Impact of pretreatment quality of life on tolerance and survival outcome in head and neck cancer patients undergoing definitive CCRT.

BACKGROUND: Health-related quality of life (HRQoL) is a predictor of treatment outcomes in cancer patients. This study aimed to evaluate the effect of pretreatment HRQoL on treatment tolerance and survival outcomes in patients with HNC planned for concurrent chemoradiotherapy (CCRT) in Taiwan. METHODS: This study included 461 patients with HNC planned for definitive CCRT at three medical centers in Taiwan between August 2017 and December 2018. HRQoL was assessed using the QLQ-HN35 one week before the initiation of CCRT. Patients were grouped based on the sum scores of QLQ-HN35 (

[Exploration of Distress Symptoms and Medical Interventions in Patients With Terminal Cancer in Hospice Shared Care].

BACKGROUND: Hospice shared care is a model of care widely used in patients with terminal cancer. Appropriate interventions to improve related symptoms should be provided during disease progression through the end of life. PURPOSE: The purpose of this study was to explore the related symptoms and to compare symptom severity before and after the implementation of hospice shared care and medical care interventions. METHODS: Fifty patients with terminal cancer were enrolled in this longitudinal, quasi-experimental research. Inclusion criteria included having an expected life span of < 6 months and agreeing to enter hospice shared care. RESULTS: The three most-frequently noted physical symptoms were, in rank order: "pain", "weakness", and "dyspnea". In terms of severity, "pain" was the most severe, followed by "weakness" and "disturbance of sleep". The three most-frequently noted psychological symptoms were, in rank order: "depression", "worry about the disease", and "afraid of dragging others down". In terms of severity, "depression" was the most severe, followed by "anxiety" and "worry about the disease". The frequency and severity of the top-3 social and spiritual distress symptoms were, in rank order: "unfinished wish", "economic difficulties", and "painlessness". During the study period, the severity of physical symptoms improved gradually, while the severity of psychological symptoms improved significantly. The top-3 items in the original medical team`s hospice-care interventions were, in rank order: "tube care", "laboratory test", and "wound care" in the non-pharmacological category; "symptom control medication", "antibiotic injection", and "intravenous fluid infusion" in the pharmacological category; and "cognitive clarification of the prognosis condition", "do not conduct resuscitation discussions and signing", and "emotional stress consoling" in the problem-coordination and interview categories. The interventions implemented by the hospice specialist team included "emotional stress interview", "team communication", and "cognitive clarification of prognosis condition" in the problem coordination and interview categories, and "massage", "consultation", and "nursing advice" in the non-pharmacological category. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The symptoms identified in this study provide clinical staff with a reference for the rapid assessment of patients with terminal-stage cancer. Manpower from various professional fields are committed to providing diversified services in the care teams, which positively affect the control of related symptoms. The experience presented in this article may be used as a reference to promote the hospice shared care model.

Detecting phthalate esters in sludge particulates from wastewater treatment plants.

This study proposed a method for analysis of 10 phthalate esters compounds from wastewater treatment plant sludges. The analytical efficiency of GC-MS for of target compounds was verified by a standard mixture of phthalate esters. The response factors related to the respective internal standards from a five-point calibration curve quantified the phthalate esters in individual compounds. Based on the literature compiled by environmental agencies, new generation phthalate compounds have been developed, such as di-iso-nonyl phthalate (DiNP), di-iso-decyl phthalate (DiDP), as alternative to conventional phthalates. The analytical results showed that the total PAEs concentration was in the range from 7.4 to 138.6 mg kg-1 dw in these seven analyzed sludge samples. More, di-iso-nonyl phthalate (DiNP), di-iso-decyl phthalate (DiDP) and bis(2-ethylhexyl) phthalate (DEHP) contributed to over 99% of PAEs in the sludge. The correlation between total PAEs concentration in household and sewage flow treated at seven WWTPs and concentrations of DEHP, DiNP and DiDP was significant.

Incidence, severity, longitudinal trends and predictors of acute and chronic oxaliplatin-induced peripheral neuropathy in Taiwanese patients with colorectal cancer.

