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.
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.
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.
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.
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.
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.
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.
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.
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.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：