Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Canal wall and ossicle chain reconstruction with tragal cartilage/perichondrium composite grafts in endoscopic resection of middle ear and antrum cholesteatomas.","authors":"Kai-Fen Chuang, Yuan-Yung Lin, Chao-Yin Kuo, Hsin-Chien Chen, Chih-Hung Wang, Cheng-Ping Shih","doi":"10.1097/JCMA.0000000000001223","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001223","url":null,"abstract":"<p><strong>Background: </strong>Compared to the microscopic approach (MA), the endoscopic approach (EA) is more challenging for the removal of cholesteatomas and reconstruction of the ossicle chain and canal wall. We presented a surgical technique for rebuilding the canal wall and ossicle chain with tragal cartilage/perichondrium composite grafts in the resection of cholesteatomas under EA.</p><p><strong>Methods: </strong>This retrospective study consisted of 24 cases undergoing EA (EA group) for cholesteatomas destroying the ossicles and 28 cases undergoing MA (MA group). The aim of this study was to analyze the outcome of ossiculoplasty, the stability of the reconstructed canal wall and the recurrence rate of cholesteatoma in EA group. The postoperative outcomes between TEA and MA groups were compared.</p><p><strong>Results: </strong>In EA subgroup with an intact stapes superstructure, the pre- and postoperative air conduction (AC) thresholds and pre- and postoperative air-bone gap (ABG) were 42 ± 13.0, 37 ± 13.7, 23 ± 13.9 and 18 ± 14.8 dB, respectively. AC thresholds and ABG were significantly improved after the operation (p=0.003 and p=0.004, respectively). Gain in AC thresholds was 7.2 ± 11.1 dB in EA group and 1.6 ± 14.5 dB in MA group. There was no significant difference in the gain between two groups (p = 0.615). In EA group, two cases suffered cholesteatoma recurrence, with a recurrence rate of 8.3%. The recurrence rate was 10.7% in MA group. There was no significant difference in the recurrence rate between two groups (p = 0.772).</p><p><strong>Conclusion: </strong>Our endoscopic method had a comparable result to MA in the treatment of cholesteatomas involving the ossicle. The technique has the advantage of leaving both a smaller surgical wound and an invisible scar. The composite graft can be easily modified for reconstruction of canal wall defects and ossiculoplasty. Patients with an intact stapes superstructure had better hearing outcomes.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143545047","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}

{"title":"Feasibility and safety of Taipei Veterans General Hospital Heavy Ion Therapy Center: The first carbon-ion irradiation facility in Taiwan.","authors":"Tien-Li Lan, Cheng-Ying Shiau, Ling-Wei Wang, Yu-Ming Liu, Yi-Wei Chen, Pin-I Huang, Yu-Wen Hu, I-Chun Lai, Yuan-Hung Wu, Tzu-Yu Lai, Yu-Mei Kang, Wan-Chin Yang, Yu-Jung Lin, Yi-Ying Pan, Chi-Chuan Chiu, Ching-Sheng Liu, Tung-Sheng Hsieh, Jia-Cheng Lee, Fang-Yi Lin, Chien-Hsuan Chan, Hui-Chia Lin, Keng-Li Lan","doi":"10.1097/JCMA.0000000000001207","DOIUrl":"10.1097/JCMA.0000000000001207","url":null,"abstract":"<p><strong>Background: </strong>Unlike conventional photon radiotherapy, particle therapy has the advantage of dose distribution. Carbon-ion radiotherapy is also advantageous in terms of biological effectiveness and other radiobiological aspects. These benefits lead to a higher response probability for previously known radioresistant tumor types. Therefore, Taipei Veterans General Hospital, which is located in the northern district of Taipei, built the first carbon-ion irradiation facility in Taiwan.</p><p><strong>Methods: </strong>Taipei Veterans General Hospital completed a phase 1 trial to evaluate the safety of carbon-ion radiotherapy. Six patients (4 males and 2 females with prostate adenocarcinoma, sacral chordoma, hepatocellular carcinoma, lung adenocarcinoma, or parotid high-grade carcinoma) were enrolled in this study. The mean age of the patients was 62.7 years. The mean dose was 57.3 Gy(RBE) (fraction range, 4-16 Gy[RBE]).</p><p><strong>Results: </strong>During this phase 1 trial, all patients were monitored for 3 months to evaluate acute toxicity and short-term outcomes after treatment with carbon irradiation. Only 2 patients experienced grade 2 toxicity, which resolved without medication 1 month after completing treatment. The tumor response demonstrated 1 complete response, 1 partial response, and 4 cases of stable disease.</p><p><strong>Conclusion: </strong>Carbon-ion radiotherapy was determined to be an effective and safe treatment.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"196-204"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019001","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}

{"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":"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 (1-5 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. In addition, 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":"253-260"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","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}

