Age-specific percentile-based prostate-specific antigen cutoff values predict the risk of prostate cancer: A single hospital observation.

Background: Testing for prostate-specific antigen (PSA) is often recommended for men with a potential risk of prostate cancer (PCa) before requiring advanced examination. However, the best PSA cutoff value remains controversial. Object: We compared the predictive performance of age-specific percentile-based PSA thresholds with a conventional cutoff of >4 ng/mL for the risk of PCa. Methods: We included men who received PSA measurements between 2003 and 2017 in a medical center in Taiwan. Logistic regression modeling was used to assess the association between age-specific percentile-based PSA thresholds and PCa risk in age subgroups. We further applied C-statistic and decision curve analysis to compare the predictive performance of age-specific percentile-based PSA with that of a conventional cutoff PSA. Results: We identified 626 patients with PCa and 40 836 patients without PCa. The slope of PSA in patients >60-year-old was almost 3 times that of those <60-year-old (0.713 vs 0.259). The risk effect sizes of the 75th percentile PSA cutoff (<60-year-old: 2.19; 60-70-year-old: 4.36; >70-year-old: 5.84 ng/mL) were comparable to those observed based on the conventional cutoff in all age groups. However, the discrimination performance of the 75th percentile PSA cutoff was better than that of the conventional cutoff among patients aged <60-year-old (C-statistic, 0.783 vs. 0.729, p < 0.05). The 75th percentile cutoffs also correctly identified an additional 2 patients with PCa for every 100 patients with PSA screening at the threshold probability of 20%. Conclusions: Our data support the use of the 75th percentile PSA cutoff to facilitate individualized risk assessment, particularly for patients aged <60-year-old.

Clinical effects of dupilumab: A novel treatment for Kimura disease.

BACKGROUND: Kimura disease (KD) is a rare chronic inflammatory disorder involving the Th2 pathway. Although medical treatment with steroids or other immunosuppressants is available, they may cause developmental issues in the pediatric population. Surgical intervention has also been suggested; however, it is associated with high recurrence rates. CASE PRESENTATION: A 14-year-old boy presented with left retroauricular lymph node enlargement at the age of 5 years. At the age of 7 years, he was diagnosed with nephrotic syndrome which subsided after steroid treatment for approximately 6 years. The retroauricular lymph node was surgically excised, and KD was confirmed. However, recurrent enlargement of the left retroauricular and neck lymph nodes occurred after 2 years. Persistently high IgE levels and fluctuating eosinophil counts were observed following steroid treatment. Dupilumab was prescribed because of the difficulty in tapering the steroid dosage. A loading dose of 600 mg was administered, followed by a maintenance dose of 300 mg every 2 weeks. The IgE level decreased after 3 months, and a low eosinophil count was maintained after steroid discontinuation. Follow-up computed tomography revealed a decrease in the size of the lymph nodes with no side effects such as conjunctivitis. CONCLUSION: Traditional treatments have raised developmental concerns in the pediatric population and are associated with high recurrence rates. Dupilumab targets the Th2 pathway and provides effective results, with few adverse effects. Dupilumab may be a therapeutic option for KD and other diseases involving the Th2 pathway.

Adverse Events of Everolimus in Patients with Tuberous Sclerosis Complex Treated for Renal Angiomyolipoma/Subependymal Giant Cell Astrocytoma.

Background: Although regarded as a potentially efficient approach to address tuberous sclerosis complex (TSC)-associated complications, the adverse event profile of everolimus has not yet been fully elucidated. The present study aimed to clarify the adverse event spectrum in patients with TSC who are using everolimus for common indications, in comparison to those who do not use everolimus. Materials and Methods: We recruited patients with TSC who were followed up annually at TSC integrated clinics or referred for medical assistance. Medical reviews and laboratory investigations were performed at baseline and annually by clinical physicians. The adverse events were assessed as per the National Cancer Institute Common Terminology Criteria for Adverse Events. Results: Common adverse events in everolimus users included hypercholesterolemia (55%), gingivostomatitis (50%), proteinuria (50%), and hyperglycemia (40%). Compared with everolimus nonusers, the occurrence of gingivostomatitis and proteinuria was significantly higher in everolimus users (gingivostomatitis, p=0.02; proteinuria, p=0.02). Among the everolimus users, 12 patients had level I CTCAE, and five had level II CTCAE. None of the everolimus users presented with CTCAE level III or higher. Conclusion: Patients with TSC who are everolimus users had a higher tendency to develop gingivostomatitis and proteinuria compared to nonusers. However, no differences were observed in the occurrence of other adverse events between everolimus users and nonusers.

