Journal of the Formosan Medical Association最新文献

英文中文

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/S0929-6646(24)00603-X

引用次数: 0

Selective placement of novel compression suture technique to reduce pacemaker implantation rate following surgical aortic valve replacement with rapid deployment INTUITY valve 选择性放置新型压迫缝合技术，降低使用快速展开 INTUITY 瓣膜进行主动脉瓣置换术后的起搏器植入率。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/j.jfma.2024.03.002

Kelvin Jeason Yang , Chih-Hsien Wang , Hsiao-En Tsai , Sheng-Pin Yu , Yih-Sharng Chen , Nai-Hsin Chi

Objective

The use of RDV in SAVR is associated with risk of conduction abnormality requiring PPM implantation, when compared to conventional bioprosthetic valves. We aimed to evaluate the outcome after selective placement of annular compression sutures during surgical aortic valve replacement (SAVR) using Intuity rapid deployment valve (RDV).

Methods

This is a retrospective study of prospectively enrolled patients receiving SAVR using Intuity RDV. Selective placement of commissural compression suture was assessed for all patients based on their annular morphology. Outcomes including operative mortality, rate of pacemaker rate, paravalvular leak and change in trans-valvular pressure gradient were analyzed.

Results

56 consecutive patients underwent SAVR with the INTUITY RDV at our institution from January 2020 to November 2021. The Mean age of our cohort was 69.9 ± 10.6 years with a EuroSCORE II of 3.4 ± 2.4%. 28.6% (16/56) of patients had notable conduction abnormalities pre-operatively, which included atrial fibrillation and left/right bundle branch block. Compression sutures were selectively applied in 19/56 (33.9%) patients. Of which, 13 were bicuspid aortic valve. Post-operatively, we observed no conduction abnormality requiring PPM implantation. In addition, only 3 of the 56 (5.4%) had any degree of paravalvular leak on post-operative echocardiography (all ≤ mild). The mean reduction in trans-valvular gradient was 29.9 mmHg and the mean pressure gradient at 1 month and 1 year follow-up were 9.3 ± 3.6 mmHg and 10.2 ± 4.1 mmHg, respectively.

Conclusion

Selective placement of compression suture helps to avoid unnecessary oversizing, which may reduce the risk of paravalvular leak and post-operative PPM implantation.

目的：与传统的生物人工瓣膜相比，在主动脉瓣置换术（SAVR）中使用 RDV 与需要植入 PPM 的传导异常风险相关。我们的目的是评估在使用 Intuity 快速展开瓣膜（RDV）进行主动脉瓣置换术（SAVR）时选择性放置瓣环压缩缝合后的效果：这是一项回顾性研究，研究对象是使用 Intuity RDV 接受主动脉瓣置换术的前瞻性入组患者。根据患者的瓣环形态，对所有患者选择性放置滑膜压迫缝线进行评估。分析的结果包括手术死亡率、起搏器率、瓣旁漏和跨瓣膜压力梯度的变化：结果：2020 年 1 月至 2021 年 11 月，我院连续有 56 名患者接受了 INTUITY RDV 的 SAVR 手术。患者平均年龄为 69.9 ± 10.6 岁，EuroSCORE II 为 3.4 ± 2.4%。28.6%（16/56）的患者术前有明显的传导异常，包括心房颤动和左/右束支传导阻滞。19/56（33.9%）名患者选择性地进行了压迫缝合。其中，13 名患者为主动脉瓣双尖瓣。术后，我们没有观察到需要植入 PPM 的传导异常。此外，在术后超声心动图检查中，56 名患者中只有 3 人（5.4%）出现任何程度的瓣膜旁漏（均为轻度）。经瓣梯度的平均降幅为 29.9 mmHg，随访 1 个月和 1 年的平均压力梯度分别为 9.3 ± 3.6 mmHg 和 10.2 ± 4.1 mmHg：选择性放置加压缝合线有助于避免不必要的过大，从而降低瓣膜旁漏和术后 PPM 植入的风险。

