Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Risk factors for sialocele after parotidectomy.","authors":"Chia-Hsien Wu, Hsueh-An Sun, Heng-Jui Hsu","doi":"10.1097/JCMA.0000000000001375","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001375","url":null,"abstract":"<p><strong>Background: </strong>Parotidectomy, the surgical excision of the parotid gland to treat tumors, is frequently complicated by sialocele formation-a subcutaneous accumulation of saliva that presents clinically as a cystic mass. With reported incidences ranging from 0% to 44%, the specific etiology remains incompletely defined. This study aimed to identify independent predictors of postoperative sialocele formation to suggest targeted preventive strategies.</p><p><strong>Methods: </strong>A retrospective cohort study analyzed patients undergoing parotidectomy at a single tertiary center from 2014 to 2020. Data including patient demographics, comorbidities, lifestyle habits, operative details, and postoperative care were collected. The primary clinical outcome was clinically diagnosed sialocele. Independent predictors were evaluated using multivariable logistic regression, calculating adjusted odds ratios (aORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among 597 subjects (mean age 52.2 ± 14.4 years; 58.5% male), 54 (9.0%) developed a sialocele. Multivariable analysis revealed significant independent predictors: betel nut use (aOR = 2.37; 95% CI, 1.13-4.97, p = 0.023), history of cerebrovascular accident (aOR = 4.10; 95% CI, 1.30-14.86, p = 0.032), surgical drain removal in less than three days (aOR = 1.89; 95% CI, 1.04-3.44, p = 0.036), and a diagnosis of mucoepidermoid carcinoma (aOR = 4.18; 95% CI, 1.37-12.78, p = 0.012). Variables like age, sex, tumor size, and operative method showed no significant association.</p><p><strong>Conclusion: </strong>Betel nut use, a history of stroke, early drain removal, and malignant pathology are significant independent risk factors for postoperative sialoceles. Adjusting perioperative management, particularly delaying drain removal, may lower this risk. Tumor size and operative method did not influence outcomes. Prospective studies are needed to confirm these single-center retrospective findings.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147648035","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":"An in trans NOTCH3 loss-of-function variant modifies disease severity in CADASIL: A family-based study.","authors":"Shih-Chun Lan, Yi-Hong Liu, Jui Lan, Yi-Chu Liao, Min-Yu Lan, Yi-Chung Lee","doi":"10.1097/JCMA.0000000000001371","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001371","url":null,"abstract":"<p><strong>Background: </strong>Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by pathogenic NOTCH3 variants, most commonly heterozygous cysteine-altering variants. Disease severity varies widely, and the impact of reduced NOTCH3 dosage on CADASIL severity remains unclear. We describe a family of four individuals carrying a cysteine-altering NOTCH3 variant and/or a frameshift loss-of-function (LoF) variant, demonstrating marked intrafamilial phenotypic heterogeneity.</p><p><strong>Methods: </strong>Four related individuals underwent standardized clinical assessment, brain MRI, genetic analysis, skin biopsy, and NOTCH3 complementary DNA (cDNA) sequencing.</p><p><strong>Results: </strong>The proband, carrying p.Cys1146Ser and p.Cys1024Valfs248 in trans, developed progressive gait disturbance, dysphagia, and slurred speech beginning in his mid-thirties. Brain MRI demonstrated extensive white matter hyperintensities, multiple lacunar infarcts, and numerous cerebral microbleeds. In contrast, the father (carrying p.Cys1146Ser alone) and the mother and brother (carrying p.Cys1024Valfs248 alone) exhibited milder clinical and imaging phenotypes. Only the carriers of the cysteine-altering variant demonstrated NOTCH3 extracellular domain (NOTCH3 ECD) immunoreactivity in skin vessels. NOTCH3 cDNA sequencing from the skin tissue demonstrated reduced LoF allele expression.</p><p><strong>Conclusion: </strong>Reduced NOTCH3 dosage may modify the disease severity of CADASIL.