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We report a rare case of low-grade appendiceal mucinous neoplasm (LAMN) causing ileocolic intussusception. The case underscores the importance of considering ileocolic intussusception in differential diagnoses for nonspecific gastrointestinal symptoms. Early diagnosis via contrast-enhanced CT and scrupulous surgical intervention are crucial for favorable outcomes.

The aim of this study was to evaluate the effect of laparoscopy on patients with blunt hollow viscus and mesenteric injuries (BHVMIs). Hemodynamically stable patients with BHVMIs were diagnosed using computed tomography and serial examinations. Patients admitted from July 1, 1999 to June 30, 2006 underwent exploratory laparotomy (group A), and those admitted from January 1, 2007 to December 31, 2013 received laparoscopy (group B). There were 62 patients in group A, and 59 patients in group B. There were no significant differences in demographic characteristics, injury severity score, and injuries requiring surgical intervention between the groups (all, P > .05). Patients in group B had a shorter hospital stay (mean 11.0 vs 17.6 days, P < .001) and lower wound infection rate (mean 5.1% vs 16.1%, P = .049). The conversion rate of laparoscopy to laparotomy in group B was 8.5%, compared with a 100% laparotomy rate in group A (P < .001). There was no difference in the complication rate between groups. Laparoscopy is feasible and safe for hemodynamically stable patients with BHVMIs.

BackgroundIn this retrospective cohort study, we assessed the utility of laparoscopic surgery for diagnostic and therapeutic purposes in patients with anterior abdominal stab wounds (AASWs). We also investigated patient characteristics that might suggest a greater suitability of laparoscopic interventions.MethodsOver a 25-year span, we analyzed AASW patients who had operations, categorizing them based on the presence of significant intra-abdominal injuries and whether they received laparoscopic surgery or laparotomy. We compared variables such as preoperative conditions, surgical details, and postoperative outcomes. We further evaluated the criteria indicating the necessity of direct laparotomies and traits linked to overlooked injuries in laparoscopic surgeries.ResultsOf 142 AASWs surgical patients, laparoscopic surgery was conducted on 89 (62.7%) patients. Only 2 (2.2%) had overlooked injuries after the procedure. Among patients without significant injuries, those receiving laparoscopic surgery had less blood loss than those receiving laparotomy (30.0 vs. 150.0 ml, p = 0.004). Patients who underwent laparoscopic surgery also had shorter hospital stays (significant injuries: 6.0 vs. 11.0 days, p < 0.001; no significant injuries: 5.0 vs. 6.5 days, p = 0.014). Surgical complications and overlooked injury rates were comparable between both surgical methods. Bowel evisceration correlated with higher laparotomy odds (odds ratio = 16.224, p < 0.001), while omental evisceration did not (p = 0.107).ConclusionsLaparoscopy is a safe and effective method for patients with AASWs, fulfilling both diagnostic and therapeutic needs. For stable AASW patients, laparoscopy could be the preferred method, reducing superfluous nontherapeutic laparotomies.

Trauma team activation (TTA) is widely recognized to improve outcomes in trauma care; however, few studies have examined its long-term maturation and the effects of protocolized implementation. This study aimed to evaluate the impact of a comprehensive trauma team protocol introduced in 2012 in a single institution and to identify factors associated with patient outcomes. We conducted a retrospective cohort study of trauma patients who underwent TTA between 2006 and 2023 at a single medical center in Taiwan. The generalized protocol was implemented in 2012 for trauma patients who fulfilled the TTA criteria. Patients <18 years old, who were dead or had unknown vital signs on arrival at the emergency department (ED) or had been transferred from other institutions were excluded. The primary outcomes were the patient clinical outcomes; the time intervals to critical decision-making points after TTA were evaluated as secondary outcomes. Logistic regression was performed to identify independent risk factors. The study included 3002 patients. Compared with patients in the pre-protocolized stage (n = 518), patients in the protocolized stage (n = 2484) had a higher survival rate (90.5% vs. 79.7%, p < 0.001), lower morbidity (0.8% vs. 10.6%, p < 0.001), a higher success rate of nonoperative management (NOM) (39.0% vs. 27.2%, p < 0.001), and shorter ED-to-computed tomography (CT) times (39.0 vs. 52.6 min, p = 0.001). Multivariate analysis identified age, Trauma Score and Injury Severity Score (TRISS), Glasgow Coma Scale (GCS) score, and treatment stage as independent predictors of survival. In addition, timely ED-to-CT (≤60 min) was more frequent in the protocolized stage. Implementing a protocolized TTA system is feasible and can enhance the quality of trauma care, both in processes and outcomes. The treatment stage itself, independent of patient condition, serves as a determinant of clinical results. Tertiary trauma centers should consider adopting a standardized TTA protocol to improve patient outcomes. •Protocolized trauma care was associated with improved patient outcomes and better efficiency in terms of shorter emergency department -to-computed tomography times,