{"title":"Selective placement of novel compression suture technique to reduce pacemaker implantation rate following surgical aortic valve replacement with rapid deployment INTUITY valve","authors":"Kelvin Jeason Yang , Chih-Hsien Wang , Hsiao-En Tsai , Sheng-Pin Yu , Yih-Sharng Chen , Nai-Hsin Chi","doi":"10.1016/j.jfma.2024.03.002","DOIUrl":"10.1016/j.jfma.2024.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>The use of RDV in SAVR is associated with risk of conduction abnormality requiring PPM implantation, when compared to conventional bioprosthetic valves. We aimed to evaluate the outcome after selective placement of annular compression sutures during surgical aortic valve replacement (SAVR) using Intuity rapid deployment valve (RDV).</div></div><div><h3>Methods</h3><div>This is a retrospective study of prospectively enrolled patients receiving SAVR using Intuity RDV. Selective placement of commissural compression suture was assessed for all patients based on their annular morphology. Outcomes including operative mortality, rate of pacemaker rate, paravalvular leak and change in <em>trans</em>-valvular pressure gradient were analyzed.</div></div><div><h3>Results</h3><div>56 consecutive patients underwent SAVR with the INTUITY RDV at our institution from January 2020 to November 2021. The Mean age of our cohort was 69.9 ± 10.6 years with a EuroSCORE II of 3.4 ± 2.4%. 28.6% (16/56) of patients had notable conduction abnormalities pre-operatively, which included atrial fibrillation and left/right bundle branch block. Compression sutures were selectively applied in 19/56 (33.9%) patients. Of which, 13 were bicuspid aortic valve. Post-operatively, we observed no conduction abnormality requiring PPM implantation. In addition, only 3 of the 56 (5.4%) had any degree of paravalvular leak on post-operative echocardiography (all ≤ mild). The mean reduction in <em>trans</em>-valvular gradient was 29.9 mmHg and the mean pressure gradient at 1 month and 1 year follow-up were 9.3 ± 3.6 mmHg and 10.2 ± 4.1 mmHg, respectively.</div></div><div><h3>Conclusion</h3><div>Selective placement of compression suture helps to avoid unnecessary oversizing, which may reduce the risk of paravalvular leak and post-operative PPM implantation.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":"124 1","pages":"Pages 44-49"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140119878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Understanding the mental health impacts of biological disasters: Lessons from Taiwan's experience with COVID-19 了解生物灾害对心理健康的影响：台湾 COVID-19 的经验教训。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/j.jfma.2024.03.015

Chih-Chieh Chang , Kuan-Ying Hsieh , Su-Ting Hsu , Yu-Yuan Wang , Frank Huang-Chih Chou , Joh-Jong Huang

Biological disasters pose a growing challenge in the 21st century, significantly impacting global society. Taiwan has experienced such disasters, resulting in long-term consequences like loss of life, trauma, economic decline, and societal disruptions. Post-disaster, mental health issues such as fear, anxiety, depression, post-traumatic stress disorder (PTSD), and stress surge, accompanied by increased suicide rates. The Coronavirus disease 2019 (COVID-19) (also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) pandemic, recognized as a biological disaster, triggered lockdowns and quarantines in Taiwan, causing lifestyle changes, economic recession, and so on. These shifts may elevate uncertainty about the future, intensifying mental stress and leading to a rise in various mental illnesses. This article reviews mental health studies conducted in Taiwan during the pandemic, emphasizing the need to integrate this research for future preparedness and interventions regarding the mental health impacts of biological disasters, including COVID-19. Further research is essential to explore long-term effects, interventions, and generalizability.

