Journal of the Chinese Medical Association : JCMA最新文献

Background: While anecdotal evidence suggests a link between bipolar disorder and heightened creativity, empirical studies are scarce, and the underlying cognitive mechanisms remain unclear. This study aimed to explore the association between trait impulsivity, executive function, fluid intelligence, and creativity among euthymic patients with bipolar disorder.

Methods: Euthymic outpatients with bipolar disorder and age- and sex-matched healthy controls were enrolled in this cross-sectional study. Creativity was assessed using the Abbreviated Torrance Test for Adults and the Chinese Word Remote Associates Test, which examined divergent thinking and convergent thinking, respectively. Trait impulsivity was measured using the Barratt Impulsiveness Scale, while cognitive flexibility was evaluated using the Wisconsin Card Sorting Test. Fluid intelligence was assessed using Raven's Progressive Matrices. General linear models were used to assess the associations between these cognitive measures.

Results: Fifty-seven euthymic patients with bipolar disorder and fifty-six controls were recruited. Euthymic patients with bipolar disorder exhibited comparable overall creativity to controls but underperformed in convergent thinking. General linear models confirmed a negative association between trait impulsivity and creativity, primarily observed in patients with bipolar disorder. Cognitive flexibility positively correlated with creativity among patients with bipolar disorder, independent of fluid intelligence.

Conclusion: Our study showed that euthymic patients with bipolar disorder do not have heightened creativity. The findings underscore the importance of considering trait impulsivity and cognitive factors in understanding creativity in bipolar disorder.

Lay summary: Bipolar disorder (BD) is often linked to creativity, but scientific evidence on this connection is limited. Some individuals with BD may have creative strengths, while others struggle with cognitive challenges. This study explored how impulsivity, cognitive flexibility, and fluid intelligence affect creativity in euthymic patients with BD. Creativity was assessed by measuring divergent thinking (generating many different ideas) and convergent thinking (problem solving ability). The results showed that patients with BD do not have heightened creativity compared to healthy individuals. Importantly, higher impulsivity was linked to lower creativity, while better cognitive flexibility was associated with greater creativity in BD. The findings suggest that while BD does not enhance creativity, certain cognitive traits-such as lower impulsivity and stronger cognitive flexibility-may support creative thinking.

Background: Compared to the microscopic approach (MA), the endoscopic approach (EA) is more challenging for the removal of cholesteatomas and reconstruction of the ossicle chain and canal wall. We presented a surgical technique for rebuilding the canal wall and ossicle chain with tragal cartilage/perichondrium composite grafts in the resection of cholesteatomas under EA.

Methods: This retrospective study consisted of 24 cases undergoing EA (EA group) for cholesteatomas destroying the ossicles and 28 cases undergoing MA (MA group). The aim of this study was to analyze the outcome of ossiculoplasty, the stability of the reconstructed canal wall and the recurrence rate of cholesteatoma in EA group. The postoperative outcomes between TEA and MA groups were compared.

Results: In EA subgroup with an intact stapes superstructure, the pre- and postoperative air conduction (AC) thresholds and pre- and postoperative air-bone gap (ABG) were 42 ± 13.0, 37 ± 13.7, 23 ± 13.9 and 18 ± 14.8 dB, respectively. AC thresholds and ABG were significantly improved after the operation (p=0.003 and p=0.004, respectively). Gain in AC thresholds was 7.2 ± 11.1 dB in EA group and 1.6 ± 14.5 dB in MA group. There was no significant difference in the gain between two groups (p = 0.615). In EA group, two cases suffered cholesteatoma recurrence, with a recurrence rate of 8.3%. The recurrence rate was 10.7% in MA group. There was no significant difference in the recurrence rate between two groups (p = 0.772).

Conclusion: Our endoscopic method had a comparable result to MA in the treatment of cholesteatomas involving the ossicle. The technique has the advantage of leaving both a smaller surgical wound and an invisible scar. The composite graft can be easily modified for reconstruction of canal wall defects and ossiculoplasty. Patients with an intact stapes superstructure had better hearing outcomes.

Background: To investigate the association between air pollution and abnormal alanine aminotransferase levels in patients with chronic hepatitis B treated with nucleotide/nucleoside analogs.

Methods: This cross-sectional study enrolled 1,275 patients with chronic hepatitis B treated with nucleotide/nucleoside analogs from 2019 to 2022 in Kaohsiung and analyzed the incidence and risk factors for abnormal alanine aminotransferase levels. Daily air pollutant concentrations were estimated for the year prior to enrolment.

