Journal of the Chinese Medical Association : JCMA最新文献

{"title":"The efficacy and the safety of supraglottic airway in therapeutic procedure of trachea via flexible bronchoscopy compared with endotracheal intubation.","authors":"Chao-Lan Huang, Chien-Sheng Huang, Yi-Ying Lee, Chun-Ching Lu, Ting-Yun Chiang, Wei-Nung Teng, Wen-Kuei Chang, Chien-Kun Ting","doi":"10.1097/JCMA.0000000000001269","DOIUrl":"10.1097/JCMA.0000000000001269","url":null,"abstract":"<p><strong>Background: </strong>Flexible bronchoscopy is frequently employed for therapeutic interventions in tracheal lesions, but airway management during these procedures is challenging due to the need to share the airway for both ventilation and instrumentation. Endotracheal intubation, while providing a secure airway, often requires repeated insertion and removal of the tube to allow for bronchoscopic access. Additionally, the narrower internal diameter of the endotracheal tube can limit the maneuverability of the bronchoscope, making procedures more technically demanding. In contrast, the supraglottic airway (SGA)-originally developed by an anesthesiologist known as laryngeal mask-is a less invasive device that sits above the larynx and forms a seal around the glottic opening to allow for effective ventilation. SGAs typically have a wider lumen and do not require repeated placement during procedures, offering a more convenient and potentially safer conduit for flexible bronchoscopy. Despite these advantages, direct comparative evidence on the safety and efficacy of SGA vs endotracheal intubation in this context remains lacking.</p><p><strong>Methods: </strong>We reviewed charts and perioperative data regarding patients who underwent tracheal therapeutic procedures using flexible bronchoscopy under general anesthesia at Taipei Veterans General Hospital between 2019 and 2024. The primary outcome was the total number of repeated airway manipulations required. Secondary outcomes included oxygenation, ventilation, length of hospital stay, and procedure-related complications.</p><p><strong>Results: </strong>A total of 65 procedures were analyzed. There was a significantly higher proportion of female patients in the SGA group (67.7%) compared with the endotracheal intubation group (22.9%, p < 0.001). Mann-Whitney U tests revealed a significant reduction in the requirement for repeated airway manipulations with the SGA compared with endotracheal intubation ( p < 0.001). The median lowest oxygen saturation was higher with SGA (97% vs 94%, p = 0.001), while end-tidal carbon dioxide (EtCO 2 ) levels were comparable (45 vs 44 mmHg, p = 0.94). In addition, patients in the SGA group were weaned from mechanical ventilation earlier and had significantly shorter hospital stays (5.5 vs 30 days, p < 0.001).</p><p><strong>Conclusion: </strong>Compared with endotracheal intubation, the SGA is an effective alternative for airway management during therapeutic tracheal procedures using flexible bronchoscopy. It reduces the need for repeated airway manipulation, provides better oxygenation with comparable ventilation, maintains continuous airway control, and serves as a reliable conduit for bronchoscope insertion.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"681-685"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692866","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":"Evaluating GPT-4's visual interpretation and clinical reasoning on emergency settings: A 5-year analysis.","authors":"Te-Hao Wang, Jing-Cheng Jheng, Yen-Ting Tseng, Li-Fu Chen, Yu-Chun Chen","doi":"10.1097/JCMA.0000000000001273","DOIUrl":"10.1097/JCMA.0000000000001273","url":null,"abstract":"<p><strong>Background: </strong>The use of generative AI, particularly large language models such as GPT-4, is expanding in medical education. This study evaluated GPT-4's ability to interpret emergency medicine board exam questions, both text- and image-based, to assess its cognitive and decision-making performance in emergency settings.</p><p><strong>Methods: </strong>An observational study was conducted using Taiwan Emergency Medicine Board Exam questions (2018-2022). GPT-4's performance was assessed in terms of accuracy and reasoning across question types. Statistical analyses examined factors influencing performance, including knowledge dimension, cognitive level, clinical vignette presence, and question polarity.