Pub Date : 2024-12-30DOI: 10.1097/JCMA.0000000000001204
Ping-Lin Hsieh, Peng-Hui Wang, Jyun-Cheng Ke, Kai-Jo Chiang, Chi-Kang Lin, Fung-Wei Chang, Kuo-Min Su, Kuo-Chih Su
Background: Operative delivery is a technique used during vaginal or cesarean birth to facilitate the patient's labor course through the assistance of a vacuum extractor. This method is increasingly used compared with forceps. This study aimed to investigate the forced effects of vacuum extractors comprising vacuum cups with different thicknesses on the fetal head and the vacuum extractor during vacuum-assisted delivery and to determine the optimal thickness for reducing the failure rate and minimizing neonatal and maternal morbidity.
Methods: A biomechanical model was developed to examine the impact of vacuum cups with varying thicknesses. This simulation three-dimensional (3D) geometry model was used to evaluate hemispherical-shaped vacuum extractors made of silicone rubber having a similar cup diameter of 70 mm with varying thicknesses (1 mm to 5 mm), which were applied to the three models (flat surfaces, hemispherical balls, and fetal head). Under one boundary condition and two different loading conditions, finite element analysis was utilized to simulate the force of vacuum extractors on the fetal head during the process of operative delivery. The main observation indicators were the reaction forces of the constructed model, and von Mises stress on both the vacuum extractors and fetal head.
Results: For the reaction forces on each axis, we found that the sum of the reaction force values on each axis was increased as the thickness of the vacuum extractor was increased, regardless of the surface type. Additionally, the reaction force of the fixed-support end was increased with the increased thickness of the vacuum extractor. The von Mises stress distributions of vacuum extractors comprising vacuum cups with different thicknesses, revealed that the thinner the cup, the greater the von Mises stress exerted on the extractor itself regardless of the surface type. The distribution of von Mises stress on the skull structure of the fetal head, showed that the thinner the cup, the greater the von Mises stress exerted on the skull structure regardless of the surface type.
Conclusion: A thinner vacuum extractor cup may result in greater injury to the fetus; hence, a thicker vacuum extractor cup is preferably utilized during vacuum-assisted operative delivery. Using a thicker vacuum extractor should yield a higher successful delivery rate and reduce fetal injury.
{"title":"Selection of the apposite vacuum extractor during operative delivery: A biomechanical study.","authors":"Ping-Lin Hsieh, Peng-Hui Wang, Jyun-Cheng Ke, Kai-Jo Chiang, Chi-Kang Lin, Fung-Wei Chang, Kuo-Min Su, Kuo-Chih Su","doi":"10.1097/JCMA.0000000000001204","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001204","url":null,"abstract":"<p><strong>Background: </strong>Operative delivery is a technique used during vaginal or cesarean birth to facilitate the patient's labor course through the assistance of a vacuum extractor. This method is increasingly used compared with forceps. This study aimed to investigate the forced effects of vacuum extractors comprising vacuum cups with different thicknesses on the fetal head and the vacuum extractor during vacuum-assisted delivery and to determine the optimal thickness for reducing the failure rate and minimizing neonatal and maternal morbidity.</p><p><strong>Methods: </strong>A biomechanical model was developed to examine the impact of vacuum cups with varying thicknesses. This simulation three-dimensional (3D) geometry model was used to evaluate hemispherical-shaped vacuum extractors made of silicone rubber having a similar cup diameter of 70 mm with varying thicknesses (1 mm to 5 mm), which were applied to the three models (flat surfaces, hemispherical balls, and fetal head). Under one boundary condition and two different loading conditions, finite element analysis was utilized to simulate the force of vacuum extractors on the fetal head during the process of operative delivery. The main observation indicators were the reaction forces of the constructed model, and von Mises stress on both the vacuum extractors and fetal head.