This study investigated the hydraulic properties of the heterogeneous aquifers of an artificial island (Yunlin Offshore Industrial Park) in Taiwan. The research was based on the groundwater level response affected by tidal fluctuation using the hydraulic tomography (HT) to analyze the hydraulic diffusivity (α). Specifically, the power spectrum ratio of groundwater and tidal fluctuations derived from the Gelhar solution was used to estimate α in homogeneous aquifers; this, however, could not be applied in the artificial island. Next, the spatial distribution of the groundwater level response affected by tidal fluctuation was analyzed and found to be irregular, proving the existence of hydrogeological heterogeneity in the artificial island. Furthermore, the results of the estimated α using the HT showed low error and high correlation, 0.41 m2/hr and 0.83, respectively, between the optimal estimated heterogeneous and reference α fields in the synthetic aquifer. Last, the HT was used in the real tested scenario. By comparing the predicted groundwater levels of the optimal estimated heterogeneous α field and the observed groundwater levels of the real aquifer, it was found that the correlation was higher than 0.99. Therefore, the HT can be used to obtain the optimal estimated heterogeneous α field in the artificial island.

Intracranial germinoma (IG) rarely occurs in adults. Its optimal treatment strategy is unclear. We evaluated the outcomes of radiotherapy in adults with intracranial germinoma. Data of 29 adult patients (age, 18–52 years; median age, 24.3 years) with IG treated with radiotherapy at Taipei Veterans General Hospital were retrospectively reviewed. They were followed up for a median time of 5.9 years (range, 1.0–12.8 years). We used the Kaplan–Meier method to estimate the progression-free survival (PFS) and overall survival (OS), and univariate and multivariate Cox proportional hazards regression models to identify the factors affecting PFS. PFS and OS were compared between adult and pediatric patients with IG. The 1-, 3-, and 5-year PFS rates were 96.6%, 85.8%, and 77.8%, respectively, in the adult patients, and the OS rate were all 100%. Seven patients (24.1%) experienced recurrence, and in six of them, salvage therapy successfully controlled the disease. Two patients (6.9%) died after 5 years of follow-up due to disease progression and central pontine myelinolysis. In the univariate and multivariate Cox analysis, bifocal lesions had a significantly lower PFS than those with single lesions ( p = 0.008). Kaplan–Meier survival analysis showed that adult patients had a poorer PFS ( p = 0.06) and OS ( p = 0.025) than pediatric patients. Our study showed bifocal lesions were associated with lower PFS than a single lesion among adult IG patients, and adult IG patients tended to have poorer PFS and OS compared to pediatric IG patients. For adult patients with bifocal IG, we recommend treatment with craniospinal irradiation, whole ventricle irradiation (WVI) with chemotherapy, or frequent spine images follow-up for patients who received only WVI.

PurposeBecause of an increase in consumer awareness and the ease of information dissemination on the Internet, brands have increasingly become the target of online criticism. Several factors affect consumers’ reactions to public criticism against brands that they support. The present study investigated the interactive effects of psychological ownership, agency–communion orientation, and internal attribution on self-threat in the context of such criticism.Design/methodology/approachThree studies were conducted to test several research hypotheses. The psychological ownership, agency–communion orientation, and internal attribution of the participants in this study were manipulated using an experimental scenario. Subsequently, they completed a questionnaire with items used to assess purchase intention, self-threat, and demographic variables and for performing manipulation checks.FindingsWhen a brand is criticized, (1) consumers with high psychological ownership of the brand are likely to buy more of that brand’s products, (2) communion-oriented consumers with high psychological ownership of the brand experience greater self-threat relative to those with low psychological ownership, and (3) agency-oriented consumers experience a consistent level of self-threat regardless of their level of psychological ownership.Research limitations/implicationsBrands should endeavor to enhance consumers’ psychological ownership of the brand to increase their support in times of crisis.Originality/valueThis study investigated how psychological ownership of a brand among consumers affected their reactions when a brand was criticized. The effect of self-threat as a mediating mechanism was also considered. Furthermore, agency and communion orientation were proposed as crucial moderators that should be considered in research on consumer–brand relationships.

