Tzu Chi Medical Journal最新文献

Objectives: Postextubation, individuals may experience the discomfort of a sore throat. Our main aim of the study was to investigate if intranasal dexamethasone is successful in reducing postoperative sore throat occurrence.

Materials and methods: The study involved 96 adult individuals who were scheduled for elective eye surgery at Faiz Medical Center, which is affiliated with Isfahan University, between July 2020 and March 2021. The individuals were assigned by chance to two cohorts of 48 people each, with one cohort getting dexamethasone (IND) through the nose and the other cohort getting normal saline (INS) through the nose right after the endotracheal tube insertion. The presence of symptoms such as aching throat, cough, and hoarseness after surgery was recorded and examined with version 23 of the SPSS software.

Results: Upon analysis, it was observed that there were no statistically significant alterations in demographic attributes, tracheal intubation variables, duration of surgery, and postoperative outcomes (P < 0.05). Within the IND cohort, a notable 80.2% decrease in the occurrence of sore throat was noted immediately following the surgical procedure, along with a 34% reduction within the initial 6 hours of hospital stay (P < 0.001). Moreover, dexamethasone also decreased the occurrence of cough and hoarseness by 31.7% and 38.2% during recovery, as well as 19% and 25.4% within the initial 2 h upon admission to the ward (P < 0.001).

Conclusion: The current study showcased the preventive impact of dexamethasone intranasally in decreasing the occurrence of sore throat in the early stages of postoperative period. Nevertheless, its efficacy diminished after 6 h. Furthermore, the intranasal application of dexamethasone exhibited the ability to alleviate hoarseness and cough within the first 2 h following surgical intervention.

Objectives: Gastric cancer (GC) is one of the most malignant tumors. Mounting studies highlighted gastric cancer stem cells (GCSCs) were responsible for the failure of treatment due to recurrence and drug resistance of advanced GC. However, targeted therapy against GCSC for improving GC prognosis suffered from lack of suitable models and molecular targets in terms of personalized medicine. To address this issue, two patient-derived GC cell lines SD209 and SD292 with cancer stem cells (CSCs) such as phenotype were isolated for establishing targeted therapy aiming at critical metastatic signaling in GC.

Materials and methods: The primary patient-derived GCSCs were established from parts of GC tissues for characterization of stem cells (SCs) phenotype at both cellular and molecular levels. Western blot and Immunohistochemistry (IHC) were performed for identifying the deregulated signaling in GC tissue. Immunofluorescence was used for analyzing proliferating and SC markers in GCSC attached on fibroblast. Acridine orange and propidium iodide analyses were performed for the survival of GCSC in suspensions.

Results: In the culture environments of both SD209 and SD292, a lot of mesenchymal fibroblasts spread and crowd together on which a lot of cell clumps, suspected as GCSC, were firmly attached. In the IHC analysis, the GCSC stemness genes CD44 and Ep-CAM increased in tumor tissues of SD209, whereas Nanog-1 and octamer-binding transcription factor 3 (OCT-3) increased in that of SD292. By immunofluorescent analysis of a proliferation marker Ki67, the growth of SD209 and SD292 on mesenchymal fibroblasts was found to be reduced by dasatinib, the inhibitor of the Src kinase whose activity was upregulated in tumor tissues of both GCs. Dasatinib also suppressed the expression of Nanog-1 and OCT-3 in SD292 attached on mesenchymal fibroblasts.

Conclusion: This study may provide a base for targeted therapy against GCSCs/GCs progression in future preclinical/clinical settings.

The traditional classification and risk stratification systems of endometrial cancer (EC), which relied on histomorphological features, were limited and poor reproducible. The classification of new molecular subtypes of EC has been developing, including The Cancer Genome Atlas (TCGA)-four molecular subtypes: Polymerase epsilon (POLE) mutation (POLEmut), microsatellite instability hypermutated, copy number-low, and copy number-high and ProMisE-four molecular subtypes: POLEmut, mismatch repair deficiency, no specific molecular profile, and p53 abnormal. POLEmut usually correlates with a favorable outcome. Hence, we reviewed the research since the TCGA molecular subtypes developed in 2013 and summarized the characteristics and prognosis of POLEmut EC patients. In summary, we found POLEmut occurs in 7.3%-9.6% of EC in the previous studies. POLEmut EC consistently exhibits favorable patient outcomes, regardless of adjuvant therapy. The research of POLEmut in EC is absent in Taiwan, and the underlying mechanisms and cost-effectiveness need further investigation.

