Using Trastuzumab Deruxtecan to treat advanced metastatic breast cancer in patients with varying HER2 expression levels: A single-center experience in Taiwan.

To observe the clinical outcomes of patients diagnosed with metastatic breast cancer undergoing Trastuzumab Deruxtecan (T-DXd) therapy in a real-world setting. The study retrospectively reviewed and collected medical data from 13 patients at Shin Kong Wu Ho-Su Memorial Hospital who underwent T-DXd treatment over a period from April 2022 to June 2023. Demographics, pathological characteristics, treatment patterns, and outcomes were descriptively analyzed. Thirteen patients diagnosed with metastatic breast cancer underwent T-DXd treatment between April 2022 and June 2023. This study observed that T-DXd was effective in patients with high human epidermal growth factor receptor 2 (HER2) levels. In patients with low HER2, the majority also experienced favorable responses. Only 2 patients exhibited poor or no response: one was a BRCA2 carrier with unmanageable disease progression, and the other had a HER2 1 + status with multiorgan metastases whose cancer was not controlled by T-DXd. Additionally, 2 patients with no HER2 expression responded well to T-DXd treatment. T-DXd is a valuable treatment alternative for patients with breast cancer, including those with HER2-high, HER2-low, and HER2-negative statuses. In this study, the majority of patients experienced positive therapeutic effects. However, this evaluation relied on a limited sample size and short-term observations. Additional studies involving larger and more diverse patient groups and long follow-up durations are required.

Spleen metastasis of recurrent malignant thymoma.

Thymoma is a rare tumour that often occurs in the anterior mediastinum. Thymomas are usually diagnosed in middle-aged patients, and nearly half of cases are associated with myasthenia gravis. Thymomas typically progress through direct invasion of the thoracic cavity with extra-thoracic distant metastasis being uncommon. Here we report the case of a male patient who underwent an extensive thymectomy and radiotherapy 10 years before presentation, and in whom we detected a spleen tumour during regular out-patient follow-up. The patient underwent a splenectomy, and a final diagnosis of type B3 malignant thymoma was established.

Improved diffusion and storage of lithium ions via recrystallization induced conducting pathways in a Li:Ta2O5-based electrolyte for all-solid-state electrochromic devices with enhanced performance.

In this study, we have investigated the improvements in the performance of an all-solid-state complementary electrochromic device (ECD) by using the proposed high pressure treatment (HPT). The Li:Ta2O5electrolyte layer was recrystallized by the HPT utilizing pressurized CO2gas (∼200 atm) and at low temperature (<60 °C), which enhanced the coloration performance of the WO3/Li:Ta2O5/NiO complementary ECD by ∼20%. The reliability and durability of the ECD were confirmed by long term transmittance retention measurements, which indicated an improvement in the coloration performance by ∼14% upon the release of the bias voltages. The ability of the devices that were fabricated with and without the HPT process to withstand high temperature environments was also verified. In addition, photoluminescence (PL) and transmittance measurements were carried out to examine the effects of the bonding between WO3and NiO. To determine the differences in lithium-ion (Li+) injection, electrical measurements were performed by utilizing varying pulse rising speeds to confirm device characteristics. The materials were characterized in terms of their composition and structure using high-resolution transmission electron microscopy along with energy-dispersive x-ray spectroscopy. Finally, a mechanistic model has been proposed to explain the improved EC characteristics based on the amorphous to crystalline transition accompanying the HPT process.

Risk factors of vesicoureteral reflux and urinary tract infections in children with imperforate anus: A population-based case-control study in Taiwan.

ABSTRACT: Imperforate anus (IA) is associated with several urological anomalies, including vesicoureteral reflux (VUR), a major contributor to high morbidity in patients with anorectal malformations. This retrospective study was performed to elucidate the risk factors of vesicoureteral reflux (VUR) and UTI in children with IA.We used the National Health Insurance Research Database (NHIRD) to estimate the frequency of congenital anomalies of the kidney and urinary tract (CAKUT) in children with IA. We also investigated the frequencies of VUR, UTI, and CAKUT in children with IA along with the risk factors of VUR.We enrolled 613 children between 2000 and 2008 (367 males and 246 females; 489 low-position IA and 124 high-position IA). High-position IA was associated with a significantly increased risk of VUR compared with low-position IA (OR: 2.68, 95% CI: 1.61, 4.45). In addition, children with IA along with CAKUT, hydronephrosis, or UTI had a higher risk of VUR (OR: 8.57, 95% CI: 3.75, 19.6; OR: 7.65, 95% CI: 4.48, 13.1; and OR: 31.8, 95% CI: 11.5, 88.3, respectively). UTI, as well as chromosomal anomalies, were more frequent in children with high-position IA.Patients with a high-position IA had a greater risk of VUR, particularly those with CAKUT, hydronephrosis, or UTI. Such patients must periodically undergo urinalysis to screen for UTI and early voiding cystourethrogram to rule out VUR and prevent consequent renal damage. Chromosomal analysis is suggested to rule out Down syndrome.