生物灾害在 21 世纪构成了日益严峻的挑战，对全球社会产生了重大影响。台湾曾经历过此类灾难，造成了生命损失、心理创伤、经济衰退和社会混乱等长期后果。灾后，恐惧、焦虑、抑郁、创伤后应激障碍（PTSD）和压力等心理健康问题激增，自杀率也随之上升。被认定为生物灾难的 2019 年冠状病毒病（COVID-19）（又称严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2））大流行在台湾引发了封锁和隔离，导致生活方式改变、经济衰退等。这些变化可能会增加对未来的不确定性，加剧精神压力，导致各种精神疾病的增加。本文回顾了大流行期间在台湾开展的心理健康研究，强调有必要整合这些研究，以便在未来准备和干预包括 COVID-19 在内的生物灾难对心理健康的影响。进一步的研究对于探索长期影响、干预措施和可推广性至关重要。

{"title":"Understanding the mental health impacts of biological disasters: Lessons from Taiwan's experience with COVID-19","authors":"Chih-Chieh Chang , Kuan-Ying Hsieh , Su-Ting Hsu , Yu-Yuan Wang , Frank Huang-Chih Chou , Joh-Jong Huang","doi":"10.1016/j.jfma.2024.03.015","DOIUrl":"10.1016/j.jfma.2024.03.015","url":null,"abstract":"<div><div>Biological disasters pose a growing challenge in the 21st century, significantly impacting global society. Taiwan has experienced such disasters, resulting in long-term consequences like loss of life, trauma, economic decline, and societal disruptions. Post-disaster, mental health issues such as fear, anxiety, depression, post-traumatic stress disorder (PTSD), and stress surge, accompanied by increased suicide rates. The Coronavirus disease 2019 (COVID-19) (also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) pandemic, recognized as a biological disaster, triggered lockdowns and quarantines in Taiwan, causing lifestyle changes, economic recession, and so on. These shifts may elevate uncertainty about the future, intensifying mental stress and leading to a rise in various mental illnesses. This article reviews mental health studies conducted in Taiwan during the pandemic, emphasizing the need to integrate this research for future preparedness and interventions regarding the mental health impacts of biological disasters, including COVID-19. Further research is essential to explore long-term effects, interventions, and generalizability.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":"124 1","pages":"Pages 6-14"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140189827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sequential multimodal treatments with chemotherapy and surgery for advanced soft tissue sarcoma may be associated with better survival than chemotherapy 对晚期软组织肉瘤进行化疗和手术的序贯多模式治疗可能比化疗带来更好的生存率。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/j.jfma.2024.03.007

Ching-Tso Chen , Hsing-Wu Chen , Wei-Hsin Lin , Pei-Ming Huang , Mong-Wei Lin , Ching-Yao Yang , Che-Yu Hsu , Chia-Chun Wang , Jen-Chieh Lee , Koping Chang , Kuo-Hao Huang , Ho-Min Chen , Tom Wei-Wu Chen , Rong-Sen Yang , Ruey-Long Hong

Background

In patients with advanced soft tissue sarcoma (STS), surgery had been reported to be associated with superior overall survival (OS). Chemotherapy details for such patients were less reported, and whether multimodal treatment with surgery and chemotherapy provides extra survival benefit remains unclear.

Methods

We retrospectively reviewed patients with newly diagnosed advanced STS treated at National Taiwan University Hospital from January 1, 2011, to December 31, 2017. OS was calculated from the day of diagnosis of advanced STS to the day of death or last follow-up. Baseline patient characteristics and details regarding surgery and chemotherapy were recorded.

Results

A total of 545 patients were diagnosed with STS from 2011 to 2017, of which 226 patients had advanced STS. The median age was 54.7 years, and 54% of patients were women. Approximately 38% of patients with advanced STS underwent surgery and exhibited a trend of longer OS compared with who did not (median = 18.6 vs. 11.9 months, p = 0.083). In the chemotherapy subgroup, the benefit of surgery was more prominent (median = 21.9 vs. 16.5 months, p = 0.037). Patients who received chemotherapy prior to surgery exhibited numerically longer OS than those who underwent surgery first (median = 33.9 vs. 18.3 months, p = 0.155). After adjusting other clinical factors, chemotherapy remained an independent factor associated with favourable OS.