The purpose of this study was to evaluate the longitudinal incidence, severity, pattern of changes or predictors of oxaliplatin-induced peripheral neuropathy (OXAIPN) in Taiwanese patients with colorectal cancer. A longitudinal repeated measures study design was employed, and 77 participants were recruited from the colorectal and oncology departments of two teaching medical centres in Taiwan. Physical examinations were performed, and self-reports regarding adverse impacts of OXAIPN and quality of life were obtained at five time points throughout 12 cycles of chemotherapy (C/T). The incidence of OXAIPN increased with C/T cycles (31.1%-81.9%), and the upper limb numbness and cold sensitivity were most significant acute OXAIPN symptoms (29.9%-73.6%). Findings also documented significant increases in overall severity, symptom distress, interference and physical results associated with OXAIPN over the course of C/T. Predictors of OXAIPN severity varied by treatment cycle, including younger patient, higher cumulative dose of oxaliplatin, greater body surface area, receipt of chemotherapy in winter and the occurrence of OXAIPN during prior C/T cycles. The results from this study might help healthcare providers to recognise the symptom characteristics, degree of influences, trends and high-risk group of OXAIPN, facilitating early evaluation and potential interventions to mitigate or prevent negative effects of OXAIPN on patients.

Clinical characteristics and survival outcomes of terminally ill patients undergoing withdrawal of mechanical ventilation.

BACKGROUND: Withdrawal of mechanical ventilation is an important, but rarely explored issue in Asia during end-of-life care. This study aimed to describe the clinical characteristics and survival outcomes of terminally ill patients undergoing withdrawal of mechanical ventilation in Taiwan. METHODS: One-hundred-thirty-five terminally ill patients who had mechanical ventilation withdrawn between 2013 and 2016, from a medical center in Taiwan, were enrolled. Patients' clinical characteristics and survival outcomes after withdrawal of mechanical ventilation were analyzed. RESULTS: The three most common diagnoses were organic brain lesion, advanced cancer, and newborn sequelae. The initiator of the withdrawal process was family, medical personnel, and patient him/herself. The median survival time was 45 min (95% confidence interval, 33-57 min) after the withdrawal of mechanical ventilation, and 102 patients (75.6%) died within one day after extubation. The median time from diagnosis of disease to receiving life-sustaining treatment and artificial ventilation support, receiving life-sustaining treatment and artificial ventilation support to "Withdrawal meeting," "Withdrawal meeting" to ventilator withdrawn, and ventilator withdrawn to death was 12.1 months, 19 days, 1 day, and 0 days, respectively. Patients with a diagnosis of advanced cancer and withdrawal initiation by the patients themselves had a significantly shorter time interval between receiving life-sustaining treatment and artificial ventilation support to "Withdrawal meeting" compared to those with non-cancer diseases and withdrawal initiation by family or medical personnel. CONCLUSION: This study is the first observational study to describe the patients' characteristics and elaborate on the survival outcome of withdrawal of mechanical ventilation in patients who are terminally ill in an Asian population. Understanding the clinical characteristics and survival outcomes of mechanical ventilation withdrawal might help medical personnel provide appropriate end-of-life care and help patients/families decide about the withdrawal process earlier.

Lipidomics as a diagnostic tool of the metabolic and physiological state of managed whales: A correlation study of systemic metabolism.

Integrating multifactor blood analysis is a key step toward a precise diagnosis of the health status of marine mammals. Variations in the circulating lipid profile reflect changes in the metabolism and physiology of an individual. To demonstrate the practicability of lipid profiling for physiological assessment, the phosphorylcholine-containing lipids in the plasma of long-term managed beluga whales (Delphinapterus leucas) were profiled using a lipidomics methodology. Using a multivariate analysis, the mean corpuscular volume, cholesterol, potassium, and γ-glutamyltranspeptidase levels were well modeled with the lipid profile of the female whales. In the models, the correlated lipids provided information about blood parameter-related metabolism and physiological regulation, in particular relating to cholesterol and inflammation. In the males, the levels of cholesterol, triglycerides, blood urea nitrogen, creatinine, plasma iron, and segmented neutrophil were well modeled with the lipid profile. In addition to providing information about the related metabolism and regulation, through a cross-linked analysis of the blood parameters, the correlated lipids indicated a parallel regulation involved in the energy metabolism of the male whales. Lipidomics as a method for revealing the context of physiological change shows practical potential for the health care of managed whales.