</p><p><strong>Results: </strong>For the reaction forces on each axis, we found that the sum of the reaction force values on each axis was increased as the thickness of the vacuum extractor was increased, regardless of the surface type. Additionally, the reaction force of the fixed-support end was increased with the increased thickness of the vacuum extractor. The von Mises stress distributions of vacuum extractors comprising vacuum cups with different thicknesses, revealed that the thinner the cup, the greater the von Mises stress exerted on the extractor itself regardless of the surface type. The distribution of von Mises stress on the skull structure of the fetal head, showed that the thinner the cup, the greater the von Mises stress exerted on the skull structure regardless of the surface type.</p><p><strong>Conclusion: </strong>A thinner vacuum extractor cup may result in greater injury to the fetus; hence, a thicker vacuum extractor cup is preferably utilized during vacuum-assisted operative delivery. Using a thicker vacuum extractor should yield a higher successful delivery rate and reduce fetal injury.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960580","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}
<p><strong>Background: </strong>COVID-19, caused by the SARS-CoV-2 virus, presents with varying severity among individuals. Both viral and host factors can influence the severity of acute and chronic COVID-19, with chronic COVID-19 commonly referred to as long COVID. SARS-CoV-2 infection can be properly diagnosed by performing real-time reverse transcription PCR analysis of nasal swab samples. Pulse oximetry, chest X-ray, and complete blood count (CBC) analysis can be used to assess the condition of the patient to ensure that the appropriate medical care is delivered. This study aimed to develop biosignatures that can be used to distinguish between patients who are likely to develop severe disease and require hospitalization from patients who can be safely monitored in less intensive settings.</p><p><strong>Methods: </strong>A retrospective investigation was conducted on 7897 adult patients with virologically confirmed SARS-CoV-2 infection between January 26, 2020, and November 30, 2023; all patients underwent comprehensive CBC testing at Taipei Veterans General Hospital). Among them, 1867 patients were independently recruited for a population study involving genome-wide genotyping of approximately 424 000 genomic variants. Therefore, the participants were divided into two patient cohorts, one with genomic data (n = 1867) and one without (n = 6030) for model validation and training, respectively.</p><p><strong>Results: </strong>We constructed and validated a biosignature model by using a combination of CBC measurements to predict subsequent hospitalization events (hazard ratio [95% confidence interval] = 3.38, [3.07, 3.73] for the training cohort and 3.03 [2.46, 3.73] for the validation cohort; both p < 10-8). The obtained scores were used to identify the top quartile of patients, who formed the "very high risk" group with a significantly higher cumulative incidence of hospitalization (log-rank p < 10-8 in both the training and validation cohorts). The "very high risk" group exhibited a cumulative hospitalization rate of >60%, whereas the rate for the other patients was approximately 30% over a 1.5-year period, providing a binary classification of patients with distinct hospitalization risks. To investigate the genetic factors mediating this risk, we conducted a genome-wide association study. Specific regions in chromosomes 7 and 10 and the mitochondrial chromosome (M), harboring IKZF1, ABLIM1 and MT-ND3, exhibited prominent associations with binary risk classification. The identified exonic variants of IKZF1 are linked to several autoimmune diseases. Notably, people with different genotypes of the leading variants (rs4132601, rs141492519, and Affx-120744614) exhibited varying cumulative hospitalization rates following infection.</p><p><strong>Conclusion: </strong>We successfully developed and validated a biosignature model of COVID-19 severe disease in virologically confirmed patients. The identified genomic variants provide new insights for inf
{"title":"Predictive biosignatures for hospitalization in patients with virologically confirmed COVID-19.","authors":"Kung-Hao Liang, Yu-Chun Chen, Chun-Yi Hsu, Zih-Kai Kao, Ping-Hsing Tsai, Hsin-Yi Huang, Yuan-Chia Chu, Hsiang-Ling Ho, Yi-Chu Liao, Yi-Chung Lee, Chi-Cheng Huang, Tzu-Chun Wei, Yi-Jia Liao, Yung-Hsiu Lu, Chen-Tsung Kuo, Shih-Hua Chiou","doi":"10.1097/JCMA.0000000000001203","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001203","url":null,"abstract":"<p><strong>Background: </strong>COVID-19, caused by the SARS-CoV-2 virus, presents with varying severity among individuals. Both viral and host factors can influence the severity of acute and chronic COVID-19, with chronic COVID-19 commonly referred to as long COVID. SARS-CoV-2 infection can be properly diagnosed by performing real-time reverse transcription PCR analysis of nasal swab samples. Pulse oximetry, chest X-ray, and complete blood count (CBC) analysis can be used to assess the condition of the patient to ensure that the appropriate medical care is delivered. This study aimed to develop biosignatures that can be used to distinguish between patients who are likely to develop severe disease and require hospitalization from patients who can be safely monitored in less intensive settings.