Journal of the Chinese Medical Association : JCMA最新文献

Background: Patients with hypopharyngeal squamous cell carcinoma (HPSCC) often present with advanced disease, resulting in poor prognoses. Traditional treatment involves radical surgery, which affects the quality of life considerably. At present, treatment is shifting away from primary surgical therapy. However, the long-term adverse effect is notable. This study examined the treatment outcomes of patients with HPSCC at a single medical center to assess the effects of evolving treatment modalities on survival and laryngeal preservation.

Methods: This retrospective study analyzed patients with HPSCC treated from 2004 to 2012. To assess the effects of changes in treatment modalities, the study period was divided into three blocks: 2004-2006, 2007-2009, and 2010-2012. Tumor recurrence, functional laryngeal outcomes, and survival rates were assessed across the three periods.

Results: A total of 167 patients with HPSCC (161 males and seven females; median age: 57 years) were analyzed. The proportion of patients undergoing surgery, specifically transoral laser microsurgery (TLM), increased over time. The laryngeal preservation rates increased from 14% to 41%, and the tumor recurrence rates reduced from 48% to 31% over the study period. Surgery-based treatment was associated with survival rates comparable to those of chemoradiotherapy, with 5-year overall survival and disease-specific survival rates increasing over time from 32% to 55% and from 37% to 73%, respectively.

Conclusion: Advancements in surgical techniques, precise radiotherapy, chemotherapy regimens, and refined treatment protocols have significantly enhanced survival outcomes and laryngeal preservation rates for patients with HPSCC over time. TLM has emerged as an effective conservation surgery in patients with early-stage and select cases of advanced HPSCC, offering the benefit of preserving laryngeal function.

Background: Phenylalanyl-tRNA synthetase subunit beta (FARSB) is implicated in the progression of multiple cancers and represents a potential therapeutic target. However, its role in lung adenocarcinoma (LUAD) progression and the immune microenvironment remains poorly understood, warranting further investigation into its regulatory mechanisms.

Methods: We conducted bioinformatics analyses to investigate the expression levels of FARSB in LUAD, identify enriched pathways, and assess its correlation with patient prognosis and CD8 + T cell infiltration. Bioinformatics analysis was also used to explore the transcriptional repression of FARSB by spi1 proto-oncogene (SPI1) and to validate the targeting relationship between SPI1 and FARSB. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was utilized to measure the mRNA expression of FARSB and SPI1, while western blot was used to detect the expression of FARSB, SPI1, programmed death-ligand 1 (PD-L1), and related signaling pathway proteins. Functional assays were performed, including CCK-8 assay for cell viability, EdU incorporation for cell proliferation, and flow cytometry for apoptosis analysis. Carboxyfluorescein succinimidyl ester (CFSE) staining was used to analyze CD8 + T cell proliferation, and flow cytometry was used to assess the expression of cytokines interferon-gamma (IFN-γ), Granzyme B (GZMB), and tumor necrosis factor-alpha (TNF-α).

Results: FARSB expression was significantly upregulated in LUAD tissues and cells, and it inhibited CD8 + T cell infiltration. Mechanistically, FARSB activated the mammalian target of rapamycin (mTOR) signaling pathway, enhancing LUAD cell viability, proliferation, and anti-apoptotic capabilities, consequently promoting CD8 + T cell exhaustion. The transcription factor SPI1 repressed FARSB expression, thus inhibiting LUAD progression and promoting CD8 + T cell anti-tumor immunity.

Conclusion: SPI1 downregulated FARSB expression through transcriptional repression, thereby blocking the mTOR signaling pathway and suppressing LUAD progression and promoting CD8 + T cell anti-tumor immunity.