Conclusion

Surgery may be more beneficial for the patients who receive chemotherapy. Our results support evaluation of sequential multimodal treatments strategy including surgery and chemotherapy in patients with advanced STS.

背景：有报道称，对于晚期软组织肉瘤（STS）患者，手术治疗可提高总生存率（OS）。此类患者的化疗细节报道较少，手术和化疗的多模式治疗是否能带来额外的生存获益仍不清楚：我们回顾性研究了 2011 年 1 月 1 日至 2017 年 12 月 31 日期间在台湾大学医院接受治疗的新确诊晚期 STS 患者。OS的计算时间为晚期STS确诊之日至死亡之日或最后一次随访。记录了患者的基线特征以及手术和化疗的详细情况：2011年至2017年期间，共有545名患者确诊为STS，其中226名患者为晚期STS。中位年龄为54.7岁，54%的患者为女性。约38%的晚期STS患者接受了手术，与未接受手术的患者相比，他们的OS有延长的趋势（中位数=18.6个月 vs. 11.9个月，p=0.083）。在化疗亚组中，手术的益处更为显著（中位 = 21.9 个月 vs. 16.5 个月，p = 0.037）。与先接受手术的患者相比，手术前接受化疗的患者显示出更长的OS（中位数=33.9个月对18.3个月，p=0.155）。在调整了其他临床因素后，化疗仍然是与良好的OS相关的独立因素：结论：手术可能对接受化疗的患者更有利。我们的研究结果支持对晚期 STS 患者进行包括手术和化疗在内的序贯多模式治疗策略评估。

{"title":"Sequential multimodal treatments with chemotherapy and surgery for advanced soft tissue sarcoma may be associated with better survival than chemotherapy","authors":"Ching-Tso Chen , Hsing-Wu Chen , Wei-Hsin Lin , Pei-Ming Huang , Mong-Wei Lin , Ching-Yao Yang , Che-Yu Hsu , Chia-Chun Wang , Jen-Chieh Lee , Koping Chang , Kuo-Hao Huang , Ho-Min Chen , Tom Wei-Wu Chen , Rong-Sen Yang , Ruey-Long Hong","doi":"10.1016/j.jfma.2024.03.007","DOIUrl":"10.1016/j.jfma.2024.03.007","url":null,"abstract":"<div><h3>Background</h3><div>In patients with advanced soft tissue sarcoma (STS), surgery had been reported to be associated with superior overall survival (OS). Chemotherapy details for such patients were less reported, and whether multimodal treatment with surgery and chemotherapy provides extra survival benefit remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients with newly diagnosed advanced STS treated at National Taiwan University Hospital from January 1, 2011, to December 31, 2017. OS was calculated from the day of diagnosis of advanced STS to the day of death or last follow-up. Baseline patient characteristics and details regarding surgery and chemotherapy were recorded.</div></div><div><h3>Results</h3><div>A total of 545 patients were diagnosed with STS from 2011 to 2017, of which 226 patients had advanced STS. The median age was 54.7 years, and 54% of patients were women. Approximately 38% of patients with advanced STS underwent surgery and exhibited a trend of longer OS compared with who did not (median = 18.6 vs. 11.9 months, <em>p</em> = 0.083). In the chemotherapy subgroup, the benefit of surgery was more prominent (median = 21.9 vs. 16.5 months, <em>p</em> = 0.037). Patients who received chemotherapy prior to surgery exhibited numerically longer OS than those who underwent surgery first (median = 33.9 vs. 18.3 months, <em>p</em> = 0.155). After adjusting other clinical factors, chemotherapy remained an independent factor associated with favourable OS.</div></div><div><h3>Conclusion</h3><div>Surgery may be more beneficial for the patients who receive chemotherapy. Our results support evaluation of sequential multimodal treatments strategy including surgery and chemotherapy in patients with advanced <span>STS</span>.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":"124 1","pages":"Pages 73-78"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fat loss and muscle gain: The possible role of striatal dopaminergic tone in determining the efficacy of physical exercise 减脂与增肌纹状体多巴胺能张力在决定体育锻炼效果方面可能发挥的作用。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/j.jfma.2024.06.024