Effectiveness and Safety of Intra-arterial Imipenem/Cilastatin Sodium Infusion for Patients with Hand Osteoarthritis-Related Interphalangeal Joint Pain.

PURPOSE: To evaluate the effectiveness and safety of intra-arterial imipenem/cilastatin sodium (IPM/CS) infusion for painful interphalangeal joint osteoarthritis (OA). MATERIALS AND METHODS: Fifty-eight patients with interphalangeal joint OA who underwent intra-arterial IPM/CS infusion were retrospectively evaluated. Intra-arterial infusions were performed via percutaneous wrist arterial access. The Numerical Rating Scale (NRS), Functional Index for Hand Osteoarthritis (FIHOA), and Patient Global Impression of Change (PGIC) scale scores were assessed at intervals of 1, 3, 6, 12, and 18 months. Clinical success was evaluated based on PGIC. RESULTS: All patients were followed up for at least 6 months after treatment. Of them, 30 and 6 patients were followed up for 12 and 18 months, respectively. No severe or life-threatening adverse events were encountered. The mean NRS score was 6.0 ± 1.4 at baseline, which significantly decreased to 2.8 ± 1.4, 2.2 ± 1.9, and 2.4 ± 1.9 at 1, 3, and 6 months after treatment, respectively (all P < .001). The mean NRS scores were 2.8 ± 1.7 and 2.9 ± 1.9 at 12 and 18 months, respectively, in the remaining patients. The mean FIHOA score significantly decreased from 9.8 ± 5.0 at the baseline to 4.1 ± 3.5 at 3 months (P < .001). The mean FIHOA score was 4.5 ± 3.3 at 12 months in the remaining 30 patients. The clinical success rates based on PGIC at 1, 3, 6, 12, and 18 months were 62.1%, 77.6%, 70.7%, 63.4%, and 50.0%, respectively. CONCLUSIONS: Intra-arterial IPM/CS infusion is a potential treatment option for interphalangeal joint OA refractory to medical management.

Ultrasonography Facilitates the Diagnosis of Traumatic Iliopsoas Hemorrhage: A Report of Two Cases with Different Patterns.

We report two cases of traumatic iliopsoas hemorrhage, without hemoperitoneum, initially detected by ultrasound. Flexion hip contracture in the first case and incomplete femoral nerve palsy in the second case alerted the sonographer to the possibility of traumatic iliopsoas hemorrhage. The first case involved a 54-year-old man who complained of progressive right flank pain and difficulty in walking after falling to the ground. The second case involved a 34-year-old man who complained of severe lower back pain and numbness and weakness of the left leg after a motorcycle accident. In both cases, iliopsoas hemorrhage was confirmed on subsequent multidetector computed tomography.

Ethnic differences in the age-related distribution of serum prostate-specific antigen values: A study in a Taiwanese male population.

This study investigates age-specific prostate-specific antigen (PSA) distributions in Taiwanese men and recommends reference ranges for this population after comparison with other studies. From January 1999 to December 2016, a total of 213,986 Taiwanese men aged above 19 years old without history of prostate cancer, urinary tract infection, or prostate infection were recruited from the Taiwan MJ cohort, an ongoing prospective cohort of health examinations conducted by the MJ Health Screening Center in Taiwan. Participants were divided into seven age groups. Simple descriptive statistical analyses were carried out and quartiles and 95th percentiles were calculated for each group as reference ranges for serum PSA in screening for prostate cancer in Taiwanese men. Serum PSA concentration correlated with age (r = 0.274, p<0.001). The median serum PSA concentration (5th to 95th percentile) ranged from 0.7 ng/ml (0.3 to 1.8) for men 20-29 years old (n = 6,382) to 1.6 ng/ml (0.4 to 8.4) for men over 79 years old (n = 504). The age-specific PSA reference ranges are as follows: 20-29 years, 1.80 ng/ml; 30-39 years, 1.80 ng/ml; 40-49 years, 2.0 ng/ml; 50-59 years, 3.20 ng/ml; 60-69 years, 5.60 ng/ml; 70-79 years, 7.40 ng/ml; over 80 years, 8.40 ng/ml. Almost no change occurred in the median serum PSA value in men 50 years old or younger, while a gradual increase was observed in men over 50. Taiwanese men aged 60 years above showed higher 95th percentile serum PSA values compared to Caucasian men and men in other Asian countries but were closer to those of Asian American and African American men. Results indicate significantly different PSA levels correlating to different ethnicities, suggesting that Oesterling's age-specific PSA reference ranges might not be appropriate for Taiwanese men. Our results should be further studied to validate the age-specific PSA reference ranges for Taiwanese men presented in this study.

