Tzu Chi Medical Journal最新文献

{"title":"Use of disease-specific biomarkers in identifying interstitial cystitis and guiding effective treatment for its different subtypes.","authors":"Wan-Ru Yu, Jia-Fong Jhang, Yuan-Hong Jiang, Hann-Chorng Kuo","doi":"10.4103/tcmj.TCMJ-D-25-00028","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00028","url":null,"abstract":"<p><p>Interstitial cystitis/bladder pain syndrome (IC/BPS) is a heterogeneous condition with unidentifiable causes and unknown pathophysiology. Exploring potential biomarkers with high reliability might predict IC/BPS subtypes and guide specific treatment to achieve successful outcomes. The currently used clinical biomarkers to identify IC/BPS include pain symptoms, low bladder capacity, bladder wall thickness, and serum or urinary parameters. The wide application of serum biomarkers for identifying IC/BPS from patients with similar bladder symptoms is not established yet due to their low specificity. Patients with IC/BPS exhibit distinct urinary inflammatory cytokine profiles and oxidative stress biomarkers compared with controls, and the urine levels of biomarkers were correlated with pathologic conditions of the bladder. Identifying IC/BPS subtypes, including Hunner's IC (HIC) and non-Hunner's IC (NHIC) with different cystoscopic characteristics, can facilitate specific treatments with satisfactory outcomes. Using a cluster of biomarkers has been reported to aid in the detection of IC/BPS patients, and patients with HIC can be recognized from patients with IC/BPS. Machine learning using the decision tree model can further provide high accuracy for predicting treatment outcomes. Currently, a satisfactory disease biomarker that can be used to identify IC/BPS subtypes and guide appropriate bladder therapy is lacking. In the future, the treatment goal may be achieved by combining noninvasive clinical parameters with cluster of urinary biomarkers and constructing nomograms for identifying IC/BPS in patients with lower urinary tract symptoms and discriminating patients with HIC from those with IC/BPS.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 2","pages":"152-163"},"PeriodicalIF":2.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early surgical decompression results in favorable outcomes in elderly patients with severe traumatic brain injury.","authors":"Yi-Shiuan Lin, Yang-Xing-Zhen Gao, Pin-Han Huang, Kuan-Pin Chen, Sheng-Tzung Tsai, Chien-Hsing Wang","doi":"10.4103/tcmj.tcmj_207_25","DOIUrl":"10.4103/tcmj.tcmj_207_25","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the impact of distinct treatment modalities on outcomes in patients with moderate-to-severe traumatic brain injury (TBI).</p><p><strong>Materials and methods: </strong>This retrospective single-center study analyzed 228 patients with moderate-to-severe TBI (Glasgow Coma Scale [GCS] 3-12) admitted to Hualien Tzu Chi Hospital from 2017 to 2019. Patients were grouped by age (<65 or ≥65) and GCS (3-8 or 9-12). Four treatment strategies were assessed: decompressive craniectomy (DC), craniotomy, intracranial pressure (ICP) monitoring alone, and conservative management. Outcomes included hospital length of stay (LOS), ICU duration, and mortality. Statistical analyses included Kaplan-Meier survival curves, Log-rank tests, Gehan-Breslow Wilcoxon tests, and Kruskal-Wallis tests.</p><p><strong>Results: </strong>In Group 1 (<i>n</i> = 58, <65, GCS: 9-12), DC was associated with the longest median hospital (43.0 days) and ICU stay (7.0 days). In Group 2 (<i>n</i> = 44, ≥65, GCS: 9-12), significant differences in ICU stay (<i>P</i> < 0.05) were observed. In Group 3 (<i>n</i> = 77, <65, GCS 3-8), ICP monitoring alone resulted in the longest hospital LOS (33.5 days), whereas DC was associated with the longest ICU stay (13 days). In Group 4 (≥65 years, GCS: 3-8, <i>n</i> = 49), DC correlated with the longest hospital LOS (39.0 days) and ICU stay (10.0 days). In severe TBI patients, the ICP monitoring group displayed better survival over time. Moreover, DC and ICP monitoring only achieved the lowest mortality rates (25%) in Group 4.</p><p><strong>Conclusion: </strong>Early DC and ICP monitoring substantially improve survival and aggravation in elderly patients with severe TBI, underscoring their critical role in outcome optimization.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"350-357"},"PeriodicalIF":2.