Buddhist Tzu Chi Medical Foundation

The discomfort, invasiveness, and inconvenience associated with traditional glucose monitoring methods continue to hinder patient compliance and the effectiveness of diabetes management. This simulation-driven feasibility study presents the design of the Photoacoustic Glucose Monitoring Device (PAGMD), a non-invasive glucose sensing system that integrates photoacoustic spectroscopy, machine learning, and IoT connectivity to enable real-time glucose estimation. PAGMD employs pulsed near-infrared light to induce glucose-dependent acoustic signals, which are detected by ultrasonic transducers and analyzed by machine learning algorithms for concentration prediction. The device features a hybrid energy harvesting system, combining thermoelectric and piezoelectric elements, to support continuous, battery-assisted operation and long-term usability. The system was theoretically validated using a multi-stage simulation pipeline that included Monte Carlo photon modeling, finite element acoustic simulation, and synthetic glucose dataset generation across a range of physiological conditions. The machine learning models achieved a coefficient of determination of 0.98 and a mean absolute relative difference of 6.97%, with 98.2% of predictions falling within clinically acceptable error zones. While current findings are based on simulated environments, a future validation roadmap encompassing in vitro, ex vivo, and in vivo studies is proposed to support clinical translation. This work should be regarded as a simulation-driven feasibility study; the reported benchmarks represent design targets for future prototyping rather than experimentally validated hardware results. By prioritizing non-invasiveness, ease of use, and adaptive intelligence, PAGMD represents a promising step toward inclusive, personalized metabolic health monitoring, especially for individuals with disabilities or limited dexterity.

In this double-blind randomised controlled trial of 58 patients with 58 diabetic foot ulcers, a topical probiotic formulation in soybean concentrate significantly accelerated wound healing compared with placebo. The mean time to complete healing was 89.6 vs. 165.9 days (P = 0.012), with higher healing rates from week 20 onwards. The treatment was safe and well tolerated, supporting topical probiotics as a promising adjunctive therapy for chronic diabetic foot ulcers.

To examine global publication trends, thematic developments, and emerging priorities in research on physical restraint from 2005 to 2024. The current bibliometric analysis was conducted using original research published in English between 2005 and 2024, retrieved from the Science Citation Index Expanded database. Analyses of publication trends, institutional and geographic productivity, and author keyword networks were performed using Bibliometrix. A total of 1,154 articles were identified, with a 5.5% annual growth rate. Long-term care and dementia, intensive care sedation and delirium, psychiatric coercion, and health care professionals' knowledge and attitudes emerged as dominant themes. Thematic evolution revealed a shift from sedation protocols and agitation management to ethical issues, and a recent emphasis on dementia care, behavioral assessments, and interventions. The field has transitioned toward ethical reflection and interdisciplinary restraint reduction. Future priorities include exploring non-institutional contexts and integrating technology for restraint-minimizing care models.

To evaluate the prognostic values of 18F-FDG PET-derived whole-body imaging features in patients with metastatic lung adenocarcinoma treated with EGFR-targeted therapies. We retrospectively analyzed 249 patients with lung adenocarcinoma who underwent pre-treatment 18F-FDG PET and were treated with EGFR-targeted agents. The patients were divided into analog (n = 150) and digital (n = 99) PET cohorts. Whole-body and primary tumor respiratory-stable imaging features were extracted. The prognostic values of the study variables for progression-free (PFS) and overall survival (OS) were assessed using univariate and multivariate Cox regression analyses across the analog and digital PET cohorts. Total sphericity and primary tumor inverse difference normalized were independent predictors of both PFS and OS. The total metabolic tumor volume was another independent predictor of OS. Combined models integrating these imaging biomarkers with clinical variables outperformed the traditional staging system (c-indices for PFS: 0.649 versus 0.550 for analog and 0.668 versus 0.583 for digital PET cohorts; for OS: 0.694 versus 0.562 for analog and 0.728 versus 0.579 for digital PET cohorts). Our models showed consistent predictive values across subgroups based on sex, EGFR mutation subtype, and clinical stage. Our results indicate that models integrating whole-body 18F-FDG PET features with traditional variables can enhance survival prediction and may support personalized treatment strategies for patients with lung adenocarcinoma treated with EGFR-targeted therapies.

Non-neurogenic voiding dysfunction is a bothersome urological condition that has a wide range of causes and limited treatment options. The current study retrospectively analyzed the treatment outcomes of botulinum toxin A (BoNT-A) injection and the predictive factors of successful therapeutic outcomes in women with non-neurogenic voiding dysfunction. This study included women diagnosed with non-neurogenic voiding dysfunction, including dysfunctional voiding (DV), poor relaxation of external sphincter (PRES), bladder neck dysfunction (BND), and detrusor underactivity (DU). Videourodynamic study (VUDS) was performed on all patients before treatment. In total, 100 U of BoNT-A was injected at 5 sites periurethrally in each patient. Treatment outcome was assessed by global response assessment (GRA) to improvement of voiding difficulty at 3 months after treatment. In total, 368 patients received urethral BoNT-A injections. The mean age was 54.1 ± 19.8years. At baseline VUDS, DV was noted in 246 (66.8%) patients, PRES in 112 (30.4%), BND in 5 (1.4%), and DU in 5 (1.4%). The overall success rate by GRA ≥ 2 was 47.8%, including 91.5% in patients with DV, 8.5% in patients with PRES, and none in patients with BND or DU. A higher voiding detrusor pressure (Pdet > 28.5 cmH2O) and a lower post-void residual volume (PVR < 222mL) at baseline could be predictors of successful outcomes after urethral sphincter BoNT-A injections. Urethral sphincter BoNT-A injection is effective in treating non-neurogenic voiding dysfunction caused by DV, but not BND or DU in women. A higher Pdet and a lower PVR at baseline indicate sustainable detrusor contractility and true urethral sphincter dysfunction rather than DU or PRES. Moreover, they may be predictors of a successful therapeutic outcome.

