Primary Urothelial Carcinoma of the Ureter: 11-Year Experience in Taipei Veterans General Hospital

BackgroundUrothelial carcinoma of the upper urinary tract is relatively rare, occurring in 5% of all urothelial tumors. Ureteral urothelial carcinoma is even less common than that of the renal pelvis, accounting for about 25% of all upper urinary tract tumors. The aim of this study was to evaluate the clinical behavior, survival, recurrence and prognostic information of primary ureteral urothelial carcinoma from our 11 years of experience at the Taipei Veterans General Hospital.MethodsWe retrospectively reviewed 111 patients with ureteral urothelial carcinoma who had been treated in our hospital between January 1993 and December 2003. Tumor staging was according to the 2002 AJCC TNM classification and stage groupings. Patients with stage 0a and stage 0is were categorized as stage 0a/is, and patients with pathologic T stage pTa and pTis were categorized as pTa/is for statistical analysis. The Kaplan-Meier method was used for survival analysis.ResultsThere were 69 males and 42 females, with a mean age of 70.5 ± 9.4 years at diagnosis. Of the 111 patients, 5 presented with stage 0a/is, 38 with stage I, 23 with stage II, 21 with stage III, and 24 with stage IV. Nephroureterectomy with bladder cuff excision was performed in 78 patients, 12 patients received segmental resection of the ureter, 4 received ureteroscopic laser coagulation, and 17 underwent chemotherapy or radiotherapy or both. Tumors were located on the left side in 53 patients, on the right in 53, and bilaterally in 5. The most frequent initial presenting symptom was gross hematuria (65%). The mean postoperative follow-up period was 49.3 months. Disease recurrence in the nephroureterectomy group occurred in 36 patients (46.2%), with 17 (21.8%) at the urinary bladder, 2 (2.6%) at the retroperitoneum, 1 (1.3%) at the contralateral ureter, 6 (7.7%) with distant metastases to the lung, bone, distant lymph nodes or liver, and 10 (12.8%) at multiple sites. The 5-year cancer-specific survival rate was 100% for pTa/is, 95.2% for pT1, 69.4% for pT2, and 43.8% for pT3. All 3 pT4 cases died of cancer in a median of 12 months. Significant prognostic factors for cancer-specific survival by univariate analysis were pT (p = 0.00001), stage (p = 0.00001), type of treatment (p = 0.00001) and grade (p = 0.0001). On multivariate analysis, only stage (p = 0.0001) and grade (p = 0.014) were significant for cancer-specific and overall survival. Stage (p = 0.0001), pT (p =0.0001) and grade (p = 0.026) were also significant prognostic factors of recurrence in multivariate analysis.ConclusionOur experience showed that patients with pTa/is and pT1 tumors treated with radical surgery have excellent prognoses. Tumor stage and grade are the only significant prognostic factors for both cancer-specific and overall survival

Earthquake Doublet Sequences: Evidence of Static Triggering in the Strong Convergent Zones of Taiwan

Three earthquake sequences, each with two main earthquakes of almost the same magnitudes (ML from 5.9 to 7.0 with differences less than 0.1), have recently been observed in Taiwan. The two largest earthquakes in each sequence occurred with a short delay time between them, were strikingly similar in terms of magnitude, location and/or focal mechanism and are referred to as doublets. They were markedly distinct from typical single mainshock sequences. Our estimated static stress field generated by the first shock in the doublet shows that the second shock and most of their aftershocks were located within a region where static stress increased substantially. Thus, a possible explanation for earthquake doublet is that seismic energy for each shock had accumulated independently within adjacent crustal volumes, separated by an asperity, and that the second shock is triggered by the increased static stress after the first one. An important implication of doublet sequence is that works by emergency response teams after the first earthquake could be made more hazardous by the second

Patient-controlled epidural Levobupicvacaine with or without Fentanyl for post-cesarean section pain relief

Purpose. The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study. Methods. We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion. Results. There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups. Conclusion. Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients

Does Air Pollution Cause the Retail Investor's Disposition Effect in Taiwan Mutual Fund Markets?

Disposition effect is a biased behavior of investor, which sells winners too early and rides losers too long. Retail investors may have a disposition effect compared to professional investor because retail investors may lack of expertise or their psychology are affected easily by external factors, such as weather, temperature, mood, etc. Recently, Taiwan suffers from air pollution problem. Does air pollution cause the retail investor's disposition effect? By using multiple regression analysis, this article investigates the relationship between air pollution and retail investor's disposition effect in Taiwan mutual fund market. We divide the market conditions into three states, bull, bear, and neutral. Empirical results revealed that although there is no significant correlation between air pollution and the disposition effect in the overall Taiwan mutual fund market, but the retailer investor's behavior is more conservative as the degree of air pollution increases under the bull and bear markets. Keywords: Mutual Fund, Disposition Effect, Air Pollution, Multiple Regression Analysis JEL Classifications: E22, G40, Q53 DOI: https://doi.org/10.32479/ijeep.729

Finding a Fair Land Dispute Settlement Mechanism Between Adat Law Community Vs. Investor

