Advanced hepatocellular carcinoma with major portal vein invasion: Therapeutic outcomes of hepatic arterial infusion chemotherapy vs concurrent radiotherapy.

BACKGROUND: Hepatocellular carcinoma (HCC) with major portal vein invasion (MPVI) presents very poor outcomes. Hepatic artery infusion chemotherapy (HAIC) and radiation therapy (RT) have both been found to be effective for advanced HCC. In this retrospective study, we compared the therapeutic outcomes of our "new" HAIC regimen with and without concurrent RT, before and after propensity score matching (PSM) in treating HCC patients with MPVI. METHODS: One hundred forty patients with MPVI received HAIC alone and 35 patients underwent concurrent HAIC and RT during a 16-year period. The left subclavian artery was adopted as the entry site for a temporary catheter placement for a 5-day chemoinfusion. The Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was adopted to assess the objective response rate (ORR). The Kaplan-Meier curve was used to calculate progression-free survival (PFS) and overall survival (OS) between the two groups. Univariate and multivariate analyses by Cox regression model were used to assess hazard ratios. RESULTS: Of the 140 patients with Child-Pugh A liver function, the median OS was 17.0 months. In the initial cohort, higher ORR and PFS were found in the concurrent RT group than in the HAIC alone group (80% vs 66.4% and 9 vs 8 months, respectively) but shorter OS (10.5 vs 14.5 months, p = 0.039) was observed. After PSM, the OS was 10 and 15 months ( p = 0.012), respectively. Multivariable Cox regression analysis revealed that the significant factors for adjusting hazard ratios for OS were Child-Pugh classification, alpha fetal protein (AFP) level, and hepatic vein invasion. CONCLUSION: HAIC is an effective treatment for advanced HCC patients with MPVI. Concurrent HAIC and full-dose RT were associated with worse clinical outcomes.

Field Test of an m-Health Worksite Health Promotion Program to Increase Physical Activity in Taiwanese Employees: A Cluster-Randomized Controlled Trial.

BACKGROUND: Occupational health nurses in workplaces aim to offer evidence-based interventions to increase physical activity among employees to promote health. Mobile health (m-health) interventions have demonstrated effectiveness in increasing physical activity, and the application of m-health solutions in workplaces warrants investigation. We examined the effectiveness of a cell phone/smart device and web-based (m-health) intervention in motivating the employees at financial enterprise firms to increase physical activity. METHODS: This study included employees from 16 banks (n = 194) who were randomly assigned to either (a) an experimental group (6 banks, n = 89), which received an intervention that integrated the Theory of Planned Behavior (TPB)-based tailored Short Message Service (SMS) with web-based knowledge or (b) a comparison group (10 banks, n = 105), which received web-based messages alone. Outcomes included psychosocial variables (attitude toward physical activity, normative beliefs, and control beliefs) and the level of physical activity. Data were collected at baseline, immediately after the intervention, and 3 months after the intervention. FINDINGS: The level of physical activity significantly increased in the experimental group (p < .05). TPB variables such as perceived social norms (p < .01) and behavioral control (p < .05) also significantly improved in the experimental group. However, all the effects had a small size (=.05) and diminished in 12 weeks. CONCLUSIONS: In addition to internet-based information, the use of mobile phones/smart devices to encourage employees to exercise for 8 weeks effectively increased employees' physical activity level. More research, specifically addressing workplace culture, is warranted to establish methods for sustaining healthy behaviors to increase physical activity.

Contralateral lymph node recurrence rate and its prognostic factors in stage IVA-B well-lateralized oral cavity cancer.