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of prelabor pelvic floor muscle training in reducing perineal tear incidence during vaginal delivery: A systematic review and meta-analysis.","authors":"Tania Tania, Gabriela Claudia, Nicolas Daniel Widjanarko, Paulus Rio Kurniawan, Dennis Adi Purnama, Thomas Hadipurnama, Erni Cornelis","doi":"10.4103/tcmj.tcmj_205_25","DOIUrl":"10.4103/tcmj.tcmj_205_25","url":null,"abstract":"<p><strong>Objectives: </strong>Pelvic floor muscle training (PFMT) is a group of exercises that can improve muscle strength and elasticity and may potentially decrease the incidence of perineal tears. However, the effectiveness of PFMT needs further investigation.</p><p><strong>Materials and methods: </strong>A literature search was conducted to identify studies published between 2014 and 2024 across several electronic databases, including MEDLINE, ProQuest, SpringerLink, Google Scholar, and the Cochrane Library. This systematic review included articles designed as randomized controlled trials (RCTs) and quasi-experimental studies that examined the effect of prelabor PFMT in preventing perineal tears during vaginal delivery. Review Manager version 5.4 was used to extract and pool data for quantitative synthesis. Participants were divided into two groups to allow for comparison between the intervention group (PFMT exercises) and the control group (standard treatment).</p><p><strong>Results: </strong>Six studies were included in the systematic review and meta-analysis. In most studies, the subjects performed PFMT daily during their third trimester of pregnancy. Meta-analysis showed that PFMT can effectively reduce the incidence of perineal tears, with significant results for grade 3 and 4 tears. Our findings also indicate that PFMT effectively shortens the postpartum length of stay (LoS), improves Redness, Edema, Ecchymosis, Discharge, Approximation scale scores, enhances 5-min APGAR scores, and decreases the need for epidural anesthesia.</p><p><strong>Conclusion: </strong>PFMT effectively reduces the incidence of perineal trauma, though statistical significance varies by tear grade. PFMT may be considered for routine inclusion in antenatal care for its broad maternal and neonatal benefits.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"364-373"},"PeriodicalIF":2.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall survival following whole-brain radiotherapy for brain and leptomeningeal metastases from solid tumors.","authors":"Atsuto Katano","doi":"10.4103/tcmj.TCMJ-D-25-00075","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00075","url":null,"abstract":"<p><strong>Objectives: </strong>Brain and leptomeningeal metastases are relatively common complications of advanced solid tumors, occurring in an estimated 20%-40% of cases and significantly reducing survival and quality of life. Despite advancements in systemic therapies and stereotactic radiosurgery, whole-brain radiotherapy (WBRT) remains the standard treatment. This study evaluates overall survival (OS) and prognostic factors in patients with brain and leptomeningeal metastases treated with WBRT at a single institution.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 228 patients with brain and leptomeningeal metastases treated with WBRT between December 2012 and April 2024. Patients received either 30 Gy in 10 fractions or 20 Gy in five fractions. Prognostic factors were assessed using multivariate Cox proportional hazards regression.</p><p><strong>Results: </strong>The median OS for the entire cohort was 5.5 months (95% confidence interval: 3.8-6.2). Female patients had a statistically significantly longer OS (8.5 months) compared with male patients (3.8 months, <i>P</i> = 0.004). Better Eastern Cooperative Oncology Group (ECOG) performance status was strongly associated with improved survival (<i>P</i> < 0.001). The median OS of the 17 patients with leptomeningeal metastases was 5.7 months, which was not statistically different from that of patients without leptomeningeal metastases (5.1 months, <i>P</i> = 0.537). In multivariate analysis, sex (Hazard ratio [HR]: 0.682, <i>P</i> = 0.039) and performance status (HR: 2.357, <i>P</i> < 0.001) were identified as statistically significant prognostic factors.</p><p><strong>Conclusion: </strong>This study confirms that WBRT offers modest survival benefits, consistent with prior research. While factors such as patient sex and ECOG performance status influence outcomes, the clinical impact of WBRT on leptomeningeal metastases remains limited. Survival outcomes are significantly impacted by factors such as patient sex and performance status, highlighting the need for personalized patient evaluation.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"358-363"},"PeriodicalIF":2.