Evidence on pre-transplant metabolic therapy remains limited. We evaluated whether concurrent glucagon-like peptide-1 receptor agonist (GLP-1 RA) plus sodium-glucose cotransporter 2 inhibitor (SGLT2i) use before solid-organ transplantation was associated with post-transplant outcomes in adults with obesity and type 2 diabetes. A target trial is emulated using de-identified electronic health records from TriNetX US. Dual therapy is compared with GLP-1 RA, SGLT2i, and usual care using 1:1 propensity-score matching. The primary outcome is all-cause mortality at 12 months; kidney graft failure, rejection, complications, and infections are secondary. Sensitivity analyses included the global network,landmark, extensions at 24 and 36 months. Three matched cohorts are constructed, dual versus GLP-1 RA (n = 4718 pairs), dual versus SGLT2i (n = 4282), and dual versus usual care (n = 3787). At 12 months, dual therapy is associated with lower mortality versus GLP-1 RA (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.57-0.85), SGLT2i (0.59, 0.48-0.72), and usual care (0.52, 0.43-0.64).Infection endpoints are neutral or lower. Estimates are consistent across sensitivity analyses. In transplant candidates with obesity and type 2 diabetes, pre-transplant GLP-1 RA+SGLT2i use is associated with lowermortalitythan monotherapy or usual care. Prospective evaluation is warranted.

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a highly time-sensitive medical emergency. Extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation, also known as extracorporeal cardiopulmonary resuscitation (ECPR), has been increasingly used in patients with refractory cardiac arrest. Despite promising results from observational studies, recent randomized controlled trials have reported conflicting evidence on the benefits of ECPR for refractory OHCA. This trial is designed to investigate the efficacy of expedited ECPR for refractory shockable OHCA using a strict ECPR application protocol and active left ventricular (LV) unloading strategies. Methods This is a multicenter randomized clinical trial (ClinicalTrials.gov NCT06692075). Eligible patients will be randomized in 1:1 ratio on arrival at emergency department into the emergency total extracorporeal life support ( total ECLS ) group and the standard advanced cardiac life support with the ECMO bailout ( standard ACLS ) group. For the emergency total ECLS group, patients will receive early initiation of ECMO within 15 minutes after randomization or up to 60 minutes after emergency calls. For standard ACLS with the ECMO bailout group, patients will receive standard ACLS for at least 15 minutes before initiating bailout ECMO. Survived patients without contraindications for coronary angiography will be transferred to the catheterization laboratory. Institutional protocols of post-cardiac arrest care will adhere to established recommendations from the latest guidelines. Active LV unloading is suggested if indicated. The primary endpoint is survival with a favorable neurological outcome at 30 days. Conclusion The ECLS-OHCA trial aims to provide complementary evidence supporting the use of ECPR in patients with refractory shockable OHCA and to assess the cost-effectiveness of its early implementation. ClinicalTrials.gov: NCT06692075.

ABSTRACTOvulation is a complex biological process essential for female fertility, driven by the luteinizing hormone (LH) surge and involving a cascade of molecular events that lead to follicular rupture and oocyte release. This process shares characteristics with acute inflammation, including the generation of reactive oxygen species (ROS) by E2, immune cell recruitment, and tissue remodeling. E2 enhances mitochondrial ROS production through integrin-dependent signaling, regulating key ovulatory events such as cumulus expansion and extracellular matrix breakdown. The LH surge triggers follicular luteinization and progesterone production, which are critical for preparing the endometrium for implantation and modulating inflammation. Progesterone, acting through its receptor (PGR), suppresses ROS-induced inflammation by inhibiting the NF-κB pathway, ensuring controlled inflammatory responses. However, a transient decline in progesterone levels following the LH surge initiates acute inflammation, leading to follicle rupture and ovulation. This process involves the upregulation of matrix metalloproteinases and other proteases that degrade the follicular wall, facilitated by structural changes such as cumulus expansion and decellularization at the follicular apex. Post-ovulation, the remaining follicular cells undergo luteinization to form the corpus luteum, which produces progesterone to support early pregnancy. The ovulation wound heals rapidly through a process resembling ordinary wound healing where follicular fluid plays a dual role by promoting ovulation wound healing and when spilled into the pelvic cavity, potentially contributing to postoperative adhesions. Understanding the molecular mechanisms of ovulation provides valuable insights into fertility promotion, contraception development, and the prevention of reproductive disorders.