Background: Surgical intervention is important for acute appendicitis. Perforated appendicitis leads to more complications and is more difficult to manage. Studies differentiating ruptured from nonruptured appendicitis are controversial. Aim: Early identification of perforated appendicitis is important for first-line medical practitioners. Our study aimed to provide more indicators to evaluate the risk of perforation before surgery. Methods: This retrospective study included 116 patients who underwent an appendectomy at the Tri-Service General Hospital between 2014 and 2018 with pathological diagnosis. Based on the surgical records, the patients were classified into two groups: simple (nonperforation) and complicated (perforation). Results: The patients (68 boys, 48 girls) were all under 18 years of age. Simple appendicitis was diagnosed in 87 patients and perforated appendicitis in 29 patients. Analysis revealed significant differences in blood C-reactive protein (CRP) levels between the two groups. The highest Youden's index was at a CRP level of 1.755 mg/dL. Positive findings were obtained for suppurative change as well as chylous ascites. Conclusion: Elevated CRP level was found to be a useful biomarker in predicting perforated appendicitis, excluding other general factors in pediatric patients. Suppurative change and chylous ascites could serve as indicators for the possibility of perforation during surgery.

Background: Acinetobacter baumannii can reside in humans without causing infection or symptoms but can opportunistically cause community and nosocomial infections. Few studies from Taiwan have used national-level data to investigate antibiotic resistance rates of A. baumannii infections in the intensive care units (ICUs) of medical centers. Aim: This study determined the number of infection sites of A. baumannii and the resistance rates of carbapenem-resistant A. baumannii (CRAB) infections in ICUs in Taiwan, and identified trends over time, variations of infection site, and factors associated with resistance. Methods: This study used the database provided by Taiwan's Centers for Disease Control. Yearly, Taiwan Nosocomial Infections Surveillance System Surveys from 2008 to 2019 were analyzed, including data on the site of infection and resistance rates of A. baumannii and patient and hospital characteristics. Results: On average, 21 hospitals as medical center/year participated in the survey, and 6803 A. baumannii isolates were identified. All isolates were health care-related infections. The most frequent sites of infection were the urinary tract (50.6%), respiratory tract (19.6%), bloodstream (18.2%), surgical wounds (4.3%), and others (7.4%). Infection rates were the highest in the urinary tract in 2019 (63.6%; P < 0.001). On average, the rate of carbapenem resistance was 66.6% (95% confidence interval: 63.1–70.1) among ICU patients at medical centers. Considerable regional differences were observed, with the highest rates of resistance in the central regions. Higher resistance rates were observed between 2019 and 2020 COVID-19 pandemic (74.2%). Conclusion: This is the first report on the prevalence of health care-related A. baumannii infection in Taiwan in 2008–2019. Several invasive diseases, such as urinary tract infections, are associated with higher rates of carbapenem resistance. The resistance rate of CRAB in Taiwan is exceptionally high. The current big-data-derived findings may inform future surveillance and research efforts in Taiwan.

Background: Laparoscopic appendectomy is the most common emergent surgery, and various techniques were used for the closure of appendicular stump and appendiceal artery. Aim: This study aimed to compare the clinical impacts of absorbable polymeric clips and traditional metallic clips. Methods: We reviewed the laparoscopic appendectomies performed from June 2020 to May 2021 in a medical center. We analyzed the characteristics and intraoperative and postoperative data of patients receiving absorbable or metallic clips during laparoscopic appendectomy. Results: A total of 120 patients were enrolled in this study. Fifty-nine patients received lapro-clips for the ligation of appendicular stump and artery (Group A), whereas 61 patients received titanium clips (Group B). The operative time for both groups was 63.6 ± 18.9 min and 65.5 ± 19.2 min, respectively (P ɢ.586). There was no significant difference in postoperative complications (P = 0.958). The length of hospital stay for each group was 3.07 ± 1.14 days and 2.90 ± 1.18 days, respectively (P = 0.435). Conclusion: The application of absorbable polymetric clips is feasible and safe with the additional benefit of leaving no foreign body for the closure of appendicular stump and ligation of appendiceal artery for laparoscopic appendectomy.

