Luodong Poh-Ai Hospital

Parkinson's disease (PD) is an increasingly prevalent neurodegenerative condition, particularly among individuals with type 2 diabetes mellitus (T2DM). While prior studies have suggested that GLP-1 receptor agonists (GLP-1RAs) and metformin may confer neuroprotective effects, most were limited by small sample sizes, short follow-up, uncontrolled designs, or lacked direct comparisons between therapies-making their findings inconclusive for clinical decision-making. Using the TriNetX Global Collaborative Network, we identified 92 485 patients with T2DM initiating GLP-1RA therapy and matched them 1:1 to new metformin users using propensity score matching. Patients with prior antidiabetic therapy, PD, or dementia were excluded. Incident PD was the primary outcome; all-cause mortality served as a secondary endpoint. Adjusted hazard ratios (aHRs) were estimated using Cox models. Competing risk and time-stratified (≤5, 5-10, >10 years) analyses were conducted. Positive and negative outcome/exposure controls were employed to validate internal consistency. The overall PD risk was comparable between GLP-1RA and metformin groups (aHR, 0.91; 95% CI, 0.79-1.05). However, between years 5 and 10, GLP-1RA use was associated with a significantly lower PD risk (aHR, 0.56; 95% CI, 0.34-0.93). Mortality risk did not differ significantly. Validation analyses confirmed the specificity of the findings. By addressing key limitations of earlier studies through a large-scale, active-comparator, new-user design, this study provides novel evidence of a delayed neuroprotective effect of GLP-1RAs. These findings support incorporating neurologic outcomes into long-term diabetes management and may inform therapy selection in high-risk populations.

Very early hospital revisits following hemorrhoidectomy, particularly within 3days of discharge, may reflect preventable peri-discharge complications more accurately than traditional 30-day readmission rates. However, few studies have systematically examined risk factors associated with this short-term outcome under real-world conditions. We conducted a retrospective cohort study of 662 patients who underwent conventional hemorrhoidectomy for grade III or IV hemorrhoids at Lotung Poh-Ai Hospital between 2021 and 2023. The primary outcome was return to the emergency department (ED) within 3days of discharge. Clinical, operative, and postoperative variables were analyzed using multivariate logistic regression. Of 662 patients, 46 (6.95%) returned to the ED within 3days. The most common presenting symptom was severe wound pain (78.3%). Multivariate analysis identified thrombosed hemorrhoids (adjusted odds ratio [aOR], 3.05; 95% CI, 1.56-5.96; p = 0.001) and use of ≥ 2 postoperative analgesics (aOR, 3.96; 95% CI, 1.99-7.84; p < 0.001) as independent predictors of early ED revisit. Other clinical and laboratory variables were not significantly associated. This study is among the first to identify specific predictors of ED visits within 3days after hemorrhoidectomy. The presence of thrombosed hemorrhoids and escalated analgesic use may signal patients at risk for very early unplanned revisits. These findings challenge reliance on 30-day readmission metrics and support 72-h revisit rates as a sensitive quality indicator for discharge appropriateness and perioperative care.

Neuropathic pain presents a persistent therapeutic challenge, arising from diverse etiologies such as trigeminal neuralgia, postherpetic neuralgia, post-amputation pain, painful polyneuropathy, peripheral nerve injury pain, and painful radiculopathy. Given the limitations and side effects associated with pharmacologic treatments, interest in interventional therapies has surged. Herein, ultrasound guidance provides real-time, radiation-free visualization that enhances procedural accuracy and safety. This narrative review synthesizes current evidence on ultrasound-guided techniques—including nerve blocks, pulsed radiofrequency, hydrodissection, and peripheral nerve stimulation—in the management of neuropathic pain. These minimally invasive approaches demonstrate potential in providing significant and durable pain relief, enhancing functional outcomes, and reducing reliance on systemic medications. Notably, much of the existing literature comprises small-scale or observational studies and larger randomized controlled trials are therefore essential to confirm efficacy, define optimal treatment parameters, and inform clinical guidelines for broader adoption.