Temporo-parietal connectivity uniquely predicts reading change from childhood to adolescence.

Previous research has shown that left posterior middle temporal gyrus (pMTG) is a core node in the semantic network, and cross-sectional studies have shown that activation in this region changes developmentally and is related to skill measured concurrently. However, it is not known how functional connectivity with this region changes developmentally, and whether functional connectivity is related to future gains in reading. We conducted a longitudinal functional magnetic resonance imaging (fMRI) study in 30 typically developing children (aged 8-15) to examine whether initial brain measures, including activation and connectivity, can predict future behavioral improvement in a semantic judgment task. Participants were scanned on entering the study (time 1, T1) and a follow-up period of 2years (time 2, T2). Character pairs were arranged in a continuous variable according to association strength (i.e. strong versus weak), and participants were asked to determine if these visually presented pairs were related in meaning. Our results demonstrated greater developmental changes from time 1 to time 2 for weaker association pairs in the left pMTG for the children (aged 8-11) as compared to the adolescents (aged 12-15). Moreover, the results showed greater developmental changes from time 1 to time 2 for weaker association pairs in connectivity between the pMTG and inferior parietal lobule (IPL) for the children as compared to the adolescents. Furthermore, a hierarchical stepwise regression model revealed that connectivity between the pMTG and IPL in weak association pairs was uniquely predictive of behavioral improvement from time 1 to time 2 for the children, but not the adolescents. Taken together, the activation results suggest relatively rapid development before adolescence of semantic representations in the pMTG. Moreover, the connectivity results of pMTG with IPL tentatively suggest that early development of semantic representations may be facilitated by enhanced engagement of phonological short-term memory.

Secretomic analysis identifies alpha-1 antitrypsin (A1AT) as a required protein in cancer cell migration, invasion, and pericellular fibronectin assembly for facilitating lung colonization of lung adenocarcinoma cells.

Metastasis is a major obstacle that must be overcome for the successful treatment of lung cancer. Proteins secreted by cancer cells may facilitate the progression of metastasis, particularly within the phases of migration and invasion. To discover metastasis-promoting secretory proteins within cancer cells, we used the label-free quantitative proteomics approach and compared the secretomes from the lung adenocarcinoma cell lines CL1-0 and CL1-5, which exhibit low and high metastatic properties, respectively. By employing quantitative analyses, we identified 660 proteins, 68 of which were considered to be expressed at different levels between the two cell lines. High levels of A1AT were secreted by CL1-5, and the roles of A1AT in the influence of lung adenocarcinoma metastasis were investigated. Molecular and pathological confirmation demonstrated that altered expression of A1AT correlates with the metastatic potential of lung adenocarcinoma. The migration and invasion properties of CL1-5 cells were significantly diminished by reducing the expression and secretion of their A1AT proteins. Conversely, the migration and invasion properties of CL1-0 cells were significantly increased through the overexpression and secretion of A1AT proteins. Furthermore, the assembly levels of the metastasis-promoting pericellular fibronectin (FN1), which facilitates colonization of lung capillary endothelia by adhering to the cell surface receptor dipeptidyl peptidase IV (DPP IV), were higher on the surfaces of suspended CL1-5 cells than on those of the CL1-0 cells. This discovery reflects previous findings in breast cancer. In line with this finding, FN1 assembly and the lung colonization of suspended CL1-5 cells were inhibited when endogenous A1AT protein was knocked down using siRNA. The major thrust of this study is to demonstrate the effects of coupling the label-free proteomics strategy with the secretomes of cancer cells that differentially exhibit invasive and metastatic properties. This provides a new opportunity for the effective identification of metastasis-associated proteins that are secreted by cancer cells and promote experimental metastasis.

The impact of pandemic-related stress on attentional bias and anxiety in alexithymia during the COVID-19 pandemic.

