Journal of the Chinese Medical Association最新文献

{"title":"Correlation of N-terminal-pro-brain natriuretic peptide with postoperative outcomes of older patients undergoing transcatheter aortic valve replacement.","authors":"Ying-Ching Huang,&nbsp;Hsiao-Huang Chang,&nbsp;Po-Lin Chen,&nbsp;Chi-Ming Chu,&nbsp;Jen-Chen Tsai,&nbsp;Kwua-Yun Wang","doi":"10.1097/JCMA.0000000000000916","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000916","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing transcatheter aortic valve replacement surgery (TAVR) are typically older adults with multiple chronic diseases and therefore have a high surgical risk. The N-terminal of brain natriuretic peptide (BNP) and pro-BNP, referred to as NT-pro-BNP, is an easily measurable biomarker of heart failure. Studies on correlation between higher NT-pro-BNP levels and adverse prognoses after TAVR have yielded inconsistent results. Here, we investigated whether preoperative NT-pro-BNP levels are correlated with outcomes among older adults undergoing TAVR.</p><p><strong>Methods: </strong>This retrospective study included older adults with severe aortic stenosis (AS) who received TAVR from a medical center between January 2013 and June 2017. The patients' demographics, preoperative laboratory data, postoperative complications, and 1-year mortality were recorded. They were divided into two groups based on their preoperative NT-pro-BNP levels. The post-TAVR outcomes in the two groups were analyzed using a multivariate logistic regression analysis of the binary results.</p><p><strong>Results: </strong>Of the 132 patients included (mean age: 81.5 ± 8.1 years; 47% men), 96 (72.7%) had preoperative NT-pro-BNP levels ≤ 4853 ng/L, and 36 (27.3%) had preoperative NT-pro-BNP levels > 4853 ng/L. The postoperative outcomes were significantly better in the NT-pro-BNP≤4853 group than in the NT-pro-BNP>4853 group: postoperative extracorporeal membrane oxygenation fittings (4.2% vs 16.7%, p = 0.025), number of days in hospital (17.5 ± 21.0 vs 27 ± 17.0, p = 0.009), in-hospital mortality (4.2% vs 16.7%, p = 0.025), and 1-year mortality (11.5% vs 38.9%, p = 0.001); the significant differences persisted after controlling for other variables.</p><p><strong>Conclusion: </strong>For older patients undergoing TAVR with NT-pro-BNP levels > 4853 ng/L, their postoperative outcomes and 1-year mortality were correlated. Thus, NT-pro-BNP is useful for the risk assessment of patients undergoing TAVR and should be regarded as a biomarker in future risk assessments.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9880103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An early report of exoscope-assisted otologic surgery.","authors":"Bang-Yan Zhang,&nbsp;Valerie Wai-Yee Ho,&nbsp;Tzong-Yun Tsai,&nbsp;Kai-Chieh Chan","doi":"10.1097/JCMA.0000000000000907","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000907","url":null,"abstract":"<p><strong>Background: </strong>Exoscope has been used in otoneurologic surgery in several reports. However, most ear surgeries are performed using either microscope or endoscopy today. The purpose of this study is to present our subjective and objective experience of using this instrument in our institution.</p><p><strong>Methods: </strong>Sixteen ears with different severity and condition in 15 consecutive patients were enrolled. A questionnaire with 12 questions was sent to different participants, including surgeons, residents, medical students, and scrub nurses in the operation room. The total score and average score of each item were calculated and analyzed.</p><p><strong>Results: </strong>Exclusive exoscopic operation was performed on 13 patients with 14 procedures. A combination of endoscopy-exoscope and microscope-exoscope was used in one patient, respectively. There were no complications. Hearing recovery or disease extirpation was achieved in most patients. Twenty participants in the operation room filled out the questionnaire. There was no significant difference between the different groups. High ratings were reported in terms of image quality, stereoscopic effects, magnification rate, and the same field of view as the surgeon. Worse ratings were reported in items related to limited working space, increase in eye strain by video observation, and focusing difficulty.