</p><p><strong>Methods: </strong>A retrospective investigation was conducted on 7897 adult patients with virologically confirmed SARS-CoV-2 infection between January 26, 2020, and November 30, 2023; all patients underwent comprehensive CBC testing at Taipei Veterans General Hospital). Among them, 1867 patients were independently recruited for a population study involving genome-wide genotyping of approximately 424 000 genomic variants. Therefore, the participants were divided into two patient cohorts, one with genomic data (n = 1867) and one without (n = 6030) for model validation and training, respectively.</p><p><strong>Results: </strong>We constructed and validated a biosignature model by using a combination of CBC measurements to predict subsequent hospitalization events (hazard ratio [95% confidence interval] = 3.38, [3.07, 3.73] for the training cohort and 3.03 [2.46, 3.73] for the validation cohort; both p < 10-8). The obtained scores were used to identify the top quartile of patients, who formed the \"very high risk\" group with a significantly higher cumulative incidence of hospitalization (log-rank p < 10-8 in both the training and validation cohorts). The \"very high risk\" group exhibited a cumulative hospitalization rate of >60%, whereas the rate for the other patients was approximately 30% over a 1.5-year period, providing a binary classification of patients with distinct hospitalization risks. To investigate the genetic factors mediating this risk, we conducted a genome-wide association study. Specific regions in chromosomes 7 and 10 and the mitochondrial chromosome (M), harboring IKZF1, ABLIM1 and MT-ND3, exhibited prominent associations with binary risk classification. The identified exonic variants of IKZF1 are linked to several autoimmune diseases. Notably, people with different genotypes of the leading variants (rs4132601, rs141492519, and Affx-120744614) exhibited varying cumulative hospitalization rates following infection.</p><p><strong>Conclusion: </strong>We successfully developed and validated a biosignature model of COVID-19 severe disease in virologically confirmed patients. The identified genomic variants provide new insights for inf","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901488","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}
Pub Date : 2024-12-27DOI: 10.1097/JCMA.0000000000001201
Ze-Su Niu, Ru-Xin Liu, Yi Hu, Xiao-Rui Meng, Li-Hong Liu, Li-Ting Yang, Xue Bai, Meng-Fei Chen, Dong-Feng Pan
Background: COVID-19, caused by SARS-CoV-2, has had a significant impact on global health. While the virus primarily affects the respiratory system, the intricate interplay between immune cells and the virus remains poorly understood. This study investigates the causal relationship between 731 immune cell phenotypes and COVID-19 using Mendelian randomization analysis.
Methods: A bidirectional two-sample Mendelian randomization (MR) analysis was conducted using genetic variants strongly associated with immune cell phenotypes as instrumental variables. Data for 731 immune cell phenotypes were sourced from the GWAS Catalog, while data for COVID-19 susceptibility were obtained from the OPEN GWAS database. Five MR methods (IVW, MR-Egger, weighted median, simple mode, and weighted mode) were employed to estimate causal effects, with IVW as the primary analysis method.
Results: The study identified 57 immune cell phenotypes causally associated with COVID-19 risk across two independent GWAS datasets. Five immune cell phenotypes were consistently associated with COVID-19 risk across both datasets: CD3-lymphocyte %lymphocyte (protective), CD27 on CD20- (protective), CD20 on IgD+ CD38- unsw mem (increased risk), CD27 on IgD- CD38- (increased risk), and CD19 on B cell (increased risk). Sensitivity analyses confirmed the robustness of the findings.
Conclusion: This study provides compelling evidence for a causal relationship between specific immune cell phenotypes and COVID-19 risk. These findings highlight the potential for targeting these immune cell phenotypes as novel therapeutic targets for COVID-19 treatment and prevention.
