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Analyzing sex-specific differences in sleep quality, resilience, and biomarkers among older adults in the Gan-Dau Healthy Longevity Plan. 分析赣鄱健康长寿计划中老年人在睡眠质量、恢复力和生物标志物方面的性别差异。
Pub Date : 2025-01-01 Epub Date: 2024-09-17 DOI: 10.1097/JCMA.0000000000001168
Fei-Yuan Hsiao, Zhi-Jun Chen, Heng-Hsin Tung, Sheng-Yuan Wang, Wei-Ju Lee, Chih-Kuang Liang, Liang-Kung Chen
<p><strong>Background: </strong>Limited knowledge exists regarding the interrelations between sleep quality and resilience within the demographic of healthy, community-residing middle-aged and older adults, with a particular dearth of information regarding sex-specific associations. This study aimed to examine the sex-specific associations between sleep quality, resilience, and biomarkers in community-dwelling middle-aged and older adults.</p><p><strong>Methods: </strong>This cross-sectional study was conducted using data from the 2022 Gan-Dau Healthy Longevity Plan survey initiated by the locality-based community hospital, Taipei Municipal Gan-Dau Hospital (TMGDH). A total of 770 participants (240 men, 530 women) who met the inclusion criteria were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while resilience was measured using the Brief Resilience Scale (BRS). Patient demographic data, including age, education, marital status, and depression level, were also collected. The sex-specific associations between sleep quality and resilience were first examined using multivariate generalized linear models (GLMs). In addition, the associations between sleep quality, resilience, and selected biomarkers were examined using multivariate GLMs.</p><p><strong>Results: </strong>Approximately 55% of men and 60% of women reported poor sleep quality. Individuals with good sleep quality had significantly lower levels of depressive symptoms ( p = 0.028 for men, p = 0.002 for women) and fewer chronic conditions ( p = 0.002 for men, p < 0.001 for women). Notably, women in the "poor sleep quality" group exhibited higher proportions of low habitual sleep efficiency (women 35.9% vs men 29.8%) and frequent use of sleeping medications (women 23.2% vs men 9.9%) than men. Good sleep quality was associated with better resilience in both men (mean BRS score: good sleep quality = 25.1 [SD: 4.3] vs poor sleep quality = 23.4 [SD: 4.7], p = 0.004) and women (mean BRS score: good sleep quality = 24.3 [SD: 5.1] vs poor sleep quality = 22.3 [SD: 5.4], p < 0.001). After adjusting for depressive symptoms and chronic conditions, this association remained significant for men ( p = 0.022) and women ( p = 0.001). In addition, greater depressive symptoms were associated with poorer resilience in both sexes ( p < 0.001). No significant associations were noted between sleep quality or resilience and the selected biomarkers.</p><p><strong>Conclusion: </strong>This study highlights the association between sleep quality and resilience in older adults. Good sleep quality is related to better resilience, but greater depressive symptoms are also linked to poorer resilience in both sexes. Nevertheless, the low habitual sleep efficiency and frequent use of sleeping medications in women but not men with poor sleep quality highlight the need to explore sex-specific approaches to address the interplay of sleep quality, resilience, and other factors
背景:对于健康、居住在社区的中老年人群中睡眠质量和恢复力之间的相互关系,人们所知有限,尤其是有关性别特异性关联的信息更是匮乏。本研究旨在探讨社区中老年人的睡眠质量、恢复力和生物标志物之间的性别特异性关联:这项横断面研究使用了由台北市立甘道医院(TMGDH)发起的 2022 年甘道健康长寿计划调查数据。研究共纳入了 770 名符合纳入标准的参与者(男性 240 人,女性 530 人)。睡眠质量采用匹兹堡睡眠质量指数(PSQI)进行评估,复原力则采用简易复原力量表(BRS)进行测量。研究还收集了患者的人口统计学数据,包括年龄、教育程度、婚姻状况和抑郁程度。首先使用多变量广义线性模型(GLMs)检验了睡眠质量和恢复力之间的性别特异性关联。此外,还使用多变量广义线性模型研究了睡眠质量、恢复力和选定生物标志物之间的关系:结果:约 55% 的男性和 60% 的女性报告睡眠质量不佳。睡眠质量好的人抑郁症状水平明显较低(男性 p=0.028,女性 p=0.028):这项研究强调了老年人睡眠质量与复原力之间的关系。良好的睡眠质量与较强的恢复能力有关,但抑郁症状较重也与男女两性较差的恢复能力有关。尽管如此,睡眠质量差的女性(而非男性)的习惯性睡眠效率较低,且经常使用安眠药物,这突出表明有必要探索针对不同性别的方法,以解决健康老龄化过程中睡眠质量、恢复力和其他人口因素(如抑郁症状)之间的相互作用问题。
{"title":"Analyzing sex-specific differences in sleep quality, resilience, and biomarkers among older adults in the Gan-Dau Healthy Longevity Plan.","authors":"Fei-Yuan Hsiao, Zhi-Jun Chen, Heng-Hsin Tung, Sheng-Yuan Wang, Wei-Ju Lee, Chih-Kuang Liang, Liang-Kung Chen","doi":"10.1097/JCMA.0000000000001168","DOIUrl":"10.1097/JCMA.0000000000001168","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Limited knowledge exists regarding the interrelations between sleep quality and resilience within the demographic of healthy, community-residing middle-aged and older adults, with a particular dearth of information regarding sex-specific associations. This study aimed to examine the sex-specific associations between sleep quality, resilience, and biomarkers in community-dwelling middle-aged and older adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study was conducted using data from the 2022 Gan-Dau Healthy Longevity Plan survey initiated by the locality-based community hospital, Taipei Municipal Gan-Dau Hospital (TMGDH). A total of 770 participants (240 men, 530 women) who met the inclusion criteria were included in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while resilience was measured using the Brief Resilience Scale (BRS). Patient demographic data, including age, education, marital status, and depression level, were also collected. The sex-specific associations between sleep quality and resilience were first examined using multivariate generalized linear models (GLMs). In addition, the associations between sleep quality, resilience, and selected biomarkers were examined using multivariate GLMs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Approximately 55% of men and 60% of women reported poor sleep quality. Individuals with good sleep quality had significantly lower levels of depressive symptoms ( p = 0.028 for men, p = 0.002 for women) and fewer chronic conditions ( p = 0.002 for men, p &lt; 0.001 for women). Notably, women in the \"poor sleep quality\" group exhibited higher proportions of low habitual sleep efficiency (women 35.9% vs men 29.8%) and frequent use of sleeping medications (women 23.2% vs men 9.9%) than men. Good sleep quality was associated with better resilience in both men (mean BRS score: good sleep quality = 25.1 [SD: 4.3] vs poor sleep quality = 23.4 [SD: 4.7], p = 0.004) and women (mean BRS score: good sleep quality = 24.3 [SD: 5.1] vs poor sleep quality = 22.3 [SD: 5.4], p &lt; 0.001). After adjusting for depressive symptoms and chronic conditions, this association remained significant for men ( p = 0.022) and women ( p = 0.001). In addition, greater depressive symptoms were associated with poorer resilience in both sexes ( p &lt; 0.001). No significant associations were noted between sleep quality or resilience and the selected biomarkers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study highlights the association between sleep quality and resilience in older adults. Good sleep quality is related to better resilience, but greater depressive symptoms are also linked to poorer resilience in both sexes. Nevertheless, the low habitual sleep efficiency and frequent use of sleeping medications in women but not men with poor sleep quality highlight the need to explore sex-specific approaches to address the interplay of sleep quality, resilience, and other factors","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"15-25"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Plate osteosynthesis of phalanx fractures using wide-awake local anesthesia no tourniquet technique is cost-effective and associated with less postoperative pain. 采用宽清醒局部麻醉无止血带技术对指骨骨折进行钢板骨合成术具有成本效益,且术后疼痛较轻。
Pub Date : 2025-01-01 Epub Date: 2024-09-24 DOI: 10.1097/JCMA.0000000000001174
Wei-Chieh Chen, Chun-Yu Chen, Yen-Chang Lin