ABSTRACTBackgroundThis study aimed to evaluate the impact of early ophthalmic referral for premyopic preschoolers on myopic spherical equivalent (SE) shift after school entry; and to identify risk factors for nonadherence to follow‐up care.MethodsA population‐based longitudinal study followed 742 premyopic preschoolers (−0.5 D < SE ≤ +0.75 D) from a countywide screening in Yilan, Taiwan (2021–2022), into first or second grade in elementary school (2023). Cycloplegic autorefraction and caregiver questionnaires were collected at baseline and follow‐up. Children screened in 2022 comprised the intervention cohort, while those screened in 2021 formed the comparison cohort. Multiple regression analyses assessed factors associated with myopic SE shift and nonadherence to follow‐up care.ResultsAmongst 742 premyopic children (mean [SD] age at follow‐up, 7.2 [0.4] years; 57.8% boys), the overall SE progression was −0.19 (0.39) D/year and the incidence of myopia was 14.8 per 100 person‐years. The intervention cohort had a slower myopic SE shift than the comparison cohort (−0.15 vs. −0.22 D/year; p = 0.009). Referral at baseline was independently associated with slower SE progression (β = 0.070; p = 0.03). Amongst those referred in the intervention cohort, 63.2% adhered to follow‐up care. Nonadherence was associated with greater baseline hyperopia (adjusted OR, 3.77; 95% CI, 1.69–8.41) and rural residency (adjusted OR, 2.01; 95% CI, 1.23–3.30).ConclusionsEarly ophthalmic referral reduced myopic progression, but follow‐up adherence was suboptimal, especially in children with greater hyperopia or living in rural areas.

The gut microbiome has emerged as a key factor influencing a wide range of host physiological processes and behaviors, though the mechanisms behind these effects remain only partially understood. In this study, we explored the role of the gut microbiome in memory regulation using a parasitoid wasp-induced oviposition depression paradigm in Drosophila melanogaster. Our findings show that flies with depleted gut microbiota, either through axenic culture or antibiotic treatment, exhibited significant memory impairments. However, reintroducing the commensal bacterium Lactobacillus plantarum alone was sufficient to restore memory, while coinoculation with Acetobacter pomorum further enhanced memory performance. Hemolymph metabolomic analyses revealed reduced amino acid levels in antibiotic-treated flies, which were linked to impaired Drosophila target of rapamycin (dTOR) signaling. Additionally, genetic manipulation of dTOR or dietary supplementation with branched-chain amino acids either mimicked or rescued the memory deficits caused by antibiotic treatments. These results suggest that the gut microbiome is essential for regulating memory function by maintaining amino acid homeostasis and proper dTOR signaling, with profound implications for advancing knowledge of cognitive regulation.

This study investigates the impact of smoking on major postoperative complications following elective off-pump coronary artery bypass graft (CABG) surgery within an enhanced recovery after surgery (ERAS) program. A total of 3168 patients who underwent elective off-pump and minimally invasive direct CABG under ERAS between January 1, 2017, and December 31, 2020, were enrolled. Propensity score matching was applied to minimize potential confounders when comparing postoperative outcomes between smokers and non-smokers. Multivariate logistic regression analyses showed no significant difference in 30-day postoperative mortality between smokers and non-smokers (adjusted odds ratio [aOR]: 1.06, 95% confidence interval [CI]: 0.40-1.56). However, smokers had a higher risk of 30-day major complications, including postoperative acute myocardial infarction (AMI) (aOR: 1.43, 95% CI: 1.02-1.99) and overall postoperative complications (aOR: 1.18, 95% CI: 1.04-1.48). Similarly, for the 31-90-day period, smokers had no significantly higher risk of mortality (aOR: 1.06, 95% CI: 0.49-1.19), but experienced higher rates of major complications, including postoperative AMI (aOR: 1.73, 95% CI: 1.17-2.55) and overall postoperative complications (aOR: 1.48, 95% CI: 1.13-1.92). The ERAS program benefits patients undergoing CABG surgery, including smokers, by providing similar major postoperative outcomes to non-smokers, except for increased risks of postoperative AMI and overall complications.

