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 : 2025-02-01 DOI: 10.1016/S0929-6646(25)00028-2

引用次数: 0

Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center 心脏手术中减少类固醇剂量的效果和趋势：一家三级医疗中心的三年回顾性分析。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jfma.2024.08.004

Jeng-Wei Chen , Hsiu-Wen Liang , Bo-Wei Fong , Chih-Yang Chan , Heng-Wen Chou , Nai-Kuan Chou , Chih-Hsien Wang , Nai-Hsin Chi , I-Hui Wu , Shu-Chien Huang , Hsi-Yu Yu , Yih-Sharng Chen , Ron-Bin Hsu

Background

Current adult cardiac surgery guidelines recommend against the routine use of prophylactic intravenous corticosteroids during cardiopulmonary bypass (CPB) due to concerns about myocardial injury, despite their potential to reduce postoperative atrial fibrillation. Traditionally, a high dose of 1,000 mg of methylprednisolone was used to attenuate the inflammatory response associated with CPB. Our institution aligned with guideline recommendations and gradually reduced methylprednisolone dosages; thus, we reevaluated the impact on postoperative clinical outcomes.

Methods

Our study reviewed 1341 cases from a total of 1680 adult cardiac surgeries performed between June 2019 and May 2022 after excluding cases with off-pump procedures, ventricular assist device implantations, heart transplants, and aortic surgeries requiring systemic circulatory arrest. The study timely sorted periods including a baseline data from 2018, and other three periods since 2019 to analyze the effects of three different methylprednisolone dosage: 0 mg, 500 mg, and 1000 mg. We assessed the annual trends in methylprednisolone administration and compared morbidity and mortality rates across the groups.

Results

We observed a significant decline in steroid use, with no-steroid surgeries increasing from 23% to 66.5% by period 3. Despite the decreased use of steroids, our study showed no increase in mortality, new-onset atrial fibrillation, acute kidney injury, cerebrovascular event and prolonged ventilation when compared to baseline data. Notably, less surgical site infection rate was observed in the no-steroid group.

Conclusion

The data indicates that a reduction or discontinuation of steroids during CPB can be performed without compromising patient outcomes. This could support a transition towards a more conservative use of steroids in adult cardiac surgery, aligning with current guidelines, and potentially reducing certain postoperative complications.

背景：尽管皮质类固醇可减少术后心房颤动，但由于担心心肌损伤，目前的成人心脏手术指南建议在心肺旁路术（CPB）期间不要常规使用预防性静脉注射皮质类固醇。传统上，使用 1000 毫克的大剂量甲基强的松龙来减轻 CPB 引起的炎症反应。我院根据指南建议，逐步减少了甲基强的松龙的剂量；因此，我们重新评估了其对术后临床结果的影响：我们的研究回顾了 2019 年 6 月至 2022 年 5 月期间进行的共计 1680 例成人心脏手术中的 1341 个病例，排除了非泵手术、心室辅助装置植入、心脏移植和需要全身循环停止的主动脉手术病例。该研究及时对2018年的基线数据和2019年以来的其他三个时间段进行了分类，以分析三种不同甲泼尼龙剂量的效果：0毫克、500毫克和1000毫克。我们评估了甲基强的松龙用量的年度趋势，并比较了各组的发病率和死亡率：结果：我们观察到类固醇用量明显下降，到第 3 期时，无类固醇手术从 23% 增加到 66.5%。尽管类固醇的使用有所减少，但与基线数据相比，我们的研究显示死亡率、新发心房颤动、急性肾损伤、脑血管事件和通气时间延长的情况没有增加。值得注意的是，无类固醇组的手术部位感染率较低：数据表明，在 CPB 期间减少或停用类固醇不会影响患者的预后。这有助于在成人心脏手术中更保守地使用类固醇，与现行指南保持一致，并有可能减少某些术后并发症。

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引用次数: 0

Reply to “Coffee and tea consumption and dementia risk: The role of sex and vascular comorbidities” 对 "饮用咖啡和茶与痴呆症风险：性别和血管合并症的作用"。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jfma.2024.07.015

Kuan-Chu Hou, Yen-Ching Chen, Jen-Hau Chen

引用次数: 0

Direct oral anticoagulants for stroke prevention and risk of bleeding 用于预防中风和出血风险的直接口服抗凝剂。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jfma.2024.06.025

Tomoyuki Kawada

引用次数: 0

Reply to "Direct oral anticoagulants vs no oral anticoagulant in patients with atrial fibrillation and high bleeding risk" 心房颤动和高出血风险患者使用直接口服抗凝剂与不使用口服抗凝剂的对比。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jfma.2024.07.014

Wei-Tse Hung, Meng Lee

引用次数: 0

Concerns regarding the safety and efficacy of the LAmbre device in patients with large LAA orifice diameter LAmbre 装置在 LAA 孔径较大的患者中的安全性和有效性令人担忧。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jfma.2024.07.006

Yuan Huang, Qiang Su, Huabin Su, Lihua Yang

引用次数: 0

Guide for Authors

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/S0929-6646(25)00025-7

引用次数: 0

Impacts of COVID-19 pandemic on the collection and use of blood and blood components in Taiwan COVID-19 大流行对台湾血液和血液成分采集与使用的影响。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jfma.2024.03.017

Ling-I Hsu , Jen-Wei Chen , Sheng-Tang Wei , Sheng-Mou Hou

Background

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the supply and transfusion of blood components. This study aims to evaluate changes in blood collection and transfusions during the period following the nationwide Level 3 alert (May–July 2021).

