Journal of the Formosan Medical Association最新文献

Background: Gestational diabetes mellitus as a common pregnancy complication carries metabolic risks for both the mother and infant. We and others have shown that ribonuclease L (RNase-L, an innate immunity regulator) regulates adipogenesis and insulin sensitivity of skeletal muscle. We further showed that its serum level was reduced in human subjects with impaired fasting glucose and metabolic syndrome. In this study we investigated its levels in gestational diabetes mellitus.

Methods: A total of 82 pregnant women who have received a one-step 75g oral glucose tolerance test (OGTT) for Gestational diabetes mellitus diagnosis were enrolled in this study, and their serum RNase-L levels during pregnancy were examined. Serum RNase-L levels were compared between women who did and did not develop Gestational diabetes mellitus. The risk for Gestational diabetes mellitus with the change of serum RNase-L concentration was estimated using a binary logistic regression model adjusting for age and body mass index.

Results: During pregnancy, serum RNase-L levels tended to descend with gestational age (P-for-trend = 0.008). The mean of serum RNase-L in the 1st, 2nd, and 3rd trimesters of pregnancy were respectively lower in the Gestational diabetes mellitus group compared with the controls (1st trimester: 17.1 ± 8.4vs.19.3 ± 7.2 μg/ml, P=0.328; 2nd: 14.7 ± 5.9vs.18.6 ± 6.8 μg/ml, P=0.017; 3rd: 13.6 ± 2.8vs.16.0 ± 3.5 μg/ml, P=0.005).

Conclusion: This is the first study on how innate immune factor affect the pregnant women in developing GDM. The serum RNase-L levels were found to be negatively associated with GDM risk during pregnancy. This observation linked GDM with innate immunity and RNA metabolism in its pathophysiology.

Purpose: To validate the use of estimated post-enucleation prostate-specific antigen (EPEPSA) and extra-transitional zone density (EtzD) in predicting clinically significant prostate cancer (csPC) in a Taiwanese cohort.

Materials and methods: Between August 2017 and June 2022, patients with PSA levels <20 ng/mL who underwent prostate biopsy at the National Taiwan University Hospital were enrolled. According to a model built by a previous cohort, EPEPSA was calculated using the following formula: 1.068 + 0.016 × PSA +0.004 × prostate volume - 1.02 × adenoma volume/prostate volume. The EtzD was calculated by dividing the EPEPSA value by the peripheral zone volume, and csPC was defined as favorable-intermediate, unfavorable-intermediate, high, very-high-risk or metastatic prostate cancer, according to the National Comprehensive Cancer Network guidelines.

Results: A total of 229 (32.1%) patients with csPC were diagnosed in the enrolled cohort (N = 714). Both EPEPSA and EtzD were statistically associated with csPC prediction (odds ratio [OR]: 29.56, 95% confidence interval [CI]: 5.41-161.6; OR: 4.11, 95% CI: 2.20-7.67, respectively). However, PSA density (PSAD) (area under the curve [AUC]: 0.77) still had the best predictive value compared with PSA, EPEPSA, and EtzD (AUC: 0.68, 0.64, and 0.67, respectively; all p < 0.05). There were no significant differences in the csPC prediction values of EPEPSA, EtzD, and PSA.

Conclusions: Although EPEPSA and EtzD can predict csPC in Taiwan, they failed to outperform PSAD and PSA. Therefore, PSAD is the best predictor for csPC.

Background: The efficacy of radiotherapy to the internal mammary node (IMN-RT) and axillary lymph node regions (ALRT) in enhancing disease-free survival (DFS) among patients with breast cancer (BC) in the context of contemporary systemic chemotherapy has not been clearly established.

Methods: This retrospective study included 512 patients with BC who underwent primary breast surgery and regional nodal irradiation between 2008 and 2014. The patient cohort was divided into 160 early-stage (T1-T2, N0-N1) and 352 locally advanced-stage (T3-T4, N2-N3) cases. We employed Kaplan-Meier survival analysis to calculate locoregional recurrence-free survival (LRFS), DFS, and overall survival (OS). A propensity score-matched (PSM) analysis was performed for patients who received IMN-RT.