Background: The wide-awake local anesthesia no tourniquet (WALANT) technique, which is based on the local infiltration of lidocaine and epinephrine, is widely used in hand and wrist surgery. However, few studies have been conducted on the cost-benefit analysis of phalanx fracture surgery using the WALANT technique. This study aimed to investigate the clinical condition, as well as the time spent for anesthesia and operation. We also performed an economic analysis to compare general anesthesia, local anesthesia with a tourniquet, and the WALANT technique for plate fixation of phalanx fractures.

Methods: This retrospective study included all patients with single phalanx fractures who underwent open reduction internal fixation with plating between January 2015 and December 2019. Patients were divided into three groups according to the anesthesia method: general anesthesia with a tourniquet (GA group), local anesthesia with a tourniquet (LA group), and the WALANT technique (WALANT group). Data, including demographics, anesthesia and surgical time, postoperative pain score, and vomiting ratio, were collected and analyzed.

Results: A total of 62 patients were included in this study. Of the 62 patients, 15 were included in the GA group, 32 in the LA group, and 15 in the WALANT group. No complications were reported during surgery or follow-up in any group. The GA group exhibited a significantly longer anesthesia time than the other two groups, with an average of 32.4 minutes. However, no significant difference in surgical time was observed among the three groups. The WALANT group exhibited a significantly lower postoperative day 1 pain score than the other two groups. The additional cost of general anesthesia was approximately 350 US dollars (USD), accounting for approximately one-third to one-fourth of the total expenses for phalanx surgery.

Conclusion: Open reduction with plate fixation of phalanx fractures using the WALANT technique or local anesthesia was cost-effective compared with general anesthesia. Patients who underwent phalanx fracture surgery using the WALANT technique experienced less pain on the first postoperative day because of the adequate tumescent technique and not using a tourniquet during surgery.

背景:宽醒局部麻醉无止血带(WALANT)技术以利多卡因和肾上腺素的局部浸润为基础,被广泛应用于手部和腕部手术。然而,有关使用 WALANT 技术进行指骨骨折手术的成本效益分析的研究却很少。本研究旨在调查临床状况、麻醉时间和手术时间。我们还对全身麻醉、止血带局部麻醉和 WALANT 技术用于指骨骨折钢板固定进行了经济性分析:这项回顾性研究纳入了2015年1月至2019年12月期间接受切开复位内固定加钢板固定术的所有单指骨骨折患者。根据麻醉方法将患者分为三组:带止血带的全身麻醉(GA组)、带止血带的局部麻醉(LA组)和WALANT技术(WALANT组)。收集和分析的数据包括人口统计学、麻醉和手术时间、术后疼痛评分和呕吐比例:结果:本研究共纳入 62 例患者。62名患者中,GA组15人,LA组32人,WALANT组15人。两组患者在手术和随访期间均未出现并发症。GA组的麻醉时间明显长于其他两组,平均为32.4分钟。不过,三组的手术时间没有明显差异。WALANT 组的术后疼痛评分明显低于其他两组。全身麻醉的额外费用约为 350 美元,约占趾骨手术总费用的三分之一到四分之一:结论:与全身麻醉相比,采用 WALANT 技术和局部麻醉对指骨骨折进行切开复位并用钢板固定具有成本效益。使用 WALANT 技术进行指骨骨折手术的患者在术后第一天的疼痛感比使用全身麻醉或局部麻醉加止血带进行手术的患者要轻,这是因为 WALANT 技术采用了充分的膨胀技术,而且在手术过程中没有使用止血带。
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引用次数: 0
Clinical outcomes of round spermatid injection vs intracytoplasmic sperm injection: The role of hormonal pretreatment for nonobstructive azoospermia. 圆形精子注射与胞浆内精子注射的临床效果:激素预处理对男性非梗阻性无精子症患者的潜在作用。
Pub Date : 2025-01-01 Epub Date: 2024-10-24 DOI: 10.1097/JCMA.0000000000001184
Nai-Ming Cheng, William J Huang, Chen-Yu Huang, Yi-Jen Chen, Chi-Hong Ho

Background: Round spermatid injection (ROSI) into oocytes offers men with nonobstructive azoospermia (NOA) the opportunity to have biological offspring in cases where mature spermatozoa are not detected. However, the clinical outcomes of ROSI remain poor. This study compared the outcomes of ROSI with intracytoplasmic sperm injection (ICSI) and investigated the effect of hormonal pretreatment.

Methods: This retrospective cohort study enrolled infertile couples undergoing either ROSI or ICSI at the reproductive center in Taipei Veterans General Hospital. The administration of selective estrogen receptor modulators, gonadotropins, and aromatase inhibitors in male patients were recorded. Relevant hormonal markers and biochemical parameters were determined. The outcomes of ROSI and ICSI were assessed based on fertilization rate, implantation rate, and live birth rate.

Results: A total of 36 couples were recruited in the ROSI group, whereas 39 couples were recruited in the ICSI group for the analysis. Patients in each group demonstrated similar characteristics, except for a higher proportion of male patients in the ROSI group who were pretreated with anastrozole. The fertilization rate and implantation rate were similar between ROSI and ICSI groups after adjusting for confounding variables. The live birth rate was significantly lower in the ROSI group (8.3%) than in the ICSI group (30.8%) before and after adjusting for confounding variables.

Conclusion: ROSI demonstrated fertilization and implantation rates comparable to those of ICSI for male patient with NOA undergoing testicular sperm extraction surgery. Anastrozole may improve the outcomes of ROSI into oocytes. Further studies evaluating the effect of anastrozole administration on ROSI outcomes are warranted.

