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  Citation statistics : Table of Contents
   2021| November-December  | Volume 41 | Issue 6  
    Online since November 1, 2021

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Pretreatment body mass index and serum uric acid and albumin levels as prognostic predictors in patients with oral squamous cell carcinoma
Wei-Chin Chang, Cheng-Yu Yang, Yu-Chun Lin, Chun-Shu Lin, Chin-Shan Kuo, Yu-Hsuan Li, Yuan-Wu Chen
November-December 2021, 41(6):295-304
Background: Oral squamous cell carcinoma (OSCC) is the most frequently found malignant tumor of the oral cavity, and the annual death rate of OSCC patients has been increasing rapidly among the Taiwanese population. Aim: The aim of this study is to evaluate if poor nutrition is a potential adverse prognostic factor in patients with OSCC. Methods: This cross-sectional study included 322 patients with OSCC who underwent therapeutic surgical treatment in Taiwan. The pretreatment body mass index (BMI) and serum uric acid and albumin levels were measured as common indicators of the nutritional status, and overall survival (OS) was analyzed using the Kaplan–Meier method and a Cox regression model. Results: The optimal cut-off values were 24.0 kg/m[2], 5.05 mg/dL, and 3.85 g/dL for BMI, serum uric acid, and serum albumin, respectively. The multivariate Cox regression analysis indicated lower BMI (hazard ratio [HR] = 1.557, 95% confidence interval [95% CI]: 1.070–2.265; P = 0.021), lower serum uric acid (HR = 1.857, 95% CI: 1.265–2.724; P = 0.002), and lower serum albumin (HR = 2.011, 95% CI: 1.278–3.163; P = 0.003) as independent and significant prognosticators of OS. Advanced stage, depth of invasion of more than 5 mm, and extranodal extension were prognostic predictors of poor OS. Conclusion: A lower preoperative BMI and lower serum uric acid and albumin levels are predictors of significantly worse survival among OSCC patients. Maintaining a healthy nutritional status is crucial to improving the survival of patients with oral cancer. The treatment for patients with poor nutritional status should be more aggressive and cautious.
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Pediatric scrub typhus complicated by meningitis
Ya-Ling Chou, Kao-Hsian Hsieh, Chiung-Hsi Tien, Chih-Chien Wang, Wen-Tsung Lo
November-December 2021, 41(6):305-308
Scrub typhus is caused by the intracellular pathogen Orientia tsutsugamushi, which is transmitted to humans by infected chigger mites. The disease causes a febrile illness accompanied by regional or generalized lymphadenopathy, hepatomegaly, splenomegaly, as well as nonspecific manifestations. Scrub typhus is an important cause of febrile disease in South and East Asia and in the Western Pacific, and can cause severe complications including meningoencephalitis and pneumonitis. Herein, we report a case of scrub typhus accompanied by meningitis, which was definitively diagnosed by serology assay, in a 4-year-old girl who presented with prolonged fever, skin rash, cough, general weakness, and poor appetite. Scrub typhus should be considered in the differential diagnosis when evaluating patients who present with nonspecific febrile illness or meningitis in areas that are endemic for O. tsutsugamushi.
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Unusual cause of abdominal pain in a young adult: The clinical pitfalls of adenocarcinoma of the gallbladder with liver invasion
Ren-Tzer Wang, Jheng-Yan Chen, Jyh-Cherng Yu, Teng-Wei Chen, Chung-Bao Hsieh, De-Chuan Chan, Kuo-Feng Hsu
November-December 2021, 41(6):309-311
Gallbladder (GB) cancer is a rare cause of abdominal pain in young adults. It is difficult to confirm an immediate and correct diagnosis based on the presentation of an acute episode of abdominal pain. We report a 36-year-old man who was referred to our hospital because of right upper abdominal pain that had persisted for 1 month. The tentative diagnosis was gallstone-induced acute on chronic cholecystitis according to the clinical symptoms/signs and imaging studies. Laparoscopic cholecystectomy (LC) was performed after admission. Histological examination revealed adenocarcinoma of the GB that was moderately differentiated and invading the perimuscular connective tissue. Magnetic resonance imaging was performed after the surgery, showing negativity for the invasion to other organs. Laparoscopic bisegmentectomy of the liver (seg. 4b + 5) and lymph node dissection was performed following LC. Adjuvant chemotherapy was administered, and the patient is currently alive without recurrence for 6 months. The uncommon etiology of cholecystitis in young adults is discussed.
  - 1,500 213
Thoracic intradural extramedullary lipomas
Liao Hsiang-Chih, Dueng-Yuan Hueng, Yuan-Hao Chen, Hsin-I Ma, Da-Tong Ju, Tang Chi-Tun
November-December 2021, 41(6):312-314
Intradural extramedullary lipomas are rare congenital and histologically benign tumors that represent <1% of all spinal cord tumors. However, the indications for surgery and the degree of resection or decompression are under debate. We report on our experience with spinal decompression for the treatment of one intradural extramedullary thoracic lipomas.