PURPOSE: To evaluate the contralateral lymph node recurrence rate (clLNRR) of stage IVA to IVB well-lateralized oral cavity cancer. To evaluate the risk factors of clLNRR. MATERIALS AND METHODS: Pathologic stage IVA-B squamous cell carcinoma of oral cavity, originating from buccal mucosa, gingiva, or retromolar trigone were retrospectively recruited. Those who did not receive definitive surgery, with previous cancer history, or with contralateral nodal metastasis at diagnosis were excluded. RESULTS: From 2010 to 2017, 120 cases were enrolled, including 103 pT4 and 38 pN2. Thirty-one patients underwent contralateral neck dissection, and 18 had contralateral elective nodal irradiation. After median follow up of 35.1 months, the 3-year clLNRR was 15.7% (95% CI: 8.8 - 22.6%) as first event and was 17.1% (95% CI: 9.8 - 24.4%) for overall recurrences. The 3-year disease-free survival and overall survival were 52.8% and 63.1%, respectively. In multivariate analysis, positive nodal metastasis, gingival origin, and perineural invasion were associated with significantly higher clLNRR. Nodal metastasis was the strongest prognostic factor for clLNRR (pN1, HR: 17.1, p = 0.010; pN2, HR: 16.7, p = 0.004, comparing to pN0). The 3-year clLNRR were 2.9% for pN0 (n = 71, 95% CI: 0 - 6.8%), 37.7% for pN1 (n = 11, 95% CI: 8.3 - 67.1%), and 38.4% for pN2 (n = 38, 95% CI: 19.2 - 57.6%). Advanced T classification, elective contralateral neck dissection, and contralateral nodal irradiation did not have significant impact on clLNRR. CONCLUSIONS: Positive homolateral nodal metastasis, gingival origin, and perineural invasion were risk factors correlated with significantly higher clLNRR. For patient without nodal metastasis, the clLNRR was low and elective contralateral neck management might be safely omitted. For patients with homolateral nodal disease, the contralateral nodal recurrence was not unusual. The optimal treatment for these high risk patients warrant further research.

Web-based intervention to promote physical activity in Taiwanese children.

PURPOSE: This study investigated the effectiveness of a theory-based, technology-integrated website in promoting the physical activity of schoolchildren. DESIGN AND METHODS: A website designed using a self-management strategy and supplemented with a geographical information system (GIS) mapping function was used to increase children's physical activity levels. A total of 524 students from six elementary schools in Taipei City completed surveys at three times during 2010 and were assigned to one of three groups: (1) a self-management group, using a website employing a goal-setting strategy and a storytelling schema based on a classical Chinese novel; (2) a knowledge-only group that was given only access to the website; or (3) a control group that was only given lectures and not allowed to access the website. RESULTS: After adjustment for the effects of the pretest, the self-management and knowledge-only groups were found to be more physically active and have higher self-efficacy than the control group. Moreover, the self-management group had higher scores for these two variables than the knowledge-only group. Furthermore, the intervention was more effectives for male students than female students. CONCLUSION: Overall, the self-management website proved to be effective in promoting schoolchildren's physical activity. The positive correlation of self-efficacy with the ability to handle the difficulties inherent in physical activity continued for 3 months after the intervention was completed.

An Analysis of Emergency Department Visits and the Survival Rate for Colorectal Cancer Patients: A Nationwide Population-based Study.

Objective We examined the general characteristics, survival rate, and most common reasons for visiting the emergency department (ED) among colorectal cancer patients in Taiwan. We performed a population-based retrospective study and used data sourced from the National Health Insurance Research Database (NHIRD). Methods The colorectal cancer patient population, their diagnosis, and their medical management at the ED were identified using the Longitudinal Health Insurance Database 2000 (HV) codes and International Classification of Diseases, Ninth Revision, Clinical Modification system. We investigated their reasons for visiting the ED and the medications used there, analyzed their cumulative survival curves using the Kaplan-Meier method, and compared the survival curves with other colorectal cancer patients who had never visited the ED. Results Between 2000 and 2012, there were 6,532 ED visits by 3,347 colorectal patients, and the number per year increased gradually. The top three most common reasons for visiting ED were ill-defined conditions, abdominal pain, and intestinal obstruction. The overall survival rates of colorectal patients in the ED visit group at 3, 5, and 10 years, were 0.65, 0.56, and 0.47, respectively, without significant differences from the rates among colorectal cancer patients who did not visit the ED (p=0.2072). Conclusion We described the circumstances of ED visitation by colorectal cancer patients in Taiwan. Health care providers and researchers should pay more attention to improve medical care quality and investigate more details to predict the outcome among colorectal cancer patients.

Transmission of Bamboo mosaic virus in Bamboos Mediated by Insects in the Order Diptera.