The COVID-19 pandemic had negative consequences for mental health, yet it is unknown how and to what extent the psychological outcomes of this stressful event are moderated by individual traits. Alexithymia is a risk factor for psychopathology, and thus likely predicted individual differences in resilience or vulnerability to stressful events during the pandemic. This study explored the moderating role of alexithymia in the relationships of pandemic-related stress with anxiety levels and attentional bias. The participants were 103 Taiwanese individuals who completed a survey during the outbreak of the Omicron wave. Additionally, an emotional Stroop task including pandemic-related or neutral stimuli was used to measure attentional bias. Our results demonstrate that pandemic-related stress had a lesser impact on anxiety in individuals with a higher level of alexithymia. Moreover, we found that in individuals with higher exposure to pandemic-related stressors, a higher level of alexithymia indicated less attentional bias toward COVID-19-related information. Thus, it is plausible that individuals with alexithymia tended to avoid pandemic-related information, which could temporarily relieve stressors during the pandemic.

Sex differences in medication-naïve adults with attention-deficit/hyperactivity disorder: A counting Stroop functional MRI study.

Emerging evidence supports deficits in executive functions in the fronto-striato-parietal network in individuals with attention-deficit/hyperactivity disorder (ADHD). However, most functional studies recruited men with ADHD only, leaving it unclear whether executive deficits are also demonstrated in women with ADHD. Thus, we used functional magnetic resonance imaging to examine the sex differences in a counting Stroop task that explored interference control. The sample consisted of 55 medication-naïve adults with ADHD (28 men, 27 women) and 52 healthy controls (HC, 26 men, 26 women). The Conners' Continuous Performance Test further evaluated the performance of focused attention (standard deviation of the reaction time, RTSD) and vigilance (the reaction time change across different inter-stimulus intervals, RTISI). First, for the main effect of diagnosis, compared to the HC group, the ADHD group showed less activation in the caudate nucleus and inferior frontal gyrus (IFG). Second, for the main effect of sex, no significant effects were found. Third, a diagnosis-by-sex interaction indicated that the magnitude of ADHD-HC difference was greater for women than men in the right IFG and precuneus, reflecting greater difficulties for ADHD women to resolve interference. Conversely, no significant brain activation showed greater ADHD-HC difference in men than women. Also, reduced right IFG and precuneus activation was negatively associated with the scores assessing focused attention and vigilance in ADHD women, indicating that the attentional abilities are disrupted in ADHD women. Abnormalities in the frontoparietal areas may represent the main difference between ADHD women and ADHD men.

Comprehensive assessment of metals and organic pollutants in pelagic fishing port sediments.

Fishing ports are among the environments that accumulate pollutants along the coast but often lack environmental data and scientific research. This study investigated 8 metals, 16 polycyclic aromatic hydrocarbons (PAHs), 10 phthalate esters (APs), and 2 alkylphenols (APs) in the surface sediments of Qianzhen Fishing Port, the largest pelagic fishing port in Taiwan. Indicator compounds, pollution hotspots, potential ecological risk levels, and pollution sources were evaluated. Results showed that copper, zinc, and bis(2-ethylhexyl) phthalate (DEHP) in surface sediments were pollution indicators posing potential toxicological risks. Metals and PAHs in sediments were mainly from ship-related sources, while PAEs and APs were related to dockland activities. Combining metal and organic pollutants, the sediments had a moderate potential ecological risk, with metals higher than organic pollutants. Cluster analysis and color geographic map of risks indicate sediment pollution hotspots and areas requiring immediate intervention. In the future, sustainable operation and management can be carried out by using metal-free antifouling paint, improving sewage treatment rate, and regular environmental dredging of fishing port.

Hexabromocyclododecane in sediments from riverine, port, and coastal areas of Kaohsiung, Taiwan: levels, spatial distribution, and potential ecological risk.

The widespread use of hexabromocyclododecane (HBCD), a brominated flame retardant, is a major public health concern because of the toxic, persistent, and bioaccumulative nature of HBCD. However, there is limited information available regarding the distribution and transportation of HBCD in sediments across various environmental settings, spanning from riverine to marine environments in the Kaohsiung area of Taiwan. In this study, we comprehensively investigated the level and distribution of and potential ecological risk posed by HBCD in surface sediments in the Kaohsiung area of Taiwan. In sediment samples from stations on the Love River and Kaohsiung Port area, the concentrations of HBCD ranged from 10.6 to 320.1 µg/kg dry weight (dw) and nondetectable (n.d.) to 58.4 µg/kg dw, respectively. The concentrations of HBCD in sediment collected from the M1, M2, and M3 sites, located in the Cijin coastal area, were 896.2 µg/kg dw, 3.2 µg/kg dw ( 1. The M1 site had the highest risk level (RQ = 5.27). These data suggest that domestic sewage and industrial wastewater discharge pose a potential risk to marine environments. Consequently, timely measures to control HBCD-related risks are required. Our study offers insight into the environmental effects of HBCD contamination of sediment and provides valuable information that can be used to guide environmental policy and safety measures.