背景:向卵母细胞注入圆形精子(ROSI)为患有非梗阻性无精子症(NOA)的男性提供了在检测不到成熟精子的情况下生育后代的机会。然而,ROSI 的临床效果仍然不佳。本研究比较了ROSI与卵胞浆内单精子显微注射(ICSI)的疗效,并探讨了激素预处理的影响:这项回顾性队列研究招募了在台北荣民总医院生殖中心接受ROSI或ICSI的不育夫妇。收集了男性患者使用选择性雌激素受体调节剂、促性腺激素和芳香化酶抑制剂的情况。测定了相关激素标记物和生化参数。根据受精率、植入率和活产率评估了ROSI和ICSI的结果:ROSI组共招募了36对夫妇,而ICSI组招募了39对夫妇进行分析。除了ROSI组中使用阿那曲唑预处理的男性患者比例较高外,两组患者的特征相似。在对混杂变量进行调整后,ROSI 组和 ICSI 组的受精率和植入率相似。在调整混杂变量前后,ROSI组的活产率(8.3%)明显低于ICSI组(30.8%):结论:对于接受睾丸取精手术的无精子症男性患者,ROSI的受精率和植入率与ICSI相当。有必要进一步研究阿那曲唑用药对ROSI结果的影响。
{"title":"Clinical outcomes of round spermatid injection vs intracytoplasmic sperm injection: The role of hormonal pretreatment for nonobstructive azoospermia.","authors":"Nai-Ming Cheng, William J Huang, Chen-Yu Huang, Yi-Jen Chen, Chi-Hong Ho","doi":"10.1097/JCMA.0000000000001184","DOIUrl":"10.1097/JCMA.0000000000001184","url":null,"abstract":"<p><strong>Background: </strong>Round spermatid injection (ROSI) into oocytes offers men with nonobstructive azoospermia (NOA) the opportunity to have biological offspring in cases where mature spermatozoa are not detected. However, the clinical outcomes of ROSI remain poor. This study compared the outcomes of ROSI with intracytoplasmic sperm injection (ICSI) and investigated the effect of hormonal pretreatment.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled infertile couples undergoing either ROSI or ICSI at the reproductive center in Taipei Veterans General Hospital. The administration of selective estrogen receptor modulators, gonadotropins, and aromatase inhibitors in male patients were recorded. Relevant hormonal markers and biochemical parameters were determined. The outcomes of ROSI and ICSI were assessed based on fertilization rate, implantation rate, and live birth rate.</p><p><strong>Results: </strong>A total of 36 couples were recruited in the ROSI group, whereas 39 couples were recruited in the ICSI group for the analysis. Patients in each group demonstrated similar characteristics, except for a higher proportion of male patients in the ROSI group who were pretreated with anastrozole. The fertilization rate and implantation rate were similar between ROSI and ICSI groups after adjusting for confounding variables. The live birth rate was significantly lower in the ROSI group (8.3%) than in the ICSI group (30.8%) before and after adjusting for confounding variables.</p><p><strong>Conclusion: </strong>ROSI demonstrated fertilization and implantation rates comparable to those of ICSI for male patient with NOA undergoing testicular sperm extraction surgery. Anastrozole may improve the outcomes of ROSI into oocytes. Further studies evaluating the effect of anastrozole administration on ROSI outcomes are warranted.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"52-57"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A prediction model of echocardiographic variables to screen for potentially correctable shunts in adult atrial septal defect-pulmonary hypertension patients. 用于筛查成人 ASD-PAH 患者潜在可纠正分流的超声心动图变量预测模型。
Pub Date : 2025-01-01 Epub Date: 2024-11-11 DOI: 10.1097/JCMA.0000000000001190
He-Zhi Li, Song Wen, Ze-Han Huang, Hong-Wen Fei, Cao-Jin Zhang

Background: Atrial septal defect (ASD) is a prevalent congenital heart condition in adults that leads to pulmonary hypertension (PAH) and right heart failure if left untreated. During a routine follow-up of adult ASD-PAH patients, the suitability of shunt closure depends on the invasive right heart catheterization (RHC). Nevertheless, performing RHC at every follow-up is impractical and may be harmful. The present retrospective cross-sectional study was designed to investigate which echocardiographic variables were associated with pulmonary vascular resistance (PVR) in adult ASD-PAH patients and propose a model using these variables to screen for patients with a correctable shunt.

Methods: A total of 530 adult ASD-PAH patients with pulmonary arterial systolic pressure (PASP) of ≥60 mmHg measured using transthoracic echocardiogram (TTE) were included in the study. All RHCs were performed within 3 months after TTE. The correctable shunt was defined as PVR ≤3 Wood units (WU). Multivariable regressions were performed utilizing echocardiographic variables. A scoring system was constructed based on the predictors of PVR ≤3 WU using multivariable logistic regression analysis. The scoring system was then examined using a receiver operating characteristic (ROC) analysis. In addition, clinical utility of the model was determined based on decision curve analysis, and a calibration curve was used to evaluate model conformity.

Results: Estimated PASP, velocity through the pulmonary valve, tricuspid annulus early diastolic velocity, and maximum defect dimension were identified as independent predictors. The area under the ROC curve of the predictive value in the model was 0.905 (95% CI, 0.878-0.931, sensitivity: 84.3%, specificity: 83.6%). The net benefit of the model was notable in terms of a wide-range probability threshold in decision curve analysis, indicating that the prediction model had good clinical applicability. The model's calibration curve was close to an ideal diagonal line, showing good predictive accuracy between the actual and predictive probabilities.

Conclusion: The study provided a valuable model in predicting adult ASD-PAH patients with a correctable shunt, which may help clinicians to make appropriate treatment decision for follow-up patients.

背景:房间隔缺损(ASD)是成人中常见的先天性心脏病,如不及时治疗会导致肺动脉高压(PAH)和右心衰竭。在对成人 ASD-PAH 患者进行常规随访时,分流关闭是否合适取决于有创的右心导管检查(RHC)。本回顾性横断面研究旨在调查哪些超声心动图变量与成人 ASD-PAH 患者的肺血管阻力(PVR)有关,并提出一个利用这些变量筛查可矫正分流患者的模型:研究共纳入了530例经胸超声心动图(TTE)测量肺动脉收缩压(PASP)≥60 mmHg的成人ASD-PAH患者。所有 RHC 均在 TTE 后 3 个月内进行。可纠正分流的定义是 PVR≤3 木单位(WU)。利用超声心动图变量进行多变量回归。通过多变量逻辑回归分析,根据 PVR ≤3 WU 的预测因素构建了一个评分系统。然后使用接收者操作特征(ROC)分析对评分系统进行了检验。此外,还根据决策曲线分析确定了模型的临床实用性,并使用校准曲线评估了模型的一致性:结果:估计的肺动脉收缩压、通过肺动脉瓣的速度、三尖瓣环早期舒张速度和最大缺损尺寸被确定为独立的预测因子。模型预测值的 ROC 曲线下面积为 0.905 [95%置信区间 (CI):0.878-0.931,敏感性:84.3%,特异性:83.6%]。在决策曲线分析中,该模型的净效益显著,概率阈值范围较宽,表明该预测模型具有良好的临床适用性。模型的校准曲线接近理想的对角线,显示出实际概率与预测概率之间良好的预测准确性:研究结果表明,该模型在预测可纠正分流的成人 ASD-PAH 患者方面具有重要价值,有助于临床医生为随访患者做出适当的治疗决策。
{"title":"A prediction model of echocardiographic variables to screen for potentially correctable shunts in adult atrial septal defect-pulmonary hypertension patients.","authors":"He-Zhi Li, Song Wen, Ze-Han Huang, Hong-Wen Fei, Cao-Jin Zhang","doi":"10.1097/JCMA.0000000000001190","DOIUrl":"10.1097/JCMA.0000000000001190","url":null,"abstract":"<p><strong>Background: </strong>Atrial septal defect (ASD) is a prevalent congenital heart condition in adults that leads to pulmonary hypertension (PAH) and right heart failure if left untreated. During a routine follow-up of adult ASD-PAH patients, the suitability of shunt closure depends on the invasive right heart catheterization (RHC). Nevertheless, performing RHC at every follow-up is impractical and may be harmful. The present retrospective cross-sectional study was designed to investigate which echocardiographic variables were associated with pulmonary vascular resistance (PVR) in adult ASD-PAH patients and propose a model using these variables to screen for patients with a correctable shunt.</p><p><strong>Methods: </strong>A total of 530 adult ASD-PAH patients with pulmonary arterial systolic pressure (PASP) of ≥60 mmHg measured using transthoracic echocardiogram (TTE) were included in the study. All RHCs were performed within 3 months after TTE. The correctable shunt was defined as PVR ≤3 Wood units (WU). Multivariable regressions were performed utilizing echocardiographic variables. A scoring system was constructed based on the predictors of PVR ≤3 WU using multivariable logistic regression analysis. The scoring system was then examined using a receiver operating characteristic (ROC) analysis. In addition, clinical utility of the model was determined based on decision curve analysis, and a calibration curve was used to evaluate model conformity.</p><p><strong>Results: </strong>Estimated PASP, velocity through the pulmonary valve, tricuspid annulus early diastolic velocity, and maximum defect dimension were identified as independent predictors. The area under the ROC curve of the predictive value in the model was 0.905 (95% CI, 0.878-0.931, sensitivity: 84.3%, specificity: 83.6%). The net benefit of the model was notable in terms of a wide-range probability threshold in decision curve analysis, indicating that the prediction model had good clinical applicability. The model's calibration curve was close to an ideal diagonal line, showing good predictive accuracy between the actual and predictive probabilities.</p><p><strong>Conclusion: </strong>The study provided a valuable model in predicting adult ASD-PAH patients with a correctable shunt, which may help clinicians to make appropriate treatment decision for follow-up patients.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"71-79"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A survey of attitudes toward and experiences with traditional Chinese medicines among people in Taiwan. 台湾民众对传统中药的态度和体验调查。
Pub Date : 2025-01-01 Epub Date: 2024-10-21 DOI: 10.1097/JCMA.0000000000001181
Cheng-Yu Chuang, Hui-Yu Chung, Fu-Shih Chen, Ichiro Arai

