Background: Controversy exists over whether aggressive surgical resection of the primary tumor without metastasectomy first or chemotherapy first in stage IV colon cancer with unresectable synchronous liver-only-metastases (CLM) improves patients. Materials and Methods: We retrospectively reviewed the outcome of 156 patients initially diagnosed with unresectable synchronous CLM who were under treatment in our institution from January 2004 to December 2012. Patients with extrahepatic diseases or previous hepatic resection were excluded. All patients with a follow-up of at least 3 months were included. Progression-free survival (PFS) and 5-year overall survival (OS) curves were calculated using the Kaplan–Meier method. Results: Among the 156 patients with CLM, 43 (27.56%) received aggressive surgical resection of the primary tumor without metastasectomy first, 113 (72.43%) received systemic chemotherapy first. At 5 years, the adjusted PFS and OS in stage IV colon cancer with inoperable metastases were 24.2% and 20.4%, respectively, in the surgical resection of the primary tumor first group and 46.0% and 16.9% in the chemotherapy first group (P = 0.515 and P= 0.742, respectively). In multivariate analysis, there was no statistical difference in the PFS and 5-year OS between the surgical resection of the primary tumor first group and chemotherapy first. Conclusion: Surgical resection of the primary tumor without metastasectomy first in CLM is not associated with improved survival as compared with chemotherapy first. Additional research is necessary to determine which patients may benefit from this intervention.

Background: This study investigated the correlation between epicardial adipose tissue (EAT), a measure of central obesity, and sexual function in males with vasculogenic erectile dysfunction (ED). Materials and Methods: The study was a cross-sectional study of selected males with ED aged <75 years who attended the Urology Outpatient Department of Tri-Service General Hospital. Sixty subjects were included in the study, which employed biochemical data, anthropometric indexes, echocardiography, and questionnaires. Biochemical lipid profiles and associated inflammation markers were recorded. The anthropometric indexes included general and central obesity and bioelectrical impedance analysis. Echocardiography results were assessed by a single experienced cardiologist and included epicardial and pericardial fat thickness measurements. Sexual function was evaluated using the International Index of Erectile Function-5 (IIEF-5) score. Results: According to the analysis of variance and multivariate logistic regression, only the erectile hardness score (EHS) was statistically positively correlated with the IIEF-5 score. All other anthropometric indexes and echocardiography parameters, including EAT thickness, pericardial adipose tissue thickness, and ejection fraction (EF), were not significantly associated with sexual function. Conclusions: Only EHS was statistically associated with sexual function in the male subjects with ED. The anthropometric indexes and EAT thickness, a measure of central obesity, were not significantly correlated with sexual function in the male patients with ED.

Background: Na⁺-K⁺-2Cl⁻ co-transporters (NKCCs) are involved in the regulation of permeability and tissue edema during sepsis. Inhibition of NKCC can reduce inflammation, edema formation, and bacterial burden. STE20/SPS1-realted proline/alanine-rich kinase (SPAK) is known to phosphorylate and activate NKCCs. However, there is no data regarding the role of SPAK in the pathological responses of sepsis. Therefore, the aim of this study was to examine the changes of systemic responses to endotoxemia in SPAK knockout mice. Materials and Methods: Wild-type and SPAK knockout mice were randomly given with vehicle (saline) or Escherichia coli lipopolysaccharide (LPS, 50 mg/kg) and monitored for 24 h. The alterations of hemodynamics, blood glucose, biochemical variables, plasma nitric oxide (NO) levels, blood flow, superoxide levels, and survival rate were analyzed during the experimental period. Results: In this study, LPS induced circulatory failure, hypoglycemia, multiple organ dysfunction, and mortality in wild-type mice. The NO levels of plasma were augmented and blood flow of the tongue, palm, sole, and abdomen were reduced in wild-type mice with endotoxic shock. However, there were no significant differences in these functional parameters and survival rate between wild-type and SPAK knockout mice with endotoxemia. Conclusions: These results demonstrate that inhibition of SPAK did not improve circulatory failure, hypoglycemia, multiple organ dysfunction, or mortality in mice that treated LPS. Thus, it seems that SPAK may not play an important role in endotoxic shock.

