Tumor initiating cells(TICs)have been identified as cells that account for tumor heterogeneity.Recent studies demonstrated that genes controlling stem cell biology play key roles in maintaining TICs and promote their development into cancer.In this review,we summarize findings from human and animal studies that indicate the presence of TICs during liver cancer development.Markers identified for liver development and regeneration are used to identify liver cancer TICs.Expression of these markers is often upregulated in human hepatocellular carcinoma(HCC)specimen.Using flow cytometry analysis and lineage tracing approaches,the presence of TICs is confirmed.Expression of TIC markers and the pres-ence of TICs are also observed in genetically modified animals that target genes that are frequently altered in human HCC.The presence of these TICs represents a major challenge for therapeutic devel-opment.Elucidating signals that can regulate the fate,transformation and growth of liver TICs is an emerging need in liver research.Sex-determining region Y-box 9(SOX9)has recently become an important marker for liver TICs.Here,we summarize the role of SOX9 in TICs and its potential interaction with other signals.This includes the Notch-Numb signal that controls asymmetrical-symmetrical cell division,Wnt-β-catenin signal that maintains cell fate and transforming growth factor(TGF)-β signal that acts as upstream inducers.

Asia ; Asian Continental Ancestry Group ; Cooperative Behavior ; Early Detection of Cancer ; Humans ; International Cooperation ; Japan ; Korea ; Liver ; Lung Neoplasms ; Mass Screening ; Oceania ; Taiwan ; Thailand ; Thyroid Neoplasms

Transanal total mesorectal excision (TaTME) was introduced as a novel technique to deal with rectal cancers. Its transanal approach offered the shortest distance to approach a challenging location, allowing an excellent visualization of the distal resection margin. Since its introduction in 2010, a significant amount of research has been put in to measure its development. In this review, we look at its ancestry, the genesis for its introduction and continued evolution as well as some of the important outcomes in its journey thus far. The importance of a structured and proctored learning journey is also stressed to enable the safe application and development of this technique. Beyond this, the TaTME movement has progressed relentlessly and its utility has been expanded to the management of benign conditions such as inflammatory bowel disease, Hartman reversals, and anastomotic strictures. We believe that the continued development and adoption of TaTME worldwide is here to stay.

Objective: The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC). Methods: We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups. Results: Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend. Conclusion For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.

Objective: The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC). Methods: We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups. Results: Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend. Conclusion For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.

Objective: The Cancer Genome Atlas study revealed an association between copy-number high (p53 abnormal) genetic mutation and poor prognosis in endometrial cancer in 2013.This retrospective study investigated outcomes in patients with abnormal p53 expression and stage I, low-grade endometrial endometrioid carcinoma (EEC). Methods: We enrolled women with stage I, grade 1 or 2 EEC who received comprehensive staging and adjuvant therapy between January 2019 and December 2022 at MacKay Memorial Hospital, Taipei, Taiwan. Pathologists interpreted immunohistochemistry stains of cancerous tissues to detect p53 mutation. We compared recurrence, survival, progressionfree survival, and overall survival between p53 abnormal and p53 normal groups. Results: Of the 115 patients included, 26 had pathologically confirmed abnormal p53 expression. Of these 26 patients, five (19.2%) experienced recurrence, and two died due to disease progression. By contrast, no patients in the normal p53 group experienced disease recurrence or died due to disease progression. Significant intergroup differences were discovered in recurrent disease status (19.4% vs. 0%, p<0.001), mortality (7.7% vs.0%, p<0.001), and progression-free survival (p<0.001). The overall survival (p=0.055) also showed powerful worse trend. Conclusion For patients with stage I, low-grade EEC, abnormal p53 expression may be used as an indicator of poor prognosis. Therefore, we suggest considering aggressive adjuvant therapies for these patients.

Objective: The Penn Alcohol Craving Scale (PACS) is a five-item, single-dimension questionnaire that is used to measure a patient’s alcohol craving. We sought to develop the Chinese version of the PACS (PACS-C) and assess its reliability and validity. Methods: A total of 160 Taiwanese patients with alcohol use disorder were enrolled in this study. The internal consistency and concurrent validity of the PASC-C with the visual analogue scale (VAS) for craving, the Yale–Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), and the Severity of Alcohol Dependence Questionnaire (SADQ) were assessed. The test–retest reliability of the PASC-C was evaluated 1 day after the baseline measurements. Confirmatory factor analysis (CFA) was performed to examine the psychometric properties of the PACS-C. Results: The PACS-C exhibited good internal consistency (Cronbach’s α=0.95) and test–retest reliability (r=0.97). This scale showed high correlations with the VAS (r=0.81) and YBOCS-hd (r=0.81 and 0.79 for the obsession and compulsion subscales, respectively), and moderate correlation with the SADQ-C (r=0.47). Furthermore, CFA results revealed that the PACS-C had good fit indices under various models. Conclusion The PACS-C appears to be a reliable and valid tool for assessing alcohol craving in patients with alcohol use disorder in Taiwan.

