Journal of the Formosan Medical Association最新文献

{"title":"A deep learning approach for the screening of referable age-related macular degeneration - Model development and external validation.","authors":"Tsui-Kang Hsu, Ivan Pochou Lai, Meng-Ju Tsai, Pei-Jung Lee, Kuo-Chi Hung, Shihyi Yang, Li-Wei Chan, I-Chan Lin, Wei-Hao Chang, Yi-Jin Huang, Meng-Che Cheng, Yi-Ting Hsieh","doi":"10.1016/j.jfma.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.008","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a deep learning image assessment software, VeriSee™ AMD, and to validate its accuracy in diagnosing referable age-related macular degeneration (AMD).</p><p><strong>Methods: </strong>For model development, a total of 6801 judgable 45-degree color fundus images from patients, aged 50 years and over, were collected. These images were assessed for AMD severity by ophthalmologists, according to the Age-Related Eye Disease Studies (AREDS) AMD category. Referable AMD was defined as category three (intermediate) or four (advanced). Of these images, 6123 were used for model training and validation. The other 678 images were used for testing the accuracy of VeriSee™ AMD relative to the ophthalmologists. Area under the receiver operating characteristic curve (AUC) for VeriSee™ AMD, and the sensitivities and specificities for VeriSee™ AMD and ophthalmologists were calculated. For external validation, another 937 color fundus images were used to test the accuracy of VeriSee™ AMD.</p><p><strong>Results: </strong>During model development, the AUC for VeriSee™ AMD in diagnosing referable AMD was 0.961. The accuracy for VeriSee™ AMD for testing was 92.04% (sensitivity 90.0% and specificity 92.43%). The mean accuracy of the ophthalmologists in diagnosing referable AMD was 85.8% (range: 75.93%-97.31%). During external validation, VeriSee AMD achieved a sensitivity of 90.03%, a specificity of 96.44%, and an accuracy of 92.04%.</p><p><strong>Conclusions: </strong>VeriSee™ AMD demonstrated good sensitivity and specificity in diagnosing referable AMD from color fundus images. The findings of this study support the use of VeriSee™ AMD in assisting with the clinical screening of intermediate and advanced AMD using color fundus photography.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-recovery acute kidney injury and additional risk factors for short-term and long-term hypoglycemia: A multi-institutional cohort study.","authors":"Jia-Jin Chen, Ming-Jen Chan, Pei-Chun Fan, Tsung-Yu Tsai, Chieh-Li Yen, Ching-Chung Hsiao, Cheng-Chia Lee, Chia-Hung Lin, Yung-Chang Chen, Chih-Wei Yang, Chih-Hsiang Chang","doi":"10.1016/j.jfma.2024.12.007","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.007","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is associated with increased in-hospital and short-term hypoglycemia risk. However, the impact of non-recovery of renal function before discharge on hypoglycemia risk in AKI survivors after discharge have not been well studied. We aim to analyze the association between non-recovery of AKI and hypoglycemia, hyperglycemia crisis risk, to identify additional risk factors for hypoglycemia, and to examine the impact of AKI non-recovery on HbA1c variability.</p><p><strong>Methods: </strong>This multi-institutional retrospective cohort study based on Chang Gung Research Database included type 2 diabetes patients with first admission for AKI. Participants were categorized into renal recovery or non-recovery groups. Hypoglycemia, hyperglycemia crisis, new insulin use, re-AKI admission, all-cause mortality and HbA1c variability within 2 years after discharge were assessed. IPTW was used for covariate balance.</p><p><strong>Results: </strong>A total of 16,796 participants were enrolled. AKI non-recovery was associated with increased higher hypoglycemia risk (HR: 1.19; 95% CI: 1.11-1.28), increased new insulin prescriptions (HR: 1.21; 95% CI: 1.14-1.27), and lower mean HbA1c levels compared to the recovery group. Subgroup analysis showed higher hypoglycemia risk in the non-recovery group with post-AKI anemia/hypoalbuminemia status (HR: 1.39; 95% CI: 1.23-1.55). De novo CKD development in AKI non-recovery group was a protective factor for hyperglycemia crisis (HR: 0.77; 95% CI: 0.69-0.87).</p><p><strong>Conclusions: </strong>Non-recovery AKI is associated with an increased risk of hypoglycemia, regardless of whether de novo CKD develops, and is linked to lower mean A1c level within two-years post-discharge. Identifying high-risk individuals for post-AKI hypoglycemia is vital for optimal patient care.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation and clinical implications of higher intercostal space electrocardiography in the patient with Brugada syndrome in Taiwan (SADS-TW BrS registry).","authors":"Hsinyu Tseng, Mu-Ying Kuo, Chia-Chi Chu, Chiu-Ling Lai, Chu-Chun Huang, Hsiao-Ni Yan, Jimmy Jyh-Ming Juang","doi":"10.1016/j.jfma.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.005","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis of Brugada syndrome (BrS) is based on type 1 morphology (coved type) in electrocardiograms from standard (4^th) or higher (2^nd or 3^rd) intercostal spaces (ICSs). However, the clinical implications of being diagnosed only at higher ICSs remains poorly understood. We aimed to investigate the diagnostic accuracy of higher ICS leads in the Taiwanese Brugada syndrome population and clarify if there is any difference in clinical presentation.