Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Cancer publications using real-world data from the Taiwan National Health Insurance Research Database: conceptual framework and bibliometric analysis.","authors":"Wing Hin Stanford Siu, Ai Yin Lim, Jia-Rou Liu, Shu-Hao Chang, Wei-Min Chen, Pei-Ru Li, Lai-Chu See","doi":"10.1097/JCMA.0000000000001227","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001227","url":null,"abstract":"<p><strong>Background: </strong>Bibliometric analysis often overlooks study-based components such as study aims, design, and statistical methods. In this study, we propose a conceptual framework incorporating these study-based components with disease-based components for the bibliometric analysis of cancer articles using real-world data. This framework is a significant step forward in cancer research. We then investigated the distribution and temporal trends of these components for cancer articles using the Taiwan National Health Insurance Research Database (NHIRD) published from 2006 to 2022.</p><p><strong>Methods: </strong>Study- and disease-based components were extracted and cross-validated. The distribution and temporal trends of these components were then presented.</p><p><strong>Results: </strong>We analyzed 1232 articles and found a noticeable increase in the annual publication count from 2011 onward. This upward trend signified the growing momentum in cancer research. Cancer risk factors were the most studied (52%), followed by cancer outcomes (36%) and incidence/prevalence (3%). Among the publications on risk factors and outcomes, most were cohort studies (85%), followed by case-control studies (10.7%). In both study designs, the use of the propensity score method increased steadily from 2.4% in 2011 to 40% in 2022. The most frequently studied cancer site was 'all cancers or multiple cancers' (25.6%), followed by breast (9.6%), hepatobiliary (9.2%), and colorectal cancers (8.8%). Among the top 10 cited articles, the first and fourth focused on whether suppressing hepatitis B viral load with nucleoside analogs could reduce hepatocellular carcinoma recurrence and incidence in chronic hepatitis B patients. The remaining eight examined the association between medications and cancer risk.</p><p><strong>Conclusion: </strong>Beyond citation metrics, our research underscores the importance of considering study-based and disease-based components in bibliometric analysis. These components form the foundation of the real-world data cancer research framework and have practical implications for diseases beyond cancers, providing a broader perspective for researchers and practitioners.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652912","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":"While GPT-3.5 is unable to pass the Physician Licensing Exam in Taiwan, GPT-4 successfully meets the criteria.","authors":"Tsung-An Chen, Kuan-Chen Lin, Ming-Hwai Lin, Hsiao-Ting Chang, Yu-Chun Chen, Tzeng-Ji Chen","doi":"10.1097/JCMA.0000000000001225","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001225","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the performance of ChatGPT-3.5 and ChatGPT-4 in answering medical questions from Taiwan's Physician Licensing Exam, ranging from basic medical knowledge to specialized clinical topics. It aims to understand these artificial intelligence (AI) models' capabilities in a non-English context, specifically traditional Chinese.</p><p><strong>Methods: </strong>The study incorporated questions from the Taiwan Physician Licensing Exam in 2022, excluding image-based queries. Each question was manually input into ChatGPT, and responses were compared with official answers from Taiwan's Ministry of Examination. Differences across specialties and question types were assessed using the Kruskal-Wallis and Fisher's exact tests.</p><p><strong>Results: </strong>ChatGPT-3.5 achieved an average accuracy of 67.7% in basic medical sciences and 53.2% in clinical medicine. Meanwhile, ChatGPT-4 significantly outperformed ChatGPT-3.5, with average accuracies of 91.9% and 90.7%, respectively. ChatGPT-3.5 scored above 60.0% in 7 out of 10 basic medical science subjects and 3 out of 14 clinical subjects, while ChatGPT-4 scored above 60.0% in every subject. The type of question did not significantly affect accuracy rates.</p><p><strong>Conclusion: </strong>ChatGPT-3.5 showed proficiency in basic medical sciences but was less reliable in clinical medicine, whereas ChatGPT-4 demonstrated strong capabilities in both areas. However, their proficiency varied across different specialties. The type of question had minimal impact on performance. This study highlights the potential of AI models in medical education and non-English languages examination and the need for cautious and informed implementation in educational settings due to variability across specialties.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627332","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":"Differential involvement of trait impulsivity, fluid intelligence, and executive function in creativity among euthymic patients with bipolar disorder.","authors":"Mao-Hsuan Huang, Yi-Hsuan Kuan, Pei-Chi Tu, Yee-Lam E Chan, Tung-Ping Su","doi":"10.1097/JCMA.0000000000001221","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001221","url":null,"abstract":"<p><strong>Background: </strong>While anecdotal evidence suggests a link between bipolar disorder and heightened creativity, empirical studies are scarce, and the underlying cognitive mechanisms remain unclear. This study aimed to explore the association between trait impulsivity, executive function, fluid intelligence, and creativity among euthymic patients with bipolar disorder.</p><p><strong>Methods: </strong>Euthymic outpatients with bipolar disorder and age- and sex-matched healthy controls were enrolled in this cross-sectional study. Creativity was assessed using the Abbreviated Torrance Test for Adults and the Chinese Word Remote Associates Test, which examined divergent thinking and convergent thinking, respectively. Trait impulsivity was measured using the Barratt Impulsiveness Scale, while cognitive flexibility was evaluated using the Wisconsin Card Sorting Test. Fluid intelligence was assessed using Raven's Progressive Matrices. General linear models were used to assess the associations between these cognitive measures.</p><p><strong>Results: </strong>Fifty-seven euthymic patients with bipolar disorder and fifty-six controls were recruited. Euthymic patients with bipolar disorder exhibited comparable overall creativity to controls but underperformed in convergent thinking. General linear models confirmed a negative association between trait impulsivity and creativity, primarily observed in patients with bipolar disorder. Cognitive flexibility positively correlated with creativity among patients with bipolar disorder, independent of fluid intelligence.</p><p><strong>Conclusion: </strong>Our study showed that euthymic patients with bipolar disorder do not have heightened creativity. The findings underscore the importance of considering trait impulsivity and cognitive factors in understanding creativity in bipolar disorder.</p><p><strong>Lay summary: </strong>Bipolar disorder (BD) is often linked to creativity, but scientific evidence on this connection is limited. Some individuals with BD may have creative strengths, while others struggle with cognitive challenges. This study explored how impulsivity, cognitive flexibility, and fluid intelligence affect creativity in euthymic patients with BD. Creativity was assessed by measuring divergent thinking (generating many different ideas) and convergent thinking (problem solving ability). The results showed that patients with BD do not have heightened creativity compared to healthy individuals. Importantly, higher impulsivity was linked to lower creativity, while better cognitive flexibility was associated with greater creativity in BD. The findings suggest that while BD does not enhance creativity, certain cognitive traits-such as lower impulsivity and stronger cognitive flexibility-may support creative thinking.</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":"143545252","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":"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":"Harness the power of artificial intelligence to generate graphical abstracts.","authors":"Feng-Yuan Yang, Tzeng-Ji Chen","doi":"10.1097/JCMA.0000000000001222","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001222","url":null,"abstract":"","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":"143545255","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":"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":"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":"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":"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}