Chronic kidney disease (CKD) management requires a comprehensive and multidisciplinary approach to optimize clinical outcomes. This review systematically outlines essential components of CKD care from A to Z, offering evidence-based guidance to enhance patient management. Anemia treatment emphasizes iron supplementation, erythropoiesis-stimulating agents, and novel hypoxia-inducible factor prolyl hydroxylase inhibitors. Achieving optimal blood pressure control through renin-angiotensin system inhibitors and calcium channel blockers reduces cardiovascular risk and delays CKD progression. Cardiovascular risk management includes statins combined with ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors, along with appropriate anticoagulation therapy for atrial fibrillation. Individualized glycemic control strategies prioritize sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists for their cardiovascular and renal protective effects. Vigilance in avoiding nephrotoxic agents, such as non-steroidal anti-inflammatory drugs, proton pump inhibitors, aminoglycosides, and contrast media, is essential for preventing renal injury. Rigorous management of electrolytes and acid-base disturbances, involving dietary sodium and potassium restrictions, phosphate binders, and bicarbonate supplementation, reduces CKD progression and related complications. Appropriate fluid management through dietary sodium and water restriction with individualized diuretic therapy prevents volume overload and associated cardiovascular complications. Nutritional interventions, particularly low-protein diets supplemented with ketoanalogues of amino acids, effectively delay CKD progression and control metabolic disturbances. Therapies addressing CKD-related mineral and bone disorders, including phosphate binders, vitamin D analogues, and calcimimetics, reduce the risk of vascular calcification. In addition, lipid-lowering therapies, anticoagulation therapy, optimal vascular access management for dialysis, and early detection of arrhythmias and thrombotic microangiopathy significantly enhance patient outcomes. Attention to quality of life issues, such as alleviating xerosis symptoms, promoting optimal body mass index through weight management strategies, and providing psychosocial support, further enhances patient-centered care. This comprehensive review highlights the crucial importance of a multidisciplinary approach in CKD management.

Background: Hemophilic pseudotumor (HPT) is an uncommon but severe complication in patients with hemophilia (PWH). Given the rarity, case series were scarce and largely confined to case report in the literature. Consequently, the aim of this study is to present surgical results of HPT over a 20-year period from a single institute.

Methods: We retrospectively reviewed 11 HPT in 10 PWH who underwent surgical treatment in our institute between 1999 and 2020. Their clinical features, surgical management, outcomes, and complications were identified.

Results: There are 10 men PWH with 11 HPT who had undergone a total of 20 surgical procedures over a 20-year period. The mean age at surgery was 41.2 years with an average follow-up of 9.7 years. Nine patients had hemophilia A (five severe, three moderate, and one mild) and one patient had severe hemophilia B. Localization of the HPT was confined to soft tissue in two patients (9.1%), to intraosseous lesion in five patients (45.5%) and to subperiosteal location in the remaining four patients (36.4%). Three patients (27.2%) had complications, including one wound infection, one chronic osteomyelitis, and one recurrence. Postoperative complete resolution was achieved in nine HPT except one recurrence and one persistent chronic osteomyelitis; the former was stable after further excision, and the latter was resolved by amputation.

Conclusion: Surgical therapy for HTP is feasible and effective when covered with adequate factor replacement. Given the variety, careful case-to-case evaluation is important to take the appropriate surgical modality and avoid potential complication.

Background: Glaucoma is a major cause of irreversible blindness, and early detection is essential to prevent vision loss. Color fundus photography is a simple, low-cost, and noninvasive eye screening method, but diagnosis through this method can be difficult in patients with additional retinal diseases. Although artificial intelligence (AI) can address this difficulty, its effectiveness may vary between hospitals. In this study, an AI glaucoma detection system was developed and tested for reliability across different populations and clinical settings.

Methods: A stepwise AI pipeline was designed that combined image enhancement, automated identification of the optic nerve area, and deep learning-based classification. The system was trained on 1696 images from Taipei Veterans General Hospital and tested on five cross-regional external datasets. The system was also evaluated on a separate internal set of 151 images representing comorbid eye diseases.