</p><p><strong>Method: </strong>Patients enrolled in the Sudden Arrhythmic Death Syndrome-Taiwan (SADS-TW) registry from 2010/01/01 to 2021/07/30 were retrospectively reviewed. Records were examined for 163 patients whose ECGs in the 2^nd, 3^rd, and/or 4^th ICSs showed a type 1 BrS pattern in at least 1 lead. Baseline characteristics, family history, clinical presentation, SCN5A mutation status, cardiovascular events, and mortality were analyzed.</p><p><strong>Result: </strong>Using the standard ICS alone, 56.4% patients could be diagnosed with BrS, whereas the remaining 43.6% of patients could only be diagnosed using higher ICSs. The mean age of diagnosis using higher ICSs was 42.2 ± 14.7 years vs. 46.8 ± 14.6 years in patients diagnosed using the standard ICSs (p = 0.048). Hypertension was more prevalent in patients diagnosed by standard ICSs (27.2%) vs. patients diagnosed by higher ICSs (4.2%; p < 0.001). No differences were observed in family history, clinical presentation, SCN5A mutation status, cardiovascular events, or mortality (mean follow-up time = 3.96 ± 3.45 years, p = 0.28).</p><p><strong>Conclusion: </strong>Using higher intercostal leads could significantly increase the diagnosis rate of BrS in the Taiwanese population, although it would not affect the clinical prognosis.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variant-specific treatment gaps: Evaluating the low use of tocilizumab and enoxaparin in omicron ICU cases.","authors":"Chia Siang Kow, Dinesh Sangarran Ramachandram, Syed Shahzad Hasan, Kaeshaelya Thiruchelvam","doi":"10.1016/j.jfma.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.013","url":null,"abstract":"","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of loss of second molar on masticatory ability and oral health-related quality of life: A comparative cross-sectional study.","authors":"Youn-Kyung Choi, Yong-Il Kim, Ji-Young Joo, Eun-Young Kwon","doi":"10.1016/j.jfma.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.012","url":null,"abstract":"<p><strong>Background/purpose: </strong>Previous studies have reported on changes in masticatory ability and patient satisfaction after restoration of missing second molars. However, there has been no evaluation of the masticatory ability and oral health-related quality of life (OHRQoL) of patients who did not replace their second molar. The purpose of the present study was to analyze the effects of the loss of a second molar on masticatory ability and OHRQoL.</p><p><strong>Methods: </strong>Twenty-two subjects who had lost a second molar (the missing group) and another 22 subjects with complete dentition (the control group) were enrolled. In the evaluation of masticatory ability, an objective test by measurement of the mixing ability index (MAI) with the occlusal contact area and a subjective test by questionnaire on food intake ability (FIA) were used. In the assessment of the OHRQoL and patient satisfaction, the Korean Oral Health Impact Profile (OHIP-14K) questionnaire was employed.</p><p><strong>Results: </strong>The inter-group comparison revealed the control group to have significantly higher mean scores of MAI, FIA, key FIA and hard FIA. Although insignificant, the control group also had a larger mean occlusal contact area and a lower mean OHIP-14K score.</p><p><strong>Conclusion: </strong>Within the limitations of this study, a missing second molar could lead to diminished objective and subjective masticatory ability with poorer OHRQoL. In conclusion, replacement with a suitable implant prosthesis should be performed after the loss of a second molar.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative project to improve the accessibility of advanced wound care among chronic wound patients in Yunlin County, Taiwan: \"Fight Out to CARE\".","authors":"Hui-Hsiu Chang, Wen-Chu Chiang, Chen-Shu Chang, Chau-Chen Torng, Matthew Huei-Ming Ma","doi":"10.1016/j.jfma.2024.11.021","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.11.021","url":null,"abstract":"<p><p>Yunlin County, Taiwan, faces healthcare challenges given its super-aged population, limited medical accessibility, and a rise in chronic wounds. To address these issues, we introduced the \"Fight Out to CARE\" project, dispatching wound nurses to patients' locations to perform Cleansing, Avoidance, Removal, and Enhancement (CARE) under tele-supervision from a plastic surgeon. The program was conducted weekly in 2018 and twice monthly in 2019 for 53 weeks. We included 189 patients with 349 wounds in 17 homes and 17 long-term care facilities across 11 towns. Pressure injuries (PIs) comprised 67% of all wounds, with 96% of PIs categorized as full-thickness (FTPIs), including Stage 3, Stage 4, and Unstageable. Overall, 174 wounds healed, with 43% of PIs and 41% of FTPIs healed; 37% of PIs healed within 12 weeks. This innovative approach improved accessibility to chronic wound care and demonstrates promising healing outcomes, providing a valuable reference for chronic wound care policy.