Background: Despite numerous surveys on traditional Chinese medicines (TCMs) and their impact on people in Taiwan, only a few directly assessed the perspectives of the users and their experiences with the practice. In this study, we aimed to explore the attitudes, experiences, and understanding of TCMs, and also to identify the TCMs that are commonly preferred among people in Taiwan.

Methods: We conducted an online survey among people in Taiwan to reflect the viewpoints of the general public on TCMs in 2022. Individuals working in the medical field were excluded. Question topics included experience, impressions, access, and expectations.

Results: According to the results of the questionnaire survey, of the 518 participants interviewed, more than 95% had used TCMs. "Work gently" was the most common positive impression, and "Take effect slowly" was the most common negative impression. Among the over-the-counter TCMs that were taken by the participants, "Si Wu Tang," which tends to be used for treating female diseases, was the most common. The main expectations for TCMs were to improve daily health and prevent diseases. Although the participants were well informed about TCMs, there was still room for improvement. For example, 30% of the participants still did not know that TCMs might have side effects.

Conclusion: People in Taiwan who participated in the survey had a relatively positive impression of and experience with TCMs, but there were still some knowledge gaps that need to be filled with additional information. It is essential to strengthen the publicity and education about TCMs and improve the public's understanding and correct use of TCMs.

背景:尽管有许多关于传统中药及其对台湾民众影响的调查,但只有少数调查直接评估了使用者的观点及其使用传统中药的经验。在这项研究中,我们旨在探讨台湾民众对中药的态度、体验和理解,并找出台湾民众普遍偏爱的中药:方法:我们对台湾民众进行了一次在线调查,以反映 2022 年台湾民众对中医药的看法。不包括医疗相关人员。问题主题包括经验、印象、获取途径和期望:共有 518 人参与调查。结果:共有 518 人参与调查,其中 95% 以上的人服用过中药。"温和 "是最常见的正面印象,"起效慢 "是最常见的负面印象。在参与者服用过的非处方中药中,用于治疗女性疾病的 "四物汤 "最为常见。对中药的主要期望是帮助改善日常健康和预防疾病。虽然参与者对中医药的认识很高,但仍有改进的余地。例如,仍有 30% 的参与者不知道中药可能有副作用:结论:参与调查的台湾民众对中药的印象和体验相对较好,但仍有一些认知盲点需要填补。加强中药的宣传教育,提高民众对中药的认识和正确使用是十分必要的。
{"title":"A survey of attitudes toward and experiences with traditional Chinese medicines among people in Taiwan.","authors":"Cheng-Yu Chuang, Hui-Yu Chung, Fu-Shih Chen, Ichiro Arai","doi":"10.1097/JCMA.0000000000001181","DOIUrl":"10.1097/JCMA.0000000000001181","url":null,"abstract":"<p><strong>Background: </strong>Despite numerous surveys on traditional Chinese medicines (TCMs) and their impact on people in Taiwan, only a few directly assessed the perspectives of the users and their experiences with the practice. In this study, we aimed to explore the attitudes, experiences, and understanding of TCMs, and also to identify the TCMs that are commonly preferred among people in Taiwan.</p><p><strong>Methods: </strong>We conducted an online survey among people in Taiwan to reflect the viewpoints of the general public on TCMs in 2022. Individuals working in the medical field were excluded. Question topics included experience, impressions, access, and expectations.</p><p><strong>Results: </strong>According to the results of the questionnaire survey, of the 518 participants interviewed, more than 95% had used TCMs. \"Work gently\" was the most common positive impression, and \"Take effect slowly\" was the most common negative impression. Among the over-the-counter TCMs that were taken by the participants, \"Si Wu Tang,\" which tends to be used for treating female diseases, was the most common. The main expectations for TCMs were to improve daily health and prevent diseases. Although the participants were well informed about TCMs, there was still room for improvement. For example, 30% of the participants still did not know that TCMs might have side effects.</p><p><strong>Conclusion: </strong>People in Taiwan who participated in the survey had a relatively positive impression of and experience with TCMs, but there were still some knowledge gaps that need to be filled with additional information. It is essential to strengthen the publicity and education about TCMs and improve the public's understanding and correct use of TCMs.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"34-42"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
High-dose chemotherapy with autologous stem cell rescue in children and young adults with high-risk Ewing sarcoma. 高风险尤文肉瘤儿童和青少年患者的大剂量化疗与自体干细胞救治:台湾一家研究所的经验。
Pub Date : 2025-01-01 Epub Date: 2024-10-11 DOI: 10.1097/JCMA.0000000000001179
Chih-Ying Lee, Ming-Hsin Hou, Giun-Yi Hung, Cheng-Yin Ho, Ting-Yen Yu, Po-Kuei Wu, Chao-Ming Chen, Chueh-Chuan Yen, Cheng-Ying Shiau, Paul Chih-Hsueh Chen, Hung-Ta Hondar Wu, Ching-Lan Wu, Hsiu-Ju Yen, Wei-Ming Chen

Background: A combination treatment of surgery, chemotherapy, and radiotherapy can improve the survivals of pediatric patients with Ewing sarcoma (ES). However, prognosis remains poor for patients with metastatic disease at diagnosis or recurrence. Other high-risk (HR) features include large tumor burden, tumors of the axial skeleton, and poor histologic response. Several studies have documented high-dose chemotherapy with autologous stem cell rescue (HDC-ASCR) to be effective in such patients. In this retrospective study, we present the results of HDC-ASCR for high-risk ES (HRES) in children and young adults in a single institute.

