Tzu Chi Medical Journal最新文献

Radiotherapy (RT) is one of the primary treatment modalities in managing cancer patients. Recently, combined RT and immunotherapy (IT) (i.e., radio-IT [RIT]) have been aggressively investigated in managing cancer patients. However, several issues in conducting RIT are challenging, such as incorporating advanced irradiation techniques, predictive/prognostic biomarkers, and other treatment modalities. Several clinical efforts and novel biomarkers have been introduced and developed to solve these challenges. For example, stereotactic radiosurgery/stereotactic radiotherapy, stereotactic body radiotherapy/stereotactic ablative body radiotherapy, and FLASH-RT have been applied for delivering precise irradiation to lung and liver tumors in conjunction with IT. Besides, several novel IT agents and incorporations of other therapies, such as targeted and thermal therapies, have been further investigated. The present study reviewed the emerging challenges of RIT in modern oncology. We also evaluated clinical practice, bench research, and multimodality treatments. In addition to several clinically applicable biomarkers, we emphasize the roles of advanced irradiation techniques and epigenetic modification as predictive/prognostic biomarkers and potential therapeutic targets. For example, 6(m) A-based epigenetic agents demonstrate the potential to enhance the treatment effects of RIT. However, further prospective randomized trials should be conducted to confirm their roles.

Cardiovascular diseases (CVDs) are major contributors to illness and death globally. Body mass index (BMI) is a well-established prognostic factor on cardiovascular risk outcome. Numerous investigations have provided evidence for the existence of the obesity paradox after percutaneous coronary intervention (PCI). However, the association between BMI and the results following PCI has not been extensively investigated in Asian populations. The research aims to fill the current void in understanding by investigating the association between BMI and clinical consequences following PCI, with a particular focus on Asian individuals. A systematic search was conducted through PubMed, ScienceDirect, and Cochrane Library to identify studies examining the effect of BMI on clinical outcome after PCI in Asia. R Studio 4.3.2 software was used to carry out the analysis of the data. A total of 182,110 patients who had gone through PCI were found in the 5 included cohorts. A meta-analysis conducted on the subjects revealed that patients who were overweight (odds ratio [OR] = 0.60, 95% confidence interval [CI] [0.57, 0.63], P < 0.0001) had a lower risk of all-cause mortality compared to individuals with a healthy weight and patients with obesity (OR = 0.65, 95% CI [0.41, 1.05], P = 0.006) had a lower risk of all-cause mortality than healthy weight individuals. The study also found that overweight patients (OR = 0.60, 95% CI [0.39, 0.91], P = 0.02) had a lower risk of cardiac mortality. In addition, obese patients (OR = 0.41, 95% CI [0.19, 0.88], P = 0.02) had a lower risk of noncardiac mortality. However, the study found that there were no differences in major adverse cardiovascular event, myocardial infarction, and bleeding between all patient groups. This meta-analysis supports the presence of an obesity paradox after PCI in Asian populations. The obesity paradox was evident in all-cause mortality, cardiac mortality, and noncardiac mortality.

Currently, the second most commonly diagnosed cancer in the world is lung cancer, and 85% of cases are non-small cell lung cancer (NSCLC). With growing knowledge of oncogene drivers and cancer immunology, several novel therapeutics have emerged to improve the prognostic outcomes of NSCLC. However, treatment outcomes remain diverse, and an accurate tool to achieve precision medicine is an unmet need. Radiomics, a method of extracting medical imaging features, is promising for precision medicine. Among all radiomic tools, ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET)-based radiomics provides distinct information on glycolytic activity and heterogeneity. In this review, we collected relevant literature from PubMed and summarized the various applications of ¹⁸F-FDG PET-derived radiomics in improving the detection of metastasis, subtyping histopathologies, characterizing driver mutations, assessing treatment response, and evaluating survival outcomes of NSCLC. Furthermore, we reviewed the values of ¹⁸F-FDG PET-based deep learning. Finally, several challenges and caveats exist in the implementation of ¹⁸F-FDG PET-based radiomics for NSCLC. Implementing ¹⁸F-FDG PET-based radiomics in clinical practice is necessary to ensure reproducibility. Moreover, basic studies elucidating the underlying biological significance of ¹⁸F-FDG PET-based radiomics are lacking. Current inadequacies hamper immediate clinical adoption; however, radiomic studies are progressively addressing these issues. ¹⁸F-FDG PET-based radiomics remains an invaluable and indispensable aspect of precision medicine for NSCLC.

