Meiho University

IntroductionCollision tumors are extremely rare in the sellar region, less than 1 to 2% of sellar masses. Intracranial dermoid cyst is a rare, benign, slow-growing lesion accounting for 0.04 to 0.7% of all intracranial tumors. Sellar dermoid cysts are extremely rare; from 1976 to 2024, there were only 59 records of sellar dermoid cyst published in the English language. Coexisting sellar dermoid cyst and pituitary adenoma have not been reported in the literature.Case PresentationA 51-year-old man having medical history of left traumatic optic neuropathy and acute lymphoblastic leukemia posttreatment with complete remission in 2018 suffered from intermittent dizziness and occasional unsteady gait with deviation to the left side for more than 6 months prior to visiting our hospital. His brain magnetic resonance imaging disclosed a mass lesion in the sellar region with suprasellar extension, and his preoperative hormone study showed hypopituitarism. After a thorough preoperative evaluation, he underwent an endoscopic endonasal transsphenoidal approach with the removal of the lesion and skull base reconstruction. The lesion was pathologically diagnosed to be a dermoid cyst with coexisting pituitary adenoma/pituitary neuroendocrine tumor.ConclusionTo our best knowledge, this is probably the first report of sellar dermoid cyst with coexisting pituitary adenoma/pituitary neuroendocrine tumor.

Traditional Chinese Medicine (TCM) interventions have shown efficacy in aiding the outpatient treatment of patients with ischemic stroke, particularly in functional recovery and mortality reduction. Despite being covered by Taiwan National Health Insurance (NHI), TCM utilization among inpatients remains low. This study investigated the use of acupuncture, a key TCM modality, among hospitalized patients with ischemic stroke in a medical center in southern Taiwan from 2017 to 2020. Newly hospitalized ischemic stroke patients diagnosed between January 1, 2017, and December 31, 2020, were enrolled. This study assessed acupuncture interventions in hospitalized patients with stroke and evaluated whether acupuncture reduced patient mortality. Differences in demographic and clinical variables between the acupuncture and non-acupuncture groups were analyzed using independent sample t-tests or chi-square tests. Hazard ratios (HR) were used to compare the mortality risk between the acupuncture and non-acupuncture groups using Cox proportional hazards models employed for univariate and multivariate regressions. Between 2017 and 2020, 23.9% of the 1,455 inpatients with ischemic stroke at Kaohsiung Veterans General Hospital received acupuncture interventions. The demographic characteristics were similar between the two groups, except for age and renal failure. The acupuncture group showed a higher proportion of patients receiving recombinant tissue plasminogen activator, lipid-modifying agents, and endovascular thrombectomy, as well as a higher proportion of patients with baseline modified Rankin Scale scores of 3–6. Adjusted HRs for 12-month mortality in the acupuncture group were 0.45 (0.22–0.93, 95% CI) compared to the control group. This study provides real-world data on inpatients with ischemic stroke receiving acupuncture treatment during hospitalization. Patients with ischemic stroke who received acupuncture during hospitalization exhibited a lower 12-month mortality risk, even among those who were older or had severe physical disabilities at admission. This study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital (IRB No. KSVGH23-CT8-12).

Knee osteoarthritis (KOA) and sarcopenia are prevalent age-related disorders that share common pathophysiological mechanisms such as aging, chronic inflammation, and physical inactivity. Their coexistence may aggravate functional decline and disability. This cross-sectional study aimed to compare the prevalence of sarcopenia between individuals with KOA and matched controls and to explore the relationship between femoral intercondylar cartilage (FIC) thickness and muscle-related parameters. A total of 228 participants (114 KOA, 114 controls) matched by age, sex, and body mass index were enrolled. Assessments included appendicular skeletal muscle mass index (ASMMI), handgrip strength, walking speed, and physical activity. In KOA patients, ultrasound measurements of FIC and quadriceps thickness and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were additionally obtained. Sarcopenia prevalence was higher in the KOA group than in controls (41.2% vs. 26.3%, p = 0.017). Greater FIC thickness was associated with higher ASMMI, stronger handgrip strength, faster walking speed, and lower WOMAC pain and total scores. These findings indicate that FIC thickness may serve as a potential structural biomarker linking cartilage integrity with muscle function in KOA.

Fish sauce, a seasoning commonly utilized in East Asian cuisine, is produced from fish combined with a substantial quantity of salt. However, biogenic amines (BAs) accumulation poses safety concerns in fermented fish sauce during fermentation. This study characterized Tetragenococcus halophilus A003, isolated from fish sauce, which exhibited the weakest decarboxylase gene activation and lowest BA production among the tested strains. Starter inoculation with A003 yielded minimal chemical alteration compared to natural fermentation. Cadaverine levels were substantially lower (19.1 ± 1.49 mg/l) than those in sauce fermented without a starter or with T. halophilus BCRC12250. Histamine and tyramine were undetectable in isolate A003-inoculated samples. Metagenomic analysis revealed an enrichment of low BA-producing taxa, notably Tetragenococcus and Staphylococcus, comprising 97.91% of the community. These findings suggest T. halophilus A003 confers a selective advantage for low BA microbiota during fish sauce fermentation.