Muhammad Abdullah , Shih-Hsien Lin , Li-Chung Huang , Nan-Tsing Chiu , Yen Kuang Yang

The effectiveness of exercise for obesity is contentious due to individual response variability. Owing to the roles of dopamine in motor functions, metabolism, and appetite, this study aimed to identify striatal dopamine as a predictor of variability in exercise response, specifically in terms of fat loss and muscle gain. Healthy non-exercising males completed an 8-week program, exercising 1 h, 4 days a week. Striatal dopaminergic tone was assessed by measuring dopamine transporter availability using technetium-99 m labelled tropane derivative, [99mTc]TRODAT-1 (TRODAT), single-photon emission computed tomography, and body composition (fat and muscles mass) was analysed using bioelectrical impedance. Lower baseline dopamine levels were associated with greater fat mass loss (r = 0.58, p = 0.006), percentage fat mass loss (r = 0.53, p = 0.013), and increase in muscle mass (β = -0.53, p = 0.035, after taking age and smoking status as covariates). These findings enhance our understanding of obesity neurobiology and exercise response variability, necessitating further research for targeted interventions based on dopaminergic profiles.

由于个体反应的差异性，运动治疗肥胖症的效果备受争议。由于多巴胺在运动功能、新陈代谢和食欲方面的作用，本研究旨在确定纹状体多巴胺作为运动反应变异的预测因子，特别是在减脂和增肌方面。不运动的健康男性完成了一项为期 8 周的计划，每周运动 4 天，每次 1 小时。通过使用锝-99 m标记的托烷衍生物[99mTc]TRODAT-1（TRODAT）和单光子发射计算机断层扫描测量多巴胺转运体的可用性来评估纹状体多巴胺能张力，并使用生物电阻抗分析身体成分（脂肪和肌肉质量）。基线多巴胺水平较低与脂肪量减少（r = 0.58，p = 0.006）、脂肪量减少百分比（r = 0.53，p = 0.013）和肌肉量增加（β = -0.53，p = 0.035，将年龄和吸烟状况作为协变量）相关。这些发现加深了我们对肥胖神经生物学和运动反应变异性的了解，因此有必要进一步研究基于多巴胺能特征的针对性干预措施。

{"title":"Fat loss and muscle gain: The possible role of striatal dopaminergic tone in determining the efficacy of physical exercise","authors":"Muhammad Abdullah , Shih-Hsien Lin , Li-Chung Huang , Nan-Tsing Chiu , Yen Kuang Yang","doi":"10.1016/j.jfma.2024.06.024","DOIUrl":"10.1016/j.jfma.2024.06.024","url":null,"abstract":"<div><div>The effectiveness of exercise for obesity is contentious due to individual response variability. Owing to the roles of dopamine in motor functions, metabolism, and appetite, this study aimed to identify striatal dopamine as a predictor of variability in exercise response, specifically in terms of fat loss and muscle gain. Healthy non-exercising males completed an 8-week program, exercising 1 h, 4 days a week. Striatal dopaminergic tone was assessed by measuring dopamine transporter availability using technetium-99 m labelled tropane derivative, [99mTc]TRODAT-1 (TRODAT), single-photon emission computed tomography, and body composition (fat and muscles mass) was analysed using bioelectrical impedance. Lower baseline dopamine levels were associated with greater fat mass loss (<em>r</em> = 0.58, <em>p</em> = 0.006), percentage fat mass loss (<em>r</em> = 0.53, <em>p</em> = 0.013), and increase in muscle mass (<em>β</em> = -0.53, <em>p</em> = 0.035, after taking age and smoking status as covariates). These findings enhance our understanding of obesity neurobiology and exercise response variability, necessitating further research for targeted interventions based on dopaminergic profiles.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":"124 1","pages":"Pages 91-94"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Authorship statement