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shedding light on gestational loss: The role of Vitamin D 25(OH)D deficiency in miscarriage - A systematic review and meta-analysis.","authors":"Cut Adeya Adella, Felix Khosasi, Elbert Elbert","doi":"10.4103/tcmj.TCMJ-D-25-00005","DOIUrl":"10.4103/tcmj.TCMJ-D-25-00005","url":null,"abstract":"<p><strong>Objectives: </strong>Miscarriage is a common pregnancy complication with various contributing factors. Recent studies suggest that maternal Vitamin D deficiency may increase the risk of early pregnancy loss. Vitamin D is essential for immune regulation, placental development, and fetal growth. This meta-analysis aimed to evaluate the association between maternal Vitamin D status and miscarriage.</p><p><strong>Materials and methods: </strong>This meta-analysis followed PRISMA 2020 guidelines, including observational studies from PubMed, EMBASE, Scopus, Web of Science, and Cochrane (2018-2025). Eligible studies reported serum 25(OH)D levels and miscarriage outcomes. Data on serum Vitamin D, miscarriage incidence, and odds ratios (ORs) were extracted. Study quality was assessed using the Newcastle-Ottawa Scale. Statistical analyses were performed using Review Manager 5.4 and R, with evaluation of heterogeneity and publication bias.</p><p><strong>Results: </strong>Women who experienced miscarriage had significantly lower Vitamin D levels than those with ongoing pregnancies (mean difference: -5.48 ng/mL; 95% confidence interval [CI]: -9.77 to -1.19; <i>P</i> = 0.02). The miscarriage rate was higher among Vitamin D-deficient women (34%; 95% CI: 0.21-0.47) than in those with sufficient levels (16%; 95% CI: 0.08-0.24). Deficiency was significantly associated with miscarriage risk (OR: 2.02; 95% CI: 1.37-2.98; <i>P</i> = 0.0004). No significant publication bias was observed.</p><p><strong>Conclusion: </strong>Maternal Vitamin D deficiency is significantly associated with an increased risk of miscarriage. These findings support the potential benefit of assessing and optimizing Vitamin D status in preconception and antenatal care to improve the pregnancy outcomes.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 3","pages":"397-406"},"PeriodicalIF":2.4,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors and survival of patients with endometrial cancer: A 10-year retrospective cohort study in a tertiary referral center in Northern Taiwan.","authors":"Ruo-Shi Bing, Wing Lam Tsui, Kuo-Hu Chen, Dah-Ching Ding","doi":"10.4103/tcmj.tcmj_152_25","DOIUrl":"10.4103/tcmj.tcmj_152_25","url":null,"abstract":"<p><strong>Objectives: </strong>Endometrial cancer (EC) is a gynecological malignancy with diverse clinical presentations and prognoses. This study aimed to comprehensively characterize EC by examining patient demographics, disease characteristics, treatment modalities, and outcomes at a medical center in Northern Taiwan.</p><p><strong>Materials and methods: </strong>This retrospective study included 141 patients with EC who underwent a hysterectomy-based surgical intervention between January 2011 and January 2020. Excluding patients without complete data, the information gathered included demographics, clinical history, laboratory results, pathological details, and surgical information. Statistical analyses were performed using the Chi-square and Kaplan-Meier methods. Notable factors influencing cancer mortality were investigated using Cox regression analysis. Univariate and multivariate analyses were used to explore progression-free survival (PFS) and overall survival (OS).</p><p><strong>Results: </strong>The data included the mean age (57.55 years), body mass index (25.77 kg/m²), tumor size (40.87 mm), disease factors (diabetes, 16.31%; hypertension, 36.88%; and smoking, 0.71%), and predominant stage 1 patients (75.18%). The treatments included chemotherapy (21.99%) and radiotherapy (65.25%). The 5-year PFS and OS were 70.8% and 86%, respectively. Total lymph node number (hazard ratio HR = 1.05, <i>P</i> < 0.001) significantly affected PFS. Significant influences of age (HR = 1.19, <i>P</i> = 0.004), open surgery (HR = 6.60, <i>P</i> = 0.02), cervical stroma invasion (HR = 21.07, <i>P</i> = 0.007), and recurrence (HR = 8.90, <i>P</i> = 0.012) on OS.</p><p><strong>Conclusion: </strong>This study provided a comprehensive understanding of EC and emphasized the interplay between clinical and pathological factors of the disease.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 2","pages":"218-226"},"PeriodicalIF":2.