Jen-Ai Hospital

This study aimed to evaluate the perioperative safety and functional outcomes of high-power holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) and long-term indwelling urinary catheter (IUC) use, with a specific focus on the impact of catheter duration on postoperative outcomes. A retrospective analysis was conducted on 380 patients who underwent HoLEP between 2016 and 2022, stratified into two groups based on catheter duration: long-term (≥ 28 days; Group 1) and short-term catheterization (Group 2). Demographic, intraoperative, and follow-up data were collected. Functional outcomes, including International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual (PVR), were assessed preoperatively and during follow-up at 3 and 12 months. Both groups demonstrated significant and sustained improvement in voiding function and symptom scores following HoLEP. Although perioperative metrics, such as operative time, hospital stay, and catheter removal time, were comparable, Group 1 had longer enucleation times (p = 0.02). No difference in postoperative complication rate was noted. At 3 months, Group 2 exhibited superior symptom relief (IPSS: 10 vs. 12, p = 0.01), though Qmax and PVR were similar. No patients in either group required re-catheterization postoperatively. By 12 months, functional outcomes converged between groups. Multivariate analysis showed that catheter duration predicted poorer symptomatic recovery one year after surgery (OR 0.786, p < 0.001). HoLEP is effective and safe for patients with BPH and preoperative catheterization. However, prolonged catheterization negatively impacts early symptom recovery. Early surgical intervention should be considered to optimize long-term outcomes and prevent catheter-related complications.

The purpose of this study was to investigate aqueous humor total antioxidant capacity (TAC) and ascorbic acid (AA) levels of patients with diabetic retinopathy (DR), and their correlation with serum glycated hemoglobin (HbA1c) levels. This case-control study enrolled 177 eyes from 177 patients that underwent cataract surgery between April 2019 and November 2022 in Chang Gung Memorial Hospital. Group 1 comprised 103 eyes from patients without diabetes; group 2 comprised 40 eyes from patients with diabetes but without DR; and group 3 comprised 34 eyes from patients with DR. Aqueous humor samples were collected and analyzed for TAC and AA levels using the ferric reducing/antioxidant AA assay. Aqueous humor TAC and AA levels were decreased in group 3 compared with group 2 and group 1 (P < 0.001 and P < 0.001). Aqueous humor TAC and AA levels were independent protective factors against DR in the diabetes population, with adjusted odds ratios of 0.109 (95% confidence interval [CI] = 0.017-0.719, P = 0.021) and 0.095 (95% CI = 0.012-0.726, P = 0.023), respectively. Aqueous humor TAC and AA concentrations were weakly negatively correlated with serum HbA1c levels, with Pearson's correlation coefficients of -0.339 (P = 0.013) and -0.341 (P = 0.012), respectively. TAC and AA had protective effects against DR. Decreased aqueous humor TAC and AA levels may serve as potential biomarkers for DR among the diabetes population. This study highlights the role of antioxidants in DR and provides foundation for future research on AA supplementation's potential for the prophylaxis and treatment of DR.

Esophageal squamous cell carcinoma (ESCC) is a leading cause of cancer-related mortality in Taiwan, and has a poor prognosis despite treatment advances. Emerging evidence suggests environmental contaminants, including organophosphate flame retardants (OPFRs), as potential cancer contributors. This study aims to investigate the association between exposure to OPFRs and ESCC. A case–control study with 133 ESCC patients and 133 controls was conducted. Urinary concentrations of 10 OPFRs, including 5 triesters (TDCPP, TCEP, TBEP, TNBP, TPHP) and their corresponding diesters (BDCPP, BCEP, DBEP, DNBP, DPHP), were measured using UPLC-MS/MS, and the associations between OPFR levels and ESCC risk was analyzed. Survival analyses were also performed to assess prognostic impact. In vitro and in vivo experiments were conducted to explore cytotoxic effects and pathological changes induced by OPFRs, with pathways identified via RNA sequencing and gene set enrichment analysis (GSEA). Higher detection rates of BDCPP, BCEP, and TDCPP were observed in ESCC patients, with TDCPP showing the strongest association with ESCC (odds ratio [OR] = 2.58, p = 0.005) and the poorest survival outcome (hazard ratio [HR] = 1.91, p = 0.021). In cell culture experiments, TDCPP induced cytotoxicity, oxidative stress, and inhibited colony formation. In a murine animal model, combined TDCPP and 4-NQO exposure led to a significantly higher incidence of ESCC compared to 4-NQO alone. RNA sequencing and GSEA analysis identified several differentially expressed genes and pathways related to immune response and cellular stress. This study highlights TDCPP as a potential environmental risk factor for ESCC, emphasizing the importance of considering environmental exposures in patients with ESCC, and the need for further research into the carcinogenic impact of OPFRs.

