). CONCLUSIONS: Our study revealed that electromagnetic field (SR) as an add-on can improve not only sleep and quality of life but also nocturia symptoms in patients with nocturia. These findings suggest that SR can be effective for sleep disturbance secondary to physical disease, which can be a new application of the electromagnetic field.

Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy using the Taiwan upper urinary tract urothelial carcinoma database.

Purpose: Taiwan has a high incidence of upper tract urothelial carcinoma (UTUC). This study aimed to compare the surgical outcomes following transperitoneal hand-assisted laparoscopic nephroureterectomy (TP-HALNU) and transperitoneal pure laparoscopic nephroureterectomy (TP-LNU) from the Taiwan nationwide UTUC collaboration database using different parameters, including surgical volumes. Materials and methods: The nationwide UTUC collaboration database includes 14 hospitals in Taiwan from the Taiwan Cancer Registry. We retrospectively reviewed the records of 622 patients who underwent laparoscopic nephroureterectomy between July 1988 and September 2020. In total, 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncological outcomes were compared. Results: Of the 322 patients, 181 and 141 received TP-LNU and TP-HALNU, respectively. There were no differences in clinical and histopathological data between the two groups. No differences were observed in perioperative and postoperative complications. There were no significant differences in oncological outcomes between the two surgical approaches. In the multivariate analysis, the cohort showed that age ≥70 years, positive pathological lymph node metastasis, tumors located in the upper ureter, and male sex were predictive factors associated with an increased risk of adverse oncological outcomes. A surgical volume of ≥20 cases showed a trend toward favorable outcomes on cancer-specific survival [hazard ratio (HR) 0.154, p = 0.052] and marginal benefit for overall survival (HR 0.326, p = 0.019) in the multivariate analysis. Conclusion: Although different approaches to transperitoneal laparoscopic nephroureterectomy showed no significant differences in surgical outcomes, age, sex, lymph node metastasis, and tumor in the upper ureter in the following period were predictive factors for oncological outcomes. Higher surgical volume did not impact disease-free survival and bladder recurrence-free survival but was associated with improved overall survival and cancer-specific survival. Exploration of unknown influencing factors is warranted.

Doing the best to control: the experiences of Taiwanese women with lower urinary tract symptoms.

BACKGROUND: In Taiwan, most women with lower urinary tract symptoms live quietly with their symptoms without seeking medical help. These women's voices have not been heard or investigated. OBJECTIVES: The purpose of this study was to generate descriptive theory on the basis of the lived experiences of Taiwanese women with lower urinary tract symptoms. METHODS: A qualitative study on the basis of grounded theory was used. Sixteen Taiwanese women with lower urinary tract symptoms aged 41-75 years participated in in-depth interviews. The data were analyzed using the constant comparative method. RESULTS: "Doing the best to control" was the core category for describing the process of women who used their own unique ways of controlling urination problems. During the process, "Irritating urination problems" was the term identified as the antecedent condition. The woman would then begin the process of "doing the best to control," which would be marked by action and interaction among four categories: (a) self-limited activities, (b) modify daily life, (c) always looking for the toilet while outdoors, and (d) feeling stress and uneasiness. After this phase, some women would begin "seeking medical help," "trying to practice a helpful lifestyle," or both. However, a few women just "did nothing, just living with it." DISCUSSION: Women do their best to improve self-control of their urination problems. However, stress and uneasiness permeate the process and overshadow their lives.

Comparing Oncological Outcomes and Surgical Complications of Hand-Assisted, Laparoscopic and Robotic Nephroureterectomy for Upper Tract Urothelial Carcinoma.