{"title":"Complex causal relationships between genetic predictions of 731 immune cell phenotypes and novel coronavirus: A two-sample mendelian randomization analysis.","authors":"Ze-Su Niu, Ru-Xin Liu, Yi Hu, Xiao-Rui Meng, Li-Hong Liu, Li-Ting Yang, Xue Bai, Meng-Fei Chen, Dong-Feng Pan","doi":"10.1097/JCMA.0000000000001201","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001201","url":null,"abstract":"<p><strong>Background: </strong>COVID-19, caused by SARS-CoV-2, has had a significant impact on global health. While the virus primarily affects the respiratory system, the intricate interplay between immune cells and the virus remains poorly understood. This study investigates the causal relationship between 731 immune cell phenotypes and COVID-19 using Mendelian randomization analysis.</p><p><strong>Methods: </strong>A bidirectional two-sample Mendelian randomization (MR) analysis was conducted using genetic variants strongly associated with immune cell phenotypes as instrumental variables. Data for 731 immune cell phenotypes were sourced from the GWAS Catalog, while data for COVID-19 susceptibility were obtained from the OPEN GWAS database. Five MR methods (IVW, MR-Egger, weighted median, simple mode, and weighted mode) were employed to estimate causal effects, with IVW as the primary analysis method.</p><p><strong>Results: </strong>The study identified 57 immune cell phenotypes causally associated with COVID-19 risk across two independent GWAS datasets. Five immune cell phenotypes were consistently associated with COVID-19 risk across both datasets: CD3-lymphocyte %lymphocyte (protective), CD27 on CD20- (protective), CD20 on IgD+ CD38- unsw mem (increased risk), CD27 on IgD- CD38- (increased risk), and CD19 on B cell (increased risk). Sensitivity analyses confirmed the robustness of the findings.</p><p><strong>Conclusion: </strong>This study provides compelling evidence for a causal relationship between specific immune cell phenotypes and COVID-19 risk. These findings highlight the potential for targeting these immune cell phenotypes as novel therapeutic targets for COVID-19 treatment and prevention.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901486","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}
Background: Pediatric airway diseases are associated with complex challenges because of smaller and more dynamic airway structures in children. These conditions, along with specialized management by medical care staff, should be immediately and precisely recognized to prevent life-threatening obstructions and long-term respiratory complications. Recently, virtual reality (VR) has emerged as an innovative approach to clinical medical education. To evaluate and compare the effectiveness of VR-based education and traditional lectures in enhancing knowledge retention, clinical reasoning, and motivation among senior respiratory therapy students.
Methods: This experimental research was conducted between November 2020 and September 2022, involving 54 students from a School of Respiratory Therapy, with 43 completing a pre-test and undergoing random assignment into either a VR or a traditional education (non-VR) group. Samsung Gear VR Oculus headsets were used by the VR group for instructions on conditions such as laryngeal malacia, subglottic stenosis, and tracheomalacia. Theoretical exams, objective structured clinical examinations (OSCE), and instructional material motivation survey (IMMS) were used to evaluate participants' knowledge retention, clinical reasoning, and application capabilities, followed by statistical analysis comparing both study groups.
Results: No significant differences in pre-test scores were observed between the two groups. However, the VR group outperformed the non-VR group in OSCE scores significantly (p = 0.003) and demonstrated greater learning motivation and satisfaction based on IMMS scores. No notable difference in immediate post-education theoretical examination scores was observed between the groups.
Conclusion: VR-based education markedly improved the clinical reasoning and application skills of respiratory therapy students over traditional lecture methods. VR learning also increased students' motivation and satisfaction, indicating a more immersive and effective educational experience. These findings reveal that VR may be best utilized as a supplemental educational tool in clinical training programs. Future studies with larger samples and longer follow-up are warranted to further explore the optimal integration of VR in education.
{"title":"Comparison between virtual reality and traditional lecture methods in educating respiratory therapy students on pediatric difficult airway diseases.","authors":"Wen-Jing Hsu, Yi-Hsuan Tang, Wei-Chih Chen, Yu-Sheng Lee, Pei-Chen Tsao, Wei-Yu Chen, Ying-Ying Yang, Hsin-Kuo Ko, Sheng-Wei Pan, Yu-Fen Ting, Shih-Hsing Yang, Mei-Jy Jeng","doi":"10.1097/JCMA.0000000000001200","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001200","url":null,"abstract":"<p><strong>Background: </strong>Pediatric airway diseases are associated with complex challenges because of smaller and more dynamic airway structures in children. These conditions, along with specialized management by medical care staff, should be immediately and precisely recognized to prevent life-threatening obstructions and long-term respiratory complications. Recently, virtual reality (VR) has emerged as an innovative approach to clinical medical education. To evaluate and compare the effectiveness of VR-based education and traditional lectures in enhancing knowledge retention, clinical reasoning, and motivation among senior respiratory therapy students.</p><p><strong>Methods: </strong>This experimental research was conducted between November 2020 and September 2022, involving 54 students from a School of Respiratory Therapy, with 43 completing a pre-test and undergoing random assignment into either a VR or a traditional education (non-VR) group. Samsung Gear VR Oculus headsets were used by the VR group for instructions on conditions such as laryngeal malacia, subglottic stenosis, and tracheomalacia. Theoretical exams, objective structured clinical examinations (OSCE), and instructional material motivation survey (IMMS) were used to evaluate participants' knowledge retention, clinical reasoning, and application capabilities, followed by statistical analysis comparing both study groups.</p><p><strong>Results: </strong>No significant differences in pre-test scores were observed between the two groups. However, the VR group outperformed the non-VR group in OSCE scores significantly (p = 0.003) and demonstrated greater learning motivation and satisfaction based on IMMS scores. No notable difference in immediate post-education theoretical examination scores was observed between the groups.</p><p><strong>Conclusion: </strong>VR-based education markedly improved the clinical reasoning and application skills of respiratory therapy students over traditional lecture methods. VR learning also increased students' motivation and satisfaction, indicating a more immersive and effective educational experience. These findings reveal that VR may be best utilized as a supplemental educational tool in clinical training programs. Future studies with larger samples and longer follow-up are warranted to further explore the optimal integration of VR in education.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901485","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}
Pub Date : 2024-12-23DOI: 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.