Effectiveness of a Protocol Intervention for Aspiration Pneumonia Prevention in Patients With Esophageal Cancer During Concurrent Chemoradiotherapy: A Randomized Control Trial.

BACKGROUND: Dysphagia is a leading cause of aspiration pneumonia and negatively affects tolerance of chemoradiotherapy in patients with esophageal cancer. OBJECTIVE: This study aimed to assess a protocol for preventing the occurrence of aspiration pneumonia for adult patients with esophageal cancer experiencing swallowing dysfunction. METHODS: This study tested a dysphagia intervention that included high-risk patients confirmed by the Eating Assessment Tool questionnaire and Water Swallowing Test. A protocol guide (Interventions for Esophageal Dysphagia [IED]) to prevent aspiration pneumonia during chemoradiotherapy was also implemented. Thirty participants were randomly assigned to an intervention or control group. The study period was 50 days; participants were visited every 7 days for a total of 7 times. Instruments for data collection included The Eating Assessment Tool, Water Swallowing Test, and personal information. The IED was administered only to the experimental group. All data were managed using IBM SPSS statistics version 21.0. RESULTS: The IED significantly reduced the occurrence of aspiration pneumonia (P = .012), delayed the onset of aspiration pneumonia (P = .005), and extended the survival time (P = .007) in the experimental group. CONCLUSION: For patients with esophageal cancer undergoing chemoradiotherapy, this protocol improved swallowing dysfunction and reduced aspiration pneumonia. IMPLICATION FOR PRACTICE: The IED protocol should be included in continuous educational training for clinical nurses to help them become familiar with these interventions and to provide these strategies to patients.

Three-Dimensional Simulation Training for Oncology Nurses to Address Pitfalls in Current Irrigation Strategy for Intravenous Ports: Repeated Measurements Study.

OBJECTIVE: We designed an interactive visual training course and three-dimensional (3-D) simulator for participants and used verified questionnaires as tool to evaluate the efficacy of the education course. DATA SOURCES: From August 2020 to December 2021, 159 nursing staff who received the interactive visual training course and completed validated questionnaires before and after the course were included. The efficacy of the course was evaluated by comparing the pre- and post-course questionnaires. CONCLUSION: The interactive visual training course, including maintenance lectures and practice with a 3-D simulator, improved consensus among the nursing staff and increased the willingness of oncology nurses to perform the proposed port irrigation procedure. IMPLICATIONS FOR NURSING PRACTICE: An implanted intravenous port cannot be directly seen by nursing staff and can only be identified through manual palpation. This lack of visibility may result in individual variations in port identification during daily practice, potentially leading to malpractice. To minimize these individual variations, we have designed an interactive visual training course. We used validated questionnaires before and after the course to analyze its efficacy in practical education.

Comparative secretome analyses using a hollow fiber culture system with label-free quantitative proteomics indicates the influence of PARK7 on cell proliferation and migration/invasion in lung adenocarcinoma.

As the leading cause of cancer death worldwide, lung cancer lacks effective diagnosis tools and treatments to prevent its metastasis. Fortunately, secretome has clinical usages as biomarkers and protein drugs. To discover the secretome that influences lung adenocarcinoma metastasis, the hollow fiber culture (HFC) system was used along with label-free proteomics approach to analyze cell secretomes between CL1-0 and CL1-5 cell lines, which exhibit low and high metastatic potentials. Among the 703 proteins quantified, 50 possessed different levels between CL1-0 and CL1-5. PARK7 was a primary focus because of the lack of research involving lung adenocarcinoma. The cell proliferation, migration, and invasion properties of CL1-0, CL1-5, and A549 cells were significantly diminished when the expression of their PARK7 proteins was reduced. Conversely, these functions were promoted when PARK7 was overexpressed in CL1-0. In clinical expression, PARK7 levels within tissue specimens and plasma samples were significantly higher in the cancer group. This represents the first time the HFC system has been used with label-free quantification to discern the elements of metastasis in lung adenocarcinoma cell secretomes. Likewise, PARK7 has never been researched for its role in promoting lung adenocarcinoma progression.