</p><p><strong>Conclusion: </strong>Exoscopic ear surgery is feasible, safe, and effective in managing various otologic conditions involving external ear, middle ear, mastoid, and lateral skull base. Its high-definition image quality, stereoscopic effects, sufficient magnification, reliability and teaching value made it a potential instrument in general ear surgeries. Further improvements to current drawbacks can be anticipated.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9880388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An open-label randomized noninferior study of generic name and brand name of propafenone for rhythm control in patients with paroxysmal atrial fibrillation.","authors":"Chye-Gen Chin,&nbsp;Yu-Cheng Hsieh,&nbsp;Wei-Shiang Lin,&nbsp;Yenn-Jiang Lin,&nbsp;Chuen-Wang Chiou,&nbsp;Tsung-Hsien Lin,&nbsp;Chien-Lung Huang,&nbsp;Yuan Hung,&nbsp;Yung-Kuo Lin,&nbsp;Shih-Lin Chang,&nbsp;Tong-Chen Yeh,&nbsp;Hsiang-Chun Lee,&nbsp;Wen-Ter Lai,&nbsp;Ming-Hsiung Hsieh","doi":"10.1097/JCMA.0000000000000903","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000903","url":null,"abstract":"<p><strong>Background: </strong>Propafenone is a class IC antiarrhythmic agent that is commonly used as the first-line therapy for patients with paroxysmal atrial fibrillation (AF) in Taiwan. This study compared the efficacy and safety of generic (Rhynorm) and brand name (Rytmonorm) propafenone for rhythm control of paroxysmal AF in Taiwan.</p><p><strong>Methods: </strong>This was an open-label randomized multicenter noninferior study conducted in Taiwan. We enrolled 76 patients with AF. To investigate the efficacy of propafenone, we used a wearable electrocardiogram (ECG) event recorder to evaluate the daily burden of AF episodes in patients for 24 weeks. The primary efficacy endpoint was the frequency of AF with clinical significance, which was indicated by AF duration ≥30 seconds. The safety endpoints included proarrhythmic or hemodynamic adverse events.</p><p><strong>Result: </strong>To analyze the efficacy and safety of these agents, 71 patients (five patients with screen failure) were randomized to two groups, specifically a Rhynorm group (n = 37) and a Rytmonorm group (n = 34), for 24 weeks of the treatment period. The baseline patient characteristics were comparable between the groups. However, the Rhynorm group was older (65.4 ± 8.40 vs 59.8 ± 10.8 years; p = 0.02). The primary efficacy endpoint at week 24 decreased by 4.76% ± 18.5% (from 24.3% ± 33.9% to 19.0% ± 28.7%; p = 0.13) in the Rhynorm group and by 3.27% ± 15.2% (from 16.9% ± 26.4% to 13.6% ± 19.2%; p = 0.22) in the Rytmonorm group, with an intergroup difference of 1.5% ± 17.0%; p = 0.71. This finding indicates that Rhynorm is not inferior to Rytmonorm ( p = 0.023 for noninferiority). The safety profile of the agents was comparable between the two groups.</p><p><strong>Conclusion: </strong>Our results verified that Rhynorm was noninferior to Rytmonorm in terms of efficacy and safety for treating paroxysmal AF in Taiwan ( ClinicalTrials.gov Identifier: NCT03674658).</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9882475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to \"The statistical significance may be misinterpreted\".","authors":"Yu-Wen Cheng,&nbsp;Yang-Yi Chen,&nbsp;Chien-Ju Lin,&nbsp;Yi-Ting Chen,&nbsp;Ann-Shung Lieu,&nbsp;Hung-Pei Tsai,&nbsp;Aij-Lie Kwan","doi":"10.1097/JCMA.0000000000000908","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000908","url":null,"abstract":"","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9882481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it possible that advanced-stage gastric cancer patients can be cured by surgery alone?: Erratum.","authors":"","doi":"10.1097/JCMA.0000000000000920","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000920","url":null,"abstract":"","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9781891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population.","authors":"Te-Feng Arthur Chou,&nbsp;Hsuan-Hsiao Ma,&nbsp;Chi-Wu Tsai,&nbsp;Shang-Wen Tsai,&nbsp;Cheng-Fong Chen,&nbsp;Fang-Yao Chiu,&nbsp;Po-Kuei Wu,&nbsp;Wei-Ming Chen","doi":"10.1097/JCMA.0000000000000892","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000892","url":null,"abstract":"<p><strong>Background: </strong>In patients with advanced osteoarthritis (OA) of the bilateral knees, uncertainty remains as to whether simultaneous bilateral total knee arthroplasty (SiTKA) or staged TKA (StTKA) is the treatment of choice. The purpose of this study was to investigate the safety and relative cost of SiTKA vs StTKA in Taiwan patients.