Tzu Chi Medical Journal最新文献

Objectives: Physical inactivity plays a major role in promoting disease outcome, but physical activity enhances effective prevention and treatment of chronic diseases; hence, this study was to determine the effect of anthropometric and demographic factors on the physical activity level of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) on antiretroviral therapy.

Materials and methods: This study adopted a cross-sectional method of descriptive research design. A sample size of 170 participants was recruited for this research comprising 113 females and 57 males, who after obtaining their informed consent were issued questionnaires which they meticulously filled under a proper guidance. The participants were almost proportionally distributed across the three levels of physical activity, though about half of them had a normal weight of body mass index (BMI) based on the information obtained.

Results: The study showed that physical activity according to age significantly affected the BMI (P < 0.05). Physical activity level according to gender had no statistically significant effect on BMI of people living with HIV/AIDS on antiretroviral drugs (P > 0.05). However, it was observed that gender had a significant determining effect on BMI, though not related to PAL.

Conclusions: The findings possibly imply that the psychological effect and the stigma may be the determining factors for the unwillingness to engage in physical activities. This calls for a renewed sensitization and orientation in this aspect.

Objectives: The objective of this study was to describe the surgical technique using an innovative nail-stem construct in treatment of periprosthetic humeral fractures with recalcitrant nonunion after total elbow arthroplasty (TEA).

Materials and methods: Patients diagnosed with humeral recalcitrant nonunion in periprosthetic fractures and stem loosening after TEA were retrospectively recruited between 2018 and 2019. The demographic data and related clinical outcomes were recorded. We use a cutting length of the nail pushing into the humeral canal and then pull back distally to dock the tip of the humeral stem. The cement was packed into the humeral canal, and the periprosthetic bone defect was impacting with harvested allograft chip.

Results: Patient age, gender, lesion site, number of previous surgeries, and the time period from the primary TEA to the nail-stem reconstruction were allocated. Moreover, the range of motion, degree of elbow stability, and level of pain were evaluated for each patient following this procedure. All the four patients achieved an optimal range of motion and secure stability with painless elbow at final follow-up.

Conclusion: Our proposed nail-stem construct with double allogenous bone plate is a feasible alternative for revisional TEA in patients with implant loosening, periprosthetic humeral fractures, and recalcitrant nonunion.

The incidence of urinary incontinence (UI) is approximately 10%-40% in women, affecting one to two hundred million women worldwide. Stress UI (SUI) is characterized by involuntary urination due to increased abdominal stress and urine leakage without bladder contraction. Surgical treatments include midurethral slings, bulking agents, and Burch colposuspension to restore urethral continence. Nevertheless, an optimal treatment for all types of incontinence has not yet been established. Stem-cell therapy has emerged as a novel treatment for many diseases. Stem cells can self-renew and can differentiate into other cell types. Adult stem cells are suitable for clinical applications because they can be easily obtained noninvasively or minimal invasively. Stem-cell therapy for SUI has been studied preclinically and clinically. Muscle-derived progenitors have been used to treat SUI by promoting the regeneration of rhabdomyosphincters. The human trial used transurethral injection of autologous muscle-derived stem cells to improve sphincter contractility and function. Other sources of stem cells have also been studied in SUI treatment, such as umbilical cord blood, amniotic fluid, bone marrow, urine, and adipose tissue. The success rate of stem-cell therapy for SUI ranges from 13% to 100%. This review aimed to summarize the current status of stem-cell treatments for SUI, with respect to clinical trials, cell types, transplantation routes, and dosage volume and frequency.

Objectives: This study aimed to investigate the association of sarcopenia among community-dwelling older adults with chronic conditions, lipid profiles, and cognitive ability measured by multiple assessment tools.

Materials and methods: This cross-sectional study involved 398 older adults aged 60 years and older who resided in Jakarta, Indonesia. The study participants were visited and interviewed by trained interviewers in the subdistrict office. Participants were clinically examined using a standardized protocol, which included the participants' medical history, general physical examination, cognitive assessment, and blood test for lipid profile. Sarcopenia was measured using three components that were muscle strength (measured by handgrip strength), physical performance (measured by 6-m walk speed), and appendicular skeletal mass (measured using bioelectrical impedance analysis). Association was tested using multivariate logistic regression and reported as an odds ratio.

Results: Sarcopenia was significantly associated with older age (adjusted odd ratio [AOR]: 2.91, 95% confidence interval [CI]: 1.22-3.95) and smoking (AOR: 6.53, 95% CI: 2.89-14.73). Global cognitive impairment, word list recall impairment, and olfactory dysfunction have 191% (95% CI: 1.28-6.66), 141% (95% CI: 1.12-5.2), and 100% (95% CI: 1.11-3.61) increase of odds of having sarcopenia, respectively.

Conclusion: Global cognitive impairment, word list recall impairment, and olfactory dysfunction could be the predictors of sarcopenia. Strategies and implementations directed more toward the improvement of cognitive impairment might improve or prevent sarcopenia. However, the exact causality between both variables still needs to be explored further.

Objectives: It is critical to quickly and easily identify coronavirus disease 2019 (COVID-19) patients who become severely or even critically ill. Thus, this study was conducted to determine the accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score in predicting the severity and mortality of COVID-19 patients.