Results: Abnormal alanine aminotransferase levels were observed in 1,127 patients (88.4%) before treatment with nucleotide/nucleoside analogs (NAs). Logistic regression analysis revealed that the strongest factor associated with abnormal alanine aminotransferase levels was the level of hepatitis B virus DNA (odds ratio/confidence interval: 1.40/1.25-1.57; p<0.001), followed by concentration of particulate matter ≤2.5 µm in diameter (1.05/1.02-1.08; p<0.001) and liver cirrhosis (0.27/0.17-0.42; p<0.001). Among patients without cirrhosis, logistic regression analysis revealed that the strongest factors associated with abnormal alanine aminotransferase levels were the level of hepatitis B virus DNA (odds ratio/confidence interval: 1.52/1.28-1.82; p<0.001) and concentration of particulate matter ≤2.5 µm in diameter (1.06/1.101-1.11; p=0.01). Among patients with cirrhosis, logistic regression analysis revealed that the strongest factor associated with abnormal alanine aminotransferase levels was hepatitis B virus DNA level (odds ratio/confidence interval: 1.28/1.12-1.48; p=0.001).

Conclusion: Higher concentrations of particulate matter ≤2.5 µm in diameter caused elevated baseline alanine aminotransferase levels in patients with chronic hepatitis B receiving nucleotide/nucleoside analog therapy. The impact of particulate matter ≤2.5 µm in diameter on abnormal alanine aminotransferase levels was particularly pronounced in patients without cirrhosis.

Background: Clinical decision-making after allogeneic stem cell transplantation (HSCT) is partially based on hematopoietic chimerism analysis. Short tandem repeat (STR), the current gold standard for quantitative chimerism analysis, has limited sensitivity. Digital polymerase chain reaction (dPCR) combines precise quantification and high reproducibility with excellent sensitivity (usually ≤ 0.1%) in a wide measurement range. However, the reported dPCR-based chimerism detection methods were developed in non-Chinese cohorts and may not be applicable in a Chinese population.

Methods: To achieve higher sensitivity and accuracy, we first screened out 14 insertions/deletions (indel) loci with high individual recognition rates in Asian populations based on the literature and NCBI. Then, we established a dPCR detection system for routine chimerism assessment ("dPCR-chimerism system") in the Chinese transplant population. We compared the consistencies between STR and dPCR in patient samples.

Results: The newly established dPCR-chimerism system has a high coverage (12 pairs of autosomes), a sensitivity of 0.01%, and an excellent linearity of 0.016%-50%. For dual-donor samples, there was a strong correlation between STR and dPCR chimerism detection values (R2 = 0.9974). The R2 of the dPCR results was higher than STR when the theoretical chimerism rate of the single recipient was ≤ 5%. Clinical verification in 44 HSCT patients suggested a close correlation between STR and dPCR on most occasions, (mean difference, 0.68%) and differences between the two techniques in some cases.

Conclusion: Our new system has great repeatability and sensitivity, especially in detecting micro-chimerism and in dual donor samples. It is expected to show good applicability in Chinese transplant patients. Selecting dPCR/STR testing according to each individual's chimerism status facilitates sensitive and accurate analysis, effective early treatment interventions, and relapse monitoring in clinical settings.

Background: Enhanced recovery after surgery (ERAS) protocols incorporating multimodal analgesia (MMA) have become increasingly popular for breast cancer surgery. Our study evaluated an ERAS approach that combined nonintubated general anesthesia with thoracic paravertebral block (TPVB) as part of the MMA and compared it to traditional general anesthesia (GA). Postoperative outcomes were assessed using numerical rating scale (NRS) pain scores, total analgesic consumption, and nausea and vomiting (PONV).

Methods: We reviewed the medical records of 60 female patients aged 30-85 years who underwent unilateral mastectomy with or without sentinel lymph node biopsy (SLNB). Thirty patients received nonintubated general anesthesia with a regional block (MMA group), whereas the remaining 30 patients received conventional GA and were matched based on their anesthesia records. Postoperative analgesics, including pethidine and tramadol, were converted into intravenous morphine equivalents. We compared the groups using paired t tests for age, height, weight, operation duration, NRS scores, total analgesic dosage, and the Fisher exact test for PONV rates.

Results: The MMA group showed significantly lower NRS scores (p < 0.001) and total analgesic consumption (p < 0.001) than the GA group. Although PONV rates were lower in the MMA group (0% vs 13%, p = 0.112), this difference was not statistically significant, likely due to the effective PONV management in the GA group with dexamethasone or 5HT-3 antagonists. There was no significant difference in pain scores (p = 0.722) or the need for additional analgesics (p = 0.419) between double- and triple-level TPVB.

Conclusion: Nonintubated general anesthesia with TIVA and MMA using TPVB is a viable and safe alternative for breast cancer surgery. It results in reduced pain scores and analgesic needs compared with conventional GA, with PONV outcomes comparable to those managed with standard intravenous medications.

Background: The manufacturing industry, one of the largest employers of migrant workers in Taiwan, reports a high incidence of musculoskeletal disorders, particularly low back pain (LBP), among its workforce overall. Understanding the prevalence and risk factors of LBP among Indonesian migrant workers, who make up a substantial portion of this workforce, is essential for developing effective preventive programs.