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

To examine the pattern of sedative-hypnotic prescriptions associated with the risk of suicidal behavior among older adults with and without insomnia. The study included 8319 suicide cases and age- and sex-matched controls from the population-wide National Health Insurance Research Database. Suicide methods and insomnia were defined using diagnostic codes. The sedative-hypnotic use pattern was categorized by half-life, prescription volume measured in defined daily doses (DDDs), and its temporal relationship with suicide. Odds ratios were employed to assess the risk of insomnia and the prescription patterns of sedative-hypnotics on suicide. Additionally, we compared suicide methods between sedative-hypnotic users and nonusers. Insomnia was mildly associated with suicide behavior after adjusting for mental illnesses (adjusted relative risk [RR] = 1.82, OR = 1.86, 95% confidence interval [CI] = 1.76 to 1.97), but the prescription of sedative-hypnotics was associated with 5-fold suicide risk (adjusted RR = 5.22, OR = 5.90, 95% CI = 5.11 to 6.82). Among patients with insomnia, a prescription volume of ≥31 DDDs per year and a prescription within 90 days of the suicide index date were associated with increased suicide risk. Individuals prescribed sedative-hypnotics were more likely to commit suicide by methods involving sedative-hypnotic poisoning (21% vs. 0%). Among older adults, sedative-hypnotic prescription is associated with increased suicide risk and suicide by self-poisoning using such medications. Non-pharmacological treatment for insomnia, such as cognitive-behavioral therapy, is essential for suicide prevention.

Background/Objectives: A probiotic Streptococcus thermophilus (iHA318) has been demonstrated to alleviate dry eye symptoms in a mouse model. This study investigated its effects on dry eye mitigation in a clinical trial. Methods: A total of 68 volunteers were recruited in the double-blind clinical trial and randomly divided into a probiotic group and a placebo group. The probiotic group received iHA318 capsules daily for 35 days via oral intake, while the placebo group received microcrystalline cellulose capsules. Assessments before and after the intervention were performed for the tear volume (TV), tear break-up time (TBUT), tear osmolarity (Osmo), serum sialic acid (SA) concentrations, and the Ocular Surface Disease Index (OSDI), and an impression cytology analysis was conducted for immunofluorescence detection of NLRP3 expression. Results: The tear volume was significantly increased in the probiotic group, although a placebo effect was observed in the placebo group. The probiotic group showed a significant reduction in tear osmolarity, an extended TBUT, and an improved OSDI score. These parameters were also observed in the placebo group without statistical significance. In addition, the serum SA was significantly increased in the probiotic group in contrast to a slight non-significant increase in the placebo group. Reductions in NLRP3 inflammasome activation and OSDI were found only in the probiotic group. Conclusions: In conclusion, a significant improvement in major dry eye symptoms after iHA318 treatment was observed compared to the placebo group.

Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-established technique. In Taiwan, the National Health Insurance (NHI) covers the fees of the procedure and conventional mesh (polypropylene mesh), whereas the anatomical polyester mesh (Parietex™) requires additional self-pay. This study aimed to compare the outcomes of the conventional mesh with fixation versus the polyester mesh (without fixation) in laparoscopic TEP repair. We retrospectively reviewed the medical records of male patients who underwent laparoscopic TEP repair between 2017 and 2021. Patients could choose between the conventional mesh with fixation (conventional mesh group) or self-paid Parietex™ mesh without fixation (anatomical polyester mesh group). The outcomes included operation (OP) time, prolonged length of stay (LOS), and postoperative complications. A total of 74 patients with 123 hernias were included, of which 36 patients (67 hernias) underwent the anatomical mesh without fixation, while 38 patients (56 hernias) underwent the conventional mesh with fixation. The mean OP time was 102.6 ± 45.6 and 88.5 ± 42.0min in the conventional and the anatomical polyester mesh group. After adjusting for body mass index, diabetes mellitus, cardiovascular disease, and hernia type, no significant differences were observed between the two groups in OP time (p = 0.152) and the risk of acute pain (p = 0.337), chronic pain (p = 0.816), seroma (p = 0.941), hydrocele (p = 0.423), or hematoma (p = 0.347). The conventional mesh demonstrates non-inferior outcomes compared to the anatomical polyester mesh. Given that the anatomical polyester mesh is not reimbursed by Taiwan's National Health Insurance (NHI), the use of the conventional mesh with fixation in TEP inguinal hernia repair may be a more cost-effective option in Taiwan.