Specialization of the posterior temporal lobes for audio-motor processing - evidence from a functional magnetic resonance imaging study of skilled drummers.

Sounds of hammering or clapping can evoke simulation of the arm movements that have been previously associated with those sounds. This audio-motor transformation also occurs at the sequential level and plays a role in speech and music processing. The present study aimed to demonstrate how the activation pattern of the sensorimotor network was modulated by the sequential nature of the auditory input and effector. Fifteen skilled drum set players participated in our functional magnetic resonance imaging study. Prior to the scan, these drummers practiced six drumming grooves. During the scan, there were four rehearsal conditions: covertly playing the drum set under the guidance of its randomly-presented isolated stroke sounds, covertly playing the drum set along with the sounds of learned percussion music, covertly reciting the syllable representation along with this music, and covertly reciting along with the syllable representation of this music. We found greater activity in the bilateral posterior middle temporal gyri for active listening to isolated drum strokes than for active listening to learned drum music. These regions might mediate the one-to-one mappings from sounds to limb movements. Compared with subvocal rehearsals along with learned drum music, covert rehearsals of limb movements along with the same music additionally activated a lateral subregion of the left posterior planum temporale. Our results illustrate a functional specialization of the posterior temporal lobes for audio-motor processing.

Phosphorylcholine-containing lipid molecular species profiling in biological tissue using a fast HPLC/QqQ-MS method.

A fast reversed-phase liquid chromatography-electrospray ionization triple quadrupole mass spectrometry method was developed for the molecular species profiling of glycerophosphocholine (GPC) and sphingomyelin (SM) in total lipid extracts. A two-stage mass spectrometry strategy was adopted to analyze in detail the composition of lipid molecular species. Precursor ion analysis was first conducted to obtain the preliminary composition profile of the phosphorylcholine-containing lipid. The product ion spectra were sequentially acquired for each recorded signal to determine the molecular structure of the lipid. A total of 150 GPCs and 12 SMs were identified in the fetal mouse lung with relative amounts ranging from 13.7% to less than 0.002% (normalizing by the total signal response). A column packed with core-shell particles was used to obtain excellent chromatographic separation with a shorter time demand in a conventional high-performance liquid chromatography system. Considering the compromise between the chromatographic efficiency and the electrospray signal response, the optimization of the mobile phase improves the chromatographic plate number to approximately 40,000 and the detection limits to less than 0.001 mg/L. The applicability of the method was validated through a study of chemically induced early lung maturation. The metabolic alteration in the fetal mouse lung was clearly reflected in the GPC and SM composition with several characteristics of the molecular structure that related to the character of the phospholipid layer upon the epithelial lining of alveoli and the relevant cell function. The results indicated that this analytical strategy is reliable for comprehensive molecular species profiling of GPC and SM and might be extended to the analysis of other phospholipids.

Attentional Processing of Unpleasant Stimuli in Alexithymia.

Alexithymia is a multi-faceted personality trait defined by difficulties in identifying and describing emotions and is considered a risk factor for multiple psychiatric disorders. Current alexithymia research debates the type of attention bias involved in the processing of negative emotional information, especially in anxiety-evoking situations that are frequently associated with stress states. Relatedly, this study aims to examine the role of emotional influence on the attentional processing of Taiwanese alexithymic individuals. Using the Chinese version of the Toronto Alexithymia Scale-20 (TAS-20), individuals with high alexithymia (HA: TAS > 60, n = 26; Mage = 23.36) and individuals with low alexithymia (LA: TAS < 39, n = 26; Mage = 25.76) were recruited. Participants performed an emotional counting Stroop task preceded by anxiety-evoking (threatening and aversive pictures) or neutral pictures. Reaction times (RTs) of the emotional Stroop task were compared between HA and LA groups. Our results demonstrate that compared to individuals with LA, individuals with HA show early avoidance tendency (i.e., allocate less attentional resources to anxiety-evoking stimuli), and that negative affect therefore does not interfere with subsequent attention processing during the Stroop task, resulting in faster RT for unpleasant stimuli (Mthreatening = 683.87, Maversive = 685.87) than neutral stimuli (Mneutral = 695.64) (ps < .05). In addition, the attentional bias toward specific types of negative emotion was not differentiated in individuals with HA (p < .05), suggesting that alexithymic individuals' emotion schemas may be underdeveloped in terms of ability to specify exact emotions. This study provides evidence regarding early sensitization to negative stimuli during information processing, consistent with the notion that alexithymia is related to avoidant emotion regulation processes.