</p><p><strong>Results: </strong>GPT-4 achieved an overall accuracy of 60.1%, with similar results on text-based (60.2%) and image-based questions (59.3%). It showed perfect accuracy in identifying image types (100%) and high proficiency in interpreting findings (86.4%). However, accuracy declined in diagnostic reasoning (83.1%) and further dropped in final decision-making (59.3%). This stepwise decrease highlights GPT-4's difficulty integrating image analysis into clinical conclusions. No significant associations were found between question characteristics and AI performance.</p><p><strong>Conclusion: </strong>GPT-4 demonstrates strong image recognition and moderate diagnostic reasoning but limited decision-making capabilities, especially when synthesizing visual and clinical data. Although promising as a training tool, its reliance on pattern recognition over clinical understanding restricts real-world applicability. Further refinement is needed before AI can reliably support emergency medical decisions.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"672-680"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736436","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":"Complexity of metabolic dysfunction-associated steatotic liver disease: State of the art review.","authors":"Hsiao-Yun Yeh, Shang-Wei Lin, Hsiao-Chin Shen, Tzu-Hao Li, Hung-Cheng Tsai, Ying-Ying Yang, Han-Chieh Lin, Ming-Chih Hou","doi":"10.1097/JCMA.0000000000001254","DOIUrl":"10.1097/JCMA.0000000000001254","url":null,"abstract":"<p><p>This article reviews the advancements made in the diagnosis and treatment of metabolic dysfunction-associated steatotic liver disease (MASLD) and its progression to metabolic dysfunction-associated steatohepatitis (MASH). For inhibition of the MASLD progression, newly approved thyroid hormone receptor β agonists and potential agents, including farnesoid X receptor (FXR) agonists, peroxisome proliferator-activated receptor (PPAR) agonists, glucagon-like peptide-1 (GLP-1) receptor agonists, GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor co-agonists, and or GIP/GLP-1/glucagon receptor co-agonists, offering new prospects for the pharmacological management of MASLD. Lifestyle interventions, particularly personalized dietary and exercise regimens, as well as multidisciplinary collaboration, are recognized as vital components of treatment strategies. Although surgical options can yield significant benefits in certain cases, their risks and the criteria for patient selection necessitate more stringent research and guidance. Given the complexity of MASLD-related hepatocellular carcinoma (HCC), various insulin resistance, oxidative stress, gut-liver axis dysregulation, genetics, and epigenetics-based anti-tumor treatments have been ongoing explored to improve outcomes. Considering the global prevalence of MASLD and the relatively young age of disease onset, healthcare providers should be more vigilant in the timely diagnosing of MASLD progression to MASH, cirrhosis, and HCC. Likewise, regular medical check-ups are essential for early disease diagnosis and prevention before the development of complications, thereby improving their overall quality of life. Significant progress has been made in the research surrounding MASLD, MASH, and HCC, instilling new hope for future clinical practices.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"662-671"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287677","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":"Unraveling mitochondrial dysfunction in polycystic ovary syndrome: Pathophysiological insights.","authors":"Chia-Jung Li, Li-Te Lin, Pei-Hsuan Lin, Yu-Chen Chen, Po-Wen Lin, Zhi-Hong Wen, Kuan-Hao Tsui","doi":"10.1097/JCMA.0000000000001281","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001281","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder that affects women of reproductive age. It is characterized by problems with ovulation, excessive levels of androgens, and the presence of multiple cysts in the ovaries. Although the exact cause of PCOS remains uncertain, recent studies have identified mitochondrial dysfunction as a key contributing factor. Mitochondria, often described as the energy centers of the cell, are essential for producing ATP, generating reactive oxygen species (ROS), and regulating cell death pathways. A growing body of evidence shows that mitochondrial dysfunction occurs in the ovaries, skeletal muscle, and fat tissue of individuals with PCOS. This dysfunction may play a central role in the development of the disorder by increasing oxidative stress and chronic inflammation, worsening insulin resistance, and interfering with the growth and quality of eggs. This review summarizes recent progress in understanding how mitochondrial dysfunction contributes to the underlying biology of PCOS. It also explores emerging treatment strategies that aim to restore mitochondrial health, such as the use of antioxidants, therapies that specifically target mitochondria, and mitochondrial replacement techniques. These approaches hold promise for reducing the symptoms and long-term complications associated with PCOS.