A highly selective molecularly imprinted electrochemical sensor with anti-interference based on GO/ZIF-67/AgNPs for the detection of p-cresol in a water environment.

p-Cresol is a harmful phenolic substance that can cause serious effects on human health even at a low concentration in water. Therefore, the detection of p-cresol in a water environment is particularly important. In this paper, a novel zeolite imidazolate framework-67 (ZIF-67) material with regular morphology was prepared on the surface of graphene oxide doped with silver nanoparticles. The composite was modified on the glassy carbon electrode surface to increase the specific surface area, accelerate the electron transfer rate, enhance the current response and improve the performance of electrochemical sensors. Furthermore, a layer of p-cresol-molecularly imprinted polymer was prepared on the surface of the modified electrode by electropolymerization for the selective, rapid and sensitive detection of p-cresol, which greatly improved the specific recognition of p-cresol. Under optimal conditions, the prepared sensor had a good linear range of 1.0 × 10-10 M to 1.0 × 10-5 M with a detection limit as low as 5.4 × 10-11 M, and it presented excellent reproducibility, stability and selectivity. Moreover, the sensor was successfully applied for the detection of trace p-cresol in a real water environment, providing a reliable assay for sensitive, rapid and selective detection of p-cresol in complex samples.

Molecularly imprinted electrochemical sensor based on 3D-flower-like MoS2 decorated with silver nanoparticles for highly selective detection of butylated hydroxyanisole.

This study introduces an innovative procedure for the development of a molecularly imprinted electrochemical sensor for ultra-sensitive and specific recognition of butylated hydroxyanisole (BHA). First, a uniquely flower-like molybdenum disulfide/Ag nanoparticle-chitosan (MoS2/Ag NPs-CS) composite was prepared and used as a matrix to modify the electrode surface. Then, a layer of BHA-molecularly imprinted polymer was grown on the surface of the modified electrode by electropolymerization, with BHA as template molecule, which improved the specific recognition of the modified electrode to BHA. The MoS2/Ag NPs-CS material could not only increase the specific surface area of the electrode, accelerate the electron transport rate and mass transfer, but also promote the recognition of the polymer, so as to increase the current response and improve the performance of the electrochemical sensor. The prepared electrochemical sensor showed a wide linear range for BHA in the range of 1 × 10-9-1 × 10-4 mol/L with a detection limit of 7.9 × 10-9 mol/L. The recovery of BHA in several foods was from 95% to 103%. The sensor had good reproducibility, stability and excellent selectivity, and was successfully used for the detection of BHA in foods, providing a reliable detection method for sensitive, rapid and selective detection of BHA in complex food samples.

Preparation of mesh covalent organic framework Tppa-2-based adsorption enhanced magnetic molecularly imprinted composite for selective extraction of tetracycline residues from animal-derived foods.

In this study, for the first time, core-shell tetracycline hydrochloride-molecularly imprinted polymers (MIPs) were prepared by precipitation polymerization using a magnetic covalent organic framework (Fe3O4@Tppa-2) synthesized by room-temperature ultrasonic method as a substrate. Introducing Fe3O4@Tppa-2 into the molecular imprinting system can be used for efficient shortens the time for the adsorption equilibrium of MIPs due to its unique pore structure. The maximum adsorption capacity of MIPs was 87.50 mg/g, and the adsorption equilibrium reached in 14 min. The MIPs were used as magnetic solid-phase extraction sorbents in combination with high performance liquid chromatography for the determination of tetracycline in pork, chicken and chicken liver, and the detection limit reached 0.01 ng/mL. In addition, the adsorption advantages of MIPs suggest that it is a promising adsorbent for the recovery of antibiotics and has potential applications in the detection and enrichment of TC in food.

Abdominal Ultrasound in the Detection of an Incidental Paraganglioma.