Methods: From March 2004 to March 2021, patients with ES, Ewing-like sarcoma, or round cell sarcoma received HDC-ASCR as part of treatment were included. The patients' characteristics, disease status, stem cell dose, engraftment status, post-transplant complications, and outcomes were analyzed.

Results: Twenty patients receiving HDC-ASCR at complete response (n = 6), partial response (n = 13), and stable disease (n = 1) were enrolled. The male-to-female ratio was 11:9. Median age at diagnosis and transplant was 15.6 years old (range: 3.3-28.9) and 16.2 (range: 4.2-29.9), respectively. The conditioning regimens included ifosfamide-based in two and melphalan-based in 19. All patients achieved successful engraftment without transplant-related mortality. The 5-year progression-free and overall survival (OS) rate were 35% and 54.5%, respectively. The causes of death (n = 8) were all contributed to disease progression. Patients in the complete response group or with localized HRES exhibited a higher 5-year OS ( p = 0.047 and 0.05, respectively). Compared with the historical cohort without HDC-ASCR as part of primary treatment, the current cohort had a significantly better 5-year OS ( p = 0.018).

Conclusion: HDC-ASCR seems promising as an alternative treatment for HRES in improving OS in this retrospective study with a limited case number.

背景:手术、化疗和放疗的综合治疗可提高儿童尤文肉瘤(ES)患者的存活率。然而,确诊时有转移性疾病或复发的患者预后仍然很差。其他高危(HR)特征包括肿瘤负荷大、肿瘤位于轴状骨骼和组织学反应差。多项研究表明,大剂量化疗联合自体干细胞救治(HDC-ASCR)对此类患者有效。在这项回顾性研究中,我们介绍了一家研究所采用HDC-ASCR治疗高危儿童和年轻成人尤文肉瘤的结果:方法:纳入 2004 年 3 月至 2021 年 3 月期间接受 HDC-ASCR 治疗的 ES、尤文样肉瘤或圆形细胞肉瘤患者。分析了患者的特征、疾病状态、干细胞剂量、移植状态、移植后并发症和预后:20名患者在完全反应(6人)、部分反应(13人)和病情稳定(1人)时接受了HDC-ASCR治疗。男女比例为 11:9。诊断和移植时的中位年龄分别为 15.6 岁(范围:3.3-28.9)和 16.2 岁(范围:4.2-29.9)。2名患者采用了伊福酰胺治疗方案,19名患者采用了美法仑治疗方案。所有患者都成功实现了移植,且无坦杉相关死亡率。5年无进展生存率和总生存率(OS)分别为35%和54.5%。死亡原因(8 例)均与疾病进展有关。完全应答组或局部HRES患者的5年生存率较高(P = 0.047和0.05)。与未将HDC-ASCR作为主要治疗手段的历史队列相比,当前队列的5年OS明显更好(p = 0.018):结论:在这项病例数有限的回顾性研究中,HDC-ASCR似乎有望作为HRES的替代治疗方法,改善患者的OS。
{"title":"High-dose chemotherapy with autologous stem cell rescue in children and young adults with high-risk Ewing sarcoma.","authors":"Chih-Ying Lee, Ming-Hsin Hou, Giun-Yi Hung, Cheng-Yin Ho, Ting-Yen Yu, Po-Kuei Wu, Chao-Ming Chen, Chueh-Chuan Yen, Cheng-Ying Shiau, Paul Chih-Hsueh Chen, Hung-Ta Hondar Wu, Ching-Lan Wu, Hsiu-Ju Yen, Wei-Ming Chen","doi":"10.1097/JCMA.0000000000001179","DOIUrl":"10.1097/JCMA.0000000000001179","url":null,"abstract":"<p><strong>Background: </strong>A combination treatment of surgery, chemotherapy, and radiotherapy can improve the survivals of pediatric patients with Ewing sarcoma (ES). However, prognosis remains poor for patients with metastatic disease at diagnosis or recurrence. Other high-risk (HR) features include large tumor burden, tumors of the axial skeleton, and poor histologic response. Several studies have documented high-dose chemotherapy with autologous stem cell rescue (HDC-ASCR) to be effective in such patients. In this retrospective study, we present the results of HDC-ASCR for high-risk ES (HRES) in children and young adults in a single institute.</p><p><strong>Methods: </strong>From March 2004 to March 2021, patients with ES, Ewing-like sarcoma, or round cell sarcoma received HDC-ASCR as part of treatment were included. The patients' characteristics, disease status, stem cell dose, engraftment status, post-transplant complications, and outcomes were analyzed.</p><p><strong>Results: </strong>Twenty patients receiving HDC-ASCR at complete response (n = 6), partial response (n = 13), and stable disease (n = 1) were enrolled. The male-to-female ratio was 11:9. Median age at diagnosis and transplant was 15.6 years old (range: 3.3-28.9) and 16.2 (range: 4.2-29.9), respectively. The conditioning regimens included ifosfamide-based in two and melphalan-based in 19. All patients achieved successful engraftment without transplant-related mortality. The 5-year progression-free and overall survival (OS) rate were 35% and 54.5%, respectively. The causes of death (n = 8) were all contributed to disease progression. Patients in the complete response group or with localized HRES exhibited a higher 5-year OS ( p = 0.047 and 0.05, respectively). Compared with the historical cohort without HDC-ASCR as part of primary treatment, the current cohort had a significantly better 5-year OS ( p = 0.018).</p><p><strong>Conclusion: </strong>HDC-ASCR seems promising as an alternative treatment for HRES in improving OS in this retrospective study with a limited case number.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"85-91"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Associations between tooth loss, denture use, and dementia in older Taiwanese adults. 台湾老年人牙齿脱落、假牙使用与痴呆的关系。
Pub Date : 2025-01-01 Epub Date: 2024-09-20 DOI: 10.1097/JCMA.0000000000001171
Yi-Wen Chen, Chung-Yi Li, Shang-Chi Lee, Li-Jung Elizabeth Ku, Yu-Tsung Chou, Arief Hargono, Chang-Ta Chiu, Wen-Hsuan Hou

Background: The literature has mainly focused on the association between tooth loss and dementia, and evidence regarding the separate and joint effects of tooth loss and denture use on the risk of dementia is limited. This study investigated the links among tooth loss, denture use, and dementia risk in Taiwanese adults aged 65 years or older.

Methods: This retrospective cohort study utilized data from the 2009 National Health Interview Survey and 2008-2017 National Health Insurance claim records, including the records of 2247 individuals free from dementia treatment in 2008-2009. Dementia diagnoses were tracked until 2017. The Cox proportional hazards model was used to calculate hazard ratios (HRs) for exploring the correlations among tooth loss, denture use, and dementia risk.