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635412","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":"Proposed study design for estimating COVID-19 vaccine effectiveness in post-pandemic Taiwan.","authors":"Long-Sheng Chen, Cheng-Yi Lee, Hung-Wei Kuo, Yu-Lun Liu, Jen-Hsiang Chuang","doi":"10.1097/JCMA.0000000000001372","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001372","url":null,"abstract":"<p><p>Post-licensure observational studies are used to assess vaccine effectiveness (VE) when clinical randomized controlled trials are not feasible. Although vaccination engenders various effects at the individual and population levels, few studies have specifically examined the types of effects estimated in VE study. The test-negative design (TND) is more commonly used to evaluate direct vaccine performance against influenza virus, rotavirus, and SARS-CoV-2. It is preferably used within a standard sentinel surveillance platform and certain constraints may affect its validity. After the World Health Organization declared that COVID-19 is no longer a public health emergency, developing robust methodologies for evaluating VE is critical. Accordingly, this study was to (1) clarify the types of vaccine effects typically captured by current observational VE studies, and (2) propose a scientifically rigorous and operationally feasible study design for estimating seasonal COVID-19 VE against severe outcomes after the pandemic. After reviewed various VE methodological issues, including vaccine effect, study design, outcomes and exposures of interest, key covariates, and Taiwan's post-pandemic context. We propose a refined population-based retrospective cohort design. This design enables estimating direct VE against severe COVID-19 outcomes in the post pandemic era by utilizing Taiwan's integrated national databases and incorporating validated health-seeking behavior and health-care access markers, evidence-based underlying conditions, and advanced statistical models. The proposed design provides a scientifically valid and feasible alternative to the TND for direct COVID-19 VE assessment in the absence of a sentinel surveillance platform. It is also applicable to other respiratory-pathogen-related vaccines, such as the seasonal influenza vaccine, and to countries with similar settings.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611022","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":"Tumor-suppressive circRNAs in colorectal cancer spheroids and patients.","authors":"Yan-Jie Su, Guang-Yuh Chiou, Chih-Ling Yeh, Hou-Kai Hu, Teh-Ia Huo, Yuan-Tzu Lan, Ping-Hsing Tsai, Yi-Ping Yang","doi":"10.1097/JCMA.0000000000001361","DOIUrl":"10.1097/JCMA.0000000000001361","url":null,"abstract":"<p><strong>Background: </strong>Cancer stem cells pose significant clinical challenges in patients with colorectal cancer, as they complicate chemotherapy treatment and reduce survival rates. Investigating cancer stem cells may help elucidate the mechanisms driving therapeutic resistance and disease progression. Recent studies suggest that circular RNAs (circRNAs) play crucial roles in tumor formation and may offer potential for early diagnosis and novel treatment strategies. However, comprehensive validations of these circRNAs remain limited to date. The aim of this study was to elucidate the molecular roles of circRNAs that are downregulated in colorectal cancer stem-like cell populations.</p><p><strong>Methods: </strong>We established 3D spheroid cultures using HCT-15 and WiDr cell lines as cancer stem cell models. Bulk RNA sequencing profiled circRNA and mRNA expression, followed by bioinformatic analyses using CircInteractome, CircBank, miRDB, and TargetScan to construct circRNA-miRNA-mRNA interaction networks.</p><p><strong>Results: </strong>CircRNA sequencing revealed predominant downregulation of circRNAs in spheroid cultures. Integration with clinical datasets comprising 788 colorectal cancer patients identified 15 circRNAs consistently downregulated in both spheroid models and metastatic tissues. Among these, hsa_circ_0039776 and hsa_circ_0067353 emerged as key tumor-suppressive candidates, predicted to regulate three oncogenic miRNAs-hsa-miR-614, hsa-miR-645, and hsa-miR-4689-significantly upregulated in advanced-stage patients. Cross-validation confirmed circRNA-miRNA and miRNA-mRNA interactions, and four tumor-suppressive genes ( CCL5 , INSC , SLC9A1 , SLC34A1 ) were associated with improved survival. Gene set enrichment analysis suggested these networks modulate cancer stem cell phenotypes, including inhibition of differentiation, resistance to apoptosis, and enhancement of DNA damage repair.</p><p><strong>Conclusion: </strong>This study identifies hsa_circ_0039776 and hsa_circ_0067353 as novel tumor-suppressive circRNAs reduced in colorectal cancer spheroids and metastatic lesions. The circRNA-miRNA-mRNA regulatory network implicates oncogenic miRNAs and downstream tumor-suppressive targets correlating with favorable survival and cancer stemness. These findings underscore the potential of circRNAs as diagnostic biomarkers and therapeutic targets in colorectal cancer.