Ovarian granulosa cell tumor (GCT) is a malignant tumor with slow progression. The recurrence of granulosa cell tumor often happens after 5 years, leading to a ‘forgotten tumor’ by the patient. We present the case of a 64-year-old woman with a presentation of left flank pain. An initial computed tomography scan revealed a single tumor with multiple adjacent organ invasions. Surgical intervention was prescribed and the pathological results revealed a metastatic granulosa cell tumor. We also review the literature for the follow-up and further management of this tumor.

Here we conducted a retrospective analysis of hospital-based trauma registry database for evaluating the impacts of comorbidities on the prognosis for traumatized patients using Index of Coexistent Comorbidity Disease (ICED) scores. We analyzed the data of patients with blunt trauma who visited emergency department between January 1, 2011, and December 31, 2015 in Chang-Gung Memorial Hospital, Keelung branch, a single level I trauma center in the Northern Taiwan. All consecutive patients with blunt trauma who admitted to the intensive care unit or ordinary ward after initial managements in the emergency department were included. We measured the hospital mortality of blunt traumatized patients using alive discharge as a competing risk. To investigate conditional independence of mortality and ICED scores given Injury Severity Score (ISS), we used log-linear models for modeling independence structures. Overall, we included 4997 patients (median age [IQR], 59 years old (44–75 years); 55.3% male). The mortality rate of blunt traumatized patients was higher in the higher ICED scores group compared to lower ICED scores group (4.7% vs 1.8%, p < 0.001). Meanwhile, the higher ICED scores group were associated with older age, higher ISS, and longer hospital stay than lower ICED scores group. Higher ICED group had higher probability of transition-to-death and lower probability of transition-to-discharge under the competing risk model. In the multivariable analysis of transition-specific Cox models, higher ICED group were associated with higher risk for hospital mortality compared to lower ICED group (HR 1.60; [95% CI 1.04–2.47]; p = 0.032). Also, higher ICED group were associated with lower probability of transition-to-discharge (HR 0.79; [95%CI 0.73–0.86]; p < 0.001). Additionally, higher ICED scores accounted for hospital mortality among patients with ISS < 25. In conclusion, our study suggested that severity of comorbidity was associated with higher hospital mortality among traumatized patients, particularly lower ISS.

Phase change memory (PCM) cells with T-shaped structure using tungsten heater were fabricated and the cell characteristics concerning the programing pulse width were also investigated in this work. The numerical modeling shows the thermal nonuniformity over the active region due to the considerable thermal sink of tungsten heater results in the amorphous-phase residues and the incomplete set programing. The experimental results reveal the existence of residual amorphous phase and indicate that the incomplete set programing is the dominant factor to degrade the PCM cell performances, such as the sensing margin and the endurance. The strategies to eliminate the incomplete set programing are the optimization in programing pulse width and the replacement of the tungsten heater with higher resistivity metal such as TiAlN.

Highly (117)- and (001)-oriented Bi3.25La0.75Ti3O12 (BLT) thin films were fabricated on Pt/TiO2/SiO2/Si(100) substrates by chemical solution deposition under the appropriate baking and crystallization conditions. The (117)-oriented BLT films exhibited higher remanent polarization (2Pr=24 μC/cm2), than did (001)-oriented BLT films, which exhibited only a slight amount of polarization (2Pr=6.6 μC/cm2). The results of fatigue and retention tests revealed that neither film was fatigued up to 1×1010 switching cycles, and the retained charge was unchanged for 1×104 s.

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Background:In clinical trials, adjuvant therapy (AT) has been shown to improve the prognosis in patients with gastric adenocarcinoma who undergo curative gastrectomy and adequate lymph node dissection. However, the optimal timing for initiating AT is still unclear.Method:We collected data from 538 patients with stage II-III gastric cancer who underwent curative gastrectomy and AT in two tertiary hospitals from 2006 to 2013. Patients were divided into the early group (≤8 weeks, n=393) and the late group (>8 weeks, n=145), based on the interval between gastrectomy and initiation of AT. Propensity score matching was applied according to baseline characteristics.Results:After 1:1 propensity score matching, an even distribution of characteristics in both groups (143:143) was achieved. The 5-year overall survival (OS) rates were 56.6% and 40.2% in the matched early and late groups, respectively (p=0.062), while the corresponding 5-year recurrence-free survival (RFS) rates were 57.6% and 46.4%, respectively (p=0.028). The time to AT initiation was correlated with RFS and had a positive association with OS. The 5-year distant metastasis-free survival was also significantly better (HR 0.682, 95% CI 0.472-0.985, p=0.040), suggesting an early AT results in a better outcome in patients.Conclusion:We observed that initiation of AT within 8 weeks of curative gastrectomy produces better disease control and may contribute to better overall survival.

A novel phase-change memory cell with a doubleconfinement structure was proposed and fabricated in this work. By having an additional bottom Ge 2 Sb 2 Te 5 layer under the electrically confined active region, the heat loss can be effectively prevented. The temperature uniformity over the active region significantly improves and so does the thermal efficiency. Therefore, a low I RESET of about 0.3 mA and a reset power can be achieved. For the SET performance, a pulsewidth as low as 200 ns can be used without compromising the R SET .

This paper proposes a neural fuzzy evaluation system (NFES) with significant variables selected from stepwise regression to predict apnea-hypopnea index (AHI) for evaluating obstructive sleep apnea (OSA). The variables considered are the change statuses of blood pressure (BP) before going to sleep and early in the morning as well as other five easily available measurements (age, body mass index (BMI), etc.) so that users can use the system for self-evaluation of OSA. A total of 150 subjects are reviewed retrospectively and categorized as training (120 subjects) and validation (30 subjects) sets by a fivefold cross-validation scheme with stratified sampling based on the OSA severity. Among the eight variables, the stepwise regression shows that BMI, the difference of systolic BP, and Epworth Sleepiness Scale were the significant factors to predict AHI. The three variables are fed as inputs to the NFES with interpretable fuzzy rules automatically generated from the training set. The average accuracy, sensitivity (Sn), specificity (Sp), and Sn+Sp-1 of the NFES were 75.6%, 77.2%, 75.0%, and 0.552, respectively, in distinguishing the OSA level of normal-mild (AHI <15) from moderate-severe (AHI ≱ 15), and outperformed the stepwise regression, back-propagation neural network, and support vector machine models. In addition to personal self-estimation, physicians could differentiate the two OSA levels by means of the fast-screening system for both outpatients and inpatients.