Results: Older adults with 20 or more natural teeth and dentures had the lowest dementia incidence (1.43 per 100 person-years). Those with <20 natural teeth, with or without dentures, experienced high dementia incidence rates of 2.31 and 3.33 per 100 person-years, respectively. After adjusting for various factors (i.e., sociodemographic characteristics, health conditions/comorbidities, and lifestyles), having <20 natural teeth or not using dentures was associated with non-significantly increased HRs of 1.30 (95% CI, 0.99-1.71) and 1.20 (95% CI, 0.95-1.52). Subgroup analysis revealed that compared to older adults with 20 or more natural teeth and dentures, those with <20 natural teeth and not wearing dentures had a significantly increased risk of dementia (adjusted HR, 1.57; 95% CI, 1.04-2.37).

Conclusion: This study found that having <20 natural teeth and not using dentures was significantly associated with an increased risk of dementia in Taiwanese individuals aged 65 years or above.

背景:文献主要集中在牙齿脱落和痴呆之间的关系,关于牙齿脱落和义齿使用对痴呆风险的单独或联合影响的证据有限。摘要本研究调查台湾65岁以上老年人牙齿缺失、假牙使用与失智风险的关系。方法:本回顾性队列研究利用2009年全国健康访谈调查和2008-2017年国民健康保险索赔记录的数据,包括2008-2009年未接受痴呆治疗的2247人的记录。痴呆症诊断一直追踪到2017年。采用Cox比例风险模型计算风险比(hr),探讨牙齿脱落、义齿使用与痴呆风险之间的相关性。结果:拥有20颗或更多天然牙和假牙的老年人痴呆发病率最低(1.43 / 100人年)。结论:这项研究发现拥有
{"title":"Associations between tooth loss, denture use, and dementia in older Taiwanese adults.","authors":"Yi-Wen Chen, Chung-Yi Li, Shang-Chi Lee, Li-Jung Elizabeth Ku, Yu-Tsung Chou, Arief Hargono, Chang-Ta Chiu, Wen-Hsuan Hou","doi":"10.1097/JCMA.0000000000001171","DOIUrl":"10.1097/JCMA.0000000000001171","url":null,"abstract":"<p><strong>Background: </strong>The literature has mainly focused on the association between tooth loss and dementia, and evidence regarding the separate and joint effects of tooth loss and denture use on the risk of dementia is limited. This study investigated the links among tooth loss, denture use, and dementia risk in Taiwanese adults aged 65 years or older.</p><p><strong>Methods: </strong>This retrospective cohort study utilized data from the 2009 National Health Interview Survey and 2008-2017 National Health Insurance claim records, including the records of 2247 individuals free from dementia treatment in 2008-2009. Dementia diagnoses were tracked until 2017. The Cox proportional hazards model was used to calculate hazard ratios (HRs) for exploring the correlations among tooth loss, denture use, and dementia risk.</p><p><strong>Results: </strong>Older adults with 20 or more natural teeth and dentures had the lowest dementia incidence (1.43 per 100 person-years). Those with <20 natural teeth, with or without dentures, experienced high dementia incidence rates of 2.31 and 3.33 per 100 person-years, respectively. After adjusting for various factors (i.e., sociodemographic characteristics, health conditions/comorbidities, and lifestyles), having <20 natural teeth or not using dentures was associated with non-significantly increased HRs of 1.30 (95% CI, 0.99-1.71) and 1.20 (95% CI, 0.95-1.52). Subgroup analysis revealed that compared to older adults with 20 or more natural teeth and dentures, those with <20 natural teeth and not wearing dentures had a significantly increased risk of dementia (adjusted HR, 1.57; 95% CI, 1.04-2.37).</p><p><strong>Conclusion: </strong>This study found that having <20 natural teeth and not using dentures was significantly associated with an increased risk of dementia in Taiwanese individuals aged 65 years or above.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":"88 1","pages":"43-51"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The surgical safety margin after neoadjuvant chemotherapy combined with nimotuzumab leading to tumor regression. 新辅助化疗联合尼莫单抗导致肿瘤消退后的手术安全界限。
Pub Date : 2024-12-23 DOI: 10.1097/JCMA.0000000000001199
Suxin Zhang, Si Chen, Guochao Chai, Yaoyao Shi, Yang Bao, Shixiong Peng, Zifeng Cui, Jiamei Hao

Background: To investigate the effect of nimotuzumab (N) combined with nab-paclitaxel, cisplatin, and fluorouracil (APF) neoadjuvant chemotherapy on the surgical margin.

Methods: 55 patients were divided into three groups: neoadjuvant chemotherapy and surgery group (G1, 15 cases), chemotherapy and surgery group (G2 group, 20 cases), and surgery group (G3 group, 20 cases). Tissue samples of the tumor core zone (P0), adjacent (P1, 3-5mm from tumor), distal adjacent (P2, 7-10mm from tumor), and surgical margin (P3, 15mm from tumor) were collected. Morphological changes and pathological remission rates were observed. Immunohistochemistry was used to detect the expression of EGFR, elF4E, P53, and VEGF in each specimen by statistical analysis.

Results: In the G1 and G2 groups, various degrees of degeneration and necrosis were observed in the tumor retraction area. Nine cases of MPR (major pathologic response) and 4 cases of pCR (pathologic complete response) in the G1 group; 8 cases of MPR and 3 cases of pCR in the G2 group. The expressions of p53, eIF4E, and EGFR in the samples of the three groups decreased from P0 to P2 with statistical differences (p<0.05). In the molecular tumor shrinkage area, the expression levels of p53, eIF4E, and EGFR in the shrinkage zone were lower than those in the negative margin.

Conclusion: In summary, although there is no significant statistical difference between neoadjuvant chemotherapy with nimotuzumab combined with APF and APF alone in the pathological remission rate of locally advanced oral squamous cell carcinoma, there is a trend indicating that nimotuzumab combined with APF is superior.