Paraganglioma is a tumor that originates from neuroendocrine cells of the sympathetic or parasympathetic systems. Patients may suffer from headaches, palpitations, diaphoresis, and hypertension due to catecholamine excess or symptoms from the mass effect of the tumor. In the absence of typical symptoms of catecholamine excess, the diagnosis of a nonfunctional paraganglioma is often delayed. Herein, we report a case of a 63-year-old female patient with a nonfunctional paraganglioma which is an accidental finding during investigation of a fever. Abdominal ultrasonography incidentally detected this lesion as a complex, solid, cystic mass in the left suprarenal retroperitoneum.

A molecularly imprinted polymer based on MOF and deep eutectic solvent for selective recognition and adsorption of bovine hemoglobin.

In this study, a novel kind of imprinted polymers based on metal-organic frameworks (MOF@DES-MIPs) was prepared, using bovine hemoglobin (BHb) as template molecules and deep eutectic solvents (DES) as functional monomers for selective recognition and adsorption of BHb. MOF were used as the substrates to improve the accessibility of imprinted sites and DES as the functional monomers to produce different forces for BHb to help the formation of imprinted sites. Imprinted polymer films were taken to provide analyte selectivity. The MOF@DES-MIPs prepared were characterized and evaluated by scanning electron microscope, X-ray diffraction, and Fourier transform infrared spectrometer. We also investigated the influences of BHb concentration and adsorption time on the performance of MOF@DES-MIPs. The maximal adsorption capacity of MOF@DES-MIPs to BHb reached 151.28 mg g-1, and the MOF@DES-MIPs showed good selectivity and fast adsorption equilibrium, which might offer a novel method for the preparation and research of molecularly imprinted polymers of biomacromolecules. In addition, MOF@DES-MIPs were successfully applied in the selective recognition of BHb from a real bovine blood sample. Graphical abstract.

Determination of chloropropanol with an imprinted electrochemical sensor based on multi-walled carbon nanotubes/metal-organic framework composites.

In this paper, a composite composed of carboxylated multi-wall carbon nanotubes (cMWCNT) incorporated in a metal-organic framework (MOF-199) has been synthesized using 1,3,5-benzoic acid as a ligand through a simple solvothermal method. The synthesized cMWCNT/MOF-199 composite was characterized by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FT-IR) and X-ray diffractometry (XRD). The cMWCNT/MOF-199 hybrids were modified on the surface of glassy carbon electrodes (GCE) to prepare a molecularly imprinted electrochemical sensor (MIECS) for specific recognition of 3-chloro-1,2-propanediol (3-MCPD). The electrodes were characterized by differential pulse voltammetry (DPV), electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV). Under optimal conditions, the electrochemical sensor exhibited an excellent sensitivity and high selectivity with a good linear response range from 1.0 × 10-9 to 1.0 × 10-5 mol L-1 and an estimated detection limit of 4.3 × 10-10 mol L-1. Furthermore, this method has been successfully applied to the detection of 3-MCPD in soy sauce, and the recovery ranged from 96% to 108%, with RSD lower than 5.5% (n = 3), showing great potential for the selective analysis of 3-MCPD in foodstuffs.

Alpha-1 blocker use increased risk of subsequent renal cell carcinoma: A nationwide population-based study in Taiwan.

Elevated Renal cell carcinoma (RCC) risk has been associated with the use of several antihypertensive medications but has not yet been elucidated in the populations prescribed alpha-1 blockers that are commonly used in the treatment of hypertension and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS-BPH). The aim of the present study was to investigate the association between alpha-1 blocker use and the risk of developing RCC using a nationwide population-based database in Taiwan. Patients who were treated with alpha-1 blockers for at least 28 days were identified through the Taiwan National Health Insurance Research Database from 2000 to 2010. The unexposed participants were matched with the exposed cases according to age, sex, and index year at a ratio of 3:1. Cox proportional hazards regression, stratified by sex and comorbidities and adjusted for age, was performed to estimate hazard ratios (HRs) for the risk of subsequent RCC. Among 2,232,092 subjects, patients who received alpha-1 blocker treatment had a higher risk of RCC than the unexposed group. Taking into account hypertension and BPH, the adjusted HR was significantly higher in male alpha-1 blocker users who had no BPH and either the presence (HR: 1.63, 95% confidence interval [CI] = 1.22-2.18) or absence (HR: 2.31, 95% CI = 1.40-3.81) of hypertension than in men not receiving these drugs. Taken together, male alpha-1 blocker users who had no comorbidity of BPH exhibited an increased risk for developing RCC independent of hypertension. Further study is warranted to elucidate the underlying mechanisms of this association.