The primary prevention of major adverse cardiovascular events by sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with type 2 diabetes without cardiovascular disease (CVD) remains unclear. We used propensity score matching to identify 9520 pairs of SGLT2i users compared with DPP-4 inhibitor users in patients with hypertension and 3496 pairs in patients without hypertension using data from Taiwan's National Health Insurance Research Database for the period between January 1, 2008, and December 31, 2021. Cox proportional hazards models were used to assess the risk of outcomes between SGLT2i and DPP-4 inhibitor users. Mean follow-up was 2.81years for the cohort of patients with hypertension and 2.79years for those without hypertension. Compared to the use of DPP-4 inhibitors, the use of SGLT2i was significantly associated with a reduced risk of developing stroke [aHR (95% CI) 0.56(0.47-0.66)], coronary artery disease [0.80(0.69-0.94)], heart failure [0.31(0.24-0.41)], and major adverse cardiovascular events (MACE) [0.62(0.56-0.70)] in patients with hypertension. Additionally, in patients without hypertension, SGLT2i use was significantly associated with a reduced risk of developing atrial fibrillation [aHR (95% CI) 0.48(0.25-0.91)]. This nationwide cohort study demonstrates that in T2D patients without cardiovascular disease, SGLT2i use is associated with a lower risk of coronary heart disease, stroke, heart failure, and MACE in those with hypertension. In patients without hypertension, SGLT2i use was linked to a reduced risk of atrial fibrillation, suggesting its potential role in the primary prevention of cardiovascular events for T2D patients.

BackgroundOlder individuals with systemic diseases and disabilities face an elevated mortality risk, with oral functional decline further contributing to both oral and systemic health challenges. Given the rising prevalence of reduced oral function in older adults, this study aims to evaluate the effectiveness of oral exercise training on improving oral function and preventing functional decline. Additionally, the study examines potential gender differences in response to the intervention.MethodsSeventy-seven community-dwelling older adults aged 65 and above participated in a six-week oral exercise program, performed before each meal. The study measured changes in oral function post-intervention, which including swallowing ability, salivary secretion, oral diadochokinesis and bite force. Pre- and post-intervention differences were evaluated using paired t-tests and Wilcoxon signed-rank test. The trial was registered on ClinicalTrials.gov (NCT06794814‖2025-01-16).ResultsFollowing six weeks of oral exercise training, significant improvements were observed in salivary secretion, swallowing ability (RSST), oral diadochokinesis, bite force, and quality of life (assessed by OHIP-14). Notably, female participants demonstrated statistically significant increases in stimulate saliva (p =0.013), bite force (p =0.016) and Repetitive saliva swallowing test (RSST) scores (p = 0.021) post-training. ConclusionAlthough the scale of the present study was limited, its findings indicated that 6 weeks of oral exercise intervention could effectively improve oral function among older adults. Training improved swallowing ability and bite force increased mainly in females. Oral diadochokinesis significantly improved for /pa/, /ta/, and /ka/. Encouraging regular oral exercise, particularly before meals, may further optimize oral function and prevent oral hypofunction.

BackgroundThe rate of vaccination is lower in patients with schizophrenia than in the general population, and therefore, further investigation into the psychosocial impact of COVID-19 on these patients and their vaccine attitudes is warranted. In this study, we investigated factors influencing vaccine attitudes in patients with schizophrenia and explored the interactions among these factors.MethodsCross-sectional, self-report surveys were conducted among Taiwanese patients with schizophrenia to collect data on vaccine attitudes and associated variables. Our sample was drawn from the largest psychiatric specialty hospital in Taiwan. As of December 1, 2022, 88% of the Taiwanese population had received at least two doses of the COVID-19 vaccine. Factors influencing vaccine attitudes and potential moderators were investigated through correlation analyses, hierarchical regression, and Hayes’ Process Macro.ResultsThis study included 457 patients. Our results revealed that social anxiety and social desirability were respectively positively and negatively correlated with vaccine attitudes. Positive thinking moderated the overall effect of social influence on vaccine attitudes. Low levels of positive thinking intensified the effect of social influence on vaccine hesitancy.ConclusionThis study clarified the association of social influence with vaccine attitudes and the moderating effect of positive thinking on this association. Reputable medical centers can enhance patients’ confidence in vaccination policies and foster positive thinking to increase vaccine acceptance among patients with schizophrenia.