背景:探讨尼莫单抗(N)联合nab-紫杉醇、顺铂、氟尿嘧啶(APF)新辅助化疗对手术缘的影响。方法:55例患者分为新辅助化疗手术组(G1, 15例)、化疗手术组(G2组,20例)、手术组(G3组,20例)3组。采集肿瘤核心区(P0)、邻近区(P1,距肿瘤3-5mm)、远端邻近区(P2,距肿瘤7-10mm)、手术缘区(P3,距肿瘤15mm)组织标本。观察形态学改变和病理缓解率。采用免疫组化方法对各标本中EGFR、elF4E、P53、VEGF的表达进行统计分析。结果:G1组、G2组肿瘤回缩区出现不同程度的退变、坏死。G1组MPR(主要病理缓解)9例,pCR(病理完全缓解)4例;G2组MPR 8例,pCR 3例。三组样本中p53、eIF4E、EGFR的表达由P0降至P2,差异有统计学意义(p)结论:综上所述,尼莫单抗联合APF新辅助化疗与单用APF治疗局部晚期口腔鳞状细胞癌的病理缓解率虽无统计学差异,但有尼莫单抗联合APF的趋势。
{"title":"The surgical safety margin after neoadjuvant chemotherapy combined with nimotuzumab leading to tumor regression.","authors":"Suxin Zhang, Si Chen, Guochao Chai, Yaoyao Shi, Yang Bao, Shixiong Peng, Zifeng Cui, Jiamei Hao","doi":"10.1097/JCMA.0000000000001199","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001199","url":null,"abstract":"<p><strong>Background: </strong>To investigate the effect of nimotuzumab (N) combined with nab-paclitaxel, cisplatin, and fluorouracil (APF) neoadjuvant chemotherapy on the surgical margin.</p><p><strong>Methods: </strong>55 patients were divided into three groups: neoadjuvant chemotherapy and surgery group (G1, 15 cases), chemotherapy and surgery group (G2 group, 20 cases), and surgery group (G3 group, 20 cases). Tissue samples of the tumor core zone (P0), adjacent (P1, 3-5mm from tumor), distal adjacent (P2, 7-10mm from tumor), and surgical margin (P3, 15mm from tumor) were collected. Morphological changes and pathological remission rates were observed. Immunohistochemistry was used to detect the expression of EGFR, elF4E, P53, and VEGF in each specimen by statistical analysis.</p><p><strong>Results: </strong>In the G1 and G2 groups, various degrees of degeneration and necrosis were observed in the tumor retraction area. Nine cases of MPR (major pathologic response) and 4 cases of pCR (pathologic complete response) in the G1 group; 8 cases of MPR and 3 cases of pCR in the G2 group. The expressions of p53, eIF4E, and EGFR in the samples of the three groups decreased from P0 to P2 with statistical differences (p<0.05). In the molecular tumor shrinkage area, the expression levels of p53, eIF4E, and EGFR in the shrinkage zone were lower than those in the negative margin.</p><p><strong>Conclusion: </strong>In summary, although there is no significant statistical difference between neoadjuvant chemotherapy with nimotuzumab combined with APF and APF alone in the pathological remission rate of locally advanced oral squamous cell carcinoma, there is a trend indicating that nimotuzumab combined with APF is superior.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Influence of endovascular surgery on abdominal aortic aneurysm management strategies from a national health insurance database survey. 全国医疗保险数据库调查显示血管内手术对腹主动脉瘤管理策略的影响。
Pub Date : 2024-12-01 Epub Date: 2024-08-22 DOI: 10.1097/JCMA.0000000000001156
Wei-Ling Chen, Chung-Dann Kan, Yi-Ting Huang, Hsin-I Shih

Background: Abdominal aortic aneurysm (AAA) is a significant global health concern, yet comprehensive population-based studies remain limited. This study aimed to evaluate the hospitalization rates, surgical trends, mortality, and reintervention rates for ruptured (r-AAA) and nonruptured (nr-AAA) AAA using data from a national health insurance database.

Methods: A population-based retrospective cohort study was conducted utilizing data from the Taiwanese National Health Insurance Research Database from 2007 to 2018. The study included individuals aged 20 years and older with a newly diagnosed AAA.

Results: Among 70 457 patients diagnosed with aortic aneurysm or dissection, 22 538 (32%) adult patients (≥20 years) were identified with AAA. The annual incidence of AAA ranged from 7.7 to 10.3 per 100 000 population, with r-AAA decreasing from 1.3 to 0.8 per 100 000 and nr-AAA from 9.0 to 6.8 per 100 000. Most patients with AAA were older adults (85%), with 15 392 (68%) hospitalized and 4885 (32%) undergoing surgery within 14 days of diagnosis. The use of endovascular aneurysm repair (EVAR) significantly increased from 28% to 96% over the study period. Long-term survival was higher in patients who underwent open surgical repair (OSR) compared to those who received EVAR or conservative management, irrespective of whether they had r-AAA or nr-AAA.

Conclusion: AAA predominantly affects older individuals, and the annual incidence shows a declining trend. Since the introduction of EVAR, its use has steadily increased while OSR rates have decreased. Although both EVAR and OSR are associated with reduced mortality in patients with r-AAA, OSR is linked to superior long-term survival outcomes.

背景:腹主动脉瘤(AAA)对全球健康构成了相当大的挑战;然而,基于人群的 AAA 研究却很少。本研究通过使用全国健康保险数据库,确定了破裂型(r-AAA)和非破裂型(nr-AAA)AAA 的住院率、手术趋势、死亡率和再介入率:我们通过分析台湾国民健康保险研究数据库中 2007 年至 2018 年的数据,开展了一项基于人群的回顾性队列研究。结果:共有 70 457 名患者被纳入研究:研究期间,共有 70 457 名患者被诊断为主动脉瘤或夹层;22 538 名(32%)成年患者(≥20 岁)患有 AAA。AAA 的年发病率约为每 10 万人中 7.7 至 10.3 例(r-AAA:每 10 万人中 0.8 至 1.3 例;nr-AAA:每 10 万人中 6.8 至 9.0 例)。大多数 AAA 患者是老年人(85%);15 392 名患者(68%)有住院记录,4885 名患者(32%)在确诊后 14 天内接受了手术。在研究期间,接受血管内动脉瘤修补术(EVAR)的患者比例从 28% 增加到 96%。与接受EVAR或保守治疗的患者相比,无论患者是r-AAA还是nr-AAA,接受开放手术修复(OSR)的患者的长期存活率都更高:结论:AAA 在老年人中更为常见,每年的标准化发病率呈下降趋势。自EVAR问世以来,接受EVAR治疗的患者比例持续上升,而接受OSR治疗的患者比例则有所下降。虽然EVAR和OSR都能降低r-AAA患者的死亡率,但OSR的长期生存率更高。
{"title":"Influence of endovascular surgery on abdominal aortic aneurysm management strategies from a national health insurance database survey.","authors":"Wei-Ling Chen, Chung-Dann Kan, Yi-Ting Huang, Hsin-I Shih","doi":"10.1097/JCMA.0000000000001156","DOIUrl":"10.1097/JCMA.0000000000001156","url":null,"abstract":"<p><strong>Background: </strong>Abdominal aortic aneurysm (AAA) is a significant global health concern, yet comprehensive population-based studies remain limited. This study aimed to evaluate the hospitalization rates, surgical trends, mortality, and reintervention rates for ruptured (r-AAA) and nonruptured (nr-AAA) AAA using data from a national health insurance database.</p><p><strong>Methods: </strong>A population-based retrospective cohort study was conducted utilizing data from the Taiwanese National Health Insurance Research Database from 2007 to 2018. The study included individuals aged 20 years and older with a newly diagnosed AAA.</p><p><strong>Results: </strong>Among 70 457 patients diagnosed with aortic aneurysm or dissection, 22 538 (32%) adult patients (≥20 years) were identified with AAA. The annual incidence of AAA ranged from 7.7 to 10.3 per 100 000 population, with r-AAA decreasing from 1.3 to 0.8 per 100 000 and nr-AAA from 9.0 to 6.8 per 100 000. Most patients with AAA were older adults (85%), with 15 392 (68%) hospitalized and 4885 (32%) undergoing surgery within 14 days of diagnosis. The use of endovascular aneurysm repair (EVAR) significantly increased from 28% to 96% over the study period. Long-term survival was higher in patients who underwent open surgical repair (OSR) compared to those who received EVAR or conservative management, irrespective of whether they had r-AAA or nr-AAA.</p><p><strong>Conclusion: </strong>AAA predominantly affects older individuals, and the annual incidence shows a declining trend. Since the introduction of EVAR, its use has steadily increased while OSR rates have decreased. Although both EVAR and OSR are associated with reduced mortality in patients with r-AAA, OSR is linked to superior long-term survival outcomes.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"1060-1067"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Circulating T-lymphocyte subsets as promising biomarkers for the identification of sepsis-induced acute kidney injury. 循环 T 淋巴细胞亚群是识别脓毒症诱发急性肾损伤的理想生物标志物。
Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.1097/JCMA.0000000000001177
Xue-Ling Guo, Cheng-Xiang Lu, Yan Luo, Ping-Ping Wang, Wen-Song Su, Si-Jiu Yang, Ling-Hui Zhan

Background: This retrospective study investigated whether disturbances in circulating T-lymphocyte subsets could predict the incidence of acute kidney injury (AKI) and in-hospital mortality in patients with sepsis.