Objectives: The incidence of febrile nonhemolytic transfusion reactions (FNHTRs) is correlated with the level of cytokines released by donor leukocytes in blood bags during storage, which is the most common transfusion reaction. The study aimed to reveal whether the use of leukocyte-poor red blood cells (LPRBCs) can reduce the incidence of transfusion reactions to promote patient safety.

Materials and methods: From January 2014 to June 2022, 158,122 blood transfusion reports were collected from a medical center in Eastern Taiwan. Data were categorized into three groups according to usage: prepromotion use of LPRBCs (January 2014-April 2016), promotion use of LPRBCs (May 2016 to February 2018), and full utilization of LPRBCs (March 2018 to June 2022). According to the American Association of Blood Bank Common Transfusion Reaction Reporting Form version 2.0 reporting system, FNHTRs were classified as moderate transfusion reactions. We used these data to analyze the association between LPRBC use and transfusion reaction rate.

Results: At our hospital, the LPRBC usage rate from January 2014 to April 2016, May 2016 to February 2018, and March 2018 to June 2022 was 5.37%, 34.82%, and 56.45%, respectively. The total transfusion reaction rate from January 2014 to April 2016 was 1.66%, whereas the moderate reaction rate was 1.29%. The total transfusion and moderate reaction rates from May 2016 to February 2018 were 1.41% and 1.00%, whereas those from March 2018 to June 2022 were 0.95% and 0.63%, respectively. The total transfusion and moderate reaction rates from March 2018 to June 2022 decreased by 42.8% and 51.2%, respectively, compared with those from January 2014 to April 2016. We further compared the incidence of transfusion reactions caused by packed red blood cells (PRBC) and LPRBC products in different years. The results showed that between 2014 and 2022, the types of blood transfusion reaction caused using PRBC and LPRBC products are the mild transfusion reaction rate of 0.20%/0.20%, the moderate transfusion reaction rate of 1.61%/0.69%, the severe transfusion reaction rates 0.38%/0.16%, and the total transfusion reaction rates 2.19%/1.05%.

Conclusion: Our study results indicate that both total transfusion and moderate reaction rates significantly decreased with increasing LPRBC usage rate. Based on our data analysis, LPRBC is more effective in reducing moderate and severe transfusion reactions than PRBC.

Endoplasmic reticulum (ER) is a crucial organelle associated with cellular homeostasis. Accumulation of improperly folded proteins results in ER stress, accompanied by the reaction involving triggering unfolded protein response (UPR). The UPR is mediated through ER membrane-associated sensors, such as protein kinase-like ER kinase (PERK), inositol-requiring transmembrane kinase/endoribonuclease 1α, and activating transcription factor 6 (ATF6). Prolonged stress triggers cell apoptotic reaction, resulting in cell death. Neuronal cells are especially susceptible to protein misfolding. Notably, ER and UPR malfunctions are linked to many neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD), delineated by accumulation of misfolded proteins. Notably, ATF family members play key roles in AD and PD pathogenesis. However, the connection between ER stress, UPR, and neuropathology is not yet fully understood. Here, we discuss our present knowledge of the association between ER stress, the UPR, and neurodegeneration in AD and PD. We also discuss the roles of ATF family members in AD and PD pathogenesis. Moreover, we provide a mechanistic clarification of how disease-related molecules affect ER protein homeostasis and explore recent findings that connect the UPR to neuronal plasticity.

Schizophrenia (SCZ) is a chronic psychotic disorder that profoundly alters an individual's perception of reality, resulting in abnormal behavior, cognitive deficits, thought distortions, and disorientation in emotions. Many complicated factors can lead to SCZ, and investigations are ongoing to understand the neurobiological underpinnings of this condition. Presynaptic Netrin G1 and its cognate partner postsynaptic Netrin-G-Ligand-1 (NGL-1) have been implicated in SCZ. This review article emphasized the structure and expression of Netrin G1/NGL-1 in the brain, its dysregulation in SCZ patients, and its role in synaptic plasticity, synaptic interaction, learning and memory, microglia neurotrophic activity, and possible signaling between Netrin G1/NGL-1, postsynaptic density protein 95, and cyclin-dependent kinase-like 5 in synaptic morphogenesis. Pharmaceutical targets and the potential use of Netrin G1/NGL-1 as treatment targets or biomarkers for SCZ were also discussed.

Objective: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a minimally invasive technique. This study aimed to compare the safety of TOETVA with fibrin sealant (Tisseel) and TOETVA with drainage.