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus on COVID-19 vaccine recommendations: Challenges and strategies for high-risk populations in Taiwan.","authors":"Chih-Hsing Wu, Wei-Chieh Hung, Chun-Feng Huang, Yen-Tze Liu, Shao-Yi Cheng, Chai-Jan Chang, Li-Ning Peng, Chi-Hua Yen, Cheng-Kuo Huang","doi":"10.1016/j.jfma.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.003","url":null,"abstract":"<p><p>The COVID-19 pandemic has had a profound impact globally, particularly in high-risk populations such as those with underlying health conditions. In response to the evolving pandemic landscape and the recent surge in confirmed cases in Taiwan, the Taiwan Association of Family Medicine (TAFM) established a consensus on COVID-19 vaccine recommendations for vulnerable groups through a comprehensive literature review, expert panel discussions, and a practice-oriented formulation procedure to develop evidence-based guidance. Its key findings highlight the increased risk of severe COVID-19 outcomes among individuals with disorders such as diabetes, obesity, chronic kidney disease, cardiovascular disease, and respiratory illness. It emphasizes the safety and effectiveness of COVID-19 vaccines, particularly mRNA vaccines, in these high-risk populations. It particularly underscores the critical role of family medicine physicians in the COVID-19 response, including routine screening, health education, vaccination delivery, and continuous research to optimize strategies. Ongoing monitoring, adaptation, and collaborative efforts will be essential to ensure the continued effectiveness of these recommendations in the evolving COVID-19 landscape. In conclusion, the TAFM consensus recommendations provide a robust framework to guide healthcare providers and policymakers in tailoring vaccination efforts to address the unique needs of vulnerable groups in Taiwan and are an applicable template for neighboring countries.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adipose stem-cell-derived microvesicles ameliorate long-term bladder ischemia-induced bladder underactivity.","authors":"Bing-Juin Chiang, Su-Han Mao, Tung-Sheng Chen, Shiu-Dong Chung, Chiang-Ting Chien","doi":"10.1016/j.jfma.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.006","url":null,"abstract":"<p><strong>Background/purpose: </strong>The mechanism for long-term hypoxia/ischemia induced bladder underactivity is uncertain. It requires an effectively therapeutic treatment. Therefore, we determined the pathophysiologic mechanisms of long-term bilateral partial iliac arterial occlusion (BPAO)-induced bladder underactivity and explored the therapeutic potential of adipose-derived stem cells (ADSCs) and ADSC-derived microvesicles (MVs) on BPAO-induced bladder dysfunction.</p><p><strong>Methods: </strong>The study included four groups: sham, BPAO, BPAO + ADSCs, and BPAO + ADSC-MVs. ADSCs or ADSC-MVs were isolated, characterized with specific CD markers and injected through the femoral artery to the rat bladders. Real-time laser speckle contrast imaging evaluated bladder microcirculation after BPAO. The transcystometrogram, pelvic nerve activity, bladder histology, immunohistochemistry, and lipid peroxidation assays were conducted after 4-week BPAO induction. The molecular mechanisms of bladder expression of purinergic P2X2/P2X3 and cholinergic M2/M3 receptors for regulating bladder contractility, nerve growth factor (NGF) for nerve injury repair, and collagen-1 for fibrosis were evaluated.</p><p><strong>Results: </strong>Long-term BPAO significantly reduced bladder microcirculation, prolonged the intercontraction interval, decreased voiding volume, increased residual urine volume, lengthened phase 1 contraction, shortened phase 2 contraction, increased leukocytes and CD68 infiltration, increased malondialdehyde levels, and decreased levels of P2X3 and M3 receptors. ADSC-MVs were more efficient than ADSCs in improving BPAO induced parameters, recovering P2X3 and M3 receptors, increasing NGF expression, and decreasing collagen-1 expression in the bladder.</p><p><strong>Conclusions: </strong>ADSC-derived MVs were better than ADSCs to improve long-term BPAO-induced detrusor underactivity, bladder ischemia, and oxidative stress. ADSC-MVs through the therapeutic action of ameliorating inflammation, improving purinergic/cholinergic signaling and neuronal regeneration, and decreasing fibrosis improved BPAO-induced bladder underactivity.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"The association between retinal vascular fractal dimension and cognitive function in the community-dwelling older adults cohort TIGER\".","authors":"Sisi Xie, Linzhi He","doi":"10.1016/j.jfma.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.001","url":null,"abstract":"","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to comment on \"Very early neurological deterioration during intravenous thrombolysis in patients with acute ischemic stroke\".","authors":"Ying-Chi Shen, Shin-Joe Yeh, Chih-Hao Chen, Jiann-Shing Jeng","doi":"10.1016/j.jfma.2024.12.010","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.12.010","url":null,"abstract":"","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}