Methods: Clinical data from patients with sepsis admitted to the intensive care unit were reviewed. Logistic regression analyses were used to identify independent predictors of in-hospital mortality and the development of AKI.

Results: Of 81 patients with sepsis, 50 developed AKI. Both nonsurvivors and patients with septic AKI exhibited higher Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Nonsurvivors exhibited more organ damage, with significantly lower levels of peripheral T-lymphocyte subsets, including total circulating lymphocytes, and CD3 + , CD3 + CD4 + , and CD3 + CD8 + T-lymphocytes. Patients with septic AKI exhibited fewer total peripheral lymphocytes and fewer CD3 + , CD3 + CD4 + , and CD3 + CD8 + T-lymphocytes, with higher serum lactate levels and lower nadir platelet counts. Independent predictors of 30-day hospital mortality included maximum SOFA and APACHE II scores, occurrence of encephalopathy, and peripheral CD3 + and CD3 + CD8 + T-lymphocyte counts. Moreover, the maximum SOFA score and CD3 + and CD3 + CD8 + T-lymphocyte counts demonstrated good predictive power for AKI in receiver operating characteristic (ROC) curve analyses, with an area under the ROC curve of 0.810 (95% confidence interval [CI], 0.712-0.908) for SOFA score, 0.849 (95% CI, 0.764-0.934) for CD3 + T-lymphocytes, and 0.856 (95% CI, 0.772-0.941) for CD3 + CD8 + T-lymphocytes.

Conclusion: Patients with sepsis-induced AKI experienced T lymphopenia and increased in-hospital mortality. Higher maximum SOFA scores and reduced peripheral CD3 + and CD3 + CD8 + T-lymphocyte levels were associated with in-hospital mortality and the development of AKI in patients with sepsis.

背景:这项回顾性研究探讨了循环 T 淋巴细胞亚群的紊乱是否能预测脓毒症患者急性肾损伤(AKI)的发生率和院内死亡率:研究回顾了重症监护室收治的败血症患者的临床数据。方法:研究人员回顾了重症监护室收治的脓毒症患者的临床数据,并使用逻辑回归分析确定了院内死亡率和急性肾损伤发生的独立预测因素:81名脓毒症患者中有50人出现了AKI。非存活患者和脓毒症 AKI 患者的序贯器官衰竭评估(SOFA)和急性生理学与慢性健康评估(APACHE)II 评分均显著升高。非幸存者表现出更多的器官损伤,外周T淋巴细胞亚群(包括循环淋巴细胞总数、CD3+、CD3+CD4+和CD3+CD8+T淋巴细胞)水平明显降低。脓毒症 AKI 患者的外周淋巴细胞总数较少,CD3+、CD3+CD4+ 和 CD3+CD8+ T 淋巴细胞较少,血清乳酸水平较高,最低血小板计数较低。30 天住院死亡率的独立预测因素包括 SOFA 和 APACHE II 最高评分、脑病发生率以及外周 CD3+ 和 CD3+CD8+ T 淋巴细胞计数。此外,在接收器操作特征曲线(ROC)分析中,SOFA 最大评分和 CD3+ 及 CD3+CD8+ T 淋巴细胞计数对 AKI 具有良好的预测能力,ROC 曲线下面积为 0.SOFA评分的ROC曲线下面积为0.810(95%置信区间[CI] 0.712-0.908),CD3+ T淋巴细胞的ROC曲线下面积为0.849(95%置信区间[CI] 0.764-0.934),CD3+CD8+ T淋巴细胞的ROC曲线下面积为0.856(95%置信区间[CI] 0.772-0.941):结论:脓毒症诱发的 AKI 患者会出现 T 淋巴细胞减少,并增加院内死亡率。脓毒症患者较高的SOFA最高评分和较低的外周CD3+和CD3+CD8+ T淋巴细胞水平与院内死亡率和AKI的发生有关。
{"title":"Circulating T-lymphocyte subsets as promising biomarkers for the identification of sepsis-induced acute kidney injury.","authors":"Xue-Ling Guo, Cheng-Xiang Lu, Yan Luo, Ping-Ping Wang, Wen-Song Su, Si-Jiu Yang, Ling-Hui Zhan","doi":"10.1097/JCMA.0000000000001177","DOIUrl":"10.1097/JCMA.0000000000001177","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study investigated whether disturbances in circulating T-lymphocyte subsets could predict the incidence of acute kidney injury (AKI) and in-hospital mortality in patients with sepsis.</p><p><strong>Methods: </strong>Clinical data from patients with sepsis admitted to the intensive care unit were reviewed. Logistic regression analyses were used to identify independent predictors of in-hospital mortality and the development of AKI.</p><p><strong>Results: </strong>Of 81 patients with sepsis, 50 developed AKI. Both nonsurvivors and patients with septic AKI exhibited higher Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Nonsurvivors exhibited more organ damage, with significantly lower levels of peripheral T-lymphocyte subsets, including total circulating lymphocytes, and CD3 + , CD3 + CD4 + , and CD3 + CD8 + T-lymphocytes. Patients with septic AKI exhibited fewer total peripheral lymphocytes and fewer CD3 + , CD3 + CD4 + , and CD3 + CD8 + T-lymphocytes, with higher serum lactate levels and lower nadir platelet counts. Independent predictors of 30-day hospital mortality included maximum SOFA and APACHE II scores, occurrence of encephalopathy, and peripheral CD3 + and CD3 + CD8 + T-lymphocyte counts. Moreover, the maximum SOFA score and CD3 + and CD3 + CD8 + T-lymphocyte counts demonstrated good predictive power for AKI in receiver operating characteristic (ROC) curve analyses, with an area under the ROC curve of 0.810 (95% confidence interval [CI], 0.712-0.908) for SOFA score, 0.849 (95% CI, 0.764-0.934) for CD3 + T-lymphocytes, and 0.856 (95% CI, 0.772-0.941) for CD3 + CD8 + T-lymphocytes.</p><p><strong>Conclusion: </strong>Patients with sepsis-induced AKI experienced T lymphopenia and increased in-hospital mortality. Higher maximum SOFA scores and reduced peripheral CD3 + and CD3 + CD8 + T-lymphocyte levels were associated with in-hospital mortality and the development of AKI in patients with sepsis.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"1068-1077"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of the Chinese Medical Association : JCMA
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