Journal of the Formosan Medical Association最新文献

Background/purpose: To evaluate the prognostic value of body composition indices-subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), intramuscular adipose tissue index (IMATI), and skeletal muscle index (SMI)-in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). We also assessed the impact of contrast enhancement on these indices.

Methods: This retrospective, single-center study included patients who underwent preoperative abdominal computed tomography within 3 months before undergoing RNU between January 2016 and January 2020. Body composition indices were measured at T12-L5. The effect of contrast enhancement was analyzed using paired t tests. Survival outcomes (cancer-specific and overall survival) were evaluated using Kaplan-Meier curves and Cox regression models.

Results: This study included 166 patients (mean age, 70 ± 9 years; men, 72). A higher SATI value was associated with better survival (hazard ratio: 0.98; p < 0.05), whereas a higher visceral fat/subcutaneous fat ratio was associated with poorer survival (hazard ratio: 1.37-3.13; p < 0.05). Contrast enhancement significantly reduced the visceral adipose tissue index and intramuscular adipose tissue index values across multiple vertebral levels (p < 0.001).

Conclusion: The SATI and visceral fat/subcutaneous fat ratio are key prognostic indicators in patients with UTUC undergoing RNU. Our findings highlight the need for standardized imaging protocols to ensure accurate risk stratification and guide clinical decision-making.

Background: In 2019, traditional Chinese medicine (TCM) was incorporated into Taiwan's Integrated Home-Based Medical Care program (iHBMC). This study examines the implementation and challenges of this initiative.

Methods: This sequential mixed-methods study included a retrospective analysis of medical records from 116 patients who received TCM home visits at Taipei City Hospital between 2019 and 2022. Descriptive statistics were used to summarize patient characteristics, TCM modalities, and visit frequencies. For the qualitative component, shadowing observations and in-depth interviews were conducted with 20 patients, caregivers, and healthcare providers. Qualitative data were analyzed using the constant comparison method and content analysis to identify perceived benefits and challenges of home-based TCM. Quantitative and qualitative findings were integrated to provide a comprehensive understanding of service implementation and experiences.

Results: Of 116 patients receiving home-based TCM, most were aged 81+ and diagnosed with circulatory, musculoskeletal, or psychiatric conditions. Acupuncture and herbal medicine were the main modalities. TCM physicians provided more frequent visits than other home care professionals, especially in long-term cases, facilitating close monitoring and timely adjustments. Patients and caregivers reported symptom relief, improved function, and psychosocial support from regular TCM visits. Key challenges included limited interdisciplinary collaboration, high workload, suboptimal home settings, and concerns about polypharmacy and herb-drug interactions. Participants emphasized the need for improved team communication and clear guidelines for integrated care.

Conclusion: Integrating TCM into the iHBMC program offers benefits for older adults with chronic or complex conditions. However, maximizing these benefits will require policies that foster interprofessional collaboration, address practical challenges, and strengthen guidelines for safe integration. Enhancing communication among stakeholders is essential to optimizing patient outcomes and service quality within home-based care.

Background: Bronchopulmonary dysplasia (BPD) is a primary complication in preterm infants, involving multiple pathological processes. Current research indicates that lactylation may play a significant role in disease progression, but its specific mechanisms in BPD remain unclear. This study aims to explore the function of the lactylation signature in BPD.

Methods: We analyzed the GSE32472 dataset, which includes BPD and non-BPD infant samples, along with 335 lactylation-related genes (LRGs). Differentially expressed genes (DEGs) analysis was performed using the "limma" R package, followed by gene function analysis with "clusterProfiler". Weighted Gene Co-expression Network Analysis (WGCNA) and four machine learning methods were used to identify biomarkers, the "pROC" R package evaluated predictive performance, qPCR validated gene expression, CIBERSORT analyzed immune infiltration, and GSEA identified enriched pathways.

Results: WGCNA identified 15 BPD-related gene modules, with 46 lactylation-BPD genes intersecting with LRGs. Unsupervised clustering revealed two BPD subgroups with Cluster 1 enriched in immune regulation and Cluster 2 linked to apoptosis and inflammation. Six key genes (LDHB, PYGL, PFKFB2, KIF23, GK, CA4) showed high diagnostic potential (AUC >0.7), with LDHB significantly down-regulated in BPD. GSEA indicated these genes' involvement in T-cell activation and immune response pathways.

Conclusion: This study revealed the lactylation signature in BPD and may enhance our understanding of BPD pathogenesis.

Background: Larger mean corpuscular volume (MCV) may indicate impaired oxygen and nutrient delivery to the brain, and could be associated with cognitive impairment, yet longitudinal evidence remains limited. This study investigated this association in community-dwelling older adults.

Method: This prospective cohort study (2011-2022) was from the Taiwan Initiative for Geriatric Epidemiological Research at baseline with four biennial follow-ups. Global cognition was assessed longitudinally using the Montreal Cognitive Assessment, Taiwanese version, and domain-specific cognition via a battery of neuropsychiatric tests. Red cell distribution width (RDW), hemoglobin, platelet, and vitamin B12 were also collected. Generalized linear mixed models were utilized to analyze the association between baseline MCV and cognition adjusting for covariates.

Results: A total of 530 non-demented participants (mean age 72.7 ± 5.3 years, range 65-89; 247 men and 283 women) were included. MCV was non-linearly associated with cognition. Larger baseline MCV (>93.0 fL) was significantly associated with poor memory (immediate free recall, delayed free recall, and delayed theme recall: βˆ = -0.028 to -0.041) and attention (digit span forward: βˆ = -0.028) over time, particularly in those with high platelet counts (> 230 × 10³/μL), high hemoglobin, and in men. A significant interaction between MCV and age on global cognition (p_interaction = 0.04) was observed.

Conclusion: Elevated baseline MCV was associated with poor cognition, especially in memory and attention domains, over time. Future longitudinal studies are warranted to confirm this temporal relationship.

Objectives: This study evaluated the effectiveness of gonadotropin-releasing hormone analogue (GnRHa) therapy in girls with central precocious puberty (CPP) and early puberty (EP), aiming to identify a reliable marker for treatment monitoring and assessing long-term outcomes.

Study design: A retrospective case study between 2001 and 2024, a total of 265 girls with rapidly progressive CPP or EP who received GnRHa therapy were enrolled. A GnRH stimulation test was performed after 12 weeks of therapy. Receiver operating characteristic curves and the Youden index were used to identify an optimal marker and define the cut-off value indicating effective suppression. Among them, 186 reached adult height, and their height outcomes were analyzed to identify predictive factors.

Results: After 12 weeks of GnRHa therapy, effective suppression was achieved in 94.3 % of patients. Unstimulated LH was a strong predictor (AUC = 0.85), with a cut-off of <0.4 IU/L (sensitivity, 65.5 %; specificity, 86.7 %). Growth outcomes showed that patients with CPP had better adult height than those with EP (156.5 vs. 153.9 cm, p < 0.001). Positive predictors included second-year growth velocity, predicted adult height at treatment initiation, and bone age standard deviation score, while a unstimulated LH level was negatively associated with final height. Long-term follow-up revealed that 34.9 % of patients had abnormal bone mineral density (31.5 % osteopenia and 3.4 % osteoporosis), although obesity rates were comparable to the general population.

Conclusions: This study highlights the importance of early intervention and effective monitoring strategies, with unstimulated LH emerging as a useful marker for treatment efficacy.