The association among sugar sweetened beverages (SSB) consumption, addiction and depression in adults, children and adolescents is widely reported. Dieting patterns during pregnancy is complicated by maternal fetal concerns. Specifically, restrained use of SSB might be potentially a source of perinatal distress. The current study modified diagnostic criteria for Substance Use Disorder (SUD) in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into SSB-specific questions to assess SSB use tendency. Edinburgh Postpartum Depression Scores (EPDS) is used to assess maternal distress during pregnancy. One hundred and ninety-six consecutive pregnant women receiving antenatal care at Kaohsiung Medical University Hospital were invited to participate in this study. In the first trimester, 46.6% of women had none or 1 DSM-5 symptom, 27.0% had 2–3 symptoms, while 26.4% had ≥ 4 symptoms. The mean numbers of DSM-5 symptoms in each trimester were found to be 2.5 ± 2.25, 2.6 ± 2.45, 2.4 ± 2.43 for the first, second and third trimester, respectively, p = 0.750. While EPDS score showed no difference among DSM-5 symptoms 0–1, 2–3 and ≥ 4 groups in the first trimester (8.1 ± 4.59, 8.4 ± 5.00, 8.8 ± 4.82, p = 0.343), women with ≥ 4 DSM-symptoms was found significantly higher EPDS scores than those with < 4 DSM-symptoms in the second (7.2 ± 4.81, 7.7 ± 4.98, 8.8 ± 4.33, p = 0.030) and third trimester (6.8 ± 5.00, 7.2 ± 4.63, 8.7 ± 5.24, p = 0.019). The relationship remained significant after adjusting for covariates including actual SSB amount consumed (adjusted β = 0.25 with 95% confident interval (CI) 0.04–0.45 and 0.21 with 95% CI 0.04–0.38 for the second and third trimesters, respectively). Overall, the study is the first to characterize the positive relationship between SSB use tendency and antenatal distress in pregnancy, independent of actual SSB amount consumed. The observational nature of the study design precludes inferences of its underlying socio-psychomotor mechanisms, although restrained SSB use in pregnancy is suspected to contribute. The novel employment of modified SSB-specific DSM-5 scores and EPDS in this setting is feasible and further validation is promising. With better understanding and awareness, pregnant women with increased SSB use tendency should be properly counseled with special attention to their mental state.

The approved standard dose of pembrolizumab (200 mg administrated every 3 weeks) for cancer treatment imposes a significant financial burden on patients. However, no study has analyzed the clinical outcomes of low-dose pembrolizumab among individuals diagnosed with gynecologic cancer. The primary objective of this study was to assess the effectiveness and safety of a low-dose pembrolizumab regimen in real-world clinical practice. We retrospectively assessed the efficacy and safety data of patients with gynecologic malignancies who received pembrolizumab between 2017 and 2022 at Kaohsiung Chang Gung Memorial Hospital. Furthermore, we conducted a comparative analysis of the objective response rate (ORR) and progression-free survival (PFS) between patients with deficient mismatch repair (dMMR) and proficient MMR (pMMR). A total of thirty-nine patients were included and received pembrolizumab at fixed dosages of 50 mg (5.1%), 100 mg (84.6%) and 200 mg (10.3%) per cycle. Compared to the pMMR group, the dMMR group exhibited a tendency toward improved ORR (45.5% vs. 13.0%, p = 0.074), and notably, the median duration of response remained unreached. There was no significant difference in PFS between the dMMR and pMMR groups; however, the patients with dMMR in tumor tissue had a trend of better survival (p = 0.079). Incidence of immune-related adverse events (irAEs) of any grade was observed in 13 patients (33.3%), with 3 individuals (7.7%) experiencing grade 3 or 4 events. Low-dose pembrolizumab may be a cost-effective and safe treatment option without compromising clinical outcomes in patients with refractory gynecologic cancers.

Little epidemiologic research has been done on the etiology of gallbladder cancer (GC). This cohort study was undertaken to examine whether there is an association between parity and risk of death from GC. The study cohort consisted of 1,292,462 women who had a first and singleton childbirth between 1 January 1978 and 31 December 1987. We tracked each woman from the time of their first childbirth to 31 December 2009, and their vital status was ascertained by linking records with the computerized mortality database. Cox proportional hazard regression models were used to estimate the hazard ratios (HR) of death from GC associated with parity. There were 257 GC deaths during 34,980,246 person-years of follow-up. The mortality rate of GC was 0.73 cases per 100,000 person-years. As compared with women who had given birth to only one child, the adjusted HR was 1.20 (95% CI = 0.79–1.83) for women who had two children, 1.47 (95% CI = 0.95–2.29) for women who had three children, and 1.68 (95% CI = 0.99–2.85) for women with four or more births. There was a significant increasing trend in the adjusted HRs for GC with increasing parity. The findings suggested that premenopausal women of higher parity may increase the risk of death from GC.