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A rare case of symptomatic nonunion of avulsion fracture of the posterior medial meniscus root with concomitant posterior cruciate ligament injury
Shen-Han Wu, Shih-Han Lee, Chian-Her Lee, Jia-Lin Wu
November-December 2021, 41(6):315-318
The menisci are the essential structures of the knee joint because they disperse body weight and reduce friction during the movement. An avulsion fracture of the posterior medial meniscus root, also known as meniscal ossicles, can lead to meniscal extrusion. Consequently, the medial meniscus loses its ability to absorb hoop stress. One patient presented with nonunion posterior root avulsion fracture of the medial meniscus concomitant with posterior cruciate ligament (PCL) injury. The patient underwent arthroscopic suture repair through the placement of a tibial tunnel 1 year after injury. The fracture united well, and complete recovery was achieved at the 2-year follow-up. To the best of our knowledge, this is the first report describing a posterior root avulsion fracture of the medial meniscus with concomitant PCL avulsion fracture.
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The successful application of high-flow nasal cannula for a patient who underwent vertebroplasty with severe pulmonary hypertension
Lei-Ying Huang, Meng-Fu Lai, Nan-Kai Hung, Chun-Chang Yeh
November-December 2021, 41(6):319-320
  - 1,280 212
Effects of auditory and visual interference control on visuospatial working memory in children with ADHD
Thitiya Wangkawan, Cynthia Lai, Peeraya Munkhetvit, Trevor Yung, Supaporn Chinchai
November-December 2021, 41(6):265-272
Background: Interference control is the cognitive control needed to prevent interference due to competition of relevant and irrelevant information that closely related to working memory. The aim of this study was to examine the effects of auditory and visual interference control on visuospatial working memory of children with ADHD. Methods: The participants included thirty children with ADHD and thirty normal control children aged 7–12 years old. All children took the computerized test of visuospatial working memory assessment. The test comprised the N-back and running Memory tasks divided into three conditions: noninterference, auditory interference, and visual interference in three levels of difficulty. Results: The results revealed that there was a significant difference in N-back with auditory interference (t = 2.13, P = 0.04) and N-back with visual interference task (t = 2.48, P = 0.02) between normal control children and children with ADHD. However, there was no significant difference in N-back with noninterference task (t = 1.61, P = 0.11) between normal control children and children with ADHD. There was a significant difference in running memory with noninterference (t = 5.34, P ≤ 0.001), running memory with auditory interference (t = 6.23, P ≤ 0.001), and running memory with visual interference task (t = 5.86, P ≤ 0.001) between normal control children and children with ADHD. In addition, the comparison of the mean score revealed that children with ADHD had poorer performance of interference control on visuospatial working memory tasks than normal control children in overall tasks. Conclusion: Children with ADHD exhibited inefficient control over themselves, especially in the interference condition tasks in which they performed more error responses when interacting in the tasks. The present study supports the evidence-based mechanisms of auditory and visual interference control in visuospatial working memory of children with ADHD.
  - 2,318 357
Risk factors for early and late recurrence in hepatocellular carcinoma after liver transplantation
Fan Hsiu-Lung, Hsieh Chung-Bao, Kuo Shih-Ming, Chen Teng-Wei
November-December 2021, 41(6):273-279
Background: Risk factors of early and late recurrence in hepatocellular carcinoma (HCC) after liver transplantation (LT) remain unclear. Aim: To identify factors that affect, both early and late recurrence in this setting. Methods: We retrospectively analyzed outcomes of 220 patients with HCC who received LT. Two patients who underwent re-transplantation were excluded. Early, late, and very late recurrence were defined as recurrence in the 1st year, 1–5 years, and >5 years after LT, respectively. Kaplan–Meier survival curves were generated, and log-rank tests were performed to compare survival between these groups. Univariate and multivariate Cox proportional-hazard models for risks of early and late recurrence were established. Results: Twenty and 19 patients experienced HCC recurrence in the 1st year and between 1 and 5 years, respectively, after undergoing LT. The groups differed significantly in cumulative postrecurrence survival rate. The hazard ratio of early recurrence for tumor size >3 cm was 1.766 (P = 0.046) and that for tumor number >3 was 1.929 (P = 0.027). Alpha-fetoprotein >20 ng/mL was a predictor of early recurrence in multivariate analysis (P = 0.077). The hazard ratio of late recurrence for HCC with microvascular invasion was 1.891 (P = 0.047). Conclusion: The recurrence rate of HCC was high in the 1st year after LT. Patients with early recurrence had a poorer survival rate than those with late recurrence. Tumor size >3 cm and tumor number >3 were risk factors of early recurrence. Microvascular invasion was a risk factor for late recurrence. Close individual surveillance is needed in patients with these risk factors.