Bamboo mosaic virus (BaMV), a member of the genus Potexvirus, is the major threat to bamboo cultivation. Similar to most potexviruses, the transmission of BaMV by insect vectors has not been documented previously. However, field observations of BaMV disease incidences suggested that insect vectors might be involved. In this study, we aimed to investigate the possibility of insect-mediated transmission of BaMV among bamboo clumps, in order to provide further insights into the infection cycles of BaMV for the development of effective disease management measures. From the major insects collected from infected bamboo plantations, BaMV genomic RNAs were detected inside the bodies of two dipteran insects, Gastrozona fasciventris and Atherigona orientalis, but not in thrips (Scirtothrips dorsalis). Artificial feeding assays using green fluorescent protein-tagged BaMV virions revealed that BaMV could enter the digestive systems and survive in the regurgitant and excretion of the dipterans. BaMV RNA could be retained in the dipterans for up to 4 weeks. Insect-mediated transmission assays indicated that both dipterans could transmit BaMV to bamboo seedlings through artificially created wounds with low infection efficiency (14 - 41%), suggesting that the dipterans may mediate the transmission in a mechanical-like manner. These results demonstrated that dipterans with sponge-like mouthparts may also serve as vectors for at least one potexvirus, BaMV, among bamboo plants. The finding suggested that dipteran insect control should be integrated into the disease management measures against BaMV infections.

Accuracy of CO2 monitoring via nasal cannulas and oral bite blocks during sedation for esophagogastroduodenoscopy.

Esophagogastroduodenoscopy procedures are typically performed under conscious sedation. Drug-induced respiratory depression is a major cause of serious adverse effects during sedation. Capnographic monitoring of respiratory activity improves patient safety during procedural sedation. This bench study compares the performance of the nasal cannulas and oral bite blocks used to monitor exhaled CO2 during sedation. We used a spontaneously breathing mechanical lung to evaluated four CO2 sampling nasal cannulas and three CO2 sampling bite blocks. We placed pneumatic resistors in the mouth of the manikin to simulate different levels of mouth opening. We compared CO2 measurements taken from the sampling device to CO2 measurements taken directly from the trachea. The end tidal CO2 concentration (PETCO2) measured through the bite blocks and nasal cannulas was always lower than the corresponding PETCO2 measured at the trachea. The difference became larger as the amount of oxygen delivered through the devices increased. The difference was larger during normal ventilation than during hypoventilation. The difference became larger as the amount of oral breathing increased. The two nasal cannulas without oral cups failed to provide sufficient CO2 for breath detection when the mouth was fully open and oxygen was delivered at 10 L/min. Our simulation found that respiratory rate can be accurately monitored during the procedure using a CO2 sampling bite block or a nasal cannula with oral cup. The accuracy of PETCO2 measurements depends on the device used, the amount of supplement oxygen, the amount of oral breathing and the patient's minute ventilation.

Impact of intracranial extension on survival in stage IV nasopharyngeal carcinoma: identification of a subset of patients with better prognosis.

OBJECTIVE: T-stage is an imperfect prognostic indicator for patients with nasopharyngeal carcinoma. We evaluated the effect of extent of intracranial involvement on survival after conventional radiotherapy in patients with Stage T4 nasopharyngeal carcinoma. METHODS: We conducted a retrospective analysis of the results of computed tomography, magnetic resonance imaging and treatment outcomes in 84 consecutive patients with Stage T4 nasopharyngeal carcinoma during the period September 1993 to December 2002 in Taiwan. The patients were subcategorized into those who had limited intracranial involvement (primary nasopharyngeal tumors with involvement of the unilateral cavernous sinus or the parasellar region only) or extensive involvement (extension of the tumors to the bilateral cavernous sinus or the parasellar region, into the orbit and the ethmoid sinus anteriorly, or to the prepontine region and the posterior cranial fossa). RESULTS: Extensive intracranial involvement was found in 51.2% of the patients. Among these patients, the 5-year rate of overall survival after conventional radiotherapy was only 3.4%. In contrast, the 5-year survival among patients with limited intracranial involvement was 42.9%. This difference was significant (P < 0.001). In the multivariate analysis, extensive intracranial involvement, advanced age and a nodal status of N3 correlated with poor overall survival (all P < 0.05). CONCLUSIONS: Among patients with T4 nasopharyngeal carcinoma, better treatment outcomes were associated with limited intracranial involvement. We conclude that a subdivision of Stage T4 nasopharyngeal carcinoma disease based on the extent of intracranial involvement would provide better prognostic information.