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microglial activation and lysosomal dysfunction in hemorrhagic stroke.","authors":"Chien-Hui Lee, Cheng-Yoong Pang, Mei-Jen Wang, Wei-Fen Hu, Hsin-Yi Huang, Sheng-Tzung Tsai, Hock-Kean Liew","doi":"10.4103/tcmj.tcmj_213_25","DOIUrl":"10.4103/tcmj.tcmj_213_25","url":null,"abstract":"<p><p>Hemorrhagic stroke, mainly caused by intracerebral hemorrhage (ICH), is a severe neurological condition with high mortality and lasting disability. ICH involves bleeding into the brain parenchyma, hematoma formation, and subsequent edema and tissue damage, triggering inflammatory and degenerative responses that worsen secondary brain injury (SBI). Microglia, the brain's resident immune cells, are key mediators in this process. Their ability to sense, engulf, and clear hematoma-derived debris is essential for controlling neuroinflammation and promoting tissue repair. Central to microglial phagocytosis is lysosomal function. Lysosomes contain hydrolases - proteases, glycosidases, lipases, and nucleases - that degrade proteins, lipids, carbohydrates, and nucleic acids. This coordinated degradation ensures effective recycling of phagocytosed materials and clearance of cellular debris after hemorrhage. However, lysosomal dysfunction impairs microglial clearance capacity, leading to persistent inflammation, aggravated neuronal damage, and poor neurological recovery after ICH. This review focuses on the interplay between microglial activation, lysosomal function, and phagocytosis in hemorrhagic stroke. We examine how lysosomal impairment hinders hematoma resolution, propagates SBI, and delays functional recovery. In addition, we highlight emerging therapeutic strategies targeting the microglia-lysosome axis, such as enhancing lysosomal biogenesis and enzyme activity, as promising approaches to boost hematoma clearance and improve outcomes. Understanding and modulating microglial lysosomal function offers novel therapeutic avenues for ICH management, aiming to mitigate secondary injury and support neurological recovery.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 1","pages":"1-10"},"PeriodicalIF":1.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Judkins left catheter size selection during right trans-radial coronary angiography using preprocedural coronary computed tomography angiography.","authors":"Abdulameer Jasim Jawad Al-Gburi","doi":"10.4103/tcmj.tcmj_56_25","DOIUrl":"10.4103/tcmj.tcmj_56_25","url":null,"abstract":"<p><strong>Objectives: </strong>Proper catheter selection during right trans-radial coronary angiography reduces procedure duration, costs, and vascular complications. The correlation between aorta morphological parameters assessed through computed tomography (CT) and requirement for larger catheter size was investigated in this study.</p><p><strong>Materials and methods: </strong>This observational study includes 206 patients who underwent right trans-radial coronary angiography and had already undergone coronary CT angiography at a recognized center from April 2023 to January 2025. Patients who completed angiography using a Judkins left (JL) 3.5 (Group 1) catheter were compared with patients who required catheter exchange with a JL 4 or larger (Group 2). Both groups had their CT images analyzed for four specific aortic morphological variables.</p><p><strong>Results: </strong>A total of 167 patients formed Group 1, whereas 39 patients formed Group 2. The significant differences were detected in the maximal area and length of the ascending aorta among the four aortic CT variables. In multivariable logistic regression model, the strongest association with the need for JL4 or more catheter (Group 2) was found with the maximal area of the ascending aorta (odds ratio [OR] 31.82 [(95% confidence interval [CI]) 1.21-831.18], <i>P</i> < 0.001) followed by length of the ascending aorta (OR 29.97 [(95% CI) 1.06-845.08], <i>P</i> < 0.001). An ascending aorta maximal area cutoff value was 12.25 cm² (SN 94.9%, SP 95.2%) with the derived diameter of 3.94 cm.</p><p><strong>Conclusion: </strong>Maximum area (with derived diameter) and ascending aortic length were the good predictors for suitable catheter selection during right trans-radial invasive coronary angiography.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 1","pages":"104-109"},"PeriodicalIF":1.6,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of bone metabolism serum markers with clinical parameters of the disease progression during 2-year follow-up in patients with chronic obstructive pulmonary disease.","authors":"Tanya Tacheva, Dimo Dimov, Yanitsa Zhelyazkova, Elina Aleksandrova, Petya Stamenova, Tatyana Vlaykova","doi":"10.4103/tcmj.tcmj_175_25","DOIUrl":"10.4103/tcmj.tcmj_175_25","url":null,"abstract":"<p><strong>Objectives: </strong>Although chronic obstructive pulmonary disease (COPD) primarily affects the lungs, it is accepted that COPD is a complex multicomponent disease characterized by chronic systemic inflammation, often with other comorbidities, which are important determinants associated with increased risk of health deterioration, hospitalization, and mortality. One of the most common comorbidities in COPD is osteoporosis. The aim of the study was to explore the possible role of three serum markers of bone metabolism, 25-hydroxyvitamin D₃ (25[OH]D₃), osteoprotegerin (OPG), and osteopontin (OPN) as indicators of COPD progression.