Low bone mineral density (BMD) and osteoporosis are common in patients with schizophrenia and detrimental to illness prognosis and life quality. Although the pathogenesis is not fully clear, series of studies have revealed factors related to low BMD such as life style, psychotic symptoms, medication use and the activity of bone absorption markers. It has been known that antipsychotic-induced hyperprolactinemia plays a critical role on decreased BMD. However, it remains uncertain whether the risk factors differ between men and women. According to the effect on prolactin, antipsychotics can be classified into two groups: prolactin-sparing (PS) and prolactin-raising (PR). Our previous study has demonstrated that clozapine which is among the PS antipsychotics is beneficial for BMD when compared with PR antipsychotics in women with chronic schizophrenia. We have also found that risks factors associated with low BMD are different between men and women, suggesting that gender-specific risk factors should be considered for intervention of bone loss in patients with schizophrenia. This article reviews the effects of antipsychotics use on BMD with particular discussion for the differences on gender and age, which implicate the alterations of sex and other related hormones. In addition, currently reported protective and risk factors, as well as the effects of medication use on BMD including the combination of antipsychotics and other psychotropic agents and other potential medications are also reviewed.
Absorption ; Antipsychotic Agents* ; Bone Density* ; Clozapine ; Female ; Humans ; Hyperprolactinemia ; Life Style ; Male ; Osteoporosis ; Prognosis ; Prolactin ; Quality of Life ; Risk Factors ; Schizophrenia*

OBJECTIVES: The aims of this study were to compare the performance of machine learning methods for the prediction of the medical costs associated with spinal fusion in terms of profit or loss in Taiwan Diagnosis-Related Groups (Tw-DRGs) and to apply these methods to explore the important factors associated with the medical costs of spinal fusion. METHODS: A data set was obtained from a regional hospital in Taoyuan city in Taiwan, which contained data from 2010 to 2013 on patients of Tw-DRG49702 (posterior and other spinal fusion without complications or comorbidities). Naïve-Bayesian, support vector machines, logistic regression, C4.5 decision tree, and random forest methods were employed for prediction using WEKA 3.8.1. RESULTS: Five hundred thirty-two cases were categorized as belonging to the Tw-DRG49702 group. The mean medical cost was US $4,549.7, and the mean age of the patients was 62.4 years. The mean length of stay was 9.3 days. The length of stay was an important variable in terms of determining medical costs for patients undergoing spinal fusion. The random forest method had the best predictive performance in comparison to the other methods, achieving an accuracy of 84.30%, a sensitivity of 71.4%, a specificity of 92.2%, and an AUC of 0.904. CONCLUSIONS: Our study demonstrated that the random forest model can be employed to predict the medical costs of Tw-DRG49702, and could inform hospital strategy in terms of increasing the financial management efficiency of this operation.
Area Under Curve ; Costs and Cost Analysis ; Dataset ; Decision Trees ; Diagnosis-Related Groups ; Financial Management ; Forests ; Humans ; Length of Stay ; Logistic Models ; Machine Learning ; Methods ; Sensitivity and Specificity ; Spinal Fusion ; Support Vector Machine ; Taiwan

OBJECTIVE: to introduce the study method of Chinese Transanal Total Mesorectal Excision(TaTME) registry Collaborative(CTRC),and report the short-term clinical-oncological outcomes from CTRC. METHODS: Based upon the concept of real world evidence,Data of 601 cases were retrospectively and prospectively analyzed from a nationwide multi-center registry system of CTRC.The safety and effectiveness of these cases were evaluated. RESULTS: The results of the CTRC database showed that:(1) 68.7% of 601 patients were male,the average age of all patients was(59.5±11.4)years,the average BMI was 23.9±3.6. There were 558 cases of rectal cancer among the total enrolled cases. The average distance between the distal edge of rectal cancer and the anal verge was(48.1±14.8)mm,and the ratio of neoadjuvant therapy was 31.7%.(2) 24.6% of the surgical cases were completed under the supervision of TaTME experts. The mean volume of intraoperative blood loss was(115.2 ± 366.5)mL,and the mean operating time was(247.1±87.5)min. Circle stapler was used to make the anastomosis among 74.8% of rectal cancer cases. The protective stoma was performed among 49.6% of the cases of rectal cancer. Maintaining a stable pneumopelvis and excessive smoke obscuring the pelvic view,were the main intraoperative difficulties encountered during transanal procedure. According to the grading of quality and completeness of the mesorectum in the total mesorectal excision specimen,the incidence rates of TaTME specimen graded as "complete", "nearly complete" and "incomplete" were79.6%,16.8% and 0.2% respectively by the evaluation of surgeons.(3)The incidence of postoperative complications was20.2%,and the anastomotic leakage rate was 7.0%.(4) There were 8 cases of specimen perforation. The average number of lymph node harvest was 15.4±7.9. CONCLUSION: TaTME procedure seems be safe and effective regarding to the shortterm clinical-pathological outcomes. The completeness of distal mesorectal dissection,circumferential resection margin and distal resection margin can be promised by the procedure of TaTME. However,the data quality in the database of CTRC needs to be improved,and structured training for TaTME surgery is indispensable. Further national multicenter prospective clinical trials are needed to evaluate the efficacy of TaTME versus TME.