Stabilizing resistive random access memory by constructing an oxygen reservoir with analyzed state distribution.

In this paper, the instability mechanism of resistive random access memory (RRAM) was investigated, and a technique was developed to stabilize the distribution of high resistance states (HRS) and better concentrate the set voltage. Due to the accumulation of oxygen, an interface-type switching characteristic was observed on the I-V curves beneath the filament-type switching behavior. In this work, the interface-type switching characteristic is used to fit the natural distribution of HRS as an analysis of the instability mechanism. According to the results, the HRS distribution is attributed to the accumulation of excess oxygen ions left from the lower oxygen content and oxygen vacancy recombination during the reset process. The proposed solution with simple plasma treatment, can create an excess oxygen reservoir by changing the surface topography of the electrode to store the surplus oxygen ions from the reset process, eliminating the oxygen accumulation effect and further improving the device stability.

Cytochrome p450 metabolism of betel quid-derived compounds: implications for the development of prevention strategies for oral and pharyngeal cancers.

Betel quid (BQ) products, with or without tobacco, have been classified by the International Agency for Research on Cancer (IARC) as group I human carcinogens that are associated with an elevated risk of oral potentially malignant disorders (OPMDs) and cancers of the oral cavity and pharynx. There are estimated 600 million BQ users worldwide. In Taiwan alone there are 2 million habitual users (approximately 10% of the population). Oral and pharyngeal cancers result from interactions between genes and environmental factors (BQ exposure). Cytochrome p450 (CYP) families are implicated in the metabolic activation of BQ- and areca nut-specific nitrosamines. In this review, we summarize the current knowledge base regarding CYP genetic variants and related oral disorders. In clinical applications, we focus on cancers of the oral cavity and pharynx and OPMDs associated with CYP gene polymorphisms, including CYP1A1, CYP2A6, CYP2E1, and CYP26B1. Our discussion of CYP polymorphisms provides insight into the importance of screening tests in OPMDs patients for the prevention of oral and pharyngeal cancers. Future studies will establish a strong foundation for the development of chemoprevention strategies, polymorphism-based clinical diagnostic tools (e.g., specific single-nucleotide polymorphism (SNP) "barcodes"), and effective treatments for BQ-related oral disorders.

Clear-cell variant of calcifying epithelial odontogenic tumor (Pindborg tumor) in the mandible.

We present an uncommon case (female patient aged 59 years) of the clear-cell variant of calcifying epithelial odontogenic tumor (CEOT) (also known as Pindborg tumor) in the mandible. The clinical characteristics and probable origins of the clear tumor cells of previously reported cases of clear-cell variant of intraosseous CEOT are also summarized and discussed.

Mucoceles of the oral cavity in pediatric patients.

Mucoceles are quite common in the oral cavity, but reports on pediatric patients are very rare. The aims of this study were to present our data and experience in the treatment of mucoceles of the oral cavity in pediatric patients, to compare them with those of other countries, and to remind the pediatric physician to devote much attention to lesions of the oral cavity in children. This retrospective study is based on the record of the patients who received surgical treatment for mucoceles of the oral cavity with pathologic confirmation at the Department of Dentistry, Kaohsiung Medical University Hospital, Taiwan, between 2000 and 2004. Patients younger than 18 years were included in this study. The analyzed data included age, gender, site, size, histopathologic findings, surgical methods, and complications. There were a total of 289 patients with mucoceles confirmed by histopathologic examination. As many as 64 patients were younger than 18 years. Of the 64, 34 were girls and 30 were boys; 89.1% of the lesions were in the lower lip; and 48.4% of the lesions were less than 5mm in diameter. Histopathologic findings showed that all mucoceles were of the extravasation type. As many as 30 patients were treated by carbon dioxide laser vaporization, and two cases recurred (6.67%); 34 patients were treated by surgical excision, and the recurrence rate (5.88%) was not statistically different for the treatment methods. The laser vaporization has the advantage of less bleeding, no sutures, and saving time, especially suitable for children with oral mucocele.

Immunohistochemical expression of RANKL, RANK, and OPG in human oral squamous cell carcinoma.

