Tzu Chi Medical Journal最新文献

Objectives: The bladder and urethra work as a physiologically functional unit to facilitate continence in the storage and voiding phase. Sex differences have been found in the urethral contraction in response to α-adrenergic receptor activation. This study aimed to investigate the role of adrenergic receptors in the proximal urethra of male and female mice.

Materials and methods: Urinary bladder and proximal urethral smooth muscle (USM) samples from male and female C57BL/6 mice were isolated and mounted in an organ bath.

Results: Acetylcholine-induced contraction of the urinary bladder was compared in male and female mice. Phenylephrine and norepinephrine (NE) induced little contraction at a lower concentration, but a relaxing phase of female proximal USM was observed at a higher concentration. This contraction profile was inhibited by N^G-nitro-L-arginine, lidocaine, and capsaicin. In addition, the NE-induced contraction was greater in the incubation of propranolol than that of L-NNA or lidocaine. These results suggested that the β-adrenoceptor may be the dominant receptor of female proximal USM, and the activity of calcitonin gene-related peptide sensory nerves and nitrergic nerves may pose an anti-contraction effect on the proximal urethra in female mice.

Conclusion: β-adrenoceptor may be the dominant receptor of female proximal USM. The use of β-adrenergic receptor blocker agents might have the potential for the treatment of female voiding dysfunction.

Objectives: International guidelines for managing pressure injury (PI) and ulcers recommend that family members and caregivers should be involved in making decisions for appropriate wound care. However, the effect of shared decision-making (SDM) in the context of PI remains unknown. This study investigated the efficacy of nurse-led medical SDM for PI treatment.

Materials and methods: We constructed a patient decision aid (PDA) for PI treatment on the basis of nursing evidence. Subsequently, we conducted a pilot randomized controlled trial to evaluate the efficacy of SDM compared with that of usual care (control group, [CG]) for PI treatment. Participants with stage 3, stage 4, or unstageable PI were included and randomized into two groups. In the SDM group (SDMG), 10 participants received the SDM intervention for PI before treatment. All participants were followed up for 4 weeks. Primary outcomes were measured using the nine-item SDM Questionnaire (SDM-Q-9) and Decisional Conflict Scale (DCS). Secondary outcomes included wound size and cost of wound management.

Results: The expert validity (medical professors and general population) of the PDA designed for PI was measured, and the content validity index was 0.96-0.97. A total of 20 participants were enrolled (10 received SDM and 10 received usual care). The mean age of the participants was 55.7 ± 8.8 years. No significant difference in baseline characteristics (sex, age, staging, or wound area) was observed between the two groups. The SDMG had higher SDM-Q-9 (P < 0.001) and DCS (P < 0.01) scores than did the CG. For the secondary outcomes, the SDMG had a decreased change of wound size and lower wound management costs than did the CG; nevertheless, the differences were not statistically significant.

Conclusion: We constructed a PDA for PI treatment, which can be applied in clinical care. The pilot test results revealed that the participants had a lower cost related wound treatment and decreasing wound size in SDMG than CG after the intervention of SDM-PI for 4 weeks. In the future, clinical studies should conduct large-scale randomized trials based on the results of this pilot study.

Objectives: This study compared the risk of symptomatic recurrent disc herniation and clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) versus open lumbar microdiscectomy (OLM) for lumbar disc herniation with 2 years of follow-up.

Materials and methods: We analyzed 23 patients who underwent PELD and 32 patients who underwent OLM for lumbar disc herniation. The numeric rating scale of back and leg pain, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ) were assessed before and at 12 and 24 months after the surgery. The wound pain and complications were also recorded. Survival analysis was performed to estimate the risk of symptomatic recurrent disc herniation.

Results: In the comparison of groups, the reductions in back and leg pain, ODI, and RMDQ were not significantly different at 12 and 24 months. For patients who underwent PELD, the wound pain was significant lower at the day of surgery. The survival rate of patients who were free from symptomatic recurrent disc herniation at 24 months was 0.913 in PELD and 0.875 in OLM, and the log-rank test revealed no significant difference between the two survival curves. The incidence of complication was not significantly different between groups.

Conclusion: Both PELD and OLM are effective treatments for lumbar disc herniation because they have similar clinical outcomes. PELD provided patients with less painful wounds. The survival analysis revealed that the risk of symptomatic recurrent disc herniation in 2 years of follow-up was not different between PELD and OLM.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus behind the coronavirus disease 2019 (COVID-19) pandemic, is a type of RNA virus that is nonsegmented. Cardiovascular diseases (CVDs) increase the mortality risk of patients. In this review article, we overview the existing evidence regarding the potential mechanisms of myocardial damage in coronavirus disease 2019 (COVID-19) patients. Having a comprehensive knowledge of the cardiovascular damage caused by SARS-CoV-2 and its underlying mechanisms is essential for providing prompt and efficient treatment, ultimately leading to a reduction in mortality rates. Severe COVID-19 causes acute respiratory distress syndrome and shock in patients. In addition, awareness regarding COVID-19 cardiovascular manifestations has increased, including the adverse impact on prognosis with cardiovascular involvement. Angiotensin-converting enzyme 2 receptor may play a role in acute myocardial injury caused by SARS-CoV-2 infection. COVID-19 patients experiencing heart failure may have their condition exacerbated by various contributing factors and mechanisms. Increased oxygen demand, myocarditis, stress cardiomyopathy, elevated pulmonary pressures, and venous thrombosis are potential health issues. The combination of these factors may lead to COVID-19-related cardiogenic shock, resulting in acute systolic heart failure. Extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs) are treatment options when inotropic support fails for effective circulatory support. To ensure effective COVID-19-related cardiovascular disease (CVD) surveillance, it is crucial to closely monitor the future host adaptation, viral evolution, and transmissibility of SARS-CoV-2, given the virus's pandemic potential.

