Tzu Chi Medical Journal最新文献

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.

Objectives: The optimization of polyethylene glycol (PEG)-based extracellular vesicles (EVs) extraction from human follicular fluid (FF) and serum was investigated, and their functional analysis was confirmed. The PEG-based EV results were compared to the ExoQuick (ExoQ)-based EV.

Materials and methods: FF-EVs and serum-EVs were extracted by using different concentrations of PEG (8000). Nanoparticle tracking analysis was used to count the particles, and electron microscopy of EVs was performed for visualization. Exosomes were confirmed by the western blot analysis with exosome-specific markers. RNA and microRNA were extracted from exosomes and quantitative polymerase chain reaction analysis was performed. Fallopian tube epithelial (FTE) cells were used for the EV uptake experiment and an anchorage-independent growth test to confirm that extracted EVs harbor transformation activity.

Results: The PEG 8% enriched method produced the highest yield and the lowest carry-over protein. Salt containing PEG 8% produced a higher yield than nonsalted PEG 8%. Overnight enrichment increased four times and 18 times for PEG 8% and ExoQ-based EV extraction from FF. For serum EV, the same overnight enrichment moderately increased yield for both PEG 8% and ExoQ methods. Less carry-over protein resulted in more EV-promoted transformation activity.

Conclusion: This study overcomes the time-consuming, expensive, laborious, and complicated machine-dependent EV extraction methods. The study highlights that longer incubation time is needed for EV extraction from FF. PEG 8000-based EV extraction provided a higher yield and less carry-over protein than ExoQ-based EV extraction.

Objectives: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a challenging chronic inflammatory condition affecting the urinary bladder, with limited treatment options. This study aims to assess the clinical efficacy of repeated intravesical platelet-rich plasma (PRP) injections for promoting urothelial regeneration and reducing inflammation in patients with IC/BPS and investigate its correlation with subjective and objective treatment-related outcomes.

Materials and methods: Four monthly intravesical PRP injections were given to 98 patients with non-Hunner-type IC/BPS. Treatment outcomes were assessed using a global response assessment (GRA) score 3 months posttreatment. In addition, clinical symptom scores, pain severity, voiding diary data, uroflowmetry parameters, and GRA scores were compared before and after treatment and between different treatment outcome groups (satisfactory: GRA≥2 unsatisfactory: GRA<2). Baseline urine biomarkers were analyzed to identify potential treatment outcome predictors.

Results: After four PRP injections, 54 (55.1%) patients reported satisfactory outcomes. Lower urinary tract symptoms, bladder pain, urinary frequency, anxiety, and flow rate significantly improved from baseline (P < 0.05) in all patients, regardless of the treatment outcome. All patients experienced improved treatment outcomes and increased maximum bladder capacity with successive PRP treatments, and no major complications were reported. Urine biomarkers indicated elevated inflammation and oxidative stress biomarkers in patients with IC/BPS compared to controls.

Conclusion: Repeated PRP injections are safe and effective for reducing symptoms and bladder pain and improving bladder capacity in a majority of IC/BPS patients, with better outcomes observed in patients with a mild form of bladder inflammation. These results support PRP as a promising novel bladder therapy for IC/BPS.

Bladder outlet obstruction (BOO) is common in males with benign prostate enlargement (BPE) and often presents with different lower urinary tract symptoms. Overactive bladder (OAB) has been reported to be related to BOO, although it can also be idiopathic. The storage symptoms of BOO are often similar to those of OAB. The etiology and pathophysiology of both BPE and OAB are multifactorial with metabolic syndrome known as one of the factors. As of today, transurethral prostate surgery remains the gold standard for treating BOO associated with BPE. Intradetrusor onabotulinumtoxinA (BoNT-A) injections have been shown to be effective in treating OAB. However, they are usually administered after transurethral prostate surgery. In view of the strong therapeutic effects of both surgery and injections, the feasibility of combining them in one setting to increase patient comfort, convenience, and possibly results while decreasing costs is appealing to physicians. However, patient safety and possible complications have to be considered. In this article, we review available studies of concurrent intradetrusor BoNT-A injections during transurethral prostate surgery. Although there is no definitive evidence supporting the concurrent use of intradetrusor BoNT-A during transurethral prostate surgery, there are no reports of increased complications too. Further large-scale randomized controlled trials would be necessary to validate the feasibility of combining the treatments in one setting and observe for possible complications.

Objectives: This study aimed to explore perceived stress and coping strategies among undergraduate nursing students in the psychiatric practicum during the pandemic.

Materials and methods: A cross-sectional quantitative design was employed in this study. Data were collected through self-administered questionnaires consisting of demographic variables, the Perceived Stress Scale (PSS), and the Coping Behavior Inventory (CBI).

Results: Of the 73 participants, 82.2% were women. The mean age was 21.25 ± 0.69 years. The overall mean score of PSS was 1.45 ± 0.48, and that of CBI was 1.93 ± 0.31. The major sources of perceived stress were taking care of patients (1.72 ± 0.54) and assignments and workload (1.72 ± 0.75). The major coping strategies to deal with stress were problem-solving (2.66 ± 0.52) and staying optimistic (2.43 ± 0.73). Pearson's correlation analyses revealed that participants who utilized the avoidance strategy (r = 0.416) reported high-stress levels, whereas participants who utilized problem-solving (r = -0.306) and staying optimistic (r = -0.527) reported low-stress levels.

Conclusion: The nursing students perceived moderate stress mainly from taking care of patients as well as assignments and workload. Problem-solving and staying optimistic were the most frequently used coping strategies. Compared with findings from other studies, our data suggested that the impact of the COVID-19 pandemic on perceived stress was not apparent possibly due to well-established approaches and education for infection prevention and control in our hospitals and schools. Our findings may provide valuable information to maximize students' learning opportunities.