Results: The AI system achieved a balanced accuracy of at least 80% on all external datasets. For images with other eye diseases, it achieved an area under the curve of 0.93 and a balanced accuracy of 80.9%. Its performance remained consistent regardless of differences in patient ethnicity, camera types, and image quality.

Conclusion: The proposed AI system can detect glaucoma on standard color fundus photographs with high accuracy across clinical environments and in the presence of comorbid eye diseases. The system may be a practical and affordable tool for large-scale glaucoma screening, particularly in institutions with limited resources.

Background: Monteggia fracture is defined as a combination of a proximal ulnar fracture with radial head dislocation. Radial head dislocation may be misdiagnosed under an elbow radiograph, leading to further complications. This study aimed to compare the ulnar fracture pattern characteristics between Monteggia fracture and an isolated proximal ulnar fracture in terms of how close the fracture site is to the coronoid and what type of fracture pattern is more likely to result in radial head dislocation.

Methods: This single-center retrospective study, conducted from January 2014 to June 2022, included adult patients with proximal to midshaft ulnar fractures, excluding nonacute trauma, revision surgeries, and intra-articular fractures. All patients underwent anteroposterior (AP) and lateral elbow radiographs and forearm radiograph. Fracture patterns and injury mechanisms were recorded for analysis.

Results: We included 51 patients in this study. The mean age was 38.5 ± 16.1 years, and 70.1% were men (n = 36). Monteggia fractures were classified according to the Bado classification into type I (n = 5), type II (n = 7), type III (n = 8), and type IV (n = 0). Traffic accidents comprised 63% of the injuries (n = 32), and 45% were oblique type ulnar fractures (n = 23). Monteggia fracture and proximal ulnar fracture presented with mean distance from coronoid tip to fracture of 6.12 ± 2.32 cm and 9.00 ± 3.00 cm ( p < 0.01). As per the receiver operating characteristic curve (ROC), the distance from coronoid tip to fracture of 7.33 cm had the highest area under the curve (AUC) value (0.807). Angulations of Monteggia fracture and isolated ulnar fracture were 24.02° ± 12.10° and 10.77° ± 8.10° ( p < 0.01). However, there were no differences in the length of the fracture line between two groups.

Conclusion: The distance from coronoid tip to fracture within 7.3 cm is more likely to cause a Monteggia fracture than an isolated proximal ulnar fracture. Otherwise, a Monteggia fracture is prone to more severe angulation.

Background: Academic publications are important for developing medical specialties. Respiratory system diseases are among the most common human diseases and have a significant impact on morbidity and mortality. This is particularly true regarding the impact of the new coronavirus, severe acute respiratory syndrome coronavirus 2. This study aimed to perform a bibliographic analysis of Taiwanese academic publications in the Web of Science (WoS) subject category of respiratory systems.

Methods: Publications in the WoS Respiratory System Category, including papers in Science Citation Index Expanded and Social Sciences Citation Index journals from 1972 to 2023, were retrieved and analyzed.

Results: Among 392 030 papers published worldwide in the WoS Respiratory System Category from 1972 to 2023, 3672 (0.94%) were published in Taiwan, ranking 21st in the world, with a total of 82 956 citations. Over these five decades, the annual number of Taiwanese publications and citations has increased over time. However, the mean impact factor of publications has shown a tendency to decrease since 1997. International collaboration with coauthors outside Taiwan was found in 780 papers (21.24% of the total publications), mainly from the United States, the People's Republic of China, the United Kingdom, France, and South Korea. Collaborative papers had a significantly higher mean impact factor (8.2 ± 0.3 vs 5.6 ± 0.1, p < 0.001) and citation counts per paper (44.2 ± 3.3 vs 25.2 ± 0.8, p < 0.001) than those of non-collaborative papers.

Conclusion: Taiwanese publications in the WoS Respiratory System Category have a trend of increasing number and citations since 1972. However, the mean impact factor of the published papers has decreased since 1997. This disproportionate trend is an observational finding that deserves further investigation.