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"301-311"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345647","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":"Comprehensive review of current management and precision medicine in pancreatic cancer.","authors":"Hung-Yuan Yu, Le-Gin Lin, Yee Chao, Chung-Pin Li","doi":"10.1097/JCMA.0000000000001365","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001365","url":null,"abstract":"<p><p>Pancreatic cancer is one of the most lethal malignancies, with an increasing incidence and limited improvement in survival despite therapeutic advances. Surgical resection remains the only curative option; however, recurrence is frequent, and long-term outcomes remain dismal. Major risk factors include smoking, obesity, diabetes, chronic pancreatitis, and pathogenic germline variants such as BRCA1/2, ATM, and mismatch repair genes. Routine population screening is not recommended; instead, surveillance using endoscopic ultrasonography and magnetic resonance cholangiopancreatography is recommended for high-risk individuals. Diagnosis relies on multiphasic pancreatic protocol computed tomography and histological confirmation. Treatment strategies are determined based on resectability: upfront surgery with adjuvant chemotherapy for resectable disease, neoadjuvant chemotherapy for borderline resectable or high-risk patients, and palliative chemotherapy with or without chemoradiation for locally advanced cases. Systemic therapies, including FOLFIRINOX, gemcitabine plus nab-paclitaxel, and NALIRIFOX, remain the cornerstone of therapies for metastatic disease, with precision medicine offering targeted options such as PARP inhibitors for BRCA-mutated tumors. Modern radiotherapy techniques including stereotactic body radiation therapy and particle therapy enhance local control and reduce toxicity. The integration of next-generation sequencing and multidisciplinary management is essential for improving pancreatic cancer outcomes.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":"89 4","pages":"263-270"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701383","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":"After Eprex ® discontinuation: Multicenter evidence for a biosimilar erythropoietin and health system resilience in Taiwan.","authors":"Chih-Yu Yang","doi":"10.1097/JCMA.0000000000001362","DOIUrl":"10.1097/JCMA.0000000000001362","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"261-262"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350148","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":"The impact of conversion arthroplasty for failed femoral neck or intertrochanteric fractures on complication and mortality rates: A \"second-hit\" effect?","authors":"Jui-Chien Wang, Kun-Han Lee, Yueh-Ting Hung, Wei-Lin Chang, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu, Wei-Ming Chen","doi":"10.1097/JCMA.0000000000001368","DOIUrl":"10.1097/JCMA.0000000000001368","url":null,"abstract":"<p><strong>Background: </strong>Data on the risk of morbidity and mortality following conversion arthroplasty for fixation failure of femoral neck fractures (FNFs) or intertrochanteric fractures (ITFs) remains limited. This study compares medical outcomes between: (1) initial fixation and conversion arthroplasty for failed FNFs and ITFs, and (2) conversion arthroplasty for failed FNFs vs failed ITFs.</p><p><strong>Methods: </strong>A retrospective review of an institutional database at Taipei Veterans General Hospital identified patients who underwent conversion arthroplasty for failed internal fixation of FNFs or ITFs from January 2010 to December 2022. Primary outcomes included frequencies of in-hospital complications, 90-day readmissions following initial fixation and conversion arthroplasty, and 90-day and 1-year mortality after conversion arthroplasty. To compare outcomes for conversion arthroplasty between failed FNFs and ITFs, cohorts were matched by age, body mass index, and age-adjusted Charlson Comorbidity Index.</p><p><strong>Results: </strong>A total of 70 patients with failed FNFs and 66 patients with failed ITFs were included. The in-hospital complication frequency was higher following conversion arthroplasty (FNF: 44.3% vs 17.1%, p < 0.001; ITF: 54.5% vs 31.8%, p = 0.008) compared with initial fixation. Although conversion arthroplasty for failed ITFs involved a longer procedure time (125.5 ± 46.2 vs 86.8 ± 31.1 minutes, p < 0.001), greater estimated blood loss (1088.1 ± 603.8 vs 513.1 ± 287.7 mL, p < 0.001), and higher transfusion rate (81.0% vs 31.7%, p < 0.001) and volume (2.6 ± 2.0 vs 0.8 ± 1.2 units, p < 0.001) compared with failed FNFs, the in-hospital complication, readmission, and mortality rates were similar between the two groups.