Methods: This cross-sectional study surveyed Indonesian migrant workers in the manufacturing sector. The Indonesian version of the Oswestry Disability Index was used to assess LBP prevalence and disability levels. The chi-square test was used to evaluate the association between work-related factors and LBP outcomes. Multivariable logistic regression was used to identify the independent factors associated with LBP, adjusted for other variables.

Results: According to the LBP disability index, 63.14% of the participants had minimal disability, 29.80% had moderate disability, and 7.05% had severe disability. Mild trunk flexion was associated with a lower risk of LBP disability compared with neutral trunk flexion (OR [95% CI] 0.11 [0.03-0.31], p = 0.01). Among women, lifting less than 25 kg was associated with a lower risk of severe LBP compared with lifting more than 25 kg (OR [95% CI] 0.01 [0.01-0.61], p = 0.03). In men, whole-body vibration was associated with a lower risk of severe LBP compared with no vibration exposure (OR [95% CI] 0.41 [0.19-0.88], p = 0.02).

Conclusion: Trunk flexion, lifting, and whole-body vibration consistently emerged as significant determinants of LBP disability. More detailed assessments of these factors are necessary to clarify their associations.

Background: Pediatric drug intoxication is a significant public health issue worldwide. The present study aimed to delineate the epidemiology, exposure-related conditions, and outcome severity of pediatric drug intoxication cases in Taiwan for over a 36-year period.

Methods: This retrospective cohort study analyzed pediatric drug intoxication cases registered in Taiwan's National Poison Control Center (PCC) database between 1985 and 2020. Data on patient demographics, toxic substances, exposure-related conditions, and outcome severity were extracted and analyzed. Descriptive statistics were used to summarize the findings.

Results: Altogether, 19,893 pediatric drug intoxication cases were reported. The majority of cases involved boys (54.7%) and the highest percentage of cases occurred in children aged0-2 years (56.4%), but there is a second, relatively lower peak in adolescents, where female cases outnumbered the male cases. Pharmaceuticals were the predominant toxic substances (70.3%), with most drug intoxication cases being acute (97.2%) and occurring at home (88.8%). Witnesses were present in 62.8% of the cases. The outcomes were mostly asymptomatic (51.0%) or involved mild discomfort (34.1%), with severe complications and mortality occurring in 0.76% and in 0.37% of the cases, respectively. Unintentional poisoning accounted for 85.4% of the cases, whereas intentional poisoning was noted in 12.1% of the cases, with the highest rate seen in adolescents aged 15-17 years. Intentional cases mainly involved suicide attempts (68.4%) and predominantly occurred in girls (70.7%).

Conclusion: This analysis of data obtained from Taiwan's National PCC database for over 36 years reveals bimodal trends in pediatric drug intoxication, showing high rates in young children due to unintentional exposures and peaks in intentional poisoning among adolescent girls. Pharmaceuticals were the predominant toxic agents. Future efforts should focus on age- and sex-targeted preventions, public education on medication safety, and age-specific interventions.

Background: Achalasia is a rare disease of gastrointestinal motility characterized by impaired esophageal peristalsis and reduced esophageal sphincter relaxation. However, data on its epidemiology and outcomes in Taiwan are limited. This study aimed to assess the incidence, characteristics, and clinical management of achalasia in Taiwan.

Methods: Patients who were newly diagnosed with achalasia between 2001 and 2013 were recruited from the Taiwan National Health Insurance Research Database. The study obtained data on the age, sex, urbanization, socioeconomic status, area of residence, diagnostic methods, and interventional management of the patients. Incidence, diagnostic modalities, treatment methods, malignancy, and mortality outcomes were analyzed.

Results: In total, 206 new achalasia cases were identified. The mean annual incidence in Taiwan was 1.64 (95% confidence interval 1.22-2.05) per 100,000 persons. The mean age of the patients at diagnosis was 51.8 years. The age-specific incidence of achalasia peaked in patients aged between 70-80 years and above 80 years. For achalasia diagnosis, endoscopy, computed tomography (CT), barium studies, and manometry were performed in 123 (59.71%), 97 (47.09%), 49 (23.79%), and 11 patients (5.34 %), respectively. During long-term follow-up, seven patients (3.39%) developed esophageal cancer, and 39 patients (18.93%) died. The median survival was 10.65 years after achalasia diagnosis, with a 10-year survival rate of 76.22%.

Conclusion: This is the first population-based epidemiological study on achalasia in Taiwan, revealing the incidence of achalasia before the era of high-resolution manometry. Clinicians should be vigilant about the development of esophageal cancer and mortality during long-term follow-ups. There is also room to enhance the utilization of various diagnostic tools for achalasia.