Objectives: Smoking is a major lung cancer risk factor. Studies show that smoking after lung cancer diagnosis is associated with an increased risk of developing other cancers and shorter survival. The purpose of this study was to examine the association between postdiagnosis smoking cessation and survival in patients with advanced non-small cell lung cancer (NSCLC).

Materials and methods: A retrospective cohort study was conducted. Data were collected between January 2014 and December 2019 in three hospitals in Southern Taiwan. Patient data were collected from the hospitals' databases, and the correlation between smoking status and patient survival was analyzed using Kaplan-Meier curves and Cox proportional hazards regression modeling.

Results: A total of 681 patients with advanced NSCLC were included in this study. The numbers (percentage) of ex-smokers and current smokers were 334 (49%) and 347 (51%), respectively. More than half of the patients in this study continued to smoke postdiagnosis advanced NSCLC. Furthermore, ex-smokers had lower mortality risk, even though this was not statistically significant (P = 0.212). The results of this study suggest that older than 65 years, men, Eastern Cooperative Oncology Group performance score of 3 and higher, history of chronic disease, receive chemotherapy, and targeted therapy are correlated with and have predictive effects on advanced NSCLC survival.

Conclusion: There is no significant difference between postdiagnosis smoking cessation and survival in patients with advanced NSCLC. The reason for this finding may be due to lower survival rates after diagnosis with advanced NSCLC, and the benefits of smoking cessation cannot be seen immediately.

A decrease in the levels of low-density lipoprotein receptors (LDLRs) leads to the accumulation of LDL cholesterol (LDL-C) in the bloodstream, resulting in hypercholesterolemia and atherosclerotic cardiovascular diseases. Increasing the expression level or inducing the activity of LDLR in hepatocytes can effectively control hypercholesterolemia. Proprotein convertase subtilisin/kexin type 9 (PCSK9) protein, primarily produced in the liver, promotes the degradation of LDLR. Inhibiting the expression and/or function of PCSK9 can increase the levels of LDLR on the surface of hepatocytes and promote LDL-C clearance from the plasma. Thus, targeting PCSK9 represents a new strategy for developing preventive and therapeutic interventions for hypercholesterolemia. Currently, monoclonal antibodies are used as PCSK9 inhibitors in clinical practice. However, the need for oral and affordable anti-PCSK9 medications limits the perspective of choosing PCSK9 inhibitors for clinical usage. Emerging research reports have demonstrated that natural phytochemicals have efficacy in maintaining cholesterol stability and regulating lipid metabolism. Developing novel natural phytochemical PCSK9 inhibitors can serve as a starting point for developing small-molecule drugs to reduce plasma LDL-C levels in patients. In this review, we summarize the current literature on the critical role of PCSK9 in controlling LDLR degradation and hypercholesterolemia, and we discuss the results of studies attempting to develop PCSK9 inhibitors, with an emphasis on the inhibitory effects of natural phytochemicals on PCSK9. Furthermore, we provide insight into the mechanisms of action by which the reported phytochemicals exert their potential PCSK9 inhibitory effects against hypercholesterolemia.

Inflammation and stem cell mobilization or homing play pivotal roles in tissue repair and regeneration. This review explores their intricate interplay, elucidating their collaborative role in maintaining tissue homeostasis and responding to injury or disease. While examining the fundamentals of stem cells, we detail the mechanisms underlying inflammation, including immune cell recruitment and inflammatory mediator release, highlighting their self-renewal and differentiation capabilities. Central to our exploration is the modulation of hematopoietic stem cell behavior by inflammatory cues, driving their mobilization from the bone marrow niche into circulation. Key cytokines, chemokines, growth factors, and autophagy, an intracellular catabolic mechanism involved in this process, are discussed alongside their clinical relevance. Furthermore, mesenchymal stem cell homing in response to inflammation contributes to tissue repair processes. In addition, we discuss stem cell resilience in the face of inflammatory challenges. Moreover, we examine the reciprocal influence of stem cells on the inflammatory milieu, shaping immune responses and tissue repair. We underscore the potential of targeting inflammation-induced stem cell mobilization for regenerative therapies through extensive literature analysis and clinical insights. By unraveling the complex interplay between inflammation and stem cells, this review advances our understanding of tissue repair mechanisms and offers promising avenues for clinical translation in regenerative medicine.

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.