</p><p><strong>Conclusion: </strong>Conversion arthroplasty for failed FNFs and ITFs was associated with worse medical outcomes, including a higher rate of in-hospital complications, compared with initial fixation. Despite greater surgical complexity associated with conversion arthroplasty for failed ITFs compared with failed FNFs, the in-hospital complication, readmission, and mortality rates were similar.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"293-300"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438665","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":"Empirical comparison of iodine excretion estimated from spot urine samples with measured 24-hour urinary iodine excretion in healthy adults.","authors":"Chun-Jui Huang, Yi-Wen Chen, Shun-Jie Yang, Jia-Zhen Li, Chii-Min Hwu, Harn-Shen Chen, Fan-Fen Wang, Chen-Chang Yang","doi":"10.1097/JCMA.0000000000001363","DOIUrl":"10.1097/JCMA.0000000000001363","url":null,"abstract":"<p><strong>Background: </strong>Ideally, 24-hour urine collections are the reference standard for assessing iodine status. While median urinary iodine concentration (UIC) from spot samples has commonly replaced 24-hour collections for assessments of iodine status within populations, the validity of spot samples remains unclear. This study aimed to validate the estimated 24-hour urinary iodine excretion (e24-h UIE) derived from spot urine samples as an alternative to actual 24-hour urinary iodine excretion (24-h UIE).</p><p><strong>Methods: </strong>Healthy volunteers aged ≥18 years without thyroid or kidney diseases were recruited from National Yang Ming Chiao Tung University and Taipei Veterans General Hospital, Taiwan. Participants were recruited from a pool of university students, hospital staff, local vendors, and their social networks. Each participant provided one 24-hour urine sample, and two-spot urine samples collected immediately before and after the 24-hour period. UIC was measured using inductively coupled plasma mass spectrometry. The e24-h UIE was calculated from spot urine UIC and creatinine (Cr) concentrations, adjusted by anthropometry-based predicted 24-hour Cr excretion.</p><p><strong>Results: </strong>Twenty-three healthy adults (mean age: 36.4 ± 10.1 years, 60.8% men) were enrolled between September 2022 and May 2024. Median e24-h UIE (154.3 μg/d, interquartile range [IQR] 114.2-201.2) did not differ significantly from measured 24-h UIE (158.3 μg/d, IQR 106.7-213.7; Pearson's r = 0.44, indicating a moderate correlation, p = 0.003). Passing-Bablok regression and Bland-Altman analysis indicated good agreement between methods, with a mean difference of 6.8 μg/d (regression line: Y = 0.92 × X + 9.53).</p><p><strong>Conclusion: </strong>These findings suggest that e24-h UIE from spot samples reasonably estimates actual 24-h UIE, offering a practical alternative to avoid the inconvenience of complete 24-hour urine collections.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"271-278"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367834","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":"Zolpidem use and the risk of arrhythmia: A nationwide population-based cohort study in Taiwan.","authors":"Hong-Jhe Chen, Hsun Ou, Jia-Ying Shen, Chi-Hsiang Chung, Yuan Hung, Chieh-Wen Chen, Brendon Stubbs, Wu-Chien Chien, Tien-Yu Chen","doi":"10.1097/JCMA.0000000000001360","DOIUrl":"10.1097/JCMA.0000000000001360","url":null,"abstract":"<p><strong>Background: </strong>Zolpidem is a widely prescribed hypnotic agent; however, its potential cardiovascular safety remains clinically uncertain. This study aimed to investigate the association between zolpidem use and the risk of various cardiac arrhythmias, specifically identifying which subtypes are most prevalent, using a nationwide population-based cohort in Taiwan.</p><p><strong>Methods: </strong>This population-based, matched-cohort study utilized the Longitudinal Generation Tracking Database (2000-2015) in Taiwan, comprising two million randomly sampled individuals. To establish a robust new-user design and minimize confounding, we included only those with zolpidem use for at least 7 days and strictly excluded individuals with any history of arrhythmia or heart failure. Users were matched 1:2 with controls by age, sex, and index year. The primary outcome was the incidence of cardiac arrhythmia, defined using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Data were analyzed using Cox regression and Kaplan-Meier methods, adjusting for multiple comorbidities including hypertension and diabetes.