The relapse pattern following the discontinuation of tenofovir alafenamide (TAF) in patients with chronic hepatitis B (CHB) remains unclear. This study aimed to compare the 2-year incidences of virological and clinical relapses among patients who discontinued TAF versus those who discontinued tenofovir disoproxil fumarate (TDF) or entecavir (ETV). This multicenter retrospective study enrolled noncirrhotic hepatitis B e antigen (HBeAg)-negative CHB patients who discontinued TAF, TDF, or ETV with undetectable HBV DNA at treatment cessation. For patients who switched from ETV or TDF to TAF, a minimum TAF exposure duration of 12 months was required for inclusion in the off-TAF group. Inverse probability of treatment weighting was employed to adjust for baseline differences. A total of 162 patients (off-TAF: 37, off-TDF: 87, off-ETV: 38) were included in the primary analysis. The 2-year cumulative incidence of virological relapse was significantly higher in the off-TAF group (85.0%) compared to the off-TDF group (69.5%, p = 0.024) and the off-ETV group (51.5%, p = 0.010). Similarly, the 2-year cumulative incidence of clinical relapse was significantly higher in the off-TAF group (62.4%) compared to the off-TDF group (39.0%, p = 0.026) and the off-ETV group (22.5%, p = 0.024). Consistent results were observed in patients meeting the 2012 APASL stopping criteria. HBeAg-negative patients who discontinue TAF face a higher risk of both virological and clinical relapses compared to those discontinuing TDF or ETV. These findings underscore the need for more intense monitoring in CHB patients after TAF cessation.

Abstract Objectives The clinical benefit of PD-1/PD-L1 inhibitors in unselected PDAC remains uncertain. To quantify the efficacy and safety of PD-1/PD-L1 inhibitors in PDAC compared with non-immunotherapy regimens and to explore sources of heterogeneity. Methods We conducted an electronic database search and a systematic review and meta-analysis. Our primary outcome was overall survival, along with secondary outcomes including progression-free survival, objective response rate, and adverse events. Results Seven RCTs (n=754) met inclusion criteria. PD-1/PD-L1 therapy was associated with a modest improvement in OS vs. active comparators (mean difference [MD]=0.92 months, 95 % CI 0.04–1.81; p=0.041; I 2 =97.0 %). No significant benefit was observed for PFS (MD=−0.19 months, 95 % CI=−1.32 to 0.94; p=0.740; I 2 =99.6 %) or ORR (OR=1.32, 95 % CI=0.69–2.53; p=0.402; I 2 =39.2 %). Rates of grade ≥3 AEs were similar between groups (OR=1.36, 95 % CI=0.95–1.95; p=0.098; I 2 =0 %). Conclusions PD-1/PD-L1 inhibitors confer a small OS benefit in PDAC, but conclusions are constrained by small phase II studies, study-level data, high heterogeneity, non-standardized survival/AEs, and exploratory subgroup signals that need validation in phase III trials.

Chronic obstructive pulmonary disease (COPD) patients face an increased risk of developing various malignancies due to shared risk factors and underlying systemic inflammation. N-acetylcysteine (NAC) has shown potential anticancer properties in preclinical studies, but clinical evidence in COPD patients is limited. We conducted a nationwide propensity score-matched cohort study using data from Taiwan's National Health Insurance Research Database to evaluate the anticancer effects of NAC in COPD patients. Patients diagnosed with COPD between 2008 and 2019 were included, and those with pre-existing cancer were excluded. NAC use was defined as consistent administration for most days with an average dose exceeding 28 cumulative defined daily doses (cDDDs) annually. Cox regression models were adjusted for various covariates was employed. PSM yielded 91,546 patients, evenly distributed between NAC and non-NAC groups. Multivariate Cox regression analysis revealed a lower cancer risk in patients with long-term NAC use compared to non-users (adjusted hazard ratio [aHR] 0.69, 95% confidence interval [CI] 0.66-0.72; P<0.001). Dose-dependent relationships were observed, with higher daily NAC intake associated with reduced cancer risk. Time-varying Cox regression analysis demonstrated significant reductions in the risk of specific cancers, including hepatocellular carcinoma, colorectal cancer, and breast cancer, among NAC users compared to non-users. Our study provides clinical evidence supporting the potential anticancer effects of NAC in COPD patients. These findings highlight the importance of exploring NAC as a chemopreventive agent in high-risk populations and inform clinical practice and future research endeavors.