Methods

We retrieved usage data for red blood cells (RBC) from the Taiwan National Health Insurance (NHI) database 2019–2021.

Results

During the Level 3 alert period, approximately 85% of COVID-19 cases (11,455/13,624) were in Taipei. In Taipei, blood collection declined by 26.34% and RBC transfusions decreased by 17.14% compared to pre-pandemic levels. RBC usage decreased across all service types, with a significant decrease observed in hematology/oncology by 15.62% (-483 patients, -2,425 units). In non-Taipei regions, blood collection declined by 12.54%, rebounding around one month earlier than in Taipei. The decline in RBC transfusions occurred one month later than in Taipei, with a much lower magnitude (4.57%). Strain on the blood supply occurred in May and June in both Taipei and non-Taipei regions. Among 7,532 hospitalized COVID-19 patients, approximately 6.9% patients required a total of 1,873 RBC transfusions. The rapid increase in COVID-19 inpatients did not significantly increase the burden of blood demands.

Conclusion

During the Level 3 alert, the most significant decline in both RBC collection and transfusions was observed in Taipei. In non-Taipei regions, the decrease in RBC use was only marginal. Notably, there was a significant decrease in RBC use in hematology/oncology in Taipei. This study supports transfusion specialists in seeking efficient ways to address similar future challenges.

背景：2019年冠状病毒病（COVID-19）大流行严重影响了血液成分的供应和输血。本研究旨在评估全国范围内三级预警后（2021 年 5 月至 7 月）采血和输血的变化情况：方法：我们从台湾国民健康保险（NHI）2019-2021年数据库中检索了红细胞（RBC）的使用数据：结果：在三级预警期间，约 85% 的 COVID-19 病例（11,455/13,624）发生在台北。与疫情流行前的水平相比，台北的采血量减少了 26.34%，红细胞输血量减少了 17.14%。所有服务类型的红细胞使用量都有所下降，其中血液/肿瘤科的红细胞使用量大幅下降了 15.62%（-483 名患者，-2425 单位）。在非台北地区，采血量下降了 12.54%，反弹时间比台北地区早一个月左右。红细胞输血量的下降比台北晚了一个月，但下降幅度（4.57%）要小得多。5 月和 6 月，台北和非台北地区都出现了血液供应紧张的情况。在 7,532 名住院的 COVID-19 患者中，约有 6.9% 的患者总共需要输 1,873 次红细胞。总结：在三级警报期间，台北地区的红细胞采集和输血量下降最为明显。在非台北地区，红细胞使用量的下降幅度很小。值得注意的是，台北血液科/肿瘤科的红细胞使用量明显减少。这项研究有助于输血专家寻求有效的方法来应对未来类似的挑战。

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引用次数: 0

Revisiting the surgical table: An analysis of surgical dose-response in Asian exotropia 重新审视手术台：亚洲外斜视的手术剂量反应分析。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jfma.2024.03.023

I-Wen Lai , Li-Li Wu , Yao-Lin Liu , Tzu-Hsun Tsai

Background

Previous research on the factors associated with surgical dose-response in strabismus surgery for exotropia has yielded inconsistent results. This study determined the factors influencing surgical dose-response in exotropia patients who underwent recession and resection (R&R).

Methods

Exotropia patients who underwent unilateral R&R at the National Taiwan University Hospital between 2006 and 2021 were evaluated. Deviation-angle differences in prism diopters (PD) were measured preoperatively and at 1 month postoperatively. Surgical dose-response (PD/mm) was defined as the difference in deviation angle (in PD) divided by the surgical dose in millimeters. Linear and non-linear regression models were used to evaluate the influence of variables including age, sex, axial length, and preoperative deviation on surgical dose-response.

Results

Overall, 295 patients (162 children; 133 adults) were included. Average surgical dose-response in the pediatric and adult groups was 2.82 ± 0.60 PD/mm and 3.02 ± 0.62 PD/mm, respectively. Male sex was negatively correlated with surgical dose-response in children. The surgical dose-response was larger in adults with longer axial length (>25.64 mm) and patients with larger preoperative deviation (>42.6 PD and >38.7 PD in pediatric and adult groups, respectively). Surgical dose-responses peaked at 35.1 years.