Nab‐paclitaxel (Abraxane), which is a nanoparticle form of albumin‐bound paclitaxel, is one of the standard chemotherapies for pancreatic ductal adenocarcinoma (PDAC). This study determined the effect of Abraxane in combination with a fusion protein, hIL15‐ABD, on subcutaneous Panc02 and orthotopic KPC C57BL/6 murine PDAC models. Abraxane combined with hIL15‐ABD best suppressed tumour growth and produced a 40%–60% reduction in the tumour size for Panc02 and KPC, compared to the vehicle group. In the combination group, the active form of interferon‐γ (IFN‐γ)‐secreting CD8+ T cells and CD11b+CD86+ M1 macrophages in tumour infiltrating lymphocytes (TILs) were increased. In the tumour drainage lymph nodes (TDLNs) of the combination group, there was a 18% reduction in CD8+IFN‐γ+ T cells and a 0.47% reduction in CD4+CD25+FOXP3+ regulatory T cells, as opposed to 5.0% and 5.1% reductions, respectively, for the control group. Superior suppression of CD11b+GR‐1+ myeloid‐derived suppressor cells (MDSCs) and the induction of M1 macrophages in the spleen and bone marrow of mice were found in the combination group. Abraxane and hIL15‐ABD effectively suppressed NF‐κB‐mediated immune suppressive markers, including indoleamine 2,3‐dioxygenase (IDO), Foxp3 and VEGF. In conclusion, Abraxane combined with hIL15‐ABD stimulates the anticancer activity of effector cells, inhibits immunosuppressive cells within the tumour microenvironment (TME) of PDAC, and produces a greater inhibitory effect than individual monotherapies.

Background Limited literature exists on the feasibility and effectiveness of integrating stereotactic ablative radiotherapy (SABR) techniques with hyperfractionated regimens for patients with lung cancer. This study aims to assess whether the SABR technique with hyperfractionation can potentially reduce lung toxicity. Methods We utilized the linear‐quadratic model to find the optimal fraction to maximize the tumor biological equivalent dose (BED) to normal‐tissue BED ratio. Validation was performed by comparing the SABR plans with 50 Gy/5 fractions and hyperfractionationed plans with 88.8 Gy/74 fractions with the same tumor BED and planning criteria for 10 patients with early‐stage lung cancer. Mean lung BED, Lyman–Kutcher–Burman (LKB) normal tissue complication probability (NTCP), critical volume (CV) criteria (volume below BED of 22.92 and 25.65 Gy, and mean BED for lowest 1000 and 1500 cc) and the percentage of the lung receiving 20Gy or more (V20) were compared using the Wilcoxon signed‐rank test. Results The transition point occurs when the tumor‐to‐normal tissue ratio (TNR) of the physical dose equals the TNR of α/β in the BED dose‐volume histogram of the lung. Compared with the hypofractionated regimen, the hyperfractionated regimen is superior in the dose range above but inferior below the transition point. The hyperfractionated regimen showed a lower mean lung BED (6.40 Gy vs. 7.73 Gy) and NTCP (3.50% vs. 4.21%), with inferior results concerning CV criteria and higher V20 (7.37% vs. 7.03%) in comparison with the hypofractionated regimen (p < 0.01 for all). Conclusions The hyperfractionated regimen has an advantage in the high‐dose region of the lung but a disadvantage in the low‐dose region. Further research is needed to determine the superiority between hypo‐ and hyperfractionation. A simple formula to determine the transition point was found. The hypofractionated regimen is superior below this point but inferior above it compared with the hyperfractionated regimen using SABR techniques. In addition, the hyperfractionated regimens appear to be superior to the hypofractionated regimen when comparing LKB model‐estimated NTCP with mean lung BED. Conversely, hypofractionated regimens seem to be better when focusing on critical volume or V20.

(1) Background: Lung cancer is silent in its early stages and fatal in its advanced stages. The current examinations for lung cancer are usually based on imaging. Conventional chest X-rays lack accuracy, and chest computed tomography (CT) is associated with radiation exposure and cost, limiting screening effectiveness. Breathomics, a noninvasive strategy, has recently been studied extensively. Volatile organic compounds (VOCs) derived from human breath can reflect metabolic changes caused by diseases and possibly serve as biomarkers of lung cancer. (2) Methods: The selected ion flow tube mass spectrometry (SIFT-MS) technique was used to quantitatively analyze 116 VOCs in breath samples from 148 patients with histologically confirmed lung cancers and 168 healthy volunteers. We used eXtreme Gradient Boosting (XGBoost), a machine learning method, to build a model for predicting lung cancer occurrence based on quantitative VOC measurements. (3) Results: The proposed prediction model achieved better performance than other previous approaches, with an accuracy, sensitivity, specificity, and area under the curve (AUC) of 0.89, 0.82, 0.94, and 0.95, respectively. When we further adjusted the confounding effect of environmental VOCs on the relationship between participants’ exhaled VOCs and lung cancer occurrence, our model was improved to reach 0.92 accuracy, 0.96 sensitivity, 0.88 specificity, and 0.98 AUC. (4) Conclusion: A quantitative VOCs databank integrated with the application of an XGBoost classifier provides a persuasive platform for lung cancer prediction.