</p><p><strong>Methods: </strong>Using the Big Data Center of Taipei Veterans General Hospital, we retrospectively reviewed all patients who underwent SiTKA or StTKA due to OA or spontaneous osteonecrosis of the knee from January 2011 to December 2016. We assessed length of stay, transfusion rate, early postoperative complications, 30- and 90-day readmission rate, 1-year reoperation rate, and the indication for reoperation. Furthermore, we analyzed the total cost of the two groups, including reimbursement from the national health insurance (NHI), cost of the procedures, and net income from each case.</p><p><strong>Results: </strong>A total of 2016 patients (1565 SiTKA and 451 StTKA) were included in this study. The two groups had no significant differences in rates of complications, 30- and 90-day readmission, or 1-year reoperation. The length of stay was on average 5.0 days longer for StTKA ( p < 0.01). In terms of cost, all categories of medical costs were significantly lower for SiTKA, while the net hospital income was significantly higher for StTKA.</p><p><strong>Conclusion: </strong>SiTKA is a safe and cost-effective surgery. Both SiTKA and StTKA have similar rates of postoperative complications, readmission and reoperation, but SiTKA significantly reduces medical expenses for both the patient and the NHI.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9882468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal factors associated with fetal macrosomia.","authors":"Chia-Hao Liu,&nbsp;Szu-Ting Yang,&nbsp;Peng-Hui Wang","doi":"10.1097/JCMA.0000000000000894","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000894","url":null,"abstract":"","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9880386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective cohort study on the cardiotoxicity incidence rates of immune checkpoint inhibitors for oncology patients.","authors":"Chin-Chin Ho,&nbsp;Shang-Liang Wu,&nbsp;Han-Yi Tsai,&nbsp;Yu-Wen Hu,&nbsp;Yuh-Lih Chang","doi":"10.1097/JCMA.0000000000000910","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000910","url":null,"abstract":"<p><strong>Background: </strong>This present study investigated the incidence rates of cardiotoxicity among cancer patients treated with immune checkpoint inhibitors (ICIs) plus other anticancer drugs.</p><p><strong>Methods: </strong>This was a retrospective hospital-based cohort study using the medical records and the Cancer Registry records from the Taipei Veterans General Hospital. We enrolled patients diagnosed with cancer between 2011 and 2017, who were over 20 years old and had received ICI therapy, including pembrolizumab, nivolumab, atezolizumab, and ipilimumab. Cardiotoxicity was defined by the diagnosis of myocarditis, pericarditis, arrhythmia, heart failure, and Takotsubo syndrome.</p><p><strong>Results: </strong>We identified 407 patients who were eligible to participate in this study. We defined the three treatment groups as follows: ICI therapy, ICI combined with chemotherapy, and ICI combined with targeted therapy. Using ICI therapy as a reference group, the cardiotoxicity risk was not significantly higher compared to the ICI combined with chemotherapy group (adjusted hazard ratio 2.1, 95% confidence interval 0.2-21.1, p = 0.528] or to the ICI combined with targeted therapy group (adjusted hazard ratio 1.2, 95% confidence interval 0.1-9.2, p = 0.883). The total incidence rate of cardiotoxicity was 3.6 of 100 person-years, indicating an average incidence time of 1.0 ± 1.3 years (median: 0.5 years; range: 0.1-4.7 years) for 18 cardiotoxicity patients.</p><p><strong>Conclusion: </strong>The incidence rate of ICI-related cardiotoxicity is low. Combination of ICI with either chemotherapy or targeted therapy might not significantly increase the risk of cardiotoxicities among cancer patients. Nevertheless, it is recommend being careful in patients treated high-risk cardiotoxicity medications to avoid drug-related cardiotoxicity with a combination of ICI therapy.