Conclusion

Age, axial length, and preoperative deviation have a nonlinear effect on surgical dose-responses in exotropia patients undergoing R&R. Surgical dose-responses were larger in patients in young adulthood, with longer axial length and larger preoperative deviation angle. A table with fitted values for surgical dose-response based on age, axial length, and preoperative deviation was established for clinical reference.

背景：以往对斜视手术治疗外斜视的手术剂量反应相关因素的研究结果并不一致。本研究确定了外斜视患者接受眼球后缩与切除术（R&R）的手术剂量反应的影响因素：方法：对 2006 年至 2021 年期间在台湾大学医院接受单侧 R&R 的外斜视患者进行评估。术前和术后 1 个月测量棱镜屈光度（PD）的偏差-角度差异。手术剂量-反应（PD/mm）定义为偏斜角度差（PD）除以手术剂量（mm）。线性和非线性回归模型用于评估年龄、性别、轴向长度和术前偏差等变量对手术剂量反应的影响：共纳入 295 名患者（162 名儿童；133 名成人）。儿童组和成人组的平均手术剂量反应分别为 2.82 ± 0.60 PD/mm 和 3.02 ± 0.62 PD/mm。男性性别与儿童的手术剂量反应呈负相关。轴长较长（>25.64 mm）的成人和术前偏差较大（儿童组和成人组分别>42.6 PD和>38.7 PD）的患者的手术剂量反应较大。手术剂量反应在 35.1 岁时达到峰值：结论：年龄、轴向长度和术前偏差对接受R&R的外斜视患者的手术剂量反应有非线性影响。年龄越小、轴向长度越长、术前偏斜角度越大的患者手术剂量反应越大。根据年龄、轴向长度和术前偏差建立了手术剂量反应拟合值表，供临床参考。

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引用次数: 0

Clinical characteristics and outcomes of children with COVID-19 in pediatric intensive care units during the Omicron wave in Taiwan 台湾 "奥米克浪潮 "期间，儿科重症监护室中 COVID-19 患儿的临床特征和预后。

IF 2.6 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Formosan Medical Association

Pub Date : 2025-02-01 DOI: 10.1016/j.jfma.2024.07.025

Jeng-Hung Wu , Ching-Chia Wang , Frank Leigh Lu , Shu-Chien Huang , Ting-Yu Yen , Chun-Yi Lu , Luan-Yin Chang , En-Ting Wu

Background

Since April 2022, the SARS-CoV-2 Omicron variant has caused a notable increase in pediatric COVID-19 cases in Taiwan. During the acute phase of infection, some children required admissions to pediatric intensive care units (PICU). This study aimed to analyze their clinical presentations and outcomes while exploring associated factors.

Methods

Medical records were retrospectively collected from patients with COVID-19 (aged <18 years) admitted to our PICU from April 2022–March 2023. Early stage is defined as the period without adequate vaccination and treatment guidelines for children from April–June 2022, and the remaining months are referred to as late stage. Clinical characteristics and outcomes were compared between patients in early and late stages.

Results

We enrolled 78 children with COVID-19, with a median length of stay (LOS) in PICU of 3 days and a 5% mortality rate. Patients admitted during the early stage had lower vaccination rates (7% vs. 50%), higher pediatric logistic organ dysfunction scores (2 vs. 0.1), and longer LOS in the PICU (6 vs. 2 days) than those admitted during the late stage. Multivariate analysis identified admission during the early stage as a risk factor for prolonged LOS (>7 days) in the PICU (odds ratio: 3.65, p = 0.047).

Conclusion

Without available vaccinations and suitable treatment guidelines, children with COVID-19 tended to have more severe illness and prolonged LOS in the PICU. These observations highlight the importance of vaccinations and familiarity of medical providers with adequate management of this newly-emerging infectious disease.

背景：自 2022 年 4 月以来，SARS-CoV-2 Omicron 变体导致台湾小儿 COVID-19 病例显著增加。在感染的急性期，一些儿童需要入住儿科重症监护病房（PICU）。本研究旨在分析他们的临床表现和结果，同时探讨相关因素：方法：回顾性收集 COVID-19 患者的病历（年龄：岁）：我们共收治了 78 名 COVID-19 儿童，他们在 PICU 的中位住院时间（LOS）为 3 天，死亡率为 5%。与晚期入院的患者相比，早期入院的患者疫苗接种率较低（7% 对 50%），儿科逻辑器官功能障碍评分较高（2 分对 0.1 分），在 PICU 的住院时间较长（6 天对 2 天）。多变量分析表明，早期入院是延长 PICU 住院时间（>7 天）的风险因素（几率比：3.65，P = 0.047）：结论：在没有疫苗接种和适当治疗指南的情况下，COVID-19患儿的病情往往更严重，在PICU的住院时间也更长。这些观察结果凸显了接种疫苗和医疗服务提供者熟悉如何妥善处理这种新发传染病的重要性。

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