Tzu Chi Medical Journal最新文献

Concussion, one of the most common types of mild traumatic brain injury, remains a global problem that poses substantial effects on individuals, families, and society. When dealing with concussion, clinicians primarily focus on symptomatic treatment and modified activity with no established therapies specifically addressing the underlying pathophysiological changes. In recent years, there has been a growing increase in attention to the effectiveness of dietary supplements (DS) and nutritional interventions as adjunctive therapy options for concussion. Hence, this review aims to comprehensively explore the existing human studies on using DS as adjunctive therapy in the management of concussion. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The search strategy was created based on the population, intervention, comparison, outcome framework. The findings are conveyed narratively and analyzed according to the timing of the intervention. DS administered within 7 days of onset were classified as acute interventions, while those given after this period were classified as nonacute interventions. After screening, we identified 21 reports for 19 studies involving 13 DS. Thirteen DS were included in this review. Notably, omega-3 polyunsaturated fatty acids were the most extensively studied and accounted for 23.81% of studies, followed by melatonin and pine bark extract (19.05% and 9.5%). At least 13 supplements were identified in clinical studies, with 77% demonstrating favorable outcomes. However, none of the interventions reviewed offer strong enough evidence to justify regular use in clinical practice.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have convincingly demonstrated efficacy in reducing cardiovascular (CV) and renal complications in patients with diabetes mellitus, chronic kidney disease, and heart failure. However, their use is also linked to the concern of some adverse events, the most common being genital and urinary tract infections (UTIs). This review summarizes the risks of genital and UTIs of SGLT2 inhibitors across large-scale clinical trials, meta-analyses, and real-world cohort studies. SGLT2 inhibitors are shown to significantly increase the risk of genital infections in clinical trials and real-world observational studies and marginally increase the risk of UTI in meta-analyses. We also discuss the potential pathogenesis of SGLT2 inhibitor-related infections and identify the susceptible risk factors. Since most genital and UTIs associated with SGLT2 inhibitors are mild and treatable and severe infections are rare, the use of SGLT2 inhibitors is highly recommended in patients who meet the inclusion criteria of clinical trials, where the CV and renal benefits outweigh the infection risks. For all users of SGLT2 inhibitors, preventive strategies, patient education, and careful monitoring are essential to minimize the infection risks. Furthermore, we address an unmet need regarding SGLT2 inhibitors among vulnerable populations, such as older adults, frail, and immunocompromised patients, underscoring the importance of observational studies from the real-world data. Future research should focus on identifying the high-risk groups, developing SGLT2 inhibitors with a lower infection profile and establishing effective prevention strategies to mitigate the risk of genital and UTIs associated with these medications.

Objectives: The recent global coronavirus disease 2019 (COVID-19) pandemic, resulting from infection by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), can cause severe and fatal pneumonia along with other life-threatening complications.

Materials and methods: The rare and limited accessibility of approved therapeutic agents or vaccines is of great distress. Swiftly working on designing and identifying inhibitors against all possible viral key protein targets, seven key SARS-CoV-2 viral enzymes were selected as targets, particularly in the action on the virus-entry, viral replication, and immune evasion of COVID-19. Papain-like protease, main protease, RNA-dependent RNA polymerase, endoribonuclease (nsp15), receptor-binding domain-angiotensin-converting enzyme 2, transmembrane serine protease 2 (TMPRSS2), and 2'- O-ribose methyltransferase (2'MTase), which were subjected to an unbiased in silico screening against 22 small molecules originating from Garcinia linii concomitantly with Remdesivir, Nirmatrelvir, and Molnupiravir were approved by Food and Drug Administration as repurposing drugs against SARS-CoV-2 invasion.

Results: The in silico results showed that natural bioactive compounds containing α-Tocopheryolquinone, 6β-Hydroxystigmast-4-en-3-one, Squalene, Rutin and Quercetin have a high binding affinity with seven selected viral protein targets concurrently with the preference of absorption, distribution, metabolism, excretion, and toxicity and drug-likeness.

Conclusion: This study provides potential phytoactive compounds from G. linii through multi-target screen with molecular dynamic simulation for combating COVID-19 pandemics that need further experimental validation to confirm the prospective efficacy.

Objectives: We retrospectively investigated whether the habit of posttoilet rinsing as a hygiene method is a predisposing factor for prolonged pyuria and extended antibiotic use in females with uncomplicated acute cystitis as well as analyzed the clinical characteristics.

Materials and methods: Adult female patients with urinary tract infections (UTIs) were retrospectively reviewed between October 2021 and September 2022 at a regional hospital in Taiwan. Patients with uncomplicated acute cystitis were included. Exclusion criteria included patients younger than 18 years of age, those with vaginal discharge or irritation, fever, functional or anatomical abnormalities of the genitourinary tract, an indwelling urinary catheter, hormone replacement therapy, pregnancy, or other complicated UTIs. The collected information included age, self-reported comorbidities, habits of posttoilet rinsing as a hygiene method, antibiotic use, urine analysis, and pathogens obtained in urine cultures.

Results: In total, 823 women with UTI were identified. Of these, 133 were diagnosed with uncomplicated acute cystitis. Further, 35 patients had the habit of posttoilet rinsing (habit group; mean age, 60.54 ± 15.97 years). The control group included 98 patients without this habit (mean age, 53.26 ± 17.18 years) (P = 0.03). The percentage of cases wherein cystitis resolved within 1 week was significantly higher in the control group (61.86%) compared to that in the habit group (25.71%, P = 0.0002). The urine culture positivity rate between the control and habit groups was not significantly different (57.14% vs. 40.0%, P = 0.0812). The posttoilet rinsing habit was the only predictor of prolonged cystitis and antibiotic use in both univariable and multivariable analyses.

Conclusion: These results suggest that the habit of posttoilet rinsing may prolong the duration of uncomplicated acute cystitis.

Endothelial cells regulate vascular tone, blood flow, coagulation, and inflammation, with heterogeneous populations serving specific roles throughout the body. In the kidney, endothelial cells maintain vascular integrity and function, contribute to filtration, and support other renal structures. Nitric oxide (NO) is a key signaling molecule that maintains vascular tone and endothelial function. It is synthesized by nitric oxide synthase (NOS) isoforms, with endothelial NOS playing a central role in vascular health. Chronic kidney disease (CKD) is characterized by reduced NO bioavailability, driven by the accumulation of endogenous NOS inhibitors such as asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). Uremic toxins, oxidative stress, and proinflammatory cytokines contribute to a prothrombotic and proinflammatory state, contributing to endothelial dysfunction and exacerbating cardiovascular (CV) risks in CKD. Biomarkers such as ADMA, SDMA, endothelial microparticles, and soluble adhesion molecules offer insights into vascular health, while invasive or noninvasive diagnostic techniques can assess endothelial function in CKD. Effective management strategies focus on enhancing NO bioavailability, controlling oxidative stress, reducing inflammation, and optimizing dialysis to minimize uremic toxin levels. Emerging therapeutic approaches, including antioxidant therapies and endothelial progenitor cell-based interventions, show promise in preserving vascular function. A multifaceted approach to managing endothelial dysfunction is critical for mitigating CV complications and improving patient outcomes in CKD.

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.