{"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}
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.
{"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}
Pub Date : 2024-12-01Epub Date: 2024-10-04DOI: 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}
Background: Diabetes and insulin resistance alter the physiological state of serum albumin (SA), which is a prognostic marker for stable coronary artery disease (CAD). However, whether the SA concentration is associated with long-term cardiovascular (CV) outcomes in diabetic patients with stable CAD remains unclear.
Methods: In total, 1148 patients were retrospectively identified from a nationwide multicenter cohort study on patients with stable CAD. They were categorized into four groups according to their diabetes mellitus (DM) status and SA concentration (cutoff: 4 g/dL).
Results: The patients' mean age was 62.5 years, and 83.5% were male. Of the total patients, 405 were included in group 1 (SA ≥4/non-DM), 322 in group 2 (SA <4/non-DM), 201 in group 3 (SA ≥4/DM), and 220 in group 4 (SA <4/DM). Group 4 had the oldest age and a higher prevalence of prior myocardial infarction and stroke. During the median 4.5-year follow-up (interquartile range: 1.5-6.7 years), the highest and lowest survival rates in terms of all-cause and CV mortality were found in groups 1 and 4, respectively. However, no prognostic differences were noted in nonfatal stroke and myocardial infarction among the groups. The data were consistent after covariate adjustment. Using group 1 as the reference, hazard ratio (HRs) (95% CIs) for all-cause mortality in groups 2, 3, and 4 were 3.64 (1.22-10.83), 3.26 (0.95-11.33), and 5.74 (1.92-16.95), respectively, and those for CV mortality were 2.8 (0.57-13.67), 2.62 (0.40-17.28), and 6.15 (1.32-28.58), respectively.
Conclusion: In diabetic patients with stable CAD, a low SA concentration (<4 g/dL) was associated with increased long-term mortality regardless of all-cause or CV reasons but not nonfatal CV events.
{"title":"Long-term prognostic effect of serum albumin concentration in diabetic patients with stable coronary artery disease: A multicenter cohort study.","authors":"Ting-Wei Lu, Shih-Chieh Chien, Hsin-Bang Leu, Wei-Hsian Yin, Wei-Kung Tseng, Yen-Wen Wu, Tsung-Hsien Lin, Kuan-Cheng Chang, Ji-Hung Wang, Chau-Chung Wu, Hung-I Yeh, Jaw-Wen Chen","doi":"10.1097/JCMA.0000000000001158","DOIUrl":"10.1097/JCMA.0000000000001158","url":null,"abstract":"<p><strong>Background: </strong>Diabetes and insulin resistance alter the physiological state of serum albumin (SA), which is a prognostic marker for stable coronary artery disease (CAD). However, whether the SA concentration is associated with long-term cardiovascular (CV) outcomes in diabetic patients with stable CAD remains unclear.</p><p><strong>Methods: </strong>In total, 1148 patients were retrospectively identified from a nationwide multicenter cohort study on patients with stable CAD. They were categorized into four groups according to their diabetes mellitus (DM) status and SA concentration (cutoff: 4 g/dL).</p><p><strong>Results: </strong>The patients' mean age was 62.5 years, and 83.5% were male. Of the total patients, 405 were included in group 1 (SA ≥4/non-DM), 322 in group 2 (SA <4/non-DM), 201 in group 3 (SA ≥4/DM), and 220 in group 4 (SA <4/DM). Group 4 had the oldest age and a higher prevalence of prior myocardial infarction and stroke. During the median 4.5-year follow-up (interquartile range: 1.5-6.7 years), the highest and lowest survival rates in terms of all-cause and CV mortality were found in groups 1 and 4, respectively. However, no prognostic differences were noted in nonfatal stroke and myocardial infarction among the groups. The data were consistent after covariate adjustment. Using group 1 as the reference, hazard ratio (HRs) (95% CIs) for all-cause mortality in groups 2, 3, and 4 were 3.64 (1.22-10.83), 3.26 (0.95-11.33), and 5.74 (1.92-16.95), respectively, and those for CV mortality were 2.8 (0.57-13.67), 2.62 (0.40-17.28), and 6.15 (1.32-28.58), respectively.</p><p><strong>Conclusion: </strong>In diabetic patients with stable CAD, a low SA concentration (<4 g/dL) was associated with increased long-term mortality regardless of all-cause or CV reasons but not nonfatal CV events.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"1054-1059"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038127","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}
Background: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impacted on various aspects of society, including the healthcare system and patient care. In this context, this study aimed to evaluate the impact of COVID-19 control strategies on the lipid profile and blood sugar levels of peritoneal dialysis (PD) patients in Taiwan, a crucial focus for understanding the pandemic's influence on individuals with chronic kidney disease (CKD).