</p><p><strong>Materials and methods: </strong>We assessed the serum levels of these markers in 23 control individuals and in 58 patients with COPD, followed for 2 years after recruitment in the current study.</p><p><strong>Results: </strong>All examined serum markers were significantly lower in COPD patients in comparison to controls (<i>P</i> < 0.0001). Serum OPN was significantly lower in patients with early GOLD stages (stage 1 and 2) than in advanced (stage 3 and 4) (<i>P</i> = 0.035) and had a weak negative correlation with forced expiratory volume in 1 s (FEV1%) predicted at the beginning (Rho = -0.254, <i>P</i> = 0.054) and at the end of the follow-up period (Rho = -0.296, <i>P</i> = 0.028). In contrast, serum OPG tended to be higher in patients with early stages (<i>P</i> = 0.086) and to correlate positively with the spirometric lung function indexes FEV1/forced vital capacity (FVC%) at the beginning (Rho = 0.276, <i>P</i> = 0.041) and with FEV1% at the end of the study period (Rho = 0.232, <i>P</i> = 0.098). OPG was significantly higher in patients without deterioration of the lung functions during the follow-up period than those who had a decrease in FEV1% predicted (<i>P</i> = 0.045) and decreased FEV1/FVC% (<i>P</i> = 0.034). Moreover, OPG correlated negatively with the COPD assessment test scores in the beginning of the study period (Rho = -0.323, <i>P</i> = 0.016) and with the number of the hospitalization (Rho = -0.303, <i>P</i> = 0.025). There was a reliable trend for negative correlation of serum 25(OH) D₃ with the number of exacerbations during the study period (Rho = -0.291, <i>P</i> = 0.055) and a significant positive correlation with FEV1% predicted (Rho = 0.728, <i>P</i> = 0.003) but only in patients with advanced stages.</p><p><strong>Conclusion: </strong>The results suggest that the higher serum OPG and Vitamin D₃ might be markers for improving the COPD patient conditions and lung function, while the serum OPN might determine worsening.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 2","pages":"210-217"},"PeriodicalIF":2.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting large middle molecules: Clinical implications of expanded hemodialysis in hemodialysis care.","authors":"Chiu-Huang Kuo, Yu-Li Lin, Chi-Chong Tang, Bang-Gee Hsu","doi":"10.4103/tcmj.tcmj_192_25","DOIUrl":"10.4103/tcmj.tcmj_192_25","url":null,"abstract":"<p><p>End-stage kidney disease (ESKD) presents a major clinical burden, with maintenance hemodialysis (HD) patients facing high cardiovascular mortality and impaired quality of life (QoL). Despite advances from low-flux to high-flux HD and the introduction of hemodiafiltration (HDF), clearance of large middle molecules (LMMs >25 kDa) remains inadequate. These molecules contribute to inflammation, oxidative stress, atherogenesis, and mineral-bone disorders, all of which worsen patient outcomes. Expanded hemodialysis (HDx), utilizing medium cutoff membranes, represents a novel approach that combines diffusion and enhanced internal convection to improve LMMs removal, without the need for substitution fluid. This review explores the limitations of conventional HD, the pathological roles of LMMs, and the evolution of dialysis strategies aimed at enhancing solute clearance. Evidence from observational studies, randomized trials, and meta-analyses shows that HDx improves the removal of inflammatory LMMs, reduces hospitalization burden, preserves residual kidney function, and enhances patient-reported outcomes such as recovery time and symptom relief. Furthermore, HDx offers a practical and cost-effective alternative to online HDF (OL-HDF), particularly in the resource-limited settings, achieving comparable efficacy with shorter sessions and lower blood flow requirements. By addressing the key shortcomings of traditional HD and approaching the solute clearance profile of the native kidney, HDx offers a promising advancement in the care of ESKD patients.</p>","PeriodicalId":45873,"journal":{"name":"Tzu Chi Medical Journal","volume":"38 1","pages":"31-39"},"PeriodicalIF":1.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12885456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}