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857292","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":"Outcomes of postoperative preemptive sedation in the intensive care unit for geriatric patients with gastric cancer undergoing gastrectomy.","authors":"Wei-Ting Kuo, Chen-Yuan Hsiao, Shu-Cheng Chou, Ching-Shu Chiang, Tien-Hua Chen, Chi-Hung Lin, Pei-Jiun Tsai","doi":"10.1097/JCMA.0000000000001264","DOIUrl":"10.1097/JCMA.0000000000001264","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer is a common malignancy worldwide, especially in East Asia. However, increasing age is an independent risk factor associated with high operative complications and surgical mortality in radical gastrectomy. To improve the prognosis of surgery, we proposed strategic postoperative sedation for geriatric patients with gastric cancer undergoing radical gastrectomy.</p><p><strong>Methods: </strong>A total of 324 gastric cancer patients, more than 75 years of age who underwent open radical gastrectomy at Taipei Veterans General Hospital between 2006 and 2020 were enrolled. The patients were classified into the sedation group (preemptive light sedation with prolonged mechanical ventilation assistance for the first five days postoperatively in the intensive care unit, n = 53) and the control group (early extubation, received morphine for pain control but no postoperative sedatives in the ordinary ward, n = 271). We compared the two groups' baseline clinical characteristics and the associated surgical outcome. We also conducted an in vitro cell experiment with RAW 264.7 macrophage cell line and evaluated the cell performance in various concentrations of sedation drug propofol and dexmedetomidine.</p><p><strong>Results: </strong>Patients in the sedation group has significantly lower postoperative complication rates (13.7% vs 29.9%; p = 0.031). Among overall postoperative complications, the incidence rate of pulmonary events was significantly lower in the sedation group. Moreover, the incidence of other complications, including cardiac events, intra-abdominal abscesses, anastomotic leakage, adynamic ileus, and wound infection, was slightly higher in the matched control group without a statistically significant difference. Regarding surgical mortality rate and postoperative hospital length of stay (LOS), there were no significant differences between the two groups. For in vitro cell experiments with RAW 264.7 macrophage cell line, propofol, or dexmedetomidine significantly decreased tumor necrosis factor (TNF)-α production.</p><p><strong>Conclusion: </strong>For elderly patients with gastric cancer who undergo open radical gastrectomy, strategic postoperative sedation is safe and may reduce the incidence of pulmonary complications without prolonging hospital LOS.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"632-640"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556297","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":"Timely patient data-driven resource planning to optimize in-hospital emergent evacuation.","authors":"Shu-Chen Kuo, Shih-Hsin Hung, Kuan-Jui Tseng, An-Yeh Lin, Shin-Shang Chou","doi":"10.1097/JCMA.0000000000001261","DOIUrl":"10.1097/JCMA.0000000000001261","url":null,"abstract":"<p><strong>Background: </strong>Hospital fires pose significant threats, yet Hospital Incident Command Centers (HICS) often lack standardized methods for assessing the evacuation devices and workforce needed for patients of varying illness severity. Frontline nurses typically rely on personal experience and paper-based assessments, leading to communication challenges and workforce shortages, particularly during night shifts. The Emergency Evacuation Information System (EEIS) was developed to connect hospital information systems and patient data, optimizing evacuation efficiency.</p><p><strong>Methods: </strong>This mixed-methods study consisted of four phases: (1) Twenty-nine senior nurses participated in three expert group discussions, and the meeting minutes were thematically analyzed to develop a draft EEIS evacuation framework; (2) the accuracy of the EEIS draft algorithms was tested by retrieving evacuation data and validated through accuracy assessment methods; (3) the EEIS was implemented hospital-wide, with consistency between EEIS and nurse assessment data validated using kappa agreement; (4) think-aloud methods with four preset questions collected in-charge nurses' feedback during fire drills.