Spontaneous intracranial hypotension (SIH) is caused by single or multiple cerebrospinal fluid (CSF) leaks in the spine with the prototypical symptom of postural headache. One of the characteristic MRI features in SIH is intracranial venous engorgement. This report presents a case of SIH with engorgement of the bilateral superior ophthalmic veins (SOVs) which resume their normal diameters by the third day of successful epidural blood patches (EBPs). We define this phenomenon as the "reversal of the SOV" sign.
Aged ; *Blood Patch, Epidural ; Cerebrospinal Fluid Rhinorrhea/*complications ; Diagnosis, Differential ; Humans ; Intracranial Hypotension/*diagnosis/etiology/*therapy ; *Magnetic Resonance Imaging ; Male ; Orbit/*blood supply

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: To investigate whether the diffusion tensor imaging-derived metrics are capable of differentiating the ischemic penumbra (IP) from the infarct core (IC), and determining stroke onset within the first 4.5 hours. MATERIALS AND METHODS: All procedures were approved by the local animal care committee. Eight of the eleven rats having permanent middle cerebral artery occlusion were included for analyses. Using a 7 tesla magnetic resonance system, the relative cerebral blood flow and apparent diffusion coefficient maps were generated to define IP and IC, half hour after surgery and then every hour, up to 6.5 hours. Relative fractional anisotropy, pure anisotropy (rq) and diffusion magnitude (rL) maps were obtained. One-way analysis of variance, receiver operating characteristic curve and nonlinear regression analyses were performed. RESULTS: The evolutions of tensor metrics were different in ischemic regions (IC and IP) and topographic subtypes (cortical, subcortical gray matter, and white matter). The rL had a significant drop of 40% at 0.5 hour, and remained stagnant up to 6.5 hours. Significant differences (p < 0.05) in rL values were found between IP, IC, and normal tissue for all topographic subtypes. Optimal rL threshold in discriminating IP from IC was about -29%. The evolution of rq showed an exponential decrease in cortical IC, from -26.9% to -47.6%; an rq reduction smaller than 44.6% can be used to predict an acute stroke onset in less than 4.5 hours. CONCLUSION: Diffusion tensor metrics may potentially help discriminate IP from IC and determine the acute stroke age within the therapeutic time window.
Animal Care Committees ; Animals ; Anisotropy ; Cerebrovascular Circulation ; Diffusion Tensor Imaging ; Diffusion* ; Gray Matter ; Infarction, Middle Cerebral Artery ; Models, Animal* ; Rats* ; ROC Curve ; Stroke

Background: The turnover rate of nurse aides in Taiwan is high. However, the predictors of turnover behavior in the newly employed are still unclear. Objective: To examine the predictors of turnover behavior in newly employed licensed nurse aides. Methods: A longitudinal study design was used and subjects were newly employed certified nurse aides from a nurse aid training association in Taiwan. A total of five questionnaire surveys were conducted. The questionnaire was mainly used to collect information on turnover behavior, personal socioeconomic background, workplace psychosocial hazards, worker health hazards, and musculoskeletal disorders. Results: A total of 300 participants were recruited in the study. Cox regression analysis results showed that short working experience (hazard ratio [HR] = 0.21, p < 0.01), work as non-home nurse aides (HR = 0.58, p = 0.01), low monthly salary (HR = 0.68, p < 0.01), high work mental load (HR = 1.01, p = 0.01), low workplace justice (HR = 0.97, p < 0.01), high workplace violence (HR = 1.60, p < 0.01), high burnout (HR = 1.01, p = 0.04), poor mental health (HR = 1.06, p = 0.04), and high total number of musculoskeletal disorder sites (HR = 1.08, p = 0.01) contribute to a higher risk of turnover. Conclusion The results indicated that employment period, work as a home nurse aide, monthly salary, work mental load, workplace justice, workplace violence, work-related burnout, mental health, and total number of musculoskeletal disorder sites are predictors of turnover behavior in newly employed certified nurse aides.