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/S0929-6646(24)00602-8

引用次数: 0

Checklist

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/S0929-6646(24)00601-6

引用次数: 0

Comparison of the regulatory requirements for COVID-19 antigen tests in the United States, European Union, and Taiwan 美国、欧盟和台湾对 COVID-19 抗原检测监管要求的比较。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/j.jfma.2024.10.002

Jin-Yu Lee , Wen-Wei Tsai , Yin-Ting Fan

引用次数: 0

Analgesia-nociception index accurately predicts inadequate pectoralis muscle fascia block (PECS) in patients undergoing breast surgery: A prospective observational study 镇痛-痛觉指数可准确预测乳房手术患者胸肌筋膜阻滞（PECS）的不足：前瞻性观察研究。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/j.jfma.2024.02.019

Wei-Nung Teng , Yen-Shu Lin , Chun-Sung Sung , Ling-Ming Tseng , Wen-Kuei Chang , Chien-Kun Ting

Background

Postoperative opioid administration has been largely replaced by regional anesthesia techniques. We aimed to determine whether intraoperative Analgesia-Nociception Index (ANI) can aid in early evaluation of the effectiveness of regional blocks such as the pectoralis muscle fascia block (PECS, pectoserratus and interpectoral plane blocks) and predicting the need for analgesics postoperatively.

Methods

This prospective observational study enrolled 30 women (age: 20–80 years) undergoing unilateral, non-intubated, breast tumor excision alone or in conjunction with sentinel lymph node biopsy. PECS block was performed following sedation. ANI readings were obtained at 1-min intervals, and polar coordinates were assigned to the distance from the nipple (0.5-cm intervals) and o'clock position (15-min intervals) for each reading. Pain scores were assessed using a numeric rating scale from 0 to 10, and analgesics were administered depending on pain score post-operatively.

Results

8 (27%), 19 (63%), and 3 (10%) patients received morphine, tramadol, and no analgesics, respectively. In total, 954 ANI measurements were obtained. At the proposed cut-off of 50, the sensitivity and specificity of the ANI nadir for need of post-operative opioids were 0.875 and 0.932, respectively. Block effectiveness was most satisfactory in the upper lateral quadrant of the breast with nipple–areolar complex (NAC) sparing effect. Most average ANI measurements for the NAC were <50. No patient experienced postoperative nausea/vomiting, although one reported dizziness.

Conclusions

The intraoperative ANI nadir <50 was strongly correlated with need for postoperative opioids. The ANI may aid in objectively evaluating the effectiveness of pectoralis muscle fascial blocks and predicting postoperative need for analgesics.

背景：术后阿片类药物给药在很大程度上已被区域麻醉技术所取代。我们旨在确定术中镇痛-痛觉指数（ANI）是否有助于早期评估区域阻滞（如胸大肌筋膜阻滞（PECS、ectoserratus 和胸骨间平面阻滞））的效果，并预测术后镇痛剂的需求：这项前瞻性观察研究纳入了 30 名女性（年龄：20-80 岁），她们都接受了单侧、不插管的乳腺肿瘤切除术，单独或同时进行前哨淋巴结活检。镇静后进行 PECS 阻滞。每隔 1 分钟读取一次 ANI，每次读取的极坐标分别为距离乳头（间隔 0.5 厘米）和点钟位置（间隔 15 分钟）。疼痛评分采用 0 至 10 的数字评分表进行评估，术后根据疼痛评分情况使用镇痛剂：结果：分别有 8 名（27%）、19 名（63%）和 3 名（10%）患者使用了吗啡、曲马多和无镇痛药。共进行了 954 次 ANI 测量。在建议的 50 分界点上，ANI 最低值对术后阿片类药物需求的敏感性和特异性分别为 0.875 和 0.932。乳房上外侧象限的阻滞效果最令人满意，乳头-乳晕复合体（NAC）疏通效果最好。NAC的平均ANI测量值大多为结论：术中 ANI 最低点