</p><p><strong>Results: </strong>In phase 1, an evacuation framework was established covering ward resources, patient evacuation devices, and hospital support resources. Phase 2 involved building the EEIS by integrating patient data from multiple systems, achieving 100% accuracy. In phase 3, EEIS-managed units in general wards and intensive care units showed excellent agreement with nurse assessments ( κ = 0.974, p < 0.000; 0.86, p < 0.000). In phase 4, feedback from 21 in-charge nurses after fire drills emphasized the need for accessible power outlets and wireless network connectivity outside the building to optimize response procedures.</p><p><strong>Conclusion: </strong>The EEIS rapidly provides adequate resources to nurses and facilitates communication with the HICS, ensuring the efficient and safe evacuation of patients. This system can be implemented in other digitized hospitals, with future developments potentially integrating the EEIS with local fire departments to enhance rescue operations.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"609-616"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532099","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":"Incretin-based therapy: An update focusing on the major revolution in cardiovascular-kidney-metabolic health.","authors":"Chern-En Chiang, Kang-Ling Wang, Hao-Min Cheng, Tze-Fan Chao, Shih-Hsien Sung","doi":"10.1097/JCMA.0000000000001263","DOIUrl":"10.1097/JCMA.0000000000001263","url":null,"abstract":"<p><p>Type 2 diabetes mellitus and obesity have become the rising burden across various geographic and economic regions, and they are also the common causes of chronic kidney disease, which further contributes to the development and progression of cardiovascular disease. The recently proposed cardiovascular-kidney-metabolic syndrome-the new paradigm of recognizing excess or dysfunctional adipose tissue as the shared pathophysiology-has signaled the interconnection of type 2 diabetes mellitus, obesity, chronic kidney disease, and cardiovascular disease beyond the disturbance of glucose homeostasis, for which recently developed incretin-based therapy has offered an avenue of holistic management. Glucagon-like peptide-1 (GLP1) is one of the incretins and potentiates insulin secretion after food intake, additionally offering extra-pancreatic metabolic effects-reduced hepatic gluconeogenesis and steatosis, increased muscular glucose uptake, and increased lipolysis and glucose uptake in the adipose tissue. Seven different GLP1 receptor agonists have been licensed globally. For those with type 2 diabetes mellitus, GLP1 receptor agonists overall reduce major adverse cardiovascular events by 14% (hazard ratio 0.86, 95% confidence interval 0.80-0.93) and all-cause death by 18% (hazard ratio 0.82, 95% confidence interval 0.82-0.94), and semaglutide, a long-acting GLP1 receptor agonist for once weekly injection, reduces major renal events by 24% (hazard ratio 0.76, 95% confidence interval 0.66-0.88). For obese patients without diabetes mellitus, semaglutide results in a 12.4% (95% confidence interval -13.4 to -11.5) reduction in body weight and 20% lower in the risk of major adverse cardiovascular events (hazard ratio 0.80, 95% confidence interval 0.72-0.90), while the burden of heart failure can also be improved by 7.8 points (95% confidence interval 4.8-10.9) in those with heart failure with preserved ejection fraction and obesity. These findings highlight the transformative role of GLP1 receptor agonists in the management of cardiovascular-kidney-metabolic syndrome. We reviewed the updated clinical evidence of incretin-based therapy and summarized its outcome benefits.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"585-593"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556295","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":"Normative study of the Taiwanese version of the Montreal Cognitive Assessment (MoCA) in community-dwelling individuals in Taiwan.","authors":"Yu-Hsiang Cheng, Shih-Chieh Lee, Yen-Ching Chen, Jen-Hau Chen, Rwei-Ling Yu, Wei-Ju Lee, Jung-Lung Hsu, Cheng-Sheng Chen, Jong-Ling Fuh","doi":"10.1097/JCMA.0000000000001265","DOIUrl":"10.1097/JCMA.0000000000001265","url":null,"abstract":"<p><strong>Background: </strong>The Montreal Cognitive Assessment (MoCA) may not be appropriately interpreted in Taiwan because of the lack of large-scale normative data. Moreover, examinees' demographic characteristics may influence their MoCA scores. However, previous studies have not adequately adjusted for these effects. This study aimed to use regression-based methods to establish demographically adjusted MoCA norms.