Materials and methods: Patients who underwent TOETVA between January 2018 and December 2021 were divided into drainage (n = 20) and Tisseel (n = 30) groups.

Results: The primary outcome was the incidence of complications. The secondary outcomes were operative time and postoperative pain. There were no significant differences in patient demographics, tumor size, intraoperative blood loss, and hospitalization days between the two groups. No patient required conversion to open thyroidectomy. The incidence of complications and postoperative pain was similar in the two groups. The operative time for TOETVA with Tisseel was significantly shorter than for TOETVA with drainage (P = 0.038).

Conclusion: TOETVA with Tisseel is a safe alternative to TOETVA with drainage, having a short operative time.

Objectives: Endovascular coiling is a minimally invasive method to manage intracranial aneurysms. However, patients who undergo stent-assisted coiling (SAC) for acutely ruptured intracranial aneurysms need dual antiplatelet treatment. We reported our experience and outcomes of SAC for ruptured intracranial aneurysm.

Materials and methods: We retrospectively collected data on procedure-related complications, rates of aneurysm rebleeding and recurrence, and clinical outcomes of patients with ruptured aneurysms managed by SAC over 2 years.

Results: Among the 17 patients included in this study, there were 14 (82.4%) women and 3 (17.6%) men, with a mean age of 58.59 years (standard deviation = 13.57; range: 40-82 years). There were no periprocedural hemorrhagic complications and no aneurysm rebleeding before discharge. However, two patients developed acute brain infarction because of symptomatic vasospasm. Linear regression revealed significant associations of posterior circulation involvement with the Glasgow Outcome Score and modified Rankin Scale (mRS) at discharge and 6 months after. Besides, Hunt and Hess grade ≥3 has a significant association with mRS at discharge, 6 months, and 1 year after.

Conclusion: SAC for ruptured aneurysm was technically feasible and did not carry an additional risk of postoperative aneurysm rebleeding secondary to antiplatelet treatment. Moreover, it had relatively low rates of aneurysm regrowth and coil compaction. Therefore, it can be a safe and effective endovascular treatment for acutely ruptured intracranial aneurysm.

Nocturia is defined as the nocturnal frequency of one or more voiding episodes per night. It increases with aging and has an impact on sleep quality and the risks of falling and mortality. Nocturia disorder involves nighttime frequency, nocturnal polyuria, and nocturnal enuresis. In older adults with nocturia disorder, multiple factors could contribute to nocturia severity and characteristics, including poor sleep quality, lower urinary tract dysfunction, and excessive fluid output. Several nonurological medical diseases have been found to result in nocturia, such as hypertension, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, metabolic syndrome, and diabetes. Urological and medical assessments should be performed to diagnose nocturia disorder. A frequency volume chart to evaluate the nocturnal polyuria index, functional bladder capacity, and urodynamic study can reveal the presence of nocturnal polyuria and lower urinary tract dysfunction. Treatment should be based on multiple nocturia etiologies, and a combination of multiple therapies for individual pathophysiology will achieve a better treatment outcome.

Periprosthetic joint infection (PJI) is a significant issue in orthopedic surgery. Urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB) have been identified as potential causes of PJI; however, evidence is inconclusive. Understanding these relationships is critical for improving therapy and patient outcomes. A systematic review was performed by conducting searches from PubMed, EBSCO, ProQuest, and manual searching with adherence to the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 guideline. Studies that reported UTI/ASB and PJI were included. Meta-analysis was conducted using a random-effects model using RevMan 5.4 software. A total of 14 studies were included with UTIs and ASB showed an overall association with increased risk of PJI (odds ratio [OR]: 1.84, 95% confidence interval [CI]: 1.14-2.99, P = 0.01). However, subgroup analysis for UTIs and ASB was not significant. Further analysis of UTIs in total hip arthroplasty (THA) surgery showed a significant association (OR: 1.76, 95% CI: 1.57-1.96) with PJI. Preoperative UTIs timing between 0 and 2 weeks before surgery showed an increased risk of PJI (OR: 1.45, 95% CI: 1.35-1.55). Antibiotic treatment in ASB did not significantly impact PJI rates. Urine and PJI sample cultures in four studies showed no correlation of microorganisms between the two sites. According to recent evidence, a statistically significant association was found between UTIs and PJI in patients who underwent THA surgery. However, ASB did not yield significant results in relation to PJI. These results should be supported by larger and well-designed studies to make proper clinical suggestion in future. For further research, it is recommended to adopt standardized criteria for outcome measurement and to involve larger sample sizes to enhance the reliability and generalizability of findings.