The incidence of upper tract urothelial carcinoma (UTUC) in Taiwan is high, characterized by aggressive clinical behavior and a tendency to be more invasive at diagnosis. Identifying tumorigenic genes remains an important challenge. Myc binding protein 2 (MYCBP2) regulates the cAMP, p38MAPK, TSC/mTOR, and autophagy signaling pathways in mammalian cells. MYCBP2 dysfunction has been associated with poor prognosis in leukemia, melanoma, colon, and prostate cancer. Its role in UTUC needs to be clarified. We investigated the expression of MYCBP2 in UTUC and its relationship to patient outcomes. MYCBP2 expression levels were assessed by immunohistochemistry in 110 tissue samples from UTUC patients. Higher MYCBP2 protein expression was significantly correlated with worse disease-free survival (p = 0.001) and cancer-specific survival (p = 0.007). The major clinicopathological characteristics associated with MYCBP2 expression were stage, lymphovascular invasion, distant metastasis, recurrence, and cancer death. Based on multivariate analysis, pathological stage (HR:2.31, p = 0.017) and MYCBP2 expression (HR:2.75, p = 0.015) were significant predictors of disease-free survival in UTUC. MYCBP2 is elevated in UTUC cell lines compared with immortalized uroepithelial cells. Knocking down MYCBP2 significantly suppressed cellular migration and invasion activity in BFTC909 cells. In conclusion, MYCBP2 expression might predict poor survival among UTUC patients.

The Taiwan Nurses Association has organized the Nightingale Nursing Leadership Institute (NNLI) training program since 2009 to further cultivate leadership and strategic thinking capabilities in nursing professionals. Over the past decade, NNLI has become a key platform for nursing leadership development in Taiwan. This study was designed to evaluate impact of the NNLI training program on participants' core competencies in communication, leadership, policy and political participation, macro-level perspectives, social impact, and personal growth. A convergent parallel mixed-methods design was adopted. From October 2022 to April 2023, an online survey and focus group interviews were conducted NNLI graduates from 2011 to 2020. Qualitative and quantitative data were analyzed based on the NNLI core competency framework. The average post-training scores for core competencies were 4.33 for communication skills (with average scores of >4 for all items in this category), 4.23 for leadership skills, 3.67 for political skills, 3.83 for policy implementation, and 3.91 for external awareness. Moreover, the average score of 5.94 for external engagement in policy and political participation was lower than that of 7.15 for internal engagement. Also, the average scores for personal growth, social impact, and macro-level perspectives were 8.58, 7.50, and 8.79, respectively. The focus group interviews revealed the NNLI program broadened the participants' perspectives, strengthened their connections with nursing organizations, and enhanced their communication and leadership skills. However, most participants had no prior experience in policy and political engagement, their related practical experience in this arena was limited. The results of the generalized linear model analysis revealed age, educational level, and managerial position to significantly influence communication, leadership, and personal growth. The NNLI training program significantly enhances the core competencies of its participants in the realms communication, leadership, personal growth, social impact, and macro-level perspectives. Thus, this program may be treated as a benchmark for nursing leadership training nationwide. Future programs should incorporate mentorship mechanisms to help participants integrate theoretical knowledge with practical policy and political engagement, thereby enhancing participants' confidence and practical skills in these areas.

A 52-year-old male, a property broker known for his fast-paced lifestyle, presented with a history of severe chest discomfort immediately after consuming a large slice of bread (Figure 1) in his rush to get to work. He exhibited a type A personality, had no comorbidities, and did not take any regular medications. Since then, he has experienced ongoing chest pain accompanied by a sensation of the bread being lodged in his chest. Six hours later, his incarcerated sensation started to decrease after massive water and milk consumption. However, the chest pain still persisted. His gastroduodenoscopy showed a 3.5-cm ulcer in the middle esophagus (Figure 2). His chest symptoms gradually improved after a week treatment with sucralfate 1 g four times daily. The decision to use sucralfate instead of proton pump inhibitors was based on its direct action on the ulcer, forming a protective film that could prevent further deterioration of the esophageal ulcer. A compression ulcer produced by incarcerated bread might occur, possibly due to compression-related ischemia of the mucosa. A bread-related esophageal ulcer tends to occur at middle esophagus, the anatomical narrowing site behind left atrium. Esophageal ulcers can arise from various factors, including reflux esophagitis, viral infections, or medication use.1-3 In this case, the mechanical obstruction caused by the bread likely contributed to the development of the ulcer given the sequence of events. In the literature, there have been reports of fatality and laceration caused by bread crust and bagel, respectively.4, 5 The autopsy of the former case revealed perforation at the upper end of the esophagus with a mediastinal abscess.4 In the latter case, a barium-swallow exam indicated a 4-cm mucosal tear extending from the upper esophagus to the cricopharyngeal muscle.5 However, the patient survived with conservative medical treatment involving narcotic analgesics, antacids, and intravenous hydration. All authors contributed equally to the review of data, drafting of manuscript, and approval of final version. The study was funded by research foundation of An Nan Hospital (grant numbers: ANHRF112-09 and ANHRF112-45), China Medical University, Taiwan and Ping Tung Christian Hospital Research Fund (grant number: PS 113005). The authors declare no conflicts of interest. Informed consent was taken from patient for clinical image submission.