{"title":"Comparison of clinical outcomes in women with surgically treated early primary cervical cancer: Lymphadenectomy vs sentinel lymph node biopsy.","authors":"Wan-Hua Ting, Hui-Hua Chen, Shu-Wei Hsieh, Ming-Chow Wei, Sheng-Mou Hsiao","doi":"10.1097/JCMA.0000000000001169","DOIUrl":"10.1097/JCMA.0000000000001169","url":null,"abstract":"<p><strong>Background: </strong>The primary objective of this study was to elucidate the impact of sentinel lymph node (SLN) mapping and biopsy techniques on the clinical outcomes of women with early primary cervical cancer.</p><p><strong>Methods: </strong>All consecutive women with clinically determined stage I-IIA cervical cancer who underwent lymph node assessment with either SLN mapping or conventional pelvic/para-aortic lymphadenectomy were reviewed.</p><p><strong>Results: </strong>Women in the SLN group (n = 33) had fewer total dissected pelvic nodes (8.3 ± 5.9 vs 17.4 ± 7.7, p < 0.001), less intraoperative blood loss (513 ± 332 vs 1228 ± 1170 mL, p < 0.001), a shorter length of hospital stay (7.1 ± 2.4 vs 10.2 ± 6.1 days, p = 0.004) than women in the conventional lymphadenectomy group (n = 74). The rates of recurrence-free survival (3-year: 87.6% vs 82.9%) and overall survival (3-year: 100% vs 91.0%) did not differ between the SLN group and the conventional lymphadenectomy group ( p = 0.846 and p = 0.254, respectively).</p><p><strong>Conclusion: </strong>SLN biopsy does not seem to be associated with an inferior survival outcome compared with conventional lymphadenectomy in women with early primary cervical cancer. In addition, it is associated with less blood loss and a shorter length of hospital stay.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"238-245"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305008","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}

{"title":"Two novel SNPs rs1736952 and rs17354984 are highly associated with uveitis in ankylosing spondylitis.","authors":"Ssu-Cheng Huang, De-Kuang Hwang, Wei-Chieh Fang, Ai-Ru Hsieh, Mei-Lin Shih, Zi-Qing Zhuang, Chong-En Gao, Tai-Chi Lin, Shih-Jen Chen, Chih-Chien Hsu","doi":"10.1097/JCMA.0000000000001210","DOIUrl":"10.1097/JCMA.0000000000001210","url":null,"abstract":"<p><strong>Background: </strong>Noninfectious anterior uveitis shares genetic factors, including HLA-B27, with ankylosing spondylitis (AS). The aim of this study was to identify significant single nucleotide polymorphisms (SNPs) associated with noninfectious anterior uveitis in AS patients, which may help predict help predict the risk of developing this condition and provide deeper insights into its genetic basis.</p><p><strong>Methods: </strong>A genome-wide association study (GWAS) was conducted using the genomic data of 468 AS patients, including 90 with noninfectious anterior uveitis and 378 without it, from the Taiwan Precision Medicine Initiative. This study identified relevant genes using SnpXplorer and developed a polygenic risk score (PRS) model to identify AS patients with an increased risk of noninfectious anterior uveitis. Biological pathways were analyzed via Enrichr-KG and various databases.</p><p><strong>Results: </strong>GWAS revealed two novel SNPs, rs1736952 and rs17354984, with p values <5 × 10 -8 , and 74 SNPs with p values <1 × 10 -4 . The associated genes were involved mainly in antigen presentation, interferon signaling, immune regulation pathways, ciliary movement, and neurodegeneration. An optimal PRS model was constructed using 19 SNPs, achieving an area under the curve (AUC) of 0.907.</p><p><strong>Conclusion: </strong>Our results revealed that two novel and significant SNP loci, rs1736952 and rs17354984, are strongly associated with noninfectious anterior uveitis in patients with AS. However, their roles in uveitis and other immune disorders warrant further investigation.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"211-221"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019018","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}

{"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":"10.1097/JCMA.0000000000001201","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (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 (MR) analysis.</p><p><strong>Methods: </strong>A bidirectional two-sample 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 Genome-Wide Association Study (GWAS) catalog, while data for COVID-19 susceptibility were obtained from the OPEN GWAS database. Five MR methods (inverse variance weighted [IVW], MR-Egger, weighted median, simple mode, and weighted mode) were used 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":"231-237"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","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}

{"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-Hwa Chiou","doi":"10.1097/JCMA.0000000000001203","DOIUrl":"10.1097/JCMA.0000000000001203","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (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 polymerase chain reaction 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We constructed and validated a biosignature model by using a combination of CBC measurements to predict subsequent hospitalization events (hazard ratio = 3.38, 95% confidence interval: 3.07-3.73 for the training cohort and 3.03 [2.46-3.73] for the validation cohort; both p &lt; 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 &lt; 10 -8 in both the training and validation cohorts). The \"very high risk\" group exhibited a cumulative hospitalization rate of &gt;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 IKAROS family zinc finger 1 ( IKZF1 ), actin binding LIM protein 1 ( ABLIM1 ), and mitochondrially encoded NADH:ubiquinone oxidoreductase core subunit 3 ( 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 after ","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"246-252"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","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}