Impacts of doctor-shopping behavior on diabetic patients' health: A retrospective longitudinal study in Taiwan.

The aim of this study was to clarify the relationship between doctor-shopping behavior and clinical conditions, and to clearly outline the effects of both the number of clinic visits and the number of doctor changes on patients' health conditions. Data from January 1, 2000 to December 31, 2004 was collected from the National Health Insurance Research Database in Taiwan. After randomly selecting one million people, we extracted 5-year longitudinal data, about the number of clinic visits, number of doctor changes, and changes in self-health status for each patient with diabetes over the age of 18. We developed a relationship among the variables by using the generalized estimating equation. The results revealed that the number of clinic visits on the change of health status is a U curve, suggesting that health condition could be optimal with an appropriate number of clinic visits. The effect of the number of doctor changes is linearly correlated with health deterioration. The results suggest that disease conditions can only be controlled with an adequate number of clinic visits. Excessively frequent clinic visits are not only unfavorable to patients' health status but are also wasteful of limited medical resources. For diabetic mellitus patients, the more they change doctors, the worse their health status. All of these results are important for patients to stay healthy and to save medical resources.

[Producing Coefficients and Emission Coefficients of Volatile Organic Compounds from the Automobile Manufacturing Industry in Zhejiang Province].

Four typical automobile manufacturing enterprises in Zhejiang Province were selected to determine the main production and emission links of volatile organic compounds (VOCs) in this industry by analyzing their production processes and the main raw and auxiliary materials used. Two of them were monitored on the spot, and the producing coefficients and emission coefficients of the VOCs discharged from the automobile manufacturing industry in Zhejiang Province were calculated. Then, the production and emission of VOCs in this industry in 2017 in Zhejiang Province were estimated. The results show that the main production and emission links of VOCs in the automobile manufacturing industry in Zhejiang Province are coating processes. Only a few of the automobile manufacturers in Zhejiang Province can deal with the paint exhaust gas effectively at present; in addition to coatings, solvent-based cleaning agents are also one of the main sources of VOCs in this industry. The VOC producing coefficients of the automobile manufacturing industry in Zhejiang Province are 0.20 t·t-1, 3.92 kg·vehicle-1, and 29.36 g·m-2; the emission coefficients are 0.13 t·t-1, 2.63 kg·vehicle-1, and 19.72 g·m-2. The quantity of VOCs generated by this industry in 2017 was 2425.84 t, while the quantity of emissions was 1627.54 t.

A study on the impact of poor medication adherence on health status and medical expense for diabetes mellitus patients in Taiwan: A longitudinal panel data analysis.

Medication adherence plays an important role in disease management, especially for diabetes. The aim of this study was to examine the impacts of demographic characteristics on medication nonadherence and the impacts of nonadherence on both health status and medical expenses for diabetic patients in Taiwan.A total of 1 million diabetes mellitus patients were randomly selected from the National Health Insurance Research Database between January 1, 2000 and December 31, 2004. All records with missing values and those for participants under 18 years of age were then deleted. Because many patients had multiple clinical visit records, all records within the same calendar year were summarized into 1 single record for each person. This pre-processing resulted in 14,602 total patients with a combined 73,010 records over the course of 5 years. Generalized estimating equation models were then constructed to investigate the effects of demographic characteristics on medication nonadherence and the effects of nonadherence on patient health status and medical expenses. The demographic characteristics examined for each patient include gender, age, residential area, and socioeconomic status.Our analysis of how demographic variables impacted nonadherence revealed that elderly patients exhibited better overall medication adherence, but that male patients exhibited poorer medication adherence than female patients. Next, our analysis of how nonadherence impacted health status revealed that patients who exhibited medication nonadherence had poorer health status than patients with proper medication adherence. Finally, our analysis of how nonadherence impacted medical expenses revealed that patients who exhibited medication nonadherence incurred more medical expenses than those who exhibited proper medication adherence.This study's empirical results corroborate the general relationships expressed in the current literature regarding medication nonadherence. However, this study's results were statistically more reliable and revealed the precise impact on health status in terms of the Charlson comorbidity index and increased annual medical expenses. This indicates the need to improve patient attitudes toward medication adherence, which can have substantial effects both medically and economically.