Land utilization for investment in local areas raises various land related problems that ends with conflicts within the community. A conflict that occurs, usually begins with the management of communal land “tanah ulayat” within the adat law community environment, and in this case, land utilization that is managed by the third party (investors). The basic problem is the difference of perception and expectations toward the company that exists in the land which is claimed by the community. Both parties have their own claim on the land based on each legal systems, in this situation adat law or local law faced with state law which is used by investors. So far, the Indonesian government has yet to have legal grounds in giving a directions for land dispute/conflict settlement mechanism. This paper attempts to give an input regarding a land dispute settlement mechanism that can be accepted for all disputing parties. The paper features critical analysis using legal pluralism approach towards related government policies and technical regulations in the ministerial level. These regulations, among others are, Minister of Agrarian Regulation No. 5 of 1999 on the Guidance for Dispute Settlement of Communal Land Rights, and Ministry of Agrarian and Spatial Affairs Regulation No. 9 of 2015 on Procedures of Appointment of Communal Land Rights for Adat Law Community and Communities Located in certain regions, also the draft of Law regarding Recognition and Protection of Adat Law Community

Low Cost Seismic Network Practical Applications for Producing Quick Shaking Maps in Taiwan

Two major earthquakes of ML greater than 6.0 occurred in Taiwan in the first half of 2013. The vibrant shaking brought landslides, falling rocks and casualties. This paper presents a seismic network developed by National Taiwan University (NTU) with 401 Micro-Electro Mechanical System (MEMS) accelerators. The network recorded high quality strong motion signals from the two events and produced delicate shaking maps within one minute after the earthquake occurrence. The high shaking regions of the intensity map produced by the NTU system suggest damage and casualty locations. Equipped with a dense array of MEMS accelerometers, the NTU system is able to accommodate 10% signals loss from part of the seismic stations and maintain its normal functions for producing shaking maps. The system also has the potential to identify the rupture direction which is one of the key indices used to estimate possible damage. The low cost MEMS accelerator array shows its potential in real-time earthquake shaking map generation and damage avoidance

The 2005 Ilan earthquake doublet and seismic crisis in northeastern Taiwan: evidence for dyke intrusion associated with on-land propagation of the Okinawa Trough

Northern Taiwan underwent mountain building in the early stage of the Taiwan orogeny but is currently subjected to post-collisional crustal extension. It may be related to gravitational collapse or to the rifting of the Okinawa Trough, which lies offshore northeastern Taiwan. The Ilan Plain, northeastern Taiwan, which is bounded by the normal fault systems and filled up with thick Pliocene–Pleistocene sedimentary sequences, formed under such an extension environment. Over there on 2005 March 5 two earthquakes with about the same magnitude (M_L = 5.9) occurred within 68 s and produced intense aftershocks activity according to the records of Central Weather Bureau Seismic Network of Taiwan. We relocated the earthquake sequence by the three-dimension earthquake location algorithm with the newly published 3-D Vp and Vp/Vs velocity model, and determined the first-polarity focal mechanisms of the earthquake doublet. One major cluster of aftershocks which trends E–W and dips steeply to the south can be identified and picked up as a potential fault plane. The focal mechanisms of the two main shocks are both classified as normal type by first-polarity but strike-slip by centroid moment tensor inversion; however two methods both yield consistent E–W strike. Static coseismic deformation was additionally determined from Global Positioning System (GPS) daily solutions at a set of continuous GPS stations and from strong-motion seismographs. These data show NW–SE extension at high angle to the fault plane, which cannot be explained from a simple strike-slip double-couple mechanism. On the other hand, the small vertical displacements and steep fault plane cannot be explained from a simple normal event as well. We present from elastic dislocation modelling that the geodetic data are best explained by significant component of tensile source with centimetre-scale of opening on a 15-km-long fault extending from 1 to 13 km depth. We therefore interpret the crisis as the result of dyke intrusion at the very tip of the Okinawa Trough, which is reasonably driven by backarc spreading

Multi-scale symbolic entropy analysis provides prognostic prediction in patients receiving extracorporeal life support

Introduction: Extracorporeal life support (ECLS) can temporarily support cardiopulmonary function, and is occasionally used in resuscitation. Multi-scale entropy (MSE) derived from heart rate variability (HRV) is a powerful tool in outcome prediction of patients with cardiovascular diseases. Multi-scale symbolic entropy analysis (MSsE), a new method derived from MSE, mitigates the effect of arrhythmia on analysis. The objective is to evaluate the prognostic value of MSsE in patients receiving ECLS. The primary outcome is death or urgent transplantation during the index admission. Methods: Fifty-seven patients receiving ECLS less than 24 hours and 23 control subjects were enrolled. Digital 24-hour Holter electrocardiograms were recorded and three MSsE parameters (slope 5, Area 6–20, Area 6–40) associated with the multiscale correlation and complexity of heart beat fluctuation were calculated. Results: Patients receiving ECLS had significantly lower value of slope 5, area 6 to 20, and area 6 to 40 than control subjects. During the follow-up period, 29 patients met primary outcome. Age, slope 5, Area 6 to 20, Area 6 to 40, acute physiology and chronic health evaluation II score, multiple organ dysfunction score (MODS), logistic organ dysfunction score (LODS), and myocardial infarction history were significantly associated with primary outcome. Slope 5 showed the greatest discriminatory power. In a net reclassification improvement model, slope 5 significantly improved the predictive power of LODS; Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in MODS. In an integrated discrimination improvement model, slope 5 added significantly to the prediction power of each clinical parameter. Area 6 to 20 and Area 6 to 40 significantly improved the predictive power in sequential organ failure assessment. Conclusions: MSsE provides additional prognostic information in patients receiving ECLS. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0548-3) contains supplementary material, which is available to authorized users