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10256225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of stone-free rate between percutaneous nephrolithotomy and retrograde intrarenal surgery.","authors":"Peng Chen,&nbsp;Tony Tzu-Chun Wei,&nbsp;Eric Yi-Hsiu Huang,&nbsp;Tzu-Ping Lin,&nbsp;Tzu-Hao Huang,&nbsp;Chih-Chieh Lin,&nbsp;I-Shen Huang,&nbsp;William J Huang","doi":"10.1097/JCMA.0000000000000913","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000913","url":null,"abstract":"<p><strong>Background: </strong>The management of urolithiasis in the kidney has been drastically changed in the era of endourology, mainly consisting of three surgical procedures: extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). Since ESWL is usually less invasive via ambulatory clinic routes, this study aimed to examine the stone-free rate (SFR) between PCNL and RIRS.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who had renal stones and were treated with either PCNL or RIRS from June 2016 to June 2018. Staghorn stones, stones with diameters <1 cm, and stones with diameters >2 cm were excluded. Patients who underwent multiple surgeries for bilateral renal stones and those with graft kidney stones were excluded from the study. X-ray, sonography, and/or computed tomography (CT) were used to calculate the size of the stones. Follow-up was evaluated by the same image examination within three months after surgery. Stone-free was defined as no residual stone or the presence of asymptomatic calculi <4 mm. The operation time was defined as a skin-to-skin interval.</p><p><strong>Results: </strong>Following exclusion criteria, there were 39 patients in each arm, with no difference in age, sex, or any other demographic data. The average stone size in the PCNL and RIRS groups was 16.3 and 14.0 mm, respectively ( p = 0.009). There was no significant difference in SFR (71.8% vs 61.5%, p = 0.337); the operation time was significant longer ( p < 0.001), and the hospital stay was significantly shorter ( p < 0.001) in the RIRS group.</p><p><strong>Conclusion: </strong>PCNL and RIRS are both feasible options for managing kidney stones. However, the initial stone size might affect the selection of operation. The SFR in the PCNL group was numerically but not statistically higher. The RIRS group, on the other hand, had a longer operation time but a shorter hospital stays.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9880091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Portable sensing devices for smart healthcare and prevention of lead poisoning.","authors":"Wei-Qun Lai,&nbsp;Ta-Chou Huang,&nbsp;Kung-Hao Liang,&nbsp;Yu-Fen Chang,&nbsp;De-Ming Yang","doi":"10.1097/JCMA.0000000000000904","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000000904","url":null,"abstract":"<p><p>Lead (Pb) poisoning can damage human bodies silently, without specific symptoms or conspicuous warning signs. To provide safe and user-friendly tools for detecting heavy metals at low concentrations, scientists have developed and optimized versatile biosensors. To practically employ the developed biosensors specific for Pb (eg, the optimized Met-lead 1.44 M1), smartphone applications designed for user convenience and are easily operable for the on-site detection of Pb in environmental water, drinking water, food, and blood/urine are urgently needed. To establish a monitoring system for home health maintenance, a portable device and useful apps installed on a smartphone can be integrated, and the data acquired can be sent to and stored in the cloud for further analysis and evidence preservation. With the high transmissions speeds for 4G and 4G wireless Internet, such a system can be applied for health protection; water-quality data can be provided by anyone and publicly shared for display on smartphone interfaces, alerting individuals of heavy metal contamination. In this review, we describe recent developments in heavy metal-sensing devices, including home health maintenance systems, which have been successfully and practically applied to prevent heavy metal Pb poisoning.</p>","PeriodicalId":17251,"journal":{"name":"Journal of the Chinese Medical Association","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9882478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}