{"title":"Analgesia-nociception index accurately predicts inadequate pectoralis muscle fascia block (PECS) in patients undergoing breast surgery: A prospective observational study","authors":"Wei-Nung Teng , Yen-Shu Lin , Chun-Sung Sung , Ling-Ming Tseng , Wen-Kuei Chang , Chien-Kun Ting","doi":"10.1016/j.jfma.2024.02.019","DOIUrl":"10.1016/j.jfma.2024.02.019","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative opioid administration has been largely replaced by regional anesthesia techniques. We aimed to determine whether intraoperative Analgesia-Nociception Index (ANI) can aid in early evaluation of the effectiveness of regional blocks such as the pectoralis muscle fascia block (PECS, pectoserratus and interpectoral plane blocks) and predicting the need for analgesics postoperatively.</div></div><div><h3>Methods</h3><div>This prospective observational study enrolled 30 women (age: 20–80 years) undergoing unilateral, non-intubated, breast tumor excision alone or in conjunction with sentinel lymph node biopsy. PECS block was performed following sedation. ANI readings were obtained at 1-min intervals, and polar coordinates were assigned to the distance from the nipple (0.5-cm intervals) and o'clock position (15-min intervals) for each reading. Pain scores were assessed using a numeric rating scale from 0 to 10, and analgesics were administered depending on pain score post-operatively.</div></div><div><h3>Results</h3><div>8 (27%), 19 (63%), and 3 (10%) patients received morphine, tramadol, and no analgesics, respectively. In total, 954 ANI measurements were obtained. At the proposed cut-off of 50, the sensitivity and specificity of the ANI nadir for need of post-operative opioids were 0.875 and 0.932, respectively. Block effectiveness was most satisfactory in the upper lateral quadrant of the breast with nipple–areolar complex (NAC) sparing effect. Most average ANI measurements for the NAC were <50. No patient experienced postoperative nausea/vomiting, although one reported dizziness.</div></div><div><h3>Conclusions</h3><div>The intraoperative ANI nadir <50 was strongly correlated with need for postoperative opioids. The ANI may aid in objectively evaluating the effectiveness of pectoralis muscle fascial blocks and predicting postoperative need for analgesics.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":"124 1","pages":"Pages 38-43"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Computer-assisted image analysis of preexisting histological patterns of the cephalic vein to predict wrist arteriovenous fistula non-maturation 通过计算机辅助图像分析头静脉预先存在的组织学模式来预测腕动静脉瘘不成熟。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-01-01 DOI: 10.1016/j.jfma.2024.03.004

Jeng-Wei Chen , Mao Ting , Po-Ya Chang , Chiau-Jing Jung , Chin-Hao Chang , Shi-Yu Fang , Li-Wei Liu , Kelvin Jeason Yang , Sz-Han Yu , Yih-Sharng Chen , Nai-Hsin Chi , Ron-Bin Hsu , Chih-Hsien Wang , I-Hui Wu , Hsi-Yu Yu , Chih-Yang Chan

Background

We used computer-assisted image analysis to determine whether preexisting histological features of the cephalic vein influence the risk of non-maturation of wrist fistulas.

Methods

This study focused on patients aged 20–80 years who underwent their first wrist fistula creation. A total of 206 patients participated, and vein samples for Masson's trichrome staining were collected from 134 patients. From these, 94 patients provided a complete girth of the venous specimen for automatic image analysis. Maturation was assessed using ultrasound within 90 days after surgery.

Results

The collagen to muscle ratio in the target vein, measured by computer-assisted imaging, was a strong predictor of non-maturation in wrist fistulas. Receiver operating characteristic analysis revealed an area under the curve of 0.864 (95% confidence interval of 0.782–0.946, p < 0.001). The optimal cut-off value for the ratio was 1.138, as determined by the Youden index maximum method, with a sensitivity of 89.0% and specificity of 71.4%. For easy application, we used a cutoff value of 1.0; the non-maturation rates for patients with ratios >1 and ≤ 1 were 51.7% (15 out of 29 patients) and 9.2% (6 out of 65 patients), respectively. Chi-square testing revealed significantly different non-maturation rates between the two groups (X² (1, N = 94) = 20.9, p < 0.01).

