Tzu Chi Medical Journal最新文献

Objectives: We aimed to explore 1-year clinical and imaging outcomes among different age groups of women undergoing pelvic organ prolapse (POP) surgeries.

Materials and methods: We retrospectively analyzed a cohort of women undergoing primary POP surgeries. All women received preoperative as well as 12-month postoperative assessments: clinical interview, pelvic exam, and introital four-dimensional ultrasound. Women should be independent in everyday living and low-risk on preoperative assessments to be eligible for surgeries. The primary outcome was composite POP outcomes comprising lump sensation, item 3 of the short version of the Pelvic Floor Distress Inventory, and points Ba, C, and Bp on POP Quantification classification system. The secondary outcomes were postoperative adverse occurrences, symptoms of stress urinary incontinence, overactive bladder, and voiding difficulty, as well as ultrasound findings. To control potential confounders in exploring the composite outcome, we adopted a linear regression to model the dependent measure.

Results: There were 23, 90, 268, 100, and 41 women aged <51, 51-60, 61-70, 71-80, and >80 years, respectively. One-year composite outcome and postoperative adverse occurrences were comparable among five age groups. Women of all ages achieved significant improvements in subjective and objective outcomes after surgeries.

Conclusion: Senior women who are independent in everyday living and low in surgical risk could acquire equivalent surgical benefits compared with younger women.

Objectives: TriNetX is a global network of deidentified electronic health record data that participating healthcare institutions can access and analyze. Despite its potential to build research capacity, the research produced using this network has not yet been independently analyzed. This study aims to characterize the research outputs produced by Taiwan-affiliated authors analyzing TriNetX data.

Materials and methods: A systematic search was performed to identify peer-reviewed Science Citation Index Expanded indexed publications with Taiwan-affiliated authors. The articles were screened and included if they were based on an analysis of data from the TriNetX platform. A bibliometric analysis was then performed to examine the composition of authorship teams, collaborations between countries/institutions, the medical specialties present, and the rankings of journals that published the articles.

Results: Ninety-two studies with Taiwan affiliations using TriNetX were identified and included. An exponential increase in publications between 2022 and 2024 was identified. 75 (81.52%) of the articles were published in Q1 journals. Most medical specialties were represented in the dataset, with many Allergy, Immunology, and Rheumatology publications present. Chung Shan Medical University Hospital and Chi Mei Medical Center were identified as influential institutions that accounted for most of the publications.

Conclusion: TriNetX is used regularly by Taiwan-based clinical researchers to conduct impactful research across a variety of medical specialties. The platform will play an increasingly important role in Taiwan's medical research. Further studies examining how TriNetX is utilized before publication are needed to better understand how the network influences research capacity building in Taiwan hospitals.

Objectives: Pancreatic stone protein (PSP) has been identified as an indicator of systemic stress and is elevated in individuals diagnosed with type 2 diabetes mellitus (T2DM), potentially serving as a prognostic marker for both the onset and progression of the disease.

Materials and methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Articles were sourced from MEDLINE, ProQuest, Science Direct, Google Scholar, and Cochrane Library electronic databases. Studies included are all observational studies examining PSP/Reg1α serum levels in patients with T2DM. The quality of the study was evaluated using the Newcastle-Ottawa Scale, as well as Review Manager 5.4 to perform the meta-analysis.

Results: Seven studies met the criteria for inclusion. Pooled analysis revealed significant differences in PSP values between T2DM individuals and healthy controls (standardized mean difference [SMD] = 2.14, 95% confidence interval CI: 1.05-1.92, P < 0.00001). Further subgroup analysis showed PSP was substantially higher in T2DM with complications (SMD = -1.57, 95% CI: -2.12 to -1.02, P < 0.00001) compared to T2DM without complications (SMD = -1.39, 95% CI: -2.17 to - 0.61) and newly diagnosed T2DM (SMD = -1.85, 95% CI: -2.96 to -0.74). Grading of Recommendations, Assessment, Development, and Evaluations demonstrated moderate quality of evidence.

Conclusion: Our analysis revealed a progressive elevation in PSP values concomitant with the worsening T2DM disease state across the entire spectrum. PSP exhibits promising potential as a biomarker for predicting both disease initiation and subsequent clinical course.

Cardiac computed tomography (CT) has evolved significantly as a critical tool in diagnosing and managing cardiac diseases, greatly facilitated by technological advancements in multidetector systems, dose-reduction techniques, and sophisticated imaging algorithms. This article discusses the historical progression and technological evolution in cardiac CT (CCT), focusing on the impact of 64-multidetector row CT and dual-energy CT systems on improving spatial and temporal resolutions and reducing radiation exposure. It explores the role of these technologies in enhancing diagnostic accuracy, such as through detailed three-dimensional reconstructions and minimized imaging artifacts. Furthermore, it highlights the integration of machine learning to automate complex imaging analysis and photon-counting CT, which promises higher resolution and further dose reduction. Prospective studies and ongoing trials such as FASTTRACK coronary artery bypass grafting also underscore the potential of advanced CT technologies in refining procedural planning and execution. The continuous advancements in detector technology, computational techniques, and image reconstruction are poised to expand the applications and efficacy of CCT, cementing its role in modern cardiology.