Distribution patterns and transportation behavior of alkylphenol polyethoxylate degradation metabolites among river, port area, and coastal water bodies of Kaohsiung City, Taiwan.

In this study, we conducted a comprehensive study of the distribution, transportation behavior and potential ecological risk of alkylphenol polyethoxylates (APnEOs) in the aquatic environments of Kaohsiung City, Taiwan because little information is available regarding the fate of APnEOs in the water bodies of a total environment. At Love River, APnEOs concentrations were much higher at upstream of interception stations L15 (27.33 ± 1.22 µg/L) and L16 (6.31 ± 0.14 µg/L) than at downstream of interception stations L1-L14 (0.69-2.54 µg/L). Additionally, the average ethoxy (EO) chain lengths of APnEOs at L15 and L16 were longer than at L1-L14. These observations were attributed to the sluice between L14 and L15 that intercepts and accumulates untreated sewage from upstream areas and to the infrastructure of the sewage system that prevents domestic sewage from flowing downstream in the river and to the Kaohsiung Port Area. At Kaohsiung Port Area, APnEO concentrations ranging from 0.63 to 6.50 µg/L were measured. The concentration range and average EO chain length of these APnEOs were similar to those of the downstream stretch of the river, which was attributed to the mixing efficiency of the Kaohsiung Port Area and Love River through tidal exchange. At Cijin Coastal Area, APnEO concentrations ranged from 0.14 to 18.77 µg/L. Notably, the APnEO concentration of surface waters was much higher than that of bottom waters. This observation was attributed to the sewage discharged from the ocean outfall buoying up to the surface instead of mixing with surrounding bottom waters. In potential ecological risk, 19 of 39 sampling points exceeded toxic equivalency of 1 µg/L, and approximately 48.7% of the sampling points would exceed the threshold. The result provides insight into the environmental implications of APnEOs contamination in aquatic environments and useful information for environmental policy and ecological risk assessments.

Utility of Palliative Prognostic Index in Predicting Survival Outcomes in Patients With Hematological Malignancies in the Acute Ward Setting.

BACKGROUND: The palliative prognostic index (PPI) predicts the life expectancy of patients with terminally ill cancer in hospice settings. This study aimed to evaluate PPI as a prognostic tool for predicting the life expectancy of patients with hematological malignancies admitted to the acute ward. METHODS: A total of 308 patients with hematological malignancies admitted to the hematological ward at a medical center between January 2016 and December 2017 were consecutively enrolled. PPI was scored within 24 h of admission. All patients were categorized into 3 groups by PPI for comparing survival and in-hospital mortality rates. RESULTS: The median survival times were 38.4, 3.6, and 1.1 months for patients with good, intermediate, and poor prognostic group, respectively. The hazard ratio was 2.31 (95% CI 1.59-3.35, p < 0.001) when comparing the intermediate and good prognosis groups, and 3.90 (95% CI 2.52-6.03, p < 0.001) when comparing the poor and good prognosis groups. Forty-five (14.6%) patients died at discharge; in-hospital mortality rates among the good, intermediate, and poor prognostic groups were 9.0%, 23.4%, and 46.4%, respectively. The adjusted odds ratio for in-hospital mortality was 1.96 (95% CI, 0.80-4.82, p = 0.14) and 5.25 (95% CI, 2.01-13.7, p < 0.001) for patients in the intermediate and poor prognostic groups compared to those in the good prognostic group. CONCLUSION: PPI is an accurate prognostic tool for predicting survival times and in-hospital mortality rates in patients with hematological malignancies in an acute ward setting. PPI could assist clinicians in discussing end-of-life issues and in referring patients with hematological malignancies to palliative care.