Conclusion

Computer-assisted image interpretation can help to quantify the preexisting histological patterns of the cephalic vein, while the collagen-to-muscle ratio can predict non-maturation of wrist fistula development at an early stage.

背景：我们使用计算机辅助图像分析来确定头静脉原有的组织学特征是否会影响腕部瘘管不成熟的风险：我们使用计算机辅助图像分析来确定头静脉原有的组织学特征是否会影响腕部瘘管不成熟的风险：这项研究的重点是首次接受腕部瘘管成形术的 20-80 岁患者。共有 206 名患者参与了研究，并从 134 名患者身上采集了用于马森三色染色的静脉样本。其中，94 名患者提供了完整的静脉周长标本，用于自动图像分析。术后 90 天内使用超声波对成熟度进行评估：结果：通过计算机辅助成像测量的目标静脉中胶原蛋白与肌肉的比例是预测腕瘘未成熟的有力指标。接收者操作特征分析显示，曲线下面积为0.864（95%置信区间为0.782-0.946，P 1和≤1分别为51.7%（29名患者中有15名）和9.2%（65名患者中有6名）。卡方检验显示，两组患者的非饱和率存在明显差异（X2 (1, N = 94) = 20.9, p 结论：计算机辅助图像判读可以帮助患者更好地了解自己的病情：计算机辅助图像解读有助于量化头静脉原有的组织学形态，而胶原蛋白与肌肉的比率则可预测腕瘘发展早期的非成熟性。

{"title":"Computer-assisted image analysis of preexisting histological patterns of the cephalic vein to predict wrist arteriovenous fistula non-maturation","authors":"Jeng-Wei Chen , Mao Ting , Po-Ya Chang , Chiau-Jing Jung , Chin-Hao Chang , Shi-Yu Fang , Li-Wei Liu , Kelvin Jeason Yang , Sz-Han Yu , Yih-Sharng Chen , Nai-Hsin Chi , Ron-Bin Hsu , Chih-Hsien Wang , I-Hui Wu , Hsi-Yu Yu , Chih-Yang Chan","doi":"10.1016/j.jfma.2024.03.004","DOIUrl":"10.1016/j.jfma.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><div>We used computer-assisted image analysis to determine whether preexisting histological features of the cephalic vein influence the risk of non-maturation of wrist fistulas.</div></div><div><h3>Methods</h3><div>This study focused on patients aged 20–80 years who underwent their first wrist fistula creation. A total of 206 patients participated, and vein samples for Masson's trichrome staining were collected from 134 patients. From these, 94 patients provided a complete girth of the venous specimen for automatic image analysis. Maturation was assessed using ultrasound within 90 days after surgery.</div></div><div><h3>Results</h3><div>The collagen to muscle ratio in the target vein, measured by computer-assisted imaging, was a strong predictor of non-maturation in wrist fistulas. Receiver operating characteristic analysis revealed an area under the curve of 0.864 (95% confidence interval of 0.782–0.946, <em>p</em> < 0.001). The optimal cut-off value for the ratio was 1.138, as determined by the Youden index maximum method, with a sensitivity of 89.0% and specificity of 71.4%. For easy application, we used a cutoff value of 1.0; the non-maturation rates for patients with ratios >1 and ≤ 1 were 51.7% (15 out of 29 patients) and 9.2% (6 out of 65 patients), respectively. Chi-square testing revealed significantly different non-maturation rates between the two groups (<em>X</em><sup>2</sup> (1, <em>N</em> = 94) = 20.9, <em>p</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>Computer-assisted image interpretation can help to quantify the preexisting histological patterns of the cephalic vein, while the collagen-to-muscle ratio can predict non-maturation of wrist fistula development at an early stage.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":"124 1","pages":"Pages 57-66"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

首页上一页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of the Formosan Medical Association

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