{"title":"Onyx as an adjunctive embolic material for transvenous embolization of cavernous sinus dural arteriovenous fistula after coiling.","authors":"Chao-Bao Luo, Chien-Hui Lee, Hsiang-Yun Lo, Feng-Chi Chang, Chung-Jung Lin","doi":"10.1097/JCMA.0000000000001196","DOIUrl":"10.1097/JCMA.0000000000001196","url":null,"abstract":"<p><strong>Background: </strong>Transvenous coil embolization (TVCE) is a common and effective treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some patients may experience residual fistulas or worsening visual symptoms after the procedure. This study aimed to compare the effectiveness of transvenous coil and Onyx embolization (TVCOE) with TVCE in treating CSDAVFs.</p><p><strong>Methods: </strong>The study included 207 patients with 222 CSDAVFs referred for TVCE, all of whom had complete angiographic follow-up over 9 years. Ninety patients (mean age, 65.3 years) with 97 CSDAVFs underwent TVCOE after coiling. Clinical data, angioarchitecture, and outcomes were retrospectively assessed and compared to 125 CSDAVFs treated with TVCE.</p><p><strong>Results: </strong>Key reasons for selecting TVCOE included improvement in immediate complete obliteration of CSDAVFs (n = 47, 48.5%), presence of cranial nerve palsy (n = 26, 26.8%), residual fistula with persistent pial venous reflux (n = 22, 22.7%), and redirection of fistula flow to pial venous reflux (n = 2, 2.1%). The average volume of Onyx used in TVCOE was 1.7 mL per CSDAVF. The mean coil lengths for TVCOE and TVCE were 143 and 228 cm, respectively, with a statistically significant difference ( p < 0.05). Immediate digital subtraction angiography showed complete obliteration or nearly complete obliteration of CSDAVFs in TVCOE and TVCE at rates of 97.9% and 76.8%, respectively, indicating statistical significance in immediate complete obliteration ( p < 0.05). Transient hemodynamic instability occurred in 81 (90.0%) patients due to Onyx toxicity, and one patient (1.1%) experienced hemorrhagic complications during TVCOE.</p><p><strong>Conclusion: </strong>The use of a small volume of Onyx as an adjunctive embolic material in TVCOE resulted in reduced coil use and improved immediate complete obliteration. This technique is viable for patients with pial venous reflux. Aside from the transient hemodynamic instability, periprocedural complications and follow-up angiographic outcomes did not show significant differences between the two groups.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"261-266"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712335","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}

{"title":"Comparison between virtual reality and traditional lecture methods in educating respiratory therapy on pediatric 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":"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, 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 study was conducted between November 2020 and September 2022, involving 54 students from a School of Respiratory Therapy, with 43 completing a pretest 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 a statistical analysis comparing both study groups.</p><p><strong>Results: </strong>No significant differences in pretest scores were observed between the two groups. However, the VR group outperformed the non-VR group in OSCE scores significantly (15 ± 3 vs 10 ± 3, p = 0.003) and demonstrated greater learning motivation and satisfaction based on IMMS scores. No notable difference in immediate posteducation theoretical examination scores was observed between the groups.</p><p><strong>Conclusion: </strong>VR can effectively serve as a supplemental educational tool in clinical training programs for pediatric airway disease. To optimize its implementation in medical educational settings, further research with larger cohorts and longer follow-up periods is needed.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"205-210"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","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}

{"title":"Intracerebral hemorrhage in CADASIL.","authors":"Shao-Lun Hsu, Yi-Chu Liao, Chih-Ping Chung, Masafumi Ihara, Jay Chol Choi, Sung-Chun Tang, Yi-Chung Lee","doi":"10.1097/JCMA.0000000000001206","DOIUrl":"10.1097/JCMA.0000000000001206","url":null,"abstract":"<p><p>Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease caused by mutations in the NOTCH3 gene. This review highlights the increasing recognition of intracerebral hemorrhage (ICH) as a significant manifestation of CADASIL, often predominantly characterized by ischemic strokes and vascular dementia. Recent studies indicate that the prevalence of ICH in CADASIL patients ranges from 0.5% to 33.3%, the variability of which is mainly influenced by ethnicity. In East Asian cohorts, specific NOTCH3 mutations like p.R544C and p.R75P are more prevalent and have been associated with a higher rate of ICH, suggesting a link between these mutations and the hemorrhagic risk. Hypertension, as with other etiologies of ICH, is a key risk factor in CADASIL patients, with 40% to 90% of those who experience ICH also having a history of hypertension. The presence of cerebral microbleeds (CMBs) and a high CMB load are strongly associated with an increased risk of ICH. Neuroimaging studies show that ICH in CADASIL patients predominantly occurs in the thalamus and basal ganglia. There is a notable spatial correlation between CMBs and subsequent ICH, suggesting that CMBs may serve as markers of microangiopathy in regions prone to vascular injury. CADASIL patients with ICH experience greater morbidity, higher mortality rates, and increased annual stroke recurrence risk compared with those with ischemic events. In summary, this review emphasizes the need for tailored management strategies that prioritize rigorous blood pressure control and the careful use of antithrombotic agents in CADASIL patients with a high burden of CMBs. By advancing our understanding of ICH in CADASIL, we aim to improve diagnostic and therapeutic approaches, ultimately enhancing patient outcomes and quality of life in this high-risk population.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"189-195"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981075","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}