</p><p><strong>Methods: </strong>Participants were recruited from six hospitals and neighboring communities from all geographic areas of Taiwan. Multiple regression analyses were conducted to quantify the effects of age, education, and sex on MoCA total and domain scores, resulting in correction equations and adjusted cutoff scores.</p><p><strong>Results: </strong>A total of 2310 cognitively healthy participants were included in the analysis. Age and education significantly affected the total and all domain scores. Sex affected naming, language, and abstract thinking domain scores. Correction equations and corresponding cutoffs were proposed for MoCA total and domain scores to support more precise clinical interpretations.</p><p><strong>Conclusion: </strong>This study provides regression-adjusted norms for the MoCA, improving its accuracy and clinical utility in Taiwan. An adjusted total MoCA score of 23 points is recommended as the cutoff for identifying potential cognitive impairment, with domain-specific cutoffs further supporting individualized interpretation.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"617-623"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585943","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":"Recalibrating MoCA thresholds in Taiwan: Commentary on new population data.","authors":"Yu-Ling Chang","doi":"10.1097/JCMA.0000000000001268","DOIUrl":"10.1097/JCMA.0000000000001268","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"581-582"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639138","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":"Outcomes of endovascular thrombectomy in acute ischemic stroke patients air-transferred from Kinmen to mainland Taiwan.","authors":"Kuan-I Chu, Chun Chien, Chia-Jung Hsu, Hui-Chi Huang, Jui-Yao Tsai, Tzu-Ching Liu, Li-Chi Hsu, Hung-Yu Liu, Nai-Fang Chi, I-Hui Lee, Chih-Ping Chung, Chun-Jen Lin","doi":"10.1097/JCMA.0000000000001256","DOIUrl":"10.1097/JCMA.0000000000001256","url":null,"abstract":"<p><strong>Background: </strong>Since 2018, Taipei Veterans General Hospital (TPEVGH) has performed endovascular thrombectomy (EVT) on acute ischemic stroke patients air-transferred from Kinmen Hospital (KMH). This study evaluated the clinical profiles and outcomes of these patients, comparing them to those treated directly at TPEVGH.</p><p><strong>Methods: </strong>In this retrospective study, we included consecutive acute ischemic stroke patients air-transferred from KMH to TVGH for EVT between January 2018 and April 2024. A comparison group comprised patients who presented directly to TVGH and underwent EVT during the same period. Transfer decisions at KMH were based on clinical presentation and neuroimaging evidence of large vessel occlusion. Only patients with salvageable brain tissue (substantial penumbra without a large infarct core) were transferred. Exclusion criteria included a premorbid modified Rankin Scale (mRS) score ≥3, in-hospital stroke, serious advanced illness, or life expectancy <6 months. Primary outcomes were 90-day functional independence (mRS 0-2), 30-day mortality, and symptomatic intracranial hemorrhage (sICH). Analyses included Mann-Whitney, χ 2 tests, and multivariate logistic regression.</p><p><strong>Results: </strong>A total of 275 patients were included: 15 from KMH (mean age 71.1 ± 11.7 years; 40% male; median National Institutes of Health Stroke Scale [NIHSS] 15) and 260 from TVGH (mean age 73.5 ± 13.6 years; 53% male; median NIHSS 18). KMH patients had longer onset-to-door times (median [interquartile range {IQR}] = 452.0 [400.0] vs 217.0 [442.8] minutes; p < 0.001] but shorter door-to-puncture times (121.5 [43.5] vs 144.0 [55.3] minutes; p = 0.031). Among KMH patients, the substantial reperfusion rate was 73.3%, 90-day functional independence was 40.0%, sICH rate was 13.3%, and 30-day mortality was 13.3%, outcomes comparable to those of TPEVGH patients.</p><p><strong>Conclusion: </strong>Despite longer transfer times, air-transferred patients achieved similar safety and efficacy outcomes after EVT compared with directly treated patients. Further studies are warranted to optimize transfer strategies and patient selection.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"594-600"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304044","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}