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Immunohistochemical evaluation of extravillous cytotrophoblasts in the uteroplacental bed in iron-deficiency anemia of pregnancy
Olena A Tiulienieva, Christos Tsagkaris, Igor S Davydenko, Anastasiia V Hoian, Svitlana M Yasnikovska, Serhiy L Hovornyan
November-December 2021, 41(6):280-285
Background: Iron deficiency anemia (IDA) in pregnancy is challenging, inducing a systemic pathological process in women's bodies. In this context, impaired protein metabolism, decreased respiratory enzyme activity, limitation of cells' proliferative potential, oxidative stress, hypoxia, and endothelial dysfunction affect the “mother-placenta-fetal” system. However, several features of this pathogenetic cascade, including the spread of extravillous cytotrophoblasts (ECT), are yet to be investigated. This research aimed to study the immunohistochemical features and quantitative indicators of ECT spread throughout the uteroplacental bed (UPB) in IDA at 37–40-week gestation. Methods: Eighty biopsies of UPB and myometrium were studied postcesarean section with the previous observation of physiological pregnancy and gestation in IDA conditions without clinical signs of placental insufficiency. Histological sections were performed on immunohistochemical techniques with primary antibodies against metalloproteinases 2 and 9, placental lactogen, and antiapoptotic protein BCL-2. Their quantitative parameters in the cytoplasm of endovascular CT cells were determined using computer microdensitometry by calculating optical color density. The arithmetic mean and its statistical error were calculated. The Shapiro–Wilk test of normality was performed. The comparisons between the groups were provided on the unpaired two-tailed Student's test. Results: The analysis of the depth of CT invasion on the material of the UPB and the myometrium in conditions of IDA showed the spread of the CT invasion not only in the area of the spiral arteries of the endometrium but also the incorporation of endovascular CT into the myometrial arteries walls. Immunohistochemical study of CT invasion showed the following results: during physiological pregnancy, the concentration of metalloproteinase 2 was 0.232 ± 0.0012 optical density units (ODU), metalloproteinase 9 - 0.219 ± 0.0014 ODU. Immunovisualization of placental lactogen during physiological pregnancy was 0.314 ± 0.0022 ODU in interstitial CT and 0.109 ± 0.0022 ODU in endovascular CT; in the conditions of IDA: 0.337 ± 0.0022 ODU in interstitial CT and 0.110 ± 0.0022 ODU in endovascular CT. Conclusion: It is established that, during gestation with IDA, a deepening of CT invasion in the structure of the UPB, an increase in the lining distance of the endothelium-replacing CT in the artery walls, and consequently, a dilatation of spiral and radial arteries takes place in the uterus of pregnant women. However, the invasive ability and synthetic activity of the CT and as a result, the adequacy of the gestational transformation of UPB structures are affected by the hypoxia and depend on the degree of IDA of pregnant women.
  - 1,720 257
Epidemiology profile and outcomes of oral potentially malignant disorders among different geographic regions of Taiwan: A retrospective observational nationwide population database study
Sheng-Fu Chiu, Chung-Han Ho, Yi-Chen Chen, Li-Wha Wu, Yuh-Ling Chen, Jer-Horng Wu, Wei-Sheng Wu, Hui-Kun Hung, Wei-Fan Chiang
November-December 2021, 41(6):286-294
Background: The malignant transformation of oral potentially malignant disorders (OPMDs) is a potential cause of oral cancers. However, epidemiological studies on malignant transformation of OPMDs are lacking. The present study is aimed to investigate the percentage of OPMD in the oral mucosal screening database and the malignant transformation (%) across different regions of Taiwan. Methods: We determined the cases of malignant transformation of OPMD to oral cancers during the 2-year follow-up by the oral mucosal screening database and the cancer registry database contained in the National Health Insurance Research Database. Patients with oral cancer history before OPMD diagnosis were excluded from the study. We collected data including clinical diagnosis, biopsy result, follow-up, and place of residence of the patient. The most widely used definition from the Council for Economic Planning and Development in Taiwan was used in this study for the classification into Southern, Northern, Eastern, and Western Taiwan regions. Differences in the malignant transformation (%) and ranking between regions were evaluated using analysis of variance test. Results: Chiayi city located in Southern Taiwan has the highest percentage of OPMD in oral screening citizen. The percentage of OPMD in the oral mucosal screening database was highest in Southern Taiwan and lowest in Eastern Taiwan; however, the malignant transformation (%) was highest in the Eastern Taiwan and lowest in Northern Taiwan. Conclusion: Dentists and otolaryngologists in Southern Taiwan, especially Chiayi city, should be cautious when screening the patient because of the high percentage of OPMD in oral mucosal screening database. The percentage of OPMD in the oral mucosal screening database and the malignant transformation (%) are different among the different regions in Taiwan. Further research is needed to clarify the reasons for the different malignant transformation (%) between regions.
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