Narrative medicine is an approach centered on patients' experiences and their illness stories. Its application in pediatric population warrants further research. This study aims to overview (1) the application of narrative medicine in pediatric medical education and (2) the implementation of narrative medicine in pediatric patient care. Searches were conducted in bibliographic databases (Cochrane Library, ClinicalTrials.gov, EBSCOhost, Embase, MedEdPORTAL, Ovid, PubMed, and Web of Science) without date or language restrictions. Researchers independently screened articles, charted data, and performed data synthesis. Educational intervention studies were evaluated with Kirkpatrick Scale, and Mixed Methods Appraisal Tool was used for methodological quality assessment of all studies. Forty-one articles met our criteria: 17 focused on the application of narrative medicine in pediatric medical education and 24 on its implementation in pediatric patient care. Educational interventions indicated general satisfaction, with reported improvements in empathy, reflection, patient understanding, and professional development. In patient care settings, narrative medicine provided a safe space for story sharing, enhancing emotional, relational, and social connections, and promoting patient- and family-centered care. This review highlights the translation of narrative medicine from educational interventions to clinical practice in pediatric settings. Although more robust research is required, existing evidence supports narrative medicine's potential to foster authentic engagement with patients and caregivers and enhance the quality of pediatric care across various conditions and developmental stages.

Nonalcoholic fatty liver disease (NAFLD), first named in 1980, is currently the most common chronic liver disease, imposing significant health, social, and economic burdens. However, it is defined as a diagnosis of exclusion, lacking a clear underlying cause in its diagnostic criteria. In 2020, metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed as a replacement for NAFLD, introducing additional criteria related to metabolic dysfunction. In 2023, metabolic dysfunction-associated steatotic liver disease (MASLD) was suggested to replace NAFLD, aiming to avoid the stigmatizing term "fatty" and incorporating cardiometabolic criteria for metabolic dysfunction. This divergence in nomenclature and diagnostic criteria between MAFLD and MASLD presents challenges to medical communication and progress. This review outlines the pros and cons of both terminologies, based on current research evidence, in the hope of fostering global consensus in the future.

The most common STD that triggers cervical cancer is the human papillomavirus. More than 20 types of human papillomavirus (HPV) can induce uterine cervical cancer. Almost all women acquire genital HPV infection soon after their first intercourse, with most of them clearing the virus within 3 years. An immune response is necessary to clear. The first responders to HPV infection are the innate immune system elements composed of macrophages, keratinocytes, natural killer cells, and natural killer T-lymphocytic (NKT) cells. Cytotoxic T lymphocytes (CTLs) comprise the second line of defense and kill HPV16-infected cells expressing various peptides derived from their transforming early viral oncoproteins, mainly E2•E6. Even though HPV can manage to trick away our immune systems, first of all, it is important to emphasize that HPV replication does not kill the host cells. It does not replicate viral antigens or cause inflammation. The HPV16 E6 and E7 genes suppress host cell type 1 interferons (IFNs), which are detectable after infection. The patient may have immunological tolerance; hence, there are no costimulatory signals from inflammatory cytokines like IFNs during antigen recognition. Evidence shows that HlA class I generations have been inhibited by HPV16 E5, which could protect this tumor cell from CTL attack. HPV16 E7 is responsible for initiating immunotolerance and increasing regulatory T cells (Treg) to repress immunological regression. Evasion from immune system protection plays a critical role in the outcome of persistent HPV infection and the development of cervical cancer. Vaccination against HPV16 and 18 during adolescence is the most effective method for preventing cervical cancer in women, considering the immunological processes involved.

Objectives: In Taiwan, acute ischemic stroke (AIS) with large vessel occlusion (LVO) remains a significant health concern. Reperfusion therapy is more effective if the patient arrives at the medical center within the early time window, emphasizing the importance of prehospital stroke assessment to identify LVO and rapid transfer. This study focused on Eastern Taiwan, where the Hualien Tzu Chi Hospital is the sole comprehensive stroke center. We compared different prehospital stroke assessment scales in identifying LVO.

Materials and methods: We reviewed 598 patients with acute stroke admitted to our hospital's emergency department between April 1, 2021, and March 31, 2022. Of these, 110 AIS cases presenting within 6 h of symptom onset were retrospectively analyzed using the medical records and National Institute of Health Stroke Scale (NIHSS) scores to evaluate the efficacies of prehospital stroke scales, including our institution's Tzu Chi Stroke Severity Scale and its modified version. LVO was defined as occlusion of the anterior cerebral artery, middle cerebral artery, and its main branches, intracranial carotid arteries, and vertebrobasilar arteries.

Results: Among 110 patients, 39.1% had LVO, which showed a higher mortality rate and prevalence of atrial fibrillation. LVO had higher NIHSS scores and longer hospital stays. The Vision Aphasia Neglect (VAN) Scale and Modified Tzu Chi Stroke Severity Scale showed the highest sensitivity, with the latter also exhibiting the highest sensitivity for posterior circulation LVO.

Conclusion: The VAN and the modified Tzu Chi Stroke Severity Scale offer comparable sensitivity for detecting LVO in the prehospital setting. Our study supports the adoption of the modified Tzu Chi scale in the regional emergency medical service transfer algorithm for LVO detection for timely intervention.