Background: Atypical meningiomas fall into a category World Health Organization Grade II, which have higher local recurrence rates and lower survival rates than their benign counterparts. The aim of this study is to review the outcome of newly diagnosed patients with atypical meningioma after therapy. Methods: We conducted a retrospective review of the medical records of patients having atypical meningiomas who were treated in our hospital between January 2005 and December 2014. Their age, sex, initial presentation, tumor location, tumor size, extent of resection, tumor recurrence or tumor progression, duration of follow-up, adjuvant therapy, and outcome were reviewed. Results: There were 27 consecutive patients (15 male and 12 female) having fresh intracranial atypical meningiomas treated in our hospital between January 2005 and December 2014. Their mean age at diagnosis was 60.81 years. Twenty-three patients (85.19%) underwent total resection of the tumor, whereas 4 patients (14.81%) had partial resection of their tumors during their first time of surgery. Fifteen patients (55.56%) had finished adjuvant radiotherapy. Nine patients (33.33%) had tumor progression or recurrence during follow-up, and 4 of them were proved to have malignant transformation to anaplastic meningiomas in the following operations. The mean time to tumor progression or recurrence of these nine patients was 17.67 months. Nineteen patients (70.37%) had a favorable outcome, 7 patients (25.93%) had an unfavorable outcome, and we lost 1 patient (3.7%) due to disease progression. Conclusions: Surgery remains the standard treatment to atypical meningioma, and postoperative adjuvant radiotherapy is still controversial especially to those who undergo total surgical resection of the tumors. Our study reveals that early postoperative adjuvant radiotherapy seems to play a role in local control. Atypical meningioma can have malignant transformation to anaplastic meningioma, so aggressive treatment and follow-up are essential to manage this particular tumor.

Background: Heart rate variability (HRV) had been promoted for longer than half a century to monitor the activity of autonomic nerve systems. Previous studies have not clarified the relationship between HRV and prehypertension (pre-HTN) status compared with the normal group. We aimed to figure out the optimal model or cutoff point for predicting the possible pre-HTN status. Patients and Methods: We retrospectively collected and reviewed 2586 Asian people who had joined annual physical examination in Tri-Service General Hospital at 2013. The patient profiles such as age, gender, body height, body weight, body weight index, waist circumferences, and serological biochemistry data were analyzed and correlated with HRV parameter. Results: A total number of 909 patients were enrolled in our study. The physical stress index (PSI) owed a small but most significant Spearman's relation coefficient (r = 0.118, P< 0.001) among the other HRV parameters. Statistical significant parameters exist between the normal blood pressure group and pre-HTN group other than gender factor. The measured blood pressure increased with elevated PSI level. A PSI level ≥58.4 has a significant β coefficient in each linear regression model for systolic blood pressure and diastolic blood pressure with a P< 0.001 for trend. Conclusion: The PSI level gains a positive correlation to elevated blood pressure. Our study emphasized that PSI is an efficient HRV parameter which represents higher risks for pre-HTN status and elevated blood pressure while the PSI level is >58.4. Early intervention to these participants may decrease cardiovascular events in the coming future.

We present a female patient without any underlying disease. Progressive pain, and locking sensation of the right hip with limited range of motion were told and synovial chondromatosis (SC) of right hip was diagnosed. Radiographies revealed characteristic finding of SC including multiple calcified loose bodies within the right hip joint. Removal of cartilaginous fragments as well as nearly total synovectomy was performed arthroscopically on the right hip. Short-term postoperative follow-up of our patient revealed improved hip function and resolution of all symptoms.

Acute diverticulitis is a rare and dangerous condition in a pediatric patient. The clinical presentation of right-sided diverticulitis mimics acute appendicitis. Hence, understanding the clinical presentation and treatment of right-sided diverticulitis is important. We report a case of right-sided diverticulitis in a 12-year-old girl and discuss the presentation and diagnosis of this disease.

Lymphoepithelial cyst (LEC) of the pancreas is rare true pancreatic cyst. The cause is unclear. We present the case of a 19-year-old man diagnosed with LEC of pancreas tail. He had experienced intermittent upper abdominal pain and distention for 2 months prior to admission. He had no any abdominal operation history. Abdomen computed tomography (CT) scan revealed a huge homogeneous mass lesion, 15cm in the long diameter, over the pancreas tail. Then he underwent laparoscopic spleen-preserving distal pancreatectomy after a series of preoperative evaluation. LEC of pancreas tail was confirmed on the basis of clinicopathological features, such as size (15 cm), benign stratified squamous epithelium atop dense lymphoid tissue. The advantages of laparoscopic resection for LEC of the pancreatic tail were discussed.