Methods: A retrospective cohort study was conducted, analyzing data from the medical records of 170 PD patients who visited the nephrology division of Taipei Veterans General Hospital in 2021. The generalized estimating equations method was used to analyze the longitudinal data and assess the changes in biomarker levels over different periods. Covariates were taken into consideration in the statistical models.
Results: The study enrolled 70 (41%) males and 100 (59%) females, with an average age of 56 years old. Over 12 months in 2021, from the first period (January to April: pre-COVID-19) to the second period (May to August: COVID-19 surge), there was a notable decline in both high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels, and a significant surge in triglyceride (TG) levels. However, total cholesterol (TC) and hemoglobin (HbA1c) levels remained stable. Furthermore, the TG to HDL, TG to LDL, TC to HDL, and TC to LDL ratios were analyzed, revealing a pronounced increase during the second period.
Conclusion: Our findings underscore the significant impact of COVID-19 pandemic-related disruptions in the healthcare system and the subsequent management strategies on dyslipidemia in PD patients while not affecting dysglycemia. These results provide valuable insights for healthcare professionals to enhance their strategies and interventions for CKD patients undergoing PD during a pandemic.
{"title":"The impact of the COVID-19 pandemic on dyslipidemia in peritoneal dialysis patients.","authors":"Fan-Yu Chen, Shu-En Li, Jen-En Tsai, Po-Yen Lu, Yu-Hsuan Li, Ann Charis Tan, Szu-Yuan Li, Yi-Fang Chuang, Chyong-Mei Chen, Chih-Ching Lin","doi":"10.1097/JCMA.0000000000001170","DOIUrl":"10.1097/JCMA.0000000000001170","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic has had a profound impacted on various aspects of society, including the healthcare system and patient care. In this context, this study aimed to evaluate the impact of COVID-19 control strategies on the lipid profile and blood sugar levels of peritoneal dialysis (PD) patients in Taiwan, a crucial focus for understanding the pandemic's influence on individuals with chronic kidney disease (CKD).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted, analyzing data from the medical records of 170 PD patients who visited the nephrology division of Taipei Veterans General Hospital in 2021. The generalized estimating equations method was used to analyze the longitudinal data and assess the changes in biomarker levels over different periods. Covariates were taken into consideration in the statistical models.</p><p><strong>Results: </strong>The study enrolled 70 (41%) males and 100 (59%) females, with an average age of 56 years old. Over 12 months in 2021, from the first period (January to April: pre-COVID-19) to the second period (May to August: COVID-19 surge), there was a notable decline in both high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels, and a significant surge in triglyceride (TG) levels. However, total cholesterol (TC) and hemoglobin (HbA1c) levels remained stable. Furthermore, the TG to HDL, TG to LDL, TC to HDL, and TC to LDL ratios were analyzed, revealing a pronounced increase during the second period.</p><p><strong>Conclusion: </strong>Our findings underscore the significant impact of COVID-19 pandemic-related disruptions in the healthcare system and the subsequent management strategies on dyslipidemia in PD patients while not affecting dysglycemia. These results provide valuable insights for healthcare professionals to enhance their strategies and interventions for CKD patients undergoing PD during a pandemic.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"1039-1046"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305026","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}
Pub Date : 2024-12-01Epub Date: 2024-12-05DOI: 10.1097/01.JCMA.0001096044.67105.d8
{"title":"Keyword Index.","authors":"","doi":"10.1097/01.JCMA.0001096044.67105.d8","DOIUrl":"https://doi.org/10.1097/01.JCMA.0001096044.67105.d8","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":"87 12","pages":"X-XV"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782319","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}