PURPOSE: This study aimed to compare the oncological outcomes and surgical complications of patients with upper tract urothelial carcinoma (UTUC) treated with different minimally invasive techniques for nephroureterectomy. METHODS: From the updated data of the Taiwan UTUC Collaboration Group, a total of 3,333 UTUC patients were identified. After excluding ineligible cases, we retrospectively included 1,340 patients from 15 institutions who received hand-assisted laparoscopic nephroureterectomy (HALNU), laparoscopic nephroureterectomy (LNU) or robotic nephroureterectomy (RNU) between 2001 and 2021. Kaplan-Meier estimator and Cox proportional hazards model were used to analyze the survival outcomes, and binary logistic regression model was selected to compare the risks of postoperative complications of different surgical approaches. RESULTS: Among the enrolled patients, 741, 458 and 141 patients received HALNU, LNU and RNU, respectively. Compared with RNU (41.1%) and LNU (32.5%), the rate of lymph node dissection in HALNU was the lowest (17.4%). In both Kaplan-Meier and univariate analysis, the type of surgery was significantly associated with overall and cancer-specific survival. The statistical significance of surgical methods on survival outcomes remained in multivariate analysis, where patients undergoing HALNU appeared to have the worst overall (p = 0.007) and cancer-specific (p = 0.047) survival rates among the three groups. In all analyses, the surgical approach was not related to bladder recurrence. In addition, HALNU was significantly associated with longer hospital stay (p = 0.002), and had the highest risk of major Clavien-Dindo complications (p = 0.011), paralytic ileus (p = 0.012), and postoperative end-stage renal disease (p <0.001). CONCLUSIONS: Minimally invasive surgery can be safe and feasible. We proved that compared with the HALNU group, the LNU and RNU groups have better survival rates and fewer surgical complications. It is crucial to uphold strict oncological principles with sophisticated technique to improve outcomes. Further prospective studies are needed to validate our findings.

Age, Period and Cohort Analysis of Rates of Emergency Department Visits Due to Pneumonia in Taiwan, 1998-2012.

BACKGROUND: Emergency room (ER) physicians need to face clinically suspected pneumonia patients in the front line of medical care and must do to give major medical interventions if patients show severity in pneumonia. METHODS: The data of pneumonia-related ER visit rates were categorized based on the International Classification of Disease (ICD) Codes (480-486) between 1998 and 2012. We use an age-period-cohort (APC) model to separate the pneumonia-related ER visit rates to identify the effects of age, time period, and cohort for a total of 1,813,588 patients. RESULTS: The age effect showed high risk for pediatric and elder populations. There is a significant increasing period effect, which increased from 1998 to 2012. The cohort effect tended to show an oscillation from 1913 to 1988 and the reverse in a recent cohort. Furthermore, the visit rate of pneumonia showed an increase from 1998 to 2012 for both genders. CONCLUSION: Age is a risk factor for pneumonia-related ER visits, especially for children and adolescents and older patients. Period and cohort effects were also found to increase the pneumonia visit rates. An APC model used to provide an advance clue for trend of pneumonia-related ER visit rates diversified.

Asthma-like syndrome in school children after accidental exposure to xylene and methylene diphenyl diisocyanate.

BACKGROUND AND PURPOSE: We assessed the signs and symptoms, pulmonary function changes and residual chemical body burden of school children in the vicinity of an accidental exposure to volatile xylene and methylene diphenyl diisocyanate (MDI). METHODS: After the exposure episode, children with significant symptoms after MDI exposure (e.g., dizziness, nausea, sore throat, and breathing difficulties) were sent to nearby emergency medical units for evaluation and admission if necessary. Clinical work-up included pulmonary function tests and measurement of residual MDI in the body by high-performance liquid chromatography analysis of urine. RESULTS: 203 students appeared to develop symptoms associated with contaminant exposure, and 173 affected students were sent to nearby emergency units. In the subsequent surveillance, 22 of 203 affected students (10.8%) revealed a positive history of asthma, which was strongly correlated with the incidence of dyspnea arising from the incident. For children with no previous history of asthma, 60.8% (110 of 181) complained of dyspnea during the episode, and 16.2% required inhaled bronchodilator therapy at the emergency medical units for relief of wheezing symptoms. In a simulation, we found the raw material used for tract surfacing, primarily MDI dissolved in xylene, to be present at a concentration (870 ppm w/w) more than 8000-fold the level defined as safe for a working environment. CONCLUSIONS: We have detected a direct cause-effect relationship between the accidental spillage of MDI and the appearance of an acute asthma-like syndrome among previously unexposed school children.