Results: A high proportion of patients (95.9%) received adjuvant chemotherapy and 89.8% received taxane-based regimens. All HER2-positive patients were treated with anti-HER2 therapy, and hormone therapy was administered to 97.5% of the patients with ER-positive tumors. While all patients underwent supraclavicular fossa RT, only 20 patients (3.9%) received additional IMN-RT. ER-negative/HER2-negative patients demonstrated a significantly lower 10-year DFS (p = 0.036) and OS (p = 0.006). PSM analysis showed that there were no differences in LRFS (p = 0.308) and DFS (p = 0.388) between patients receiving IMN-RT and those who did not. For pathological N3 patients, the 10-year LRFS (67% vs. 81.7%, p = 0.153) and DFS (62.3% vs. 64.9%, p = 0.789) rates were similar between those who underwent ALRT and those without ALRT.

Conclusion: In the modern era of systemic therapy, RT to the IMN or axilla does not substantially improve the clinical outcomes in patients with LN-positive early- or locally advanced-stage BC.

Background: Coronary artery disease (CAD) is a leading cause of cardiovascular morbidity and mortality. Exosomal microRNAs (miRNAs) play a role in vascular atherosclerosis and are involved in the pathophysiology of CAD. This study aimed to validate the associations of eight exosomal miRNAs with CAD and assess their relevance to disease severity.

Methods: A total of 875 participants who underwent elective coronary angiography were enrolled between January 2022 and August 2023. Blood samples were collected during angiography, and exosomal miRNAs were analyzed using quantitative polymerase chain reaction (qPCR). Only miRNAs with detection rates above 50% and reproducible results were included. Differential expression was evaluated using the Wilcoxon rank-sum test (also known as the Mann-Whitney U test), with statistical significance set at p < 0.05.

Results: Participants in the severe CAD group (with significant three-vessel disease) were older and had a higher incidence of hypertension than those in the non-CAD group (with patent coronary arteries). miRNA-382-3p was significantly upregulated in patients with severe CAD, correlating with the presence of disease. miRNA-3613-3p and miRNA-185-5p exhibited variable expression patterns, warranting further investigation. miRNA-200a-3p expression did not significantly differ between the groups, whereas miRNA-432-5p, miRNA-125a-5p, miRNA-151a-3p, and miRNA-328-3p had low detection rates, limiting their analytical utility.

Conclusions: miRNA-382-3p is associated with severe CAD and may contribute to understanding disease mechanisms and therapeutic development. Further studies are necessary to validate its clinical significance and broader application.

Objective: To compare the in vitro fertilization (IVF) outcomes of the progestin-primed ovarian stimulation (PPOS) protocol using dydrogesterone and the GnRH antagonist (GnRH-ant) protocol in POSEIDON group 4 patients.

Methods: This retrospective cohort study analyzed 447 POSEIDON group 4 patients who underwent IVF at a single center. Patients were categorized into GnRH-ant (n = 281) and PPOS (n = 166) groups. Propensity score matching was employed to balance baseline characteristics, yielding 165 patients in each group for comparison. The primary outcomes were the number and quality of cleavage and blastocysts embryos. Secondary outcomes included clinical pregnancy and ongoing pregnancy rates after the first frozen embryo transfer.

Results: Baseline characteristics were balanced between groups after matching. The PPOS group had a significantly lower number of good quality cleavage embryos (adjusted mean ratio 0.80, 95% CI 0.66-0.97) and blastocysts (adjusted mean ratio 0.77, 95% CI 0.62-0.96) compared to the GnRH-ant group. The number of cleavage embryos and good quality blastocysts was comparable between groups. Although not statistically significant, the clinical pregnancy (31.4% vs 36.8%) and ongoing pregnancy rates (20.3% vs 29.9%) after the first embryo transfer tended to be lower in the PPOS group.

Conclusions: In POSEIDON group 4 patients, the PPOS protocol using dydrogesterone may be associated with lower embryo quality and pregnancy outcomes compared to the GnRH-ant protocol. Further prospective randomized trials are needed to validate these findings.