Background: Health of the adolescents is an important determinant of adult health. Multiple factors may affect the adolescents' health. Aim: This exploratory cross-sectional study was to explore the effects of life stress, social support, and family hardiness on quality of life (QoL) in rural adolescents (15 to 19 years old) whose family had encountered adverse disaster events. Methods: Purposive sampling was used to recruit 350 adolescents met study criteria with 265 completing all questionnaires (response rate = 75.71%). Based on stress process model, we hypothesized that life stress and social support would directly and indirectly influence QoL, and family hardiness mediates the effects of life stress on QoL. Path analysis was employed to analyze the association among life stress, social support, family hardiness, and QoL. Results: The study showed that life stress, social support and family hardiness are significantly associated with adolescents' QoL: life stress (β = ‒ 0.30, P < 0.001), social support (β = 0.18, P = 0.010), and family hardiness (β = 0.21, P = 0.002). Life stress and social support had significant association with family hardiness: life stress (β = ‒0.23, P = 0.001) and social support (β = 0.29, P < 0.001). Conclusion: Life stress directly and indirectly influences QoL through family hardiness. Family hardiness can buffer the effects of life stress. Social support could improve the adolescents' QoL. To promote QoL, it is important for healthcare providers to attend rural adolescents' life stress, and provide psychosocial interventions to enhance family hardiness and social support.

Background: Among the regional anesthesia techniques used for postoperative analgesia for lower abdominal surgeries, epidural analgesia (EA) has been the gold standard and time-tested technique, but complications and contraindications for the same warrant the need for other equally good analgesic techniques. Aim: The present study compared posterior transversus abdominis plane (TAP) block to EA for postoperative analgesic efficacy in patients undergoing lower abdominal surgeries. Methods: Prospective, observational study in patients undergoing lower abdominal surgeries under general anesthesia. Patients received ultrasound-guided (USG) 20 ml 0.2% ropivacaine each side in TAP block (Group A, n = 50) or 10 ml of 0.2% ropivacaine was administered in epidural (Group B; n = 50) before extubation. The Visual analog scale (VAS) score, hemodynamic parameters, and ill effects were recorded. Results: The blood pressure was significantly lower in first 6 h of block in Group B. VAS score was significantly lower in Group A in first 6 h of surgery. It was observed that a significantly higher number of patients in the Group B required rescue analgesic and at higher dosages. Postoperative nausea and vomiting were found in 32% of Group B and 22% of Group A patients. Conclusion: TAP block has almost no complications, keeps the patient more hemodynamically stable, and offers a better early postoperative analgesia when compared to EA in patients undergoing lower abdominal surgeries.

Delusional infestation has been described since 1894. The variety of treatments of delusional infestation has been administered in different atypical antipsychotic agents. Here, we present a case of first treatment with lurasidone on the delusional infestation in a 68-year-old female with vascular dementia, and the literature reviews of the related delusion infestation management.

Vasoplegic syndrome (VS) is characterized by low systemic vascular resistance paired with relatively preserved cardiac output that may result in increased morbidity and mortality rate after open-heart surgery utilizing cardiopulmonary bypass. We report a case of a 61-year-old male who underwent redo open-heart surgery due to a paravalvular leak of the previous implanted mitral bioprosthesis and severe tricuspid regurgitation. The patient experienced the VS in the intensive care unit after the operation. He was resuscitated by vasopressors and recovered uneventfully.

Leiomyomatosis peritonealisis disseminata (LPD) is a rare benign tumor characterized by the dissemination of smooth muscle-like cell nodules within the peritoneal cavity. Diagnosing LPD is challenging for clinicians due to its nonspecific clinical presentation and its dissemination throughout the peritoneal cavity, which mimics intra-abdominal malignancy. In the present study, we present the case of a 47-year-old woman with severe abdominal pain and fever initially diagnosed with intra-abdominal abscess or peritoneal carcinomatosis. Exploratory laparotomy was performed to resect several leiomyoma-like tumors in the subperitoneal space. LPD was confirmed histopathologically.

Ethanol sclerotherapy is a therapeutic method commonly applied to address low-flow vascular malformations. However, numerous complications, including hemodynamic instability, may develop after ethanol injection. We present a case who experienced cardiopulmonary instability during intraoperative percutaneous ethanol injection under general anesthesia and spontaneously recovered 5 min after ethanol injection. The toxic effects of the treatment were associated with the injection volume and may be related to ethanol-induced pulmonary vasoconstriction and transient right ventricular dysfunction. Prompt and proper management, including providing supportive treatment, decreasing pulmonary vascular resistance with pulmonary vasodilators, and improving right ventricular function, should be carefully prepared to minimize the progression of cardiovascular collapse.

Intrauterine devices (IUDs) are one of the most popular reversible contraception methods. However, if an event related to them is unanticipated, or if they are not located when missing, it can be dangerous. We present a case of chronic lower abdomen pain and recurrent urinary tract infection ongoing for 1.5 years. Despite the patient undergoing laparoscopic uterine myomectomy, her symptoms had not improved. The patient visited a genitourinary clinic for lower urinary tract symptoms and accepted cystoscopy and electrohydraulic lithotomy. Incidentally, a part of an IUD was found in the calculus. This case highlights the need for careful diagnosis and for locating missing IUDs to avoid serious complications.