OBJECTIVE: The aim of this study was to investigate diffusion tensor (DT) imaging-derived properties of benign oligemia, true “at risk” penumbra (TP), and the infarct core (IC) during the first 3 hours of stroke onset. MATERIALS AND METHODS: The study was approved by the local animal care and use committee. DT imaging data were obtained from 14 rats after permanent middle cerebral artery occlusion (pMCAO) using a 7T magnetic resonance scanner (Bruker) in room air. Relative cerebral blood flow and apparent diffusion coefficient (ADC) maps were generated to define oligemia, TP, IC, and normal tissue (NT) every 30 minutes up to 3 hours. Relative fractional anisotropy (rFA), pure anisotropy (rq), diffusion magnitude (rL), ADC (rADC), axial diffusivity (rAD), and radial diffusivity (rRD) values were derived by comparison with the contralateral normal brain. RESULTS: The mean volume of oligemia was 24.7 ± 14.1 mm³, that of TP was 81.3 ± 62.6 mm³, and that of IC was 123.0 ± 85.2 mm³ at 30 minutes after pMCAO. rFA showed an initial paradoxical 10% increase in IC and TP, and declined afterward. The rq, rL, rADC, rAD, and rRD showed an initial discrepant decrease in IC (from −24% to −36%) as compared with TP (from −7% to −13%). Significant differences (p < 0.05) in metrics, except rFA, were found between tissue subtypes in the first 2.5 hours. The rq demonstrated the best overall performance in discriminating TP from IC (accuracy = 92.6%, area under curve = 0.93) and the optimal cutoff value was −33.90%. The metric values for oligemia and NT remained similar at all time points. CONCLUSION: Benign oligemia is small and remains microstructurally normal under pMCAO. TP and IC show a distinct evolution of DT-derived properties within the first 3 hours of stroke onset, and are thus potentially useful in predicting the fate of ischemic brain.
Animals ; Anisotropy ; Area Under Curve ; Brain ; Cerebrovascular Circulation ; Diffusion Tensor Imaging ; Diffusion* ; Infarction, Middle Cerebral Artery ; Models, Animal* ; Rats* ; Stroke*

After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure-like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later.
Aged ; Amebiasis/*diagnosis/parasitology/*pathology ; Central Nervous System Protozoal Infections/*diagnosis/parasitology/*pathology ; Cerebrospinal Fluid/parasitology ; DNA, Protozoan/chemistry/genetics ; Fatal Outcome ; Humans ; Male ; Microscopy ; Naegleria fowleri/classification/genetics/*isolation & purification ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Taiwan

OBJECTIVE: Logistic regression analysis (LRA), Support Vector Machine (SVM) and a neural network (NN) are commonly used statistical models in computer-aided diagnostic (CAD) systems for breast ultrasonography (US). The aim of this study was to clarify the diagnostic ability of the use of these statistical models for future applications of CAD systems, such as three-dimensional (3D) power Doppler imaging, vascularity evaluation and the differentiation of a solid mass. MATERIALS AND METHODS: A database that contained 3D power Doppler imaging pairs of non-harmonic and tissue harmonic images for 97 benign and 86 malignant solid tumors was utilized. The virtual organ computer-aided analysis-imaging program was used to analyze the stored volumes of the 183 solid breast tumors. LRA, an SVM and NN were employed in comparative analyses for the characterization of benign and malignant solid breast masses from the database. RESULTS: The values of area under receiver operating characteristic (ROC) curve, referred to as Az values for the use of non-harmonic 3D power Doppler US with LRA, SVM and NN were 0.9341, 0.9185 and 0.9086, respectively. The Az values for the use of harmonic 3D power Doppler US with LRA, SVM and NN were 0.9286, 0.8979 and 0.9009, respectively. The Az values of six ROC curves for the use of LRA, SVM and NN for non-harmonic or harmonic 3D power Doppler imaging were similar. CONCLUSION: The diagnostic performances of these three models (LRA, SVM and NN) are not different as demonstrated by ROC curve analysis. Depending on user emphasis for the use of ROC curve findings, the use of LRA appears to provide better sensitivity as compared to the other statistical models.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; *Artificial Intelligence ; Breast Neoplasms/*ultrasonography ; Diagnosis, Computer-Assisted ; Diagnosis, Differential ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Imaging, Three-Dimensional/*statistics & numerical data ; Logistic Models ; Middle Aged ; *Neural Networks (Computer) ; Predictive Value of Tests ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography, Doppler/*statistics & numerical data ; Ultrasonography, Mammary/*statistics & numerical data

Purpose: Plasmablastic lymphoma (PBL) is a rare, aggressive lymphoma that is characterized by terminal B-cell differ‑ entiation. In the West, PBL usually occurs in patients with immunodeficiencies, particularly those induced by human immunodeficiency virus (HIV) infection. We investigated the clinicopathological features of PBL at a single institute in Taiwan, where HIV infection is rare. Methods: This retrospective chart review identified PBL cases that were treated at a single institute in southern Tai‑ wan between 2008 and 2024. Results: We identified nine patients (four males and five females; median age 71 years). Of the eight patients tested for HIV, only one tested positive. Pathologically, the tumors showed plasmablastic morphology and immunopheno‑ type, and three (33%) cases tested positive for Epstein–Barr virus. Six (67%) patients presented with Stage IV disease, including five (56%) with malignant effusion. Six patients were treated with chemotherapy and the remaining three received only supportive care. During a median follow-up of 10 months, five patients died of progressive disease, two died of unrelated diseases, and two were alive with PBL relapse. Conclusion In Taiwan, PBL constitutes a rare and aggressive clinical condition and is frequently associated with malignant effusion. In contrast to Western patients, the PBL in most patients from Taiwan was unrelated to HIV infection.