Materials and methods: This was a prospective observational study of COVID-19 patients admitted to the emergency department (ED) between June 22, 2021, and November 21, 2021. The clinical characteristics of the participants were collected by the emergency physicians. The correlation of the qSOFA, Systemic Inflammatory Response Syndrome criteria (SIRS), Pneumonia Severity Index (PSI), and confusion, urea, respiratory rate, blood pressure, 65 years of age and older (CURB-65) scores for 14-day mortality were evaluated. The area under a receiver operating characteristic (AUROC) curve analysis was calculated to compare the effectiveness of qSOFA, SIRS, PSI, and CURB-65 to predict severe disease.

Results: Eight hundred and ninety-four subjects were included. Of them, 721 patients (80.6%) survived after 14 days of admission. The mean age was 58.92 ± 17.80 years, and 551 subjects (61.6%) were male. Nonsurvived patients were significantly older (51.09 ± 23.60 vs. 38.10 ± 18.24, P = 0.004) and had more comorbidities (diabetes mellitus, respiratory, cardiovascular, and cerebrovascular disease) in comparison with survived patients. For COVID-19 mortality prediction, the AUROCs of qSOFA, CURB-65, PSI, and SIRS score were 0.799 (95% confidence interval [CI 0.771-0.825]), 0.829 (95% CI [0.803-0.853]), 0.830 (95% CI [0.804-0.854]), and 0.759 (95% CI [0.730-0.787]), respectively. All scores were good predictors of COVID-19 mortality.

Conclusion: The qSOFA was more successful than SIRS in predicting mortality for COVID-19 patients and was similar to CURB-65 and PSI. Therefore, the qSOFA score can be considered a simple and rapid screening tool for identifying high-risk patients.

Traditional Chinese medicine (TCM) has the characteristics of multi-component, multi-target, and biological systems coordination, which meet the criteria of the network pharmacological application. Therefore, using network pharmacology to discover the relationship between TCM, diseases, and cellular responses is easily achievable. Aging-induced imbalanced homeostasis is a risk factor for Alzheimer's disease (AD), a neuronal disease regulated by multiple genes. Meta-analysis of TCM in metabolic regulation to improve symptoms of AD helps understand the pharmacological effects. The drug targets of TCM can be investigated using a holistic network pharmacology approach to find potential modulators involved in AD-related metabolic pathways. Based on the theoretical prediction of TCM for AD, experimental validation is needed to develop pure compounds for specific treatments.

Objectives: Osteocalcin, a protein from osteoblasts, affects bone mineralization and turnover. This study evaluates the association between fasting serum osteocalcin and bone mineral density (BMD) in renal transplant recipients.

Materials and methods: This study recruited 66 renal transplant recipients. We analyzed blood biochemistry studies from fasting blood samples. The serum osteocalcin levels were measured using a commercial enzyme immunoassay kit. We measure BMD by dual-energy X-ray absorptiometry in lumbar vertebrae (L2-L4). By the World Health Organization classification, we group recipients into three groups: normal, osteopenia, and osteoporosis.

Results: Of the renal transplant recipients, 8 patients (12.1%) were osteoporosis, and 28 patients (42.4%) were osteopenia. From normal to osteoporosis groups, the osteoporosis group has highest serum osteocalcin (P < 0.001), alkaline phosphatase (P = 0.005), lowest body mass index (P = 0.015), and body weight (P = 0.008). Females had lower lumbar BMD than males among recruited renal transplant recipients (P = 0.023). In the multivariate forward stepwise linear regression analysis, body weight (adjusted R² change = 0.138; P = 0.010), and logarithmically transformed osteocalcin (log-osteocalcin; adjusted R² change = 0.131; P = 0.012) can predict lumbar BMD in the renal transplant recipients.

Conclusion: Our study showed that fasting serum osteocalcin concentration was negatively correlated with the lumbar BMD in renal transplant recipients.

Objectives: This study investigated the changes of lower urinary tract function after robot-assisted radical prostatectomy (RaRP) with 1-year urodynamic follow-up.

Materials and methods: Clinically localized prostate cancer patients receiving RaRP were prospectively enrolled. We analyzed their clinical symptoms, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) status, and videourodynamic studies (VUDSs) during the postoperative 1^st year.

Results: In total, 74 patients were enrolled with a mean age of 69.4 ± 8.1 years, a mean total prostate volume of 34.7 ± 15.9 mL, a ≥pT3 stage proportion of 37.8%, and a positive surgical margin rate of 18.9%. The International Prostate Symptom Score significantly reduced from 7.3 ± 6.0 before surgery to 4.1 ± 4.1 at postoperative 1 year. Significantly increased full sensation, reduced detrusor voiding pressure, increased maximal urinary flow rate, and decreased bladder outlet obstruction index were noted at 1-year VUDS follow-up. The changes of VUDS parameters were significantly different between the patients with and without preoperative bladder outlet obstruction. At postoperative 1 year, 8.1% and 6.8% of patients experienced SUI and UUI, respectively. In multivariate analysis, the factors of T stage ≥3, preoperative detrusor overactivity (DO), and positive surgical margin were the independent predictors of immediate SUI and SUI at 3 and 12 months, respectively.

Conclusion: During the 1^st year after RaRP, patients experienced significant changes of lower urinary tract function demonstrated in VUDS with the improvement in clinical symptoms. Factors of T stage ≥3, preoperative DO, and positive surgical margin were the predictors of postoperative SUI.

Gastric cancer is among the most common cancers and the second-leading cause of death globally. A variety of artificial intelligence (AI) applications have been developed to facilitate the image-based diagnosis of gastric cancer through pathological analysis, endoscopy, and computerized tomography. This article provides an overview of these AI applications as well as suggestions pertaining to future developments in this field and their application in clinical practice.