</p><p><strong>Results: </strong>A total of 457 956 participants (152 652 zolpidem users and 305 304 matched controls) were analyzed. The groups were well-balanced with a mean age of 55.4 years and 49.2% being male. Zolpidem use was associated with a significantly increased risk of cardiac arrhythmia (adjusted hazard ratio [aHR], 1.983; 95% CI, 1.149-2.760; p < 0.001). Subgroup analyses revealed that zolpidem use notably increased the risk of paroxysmal tachycardia (aHR, 2.574; 95% CI, 1.514-3.998; p < 0.001) and atrial flutter (aHR, 2.491; 95% CI, 1.457-4.212, p < 0.001).</p><p><strong>Conclusion: </strong>Zolpidem use is independently associated with an increased risk of incident arrhythmia, particularly tachyarrhythmias such as paroxysmal tachycardia and atrial flutter. Clinicians should incorporate cardiac risk assessment into their prescribing decisions and consider periodic monitoring for high-risk patients. Study limitations include the observational design and the unavailability of granular dosage data.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"284-292"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345825","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":"Target-controlled infusion achieves smoother autonomic modulation than manual bolus during propofol induction: Evidence from wavelet-based spectral analysis.","authors":"Jing-Yang Liou, Kun-Hui Chen, Chen Lin, Hsin-Yi Huang, Chien-Kun Ting, Men-Tzung Lo, Wen-Kuei Chang, Hsin-Yi Wang","doi":"10.1097/JCMA.0000000000001364","DOIUrl":"10.1097/JCMA.0000000000001364","url":null,"abstract":"<p><strong>Background: </strong>Anesthesia induction involves rapid autonomic shifts that may compromise hemodynamic stability. Propofol administered via target-controlled infusion (TCI) produces a more gradual onset, whereas rapid manual bolus (MB) administration often triggers abrupt autonomic disturbances. Thus, the propofol delivery method is critical to autonomic stability; however, conventional monitoring lacks sufficient temporal resolution to capture transient fluctuations during early induction. To address this gap, we compared TCI and MB using high-temporal-resolution wavelet-based spectral analysis (WBSA) of heart rate variability (HRV) and pulse photoplethysmography amplitude (PPGA) to characterize real-time autonomic dynamics.</p><p><strong>Methods: </strong>This prospective, single-center observational study included adult patients undergoing elective surgery who received propofol induction via TCI or MB administered over 10 seconds. HRV and PPGA were continuously recorded and analyzed using WBSA. High-frequency power and low-to-high frequency ratio assessed parasympathetic tone and sympathovagal balance, while PPGA served as a surrogate for peripheral sympathetic tone. Simulated effect-site concentrations (CeP) were calculated to examine relationships between concentration dynamics and autonomic responses.</p><p><strong>Results: </strong>Forty-four patients were analyzed. Compared with MB, TCI produced significantly more gradual and attenuated changes in high-frequency, low-frequency, and low-to-high frequency ratio (all p < 0.05), along with slower and smaller increases in PPGA, indicating better preservation of autonomic balance and milder peripheral sympatholysis. Simulated CeP reached 5.5 μg·mL - 1 at 117 seconds with TCI vs 36 seconds with MB. Greater transient autonomic disturbance was associated with a faster rise in CeP, rather than absolute CeP values, indicating that delivery mode and rate were primary determinants of autonomic modulation.</p><p><strong>Conclusion: </strong>TCI provided smoother autonomic modulation than did MB during the physiologically unstable induction phase. By enabling real-time detection of short-lived fluctuations, WBSA revealed mechanistic differences not captured by conventional analyses, supporting TCI as a potentially more stable and physiologically balanced induction strategy, particularly for patients at risk of peri-induction instability.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"312-318"},"PeriodicalIF":2.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367816","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}