The 2023 update to the FIGO staging system for endometrial cancer has introduced important changes, particularly in classifying early disease, which now more effectively aligns with histological types and molecular profiles to guide treatment strategies. In recent years, molecular classification, including the identification of POLE mutations, mismatch repair deficiency (dMMR), and p53 abnormalities, has become essential in tailoring adjuvant therapies for patients with endometrial cancer. Women with new FIGO stage I non-TP53-mutated tumors, and stage I/II POLE-mutated tumors generally have excellent outcomes, and adjuvant therapy is typically not recommended. In contrast to the established adjuvant treatment of stage IIB disease, controversy surrounds the treatment of stage IIA and IIC patients without POLE mutations. Real-world data suggest that adjuvant radiotherapy or chemotherapy may offer no significant benefit compared to observation in these cases. For stage III POLE-mutated tumors, studies have demonstrated favorable prognoses and high salvage rates upon recurrence, raising important questions about the necessity of adjuvant treatment when complete surgical resection is achieved. For stage III/IV dMMR patients, immune checkpoint inhibitors have demonstrated substantial improvements in both progression-free survival and overall survival when added to chemotherapy, as shown in the RUBY, NRG-GY018, AtTEnd, and ENGOT-en11/GOG-3053/KEYNOTE-B21 trials. These findings have solidified the use of immunotherapy in this molecular subgroup. In the non-specific molecular profile group, hormone receptor status has emerged as a significant prognostic marker. Estrogen receptor-positive tumors in this subgroup have shown favorable responses to progestin therapy, raising the possibility that hormonal therapy could replace chemotherapy in selected patients. Lastly, patients with TP53-mutated tumors, which are associated with poor prognosis, are being evaluated in the RAINBO p53abn-RED trial to assess whether the addition of olaparib to adjuvant chemoradiation can improve outcomes in this high-risk group. In conclusion, integrating molecular subtyping with the 2023 FIGO staging system is reshaping the approach to adjuvant therapy in endometrial cancer, enabling more precise and individualized treatment strategies that improve patient outcomes.

[[abstract]]Objective: The aim of this study was to investigate whether the use of statins was associated with breast cancer risk. Background: Experimental studies have shown that statins have potential protective effects against cancer. Methods: We conducted a population-based case-control study in Taiwan. Cases consisted of all patients who were aged 50 years and older and had a first-time diagnosis of breast cancer for the period between 2004 and 2011. The controls were matched to cases by age, sex and index date. Adjusted odds ratios (ORs) and 95% CIs were estimated by using multiple logistic regression. Results: We examined 565 breast cancer cases and 2260 controls. The unadjusted OR for any statin prescription was 1.19 (95% CI = 0.95 - 1.49) and the adjusted OR was 1.13 (95% CI = 0.84 - 1.51). Compared with no use of statins, the adjusted ORs were 1.02 (95% CI = 0.61 - 1.69) for the group with cumulative defined daily doses (DDDs) below 44.67 DDDs, 1.21 (95% CI = 0.83 - 1.76) for the group with cumulative dose between 44.68 DDDs and 308 DDDs, and 1.10 (95% CI = 0.66 - 1.83) for the group with the highest cumulative dose (> 308 DDDs). Conclusions: The present data do not provide evidence to support either beneficial or harmful associations between statin use and breast cancer risk

Bevacizumab (BEV) is beneficial for ovarian cancer patients, but the real world’s patient settings differ from those in clinical trials. This study tries to illustrate adverse events in the Taiwanese population. Patients with epithelial ovarian cancer treated with BEV at Kaohsiung Chang Gung Memorial Hospital between 2009 and 2019 were retrospectively reviewed. The receiver operating characteristic curve was adopted to identify the cutoff dose and the presence of BEV-related toxicities. A total of 79 patients receiving BEV in neoadjuvant, frontline, or salvage settings were enrolled. The median follow-up time was 36.2 months. Twenty patients (25.3%) had “De novo” hypertension or the worsening of a preexisting one. Twelve patients (15.2%) had “De novo” proteinuria. Five patients (6.3%) had thromboembolic events/hemorrhage. Four patients (5.1%) had gastrointestinal perforation (GIP), and one patient (1.3%) had wound-healing complications. Patients with BEV-related GIP had at least two risk factors for developing GIP, most of which were conservatively managed. This study revealed a compatible but distinct safety profile from those reported in clinical trials. The presence of BEV-related changes in blood pressure showed a dose-dependent trend. Most of the BEV-related toxicities were managed individually. Patients with potential risks for developing BEV-related GIP should use BEV with caution.