Dynamic magnetic resonance imaging used in evaluation of female pelvic prolapse: experience from nine cases.

Prolapse of pelvic organs in a female can be simple or complex. To make a definite diagnosis of pelvic prolapse preoperatively, dynamic magnetic resonance (MR) is an alternative to conventional fluoroscopic or sonographic examination, with the advantage of providing greater details, and thus helping the surgeon to have a good preoperative plan. Nine women suffering from pelvic prolapse with or without urinary stress incontinence underwent dynamic MR imaging examination (1.0T Magnex100/HP, Shimadzu, Kyoto, Japan) before surgery. All patients were examined in the supine position. A single-shot ultra-high speed scan (FE/8/3.02-20 degrees, 128, 100%-100% 1 NEX 1 slice 10 mm L1.0 second) was used to obtain midline sagittal images, with the patients at rest and during pelvic strain. MR images were then obtained every 4 seconds. Each examination was analyzed, based on specific measurements, to determine the presence and extent of prolapse of pelvic organs. The pubococcygeal, levator hiatus width and muscular pelvic floor relaxation lines, and the angle of the levator plate were identified. Based on these measurements, multicompartment involvement in the pelvic prolapse was confirmed in five patients (5/9). Four patients (4/9) had single compartment involvement. Seven patients underwent surgery. All patients reported significant improvement in their symptoms and signs after surgical intervention. Two patients had an almost complete recovery. MR demonstrated simple or complex organ descent in all pelvic compartments, and may become a standard preoperative examination for pelvic floor abnormalities. The MR images facilitated comprehensive planning by the surgeon; thus, they can increase the success rate and help to accurately predict the outcome of the surgical intervention. The surgeons also expressed high postsurgical satisfaction with the information provided by dynamic MR.

Surface oxide effect on optical sensing and photoelectric conversion of α-In2Se3 hexagonal microplates.

The surface formation oxide assists of visible to ultraviolet photoelectric conversion in α-In2Se3 hexagonal microplates has been explored. Hexagonal α-In2Se3 microplates with the sizes of 10s to 100s of micrometers were synthesized and prepared by the chemical vapor transport method using ICl3 as a transport agent. Many vacancies and surface imperfection states have been found in the bulk and on the surface of the microplate because of the intrinsic defect nature of α-In2Se3. To discover physical and chemical properties and finding technological uses of α-In2Se3, several experiments including transmission electron miscopy (TEM), X-ray photoelectron spectroscopy (XPS), surface photovoltage (SPV), photoluminescence (PL), surface photoresponse (SPR), photoconductivity (PC), and thermoreflectance (TR) measurements have been carried out. Experimental results of TEM, XPS, SPV, PL, and SPR measurements show that a surface oxidation layer α-In2Se3-3xO3x (0 ≤ x ≤ 1) has formed on the crystal face of α-In2Se3 in environmental air with the inner layer content close to In2Se3 but the outermost layer content approaching In2O3. The near band edge transitions of α-In2Se3 microplates have been probed experimentally by TR and PC measurements. The direct band gap of α-In2Se3 has been determined to be 1.453 eV. The SPV result shows a maximum quantum efficiency of the surface oxide α-In2Se3-3xO3x (0 ≤ x ≤ 1) that presents a peak photoresponse near 2.18 eV. The analyses of SPV, SPR, PL, TR, and PC measurements revealed that the surface oxide layer facilitates the conversion of the ultraviolet to the visible range while the native defects (Se and In vacancies) sustain photoconductivity in the near-infrared region. On the basis of the experimental results a wide-energy-range photodetector that combines PC- and SPR-mode operations for α-In2Se3 microplate has been made. The testing results show a well-behaved function of photoelectric conversion in the near-infrared to ultraviolet region via the auxiliary forming of surface oxide on the crystalline face of the α-In2Se3 microplates.