BACKGROUND: The mechanism of oral squamous cell carcinoma (SCC) invading jawbone remains controversial. Interactions between receptor activator of NF-kappaB (RANK) and its ligand (RANKL) are required for osteoclastogenesis. The binding of RANK and RANKL induces differentiation of osteoclasts, leading to bony destruction. Osteoprotegerin (OPG), a decoy receptor for RANKL, also binds to RANKL by competing with RANK, and this could protect against osseous destruction. MATERIALS AND METHODS: Immunoexpression of RANKL, RANK, and OPG in 25 cases of human buccal SCCs without bony invasion and 15 cases of gingival SCCs with mandibular bony invasion was investigated. Normal oral mucosa from five individuals without betel-quid chewing or cigarette smoking was used as a control. The scores are designated as percentage of positive staining x intensity of staining for each section. RESULTS: Strong cytoplasmic staining of RANKL proteins is detected in cancer cells of both buccal and gingival SCCs. The same protein is identified in cytoplasm of osteoclasts for all cases involving bony invasion. Strong cytoplasmic staining of RANKL is confined to basal layer for all normal mucosa. A similar staining pattern is noted for RANK protein in all buccal and gingival SCCs. An absence of staining of RANK protein is noted for all normal tissues. Weak to negative cytoplasmic stained OPG protein is present in all buccal and gingival SCCs, but is absent in all normal tissues. CONCLUSION: These findings suggest the potential value of the RANK/RANKL/OPG pathway as biomarkers in human oral SCCs.

Proximal tibial bone harvesting under local anesthesia without intravenous sedation in the dental office: a case report.

Maxillary sinus enlargement often occurs in the maxillary posterior edentulous area and reduces the available bone height for implantation. Therefore, maxillary sinus lift and bone graft procedures are necessary to provide sufficient available bone. Autogenous bone grafting is the best base for implant osseointegration. Recently, tibial bone has been recognized as an alternative extraoral donor site. We present a case in which we used a proximal tibia bone graft for maxillary sinus augmentation under local anesthesia without sedation in the dental office. During a 4-year postoperative follow-up, gait was not disturbed and the scar on the donor site remained unremarkable.

The displaced lower third molar: a literature review and suggestions for management.

PURPOSE: To review the literature associated with displaced lower third molars, to introduce a modified method of retrieval of an accidentally displaced lower third molar tooth or root fragment, and to recommend rational guidelines for management. MATERIALS AND METHODS: A review of the literature was performed to record the types of displacements, patient's personal data, imaging used, and the surgical approaches with their complications. A modified technique for exploration and retrieval is described. RESULTS: Nineteen reports were identified and reviewed. Some others could not be translated. In the 32 cases reviewed, there were no gender differences and the third and fourth decades of life were the most common time for this mishap to occur. Fragments were displaced into 5 different tissue spaces. The size of the fragments varied, but the whole tooth and fragment were displaced with equal frequency. Different methods of recovery were used. CONCLUSION: The accidental displacement of a lower third molar during attempted extraction is a rare but potentially serious complication. Retrieval should be effected as soon as possible. Because of differences in the direction of displacement, the size of fragment, delay in retrieval, and tissue reactions, no one technique is uniformly applicable. The modified method we suggest appears to save time and have few complications.

Surgical management of ameloblastoma in children.

OBJECTIVE: The purpose of this study was to report experience in the treatment of ameloblastoma in Taiwanese children and to discuss the treatment regimen. STUDY DESIGN: Fifteen patients, all younger than 18 years of age, with a diagnosis of ameloblastoma in our department between January 1991 and December 2004 were selected for study. Data included sex, age at surgery, tumor type, size and site of lesion, primary surgical methods, use of adjuvant therapy, complications, recurrences, and course of follow-up. RESULTS: Ages ranged from 9 to 17 (average was 13.7 years). Nine were male, 6 were female; the sex ratio was 1.5:1. Fourteen lesions were in the mandible (1 in the symphysis, 13 in the mandibular posterior area) and only 1 was in the maxilla. The size of the lesions ranged from 4 x 2.5 cm to 8 x 8 cm. Clinical typing included 8 unicystic type, 3 multicystic type, and 4 solid types. Of the histologic types, 5 were plexiform, 3 were mixed type, and 3 were acanthomatous type. Complications included numbness of the lower lip and contour defect of the face. Three cases (20%) were recurrent, and 1 patient had 2 recurrences. CONCLUSIONS: Good results can be achieved in the treatment of ameloblastoma in children using conservative surgery. In the event of recurrence, a second surgery can be successful. Patient compliance and careful follow-up are important.