Objectives: Laparoscopic hepatectomy (LH) is still technically challenging for patients with previous nonhepatectomy abdominal surgery (AS). Therefore, this study aimed to assess the difficulty of performing LH for patients with hepatocellular carcinoma (HCC) and a history of nonhepatectomy AS during the initial developing period of LH.

Materials and methods: The retrospective study enrolled patients who were newly diagnosed with HCC receiving LH from January 2013 to June 2021. Demographic characteristics, perioperative variables, and surgical complications were prospectively collected.

Results: One hundred patients were reviewed consecutively, comprising 23 in the AS group and 77 in the non-AS group. No significant differences were observed in median IWATE score (5 vs. 5, P = 0.194), operative time (219 vs. 200 min, P = 0.609), blood loss (100.0 vs. 200.0 mL, P = 0.734), transfusion rate (4.3% vs. 10.4%, P = 0.374), duration of parenchyma transection (90.0 vs. 72.4 min, P = 0.673), and mean nonparenchymal transection time (191.0 vs. 125.0 min, P = 0.228), without increasing the conversion rate (0.0% vs. 3.9%, P = 0.336), postoperative complications (30.3% vs. 33.8%, P = 0.488), and postoperative hospital stay (6 vs. 7 days, P = 0.060) in AS group and non-AS groups.

Conclusion: History of previous nonhepatectomy AS can lead to longer nonparenchymal transection time instead of conversion and did not increase the difficulty. Prolonged nonparenchymal transection time did not increase the surgical complications, prolong the postoperative hospital stay, and compromise the survival outcomes.

Objectives: Anticoagulants have been used as therapeutic or prophylactic agents in COVID-19 and seem to be more beneficial. However, the advantage of oral anticoagulant (OAC) consumption before visit in lowering mortality in COVID-19 patients remains debatable. This meta-analysis aimed to evaluate the effect of OAC use before visit on mortality using the hazard ratio (HR) to estimate the effect of time-to-event endpoints.

Materials and methods: We conducted a literature search in the PubMed and ProQuest databases for any studies comparing groups consuming OAC to no-OAC before visit for mortality in patients with COVID-19. We calculated the overall HRs and their variances across the studies using the random-effects model to obtain pooled estimates.

Results: We included 12 studies which had sample sizes ranging from 70 to 459,402 patients. A meta-analysis comparing OAC therapy and non-OAC consumption in COVID-19 patients before visit revealed no decrease in all-cause mortality (HR = 0.92, 95% confidence interval [CI]: 0.83-1.02, P = 0.12; I² = 68%). However, subgroup analysis of laboratory-confirmed populations revealed that OAC use before visit had a beneficial effect on mortality (HR = 0.84, 95% CI: 0.73-0.98, P = 0.02; I² = 56%).

Conclusion: The use of OAC before visit had no beneficial effect on all-cause mortality in COVID-19 patients.

Objectives: This study retrospectively evaluated the effectiveness of percutaneous pulley release by our newly designed needle knife in terms of cure, relapse, and complication rates.

Materials and methods: Two hundred and fifty-seven patients were allocated into male and female groups between October 2014 and September 2021. We included patients >15 years of age with a trigger finger (TF) (types II-VI). The primary outcome was the absence of a TF and pain-free movement. In contrast, the secondary outcome included second-time surgery and the number of complications such as infection and admission for antibiotics.

Results: One hundred patients were male, and 157 patients were female. Males and females had mean ages of 62.45 ± 11.76 and 61.50 ± 8.57 years, respectively. The operative time was significantly longer in males than in females (7.88 ± 6.02 vs. 6.52 ± 3.74 min in males and females, respectively, P = 0.027). However, the percentages of diabetes mellitus and gout were the same in both groups. For the percutaneous methods with our needle knife, remission of the trigger was achieved in all cases. In addition, seven patients received revision and three patients with complications. After needle surgery, topical and joint pain scores were improved in both groups (from 5.09 ± 1.31 to 0.80 ± 1.56).

Conclusion: The percutaneous methods with our needle knife displayed effectiveness. The cure rate was high, and the relapse rate was low. Further large-scale clinical trials comparing percutaneous needle to open surgery for releasing the TF will be needed to confirm our results.

[This corrects the article on p. 286 in vol. 32.].

Spinal cord injury (SCI) is a severe central nervous system injury that can cause sensory or motor dysfunction. Although mortality rates for people with spinal cord injuries have dropped dramatically with advances in medicine, chronic long-term sequelae after SCI persist. The most bothersome problems reported by patients include pain, spasticity, urinary dysfunction, and loss of motor function. Thus, quality of life (QoL) is an essential issue in chronic SCI. Spinal cord stimulation (SCS) applies an adjustable, nondamaging electrical pulse that can reduce uncomfortable comorbidities and improve mobility, thus enhancing the QoL of patients with SCI. This review summarizes pivotal breakthroughs from SCS for individual clinical impairment from SCI. We conclude that careful evaluation of SCS can help improve neuropathic pain, spasms, motor symptoms, and voiding dysfunction in patients with SCI, thus improving QoL.

Key management schemes for hierarchical access control enable users who have hierarchical relationships with each other to manage their secret keys efficiently. In these schemes, the users are divided into several groups, and all groups have their own central authorities. Each central authority is responsible for setting parameters and generating user's secret keys in a hierarchical structure such that all users efficiently derive their secret keys and solve dynamic access control problems. Several key management schemes with Health Insurance Portability Accountability Act regulations were recently proposed for hierarchical access control in e-medicine systems. However, these schemes either are insecure or require a large amount of storage and heavy computations. Therefore, this study reviews and discusses hierarchical access control schemes with privacy/security regulations for medical record databases.