Journal of the Formosan Medical Association最新文献

Background: The human microbiome is increasingly recognized as a factor in cancer development, though its role in primary liver cancer (PLC) remains unclear. This retrospective cohort study examines tissue-specific microbiota differences between hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), and explores their association with tumor recurrence in PLC.

Methods: Clinical data from 116 patients (85 HCC and 31 age-matched CCA) were analyzed. Fresh frozen samples underwent RNAscope™ ISH assay for microbial RNA detection, while the MiSeq platform targeted 16 S ribosomal RNA. Microbiome functional pathways were explored with Tax4Fun2, and predictors of recurrence were identified through logistic regression analysis.

Results: Microbial RNA was detected within liver sinusoids, the basal lamina of intrahepatic bile ducts, and hepatocyte cytosol. 16 S ribosomal RNA analysis revealed differences in microbiome composition, including a distinct Firmicutes/Bacteroidetes ratio between CCA and HCC patients. Specific functional pathways were differentially enriched between the two groups. LEfSe and logistic regression analyses identified Aquabacterium spp. as a potential marker for HCC recurrence (OR, 14.77; 95 % CI, 1.07-203.94; p = 0.044). Increased abundances of Brevundimonas spp. (OR, 3.1 E+17; 95 % CI, 4.3 E+3-2.2 E+31; p = 0.013), Novosphingobium spp. (OR, 3.5 E+20; 95 % CI, 4.4 E+5-2.8 E+35; p = 0.007), and Pelomonas spp. (OR, 3.3 E+21; 95 % CI, 3.0 E+8-3.5 E+34; p = 0.001), along with decreased Staphylococcus spp. (OR 0.00; 95 % CI, 0.00-0.06; p = 0.003), were independent predictors of CCA occurrence.

Conclusion: This study reveals that intratumoral microbiota help distinguish PLC subtypes and are associated with recurrence, identifying Aquabacterium as a potential marker for HCC recurrence and microbiome-based management.

Background: Inhaler therapy is central for managing chronic obstructive pulmonary disease (COPD), but incorrect technique and low satisfaction limit its effectiveness. The optimal timing for reinstruction remains unclear. We evaluated the effects of educational reinstruction on patient satisfaction and inhaler technique, and explored whether prior device use duration modulates these outcomes.

Methods: In this single-center, open-label, randomized controlled trial, 126 patients with stable COPD using inhalers ≥3 months were randomized to reinstruction (n = 60) or no reinstruction (n = 66). The primary endpoint was the Patient Satisfaction and Preference Questionnaire (PASAPQ); secondary endpoints included inhaler technique, adherence, the COPD Assessment Test, the modified Medical Research Council dyspnea scale, and respiratory function. Post hoc analyses assessed predictors of technique improvement using univariable and multivariable logistic regression, and assessed the discriminative ability of device use duration.

Results: PASAPQ scores did not differ between groups. Reinstruction significantly improved inhaler technique (63.3 % vs. 27.3 %, p < 0.0001). Patients with shorter device use (<13 months) showed greater gains than those with >36 months, and this association persisted after adjustment. Receiver operating characteristic (ROC) analysis yielded an area under the curve of 0.556 with modest operating characteristics, indicating limited predictive value for timing and supporting an exploratory interpretation.

Conclusion: Reinstruction improved inhaler technique without changing satisfaction, with apparently greater benefit earlier in device use; however, timing inferences are exploratory. Early, appropriately timed education may maximize technique gains and larger studies should develop personalized, data-driven schedules and rigorously validate patient-reported measures such as the PASAPQ.

Chronic kidney disease (CKD) is a major public health challenge in Taiwan, projected to affect over three million people by 2027. Despite national Pay-for-Performance programs, gaps in early detection and risk control call for practical, standardized primary care strategies. To address this, a core group of experts systematically reviewed international and local CKD guidelines and relevant literature, with emphasis on applicability to Taiwan's health system and frontline practice, and drafted preliminary recommendations. A multidisciplinary panel comprising representatives from nephrology, endocrinology, cardiology, family medicine, nursing, nutrition, pharmacy, public health, and government reviewed, discussed, and voted on each recommendation through a formal consensus. Consensus was defined as ≥70 % agreement, with ≥90 % indicating strong consensus. Ten recommendations were endorsed, nine with strong consensus and one achieved consensus. The framework emphasizes risk-based and age-stratified screening, combined eGFR and albuminuria testing for diagnosis, and staging with the G/A classification system. Preventive measures include kidney health literacy promotion and management of modifiable risk factors. In Taiwan, CKD care is embedded within National Health Insurance-supported Pay-for-Performance programs that combine multidisciplinary management to delay disease progression, reduce cardiorenal complications, prolong survival, and improve quality of life. Recommendations also highlight patient self-management, individualized targets for blood pressure, glycemic control, and lipid management, cornerstone therapies with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEis/ARBs) and sodium-glucose cotransporter 2 inhibitor (SGLT2i), and timely nephrology referral. The 2025 Taiwan CKD Care Consensus provides evidence-based and locally tailored guidance to strengthen primary care and multidisciplinary collaboration, improving outcomes and sustaining healthcare delivery.

Background: Purpose: The benefits and risks of endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) and a history of cancer remain unclear. This study aimed to assess procedural effectiveness, safety, clinical outcomes, and their trends over time.

Methods: We analyzed data from 2011 to 2023 from binational EVT registries in Taiwan and South Korea. Patients with a history of cancer were propensity score matched (1:2) to non-cancer controls based on age, stroke severity, risk factors, imaging, and treatment. Outcomes included reperfusion, symptomatic intracerebral hemorrhage (SICH), early neurological deterioration (END), in-hospital and 90-day mortality, and favorable 90-day outcomes.

Results: Of 6526 stroke patients who received EVT, 473 (7.2 %) had cancer. After matching, 294 cancer patients were compared with 549 controls. Successful reperfusion and SICH rates were similar. Cancer patients had higher END (17.0 % vs. 10.4 %), in-hospital mortality (19.0 % vs. 8.6 %), 90-day mortality (35.4 % vs. 16.2 %), and lower chances of favorable 90-day outcomes (23.1 % vs. 35.7 %). Higher HDL and platelet count in cancer patients were linked to better outcomes. The proportion of cancer patients undergoing EVT increased over time with improved reperfusion and lower SICH rates.

Conclusions: EVT is safe and effective for AIS patients with cancer, with similar reperfusion and complication rates as non-cancer patients. However, they often have worse outcomes. Laboratory markers can help personalize prognosis. Evolving treatment patterns suggest increasing clinician confidence in this group. However, due to missing cancer-specific details, our findings should not be generalized to all cancer populations, especially those with advanced or terminal malignancies.