Min Sheng General Hospital

Despite the availability of rapid tuberculosis (TB) nucleic acid amplification (NAA) testing, prevention of TB transmission within healthcare facilities remains a challenge due to ongoing difficulties in promptly isolating infectious TB cases upon hospitalization. We reviewed all hospitalized sputum culture-positive TB patients who were not immediately placed in airborne isolation before anti-TB treatment at a high caseload medical center in Taiwan during 2016-2019, and applied root cause analysis to systematically identify structural barriers to prompt isolation. Among 235 cases, 95 (40.4%) had non-suggestive chest radiography (CXR) findings (Category 1), 62 (26.4%) had suggestive findings but sputum testing was delayed (≥3 days; Category 2), and 78 (33.2%) had timely sputum testing but delayed positive results (Category 3,). In Category 1, 52.6% later developed typical CXR findings. In Category 2, 72.6% had misread CXRs and 27.4% had delayed review. In Category 3 (65.4% had sputum result turnaround time >3 days), TB-NAA test was not done in 24 (30.8%) patients (1 smear-positive and 23 smear-negative). Of the 13 false-negative TB-NAA cases, only one had repeat NAA testing. Prompt isolation requires clinical alertness, accurate CXR interpretations, frontline TB-NAA, and repeat testing when suspicion persists despite negative results.

Traditional Chinese Medicine (TCM) has a longstanding history in the treatment of fatigue-related conditions, and is increasingly recognized as a foundation for novel therapeutic approaches. The Panax genus, extensively utilized in the fundamental TCM principles to enhance vitality, modulate immune function, and stimulate Yang energy, is a key resource in managing both physiological and pathological fatigue. This study provides a comprehensive synthesis of recent advancements in plant-derived metabolites from various Panax species with an emphasis on their structural diversity and structure-activity relationships. Notably, this represents the first systematic exploration of Panax metabolites with potential antifatigue effects. A systematic literature review was conducted using major scientific databases such as PubMed, Google Scholar, and ScienceDirect. The search query "(scientific name of herbal medicine in the Panax genus) AND ("antifatigue")" was employed. Additionally, classical herbals, botanical literature, and pharmacopoeias were reviewed to contextualize the findings. Comprehensive analysis of 105 studies elucidated 16 predominant metabolites exhibiting antifatigue activity. These metabolites primarily originated from Panax ginseng, Panax quinquefolium, and Panax notoginseng. Ginsenosides Rb1 and Rg1 demonstrated the most substantial pharmacological efficacy in experimental models, in particular by ameliorating metabolic perturbations and mitigating oxidative stress in vivo. Clinical trials predominantly relied on subjective patient-reported measures, such as the Multidimensional Fatigue Inventory (MFI) and Visual Analogue Scale (VAS), and yielded largely positive outcomes. These findings substantiate fundamental TCM principles and reinforce the therapeutic potential of Panax species in fatigue management. The integration of traditional knowledge with contemporary biomedical research enhances the understanding and clinical applicability of Panax species in addressing fatigue-related disorders.

Cardiometabolic disorders, such as diabetes, hypertension, dyslipidemia, retinopathy, and non-alcoholic fatty liver disease, present significant health challenges globally. Recent evidence suggests that sesame (Sesamum indicum L.) supplementation may offer beneficial effects in modulating various cardiometabolic risk factors, although findings from clinical trials have been inconsistent. This meta-analysis aims to systematically assess the effects of sesame supplementation on multiple cardiometabolic parameters, including lipid profiles, blood pressure, glycemic control, liver enzyme levels, inflammatory biomarkers, body weight, and body mass index (BMI), with the goal of evaluating its potential as an adjunctive therapy for clinical retinopathy. A comprehensive literature search was conducted across multiple databases through July 2025 to identify randomized controlled trials (RCTs) that compared sesame supplementation with placebo or active controls on cardiometabolic outcomes. Pooled effect sizes were calculated using a random-effects model. A total of 10 studies involving 441 participants were included in the meta-analysis. Sesame supplementation significantly reduced both systolic and diastolic blood pressure. Improvements were also observed in glycemic control, with reductions in fasting blood glucose and HbA1c levels. Further-more, sesame intake was associated with a significant reduction in liver enzyme levels, particularly alanine aminotransferase (ALT). Subgroup analyses revealed that the effects did not increase with longer durations of sesame supplementation. This meta-analysis provides evidence supporting the beneficial effects of sesame supplementation in improving various cardiometabolic risk factors. Incorporating sesame products into dietary strategies may offer a promising adjunctive intervention for managing cardiometabolic disorders and retinopathy associated with these disorders.

Purpose: Fetal bovine serum (FBS) is widely used in cell culture due to its rich nutrient and growth factor content, but it poses ethical concerns, biosafety risks, and cost limitations. This study investigates plasma-depleted lyophilized (freeze-dried) porcine platelet lysate (pPL) as a potential alternative to FBS for use in cell-based research and biomanufacturing. Materials and Methods: Fresh porcine blood was processed to obtain plasma-depleted pPL using double centrifugation and repeated freeze–thaw cycles. The lysate was analyzed for growth factor content via ELISA, then freeze-dried and sterilized with gamma irradiation. Endotoxin levels and cytotoxicity were evaluated. The ability of plasma-depleted lyophilized pPL to promote cell proliferation was assessed using L929 fibroblast cultures and compared with FBS. Results: Plasma-depleted lyophilized pPL contained significantly higher levels of TGF-β1 than FBS. The freeze-dried product remained stable for at least three months at room temperature. Gamma irradiation effectively sterilized the lysate without degrading key growth factors. Plasma-depleted lyophilized pPL showed no cytotoxicity and promoted greater proliferation of L929 cells compared to FBS, indicating enhanced mitogenic activity. Conclusions: Plasma-depleted lyophilized pPL is a stable, safe, and growth factor-rich alternative to FBS. It supports fibroblast proliferation, retains bioactivity after sterilization and storage, and may provide a scalable, ethical option for cell culture in biomedical research, regenerative medicine, and therapeutic product development.

Unplanned returns to the emergency department (RTED) and hospital readmissions after surgery are notable burdens on the healthcare system and markers of potential gaps in patient care. The objective of this study was to identify the risk factors associated with RTED and unplanned readmissions after pediatric orthopaedic surgery. A retrospective cohort study was conducted between 2017 and 2023 and included patients younger than 18 who underwent orthopaedic surgery at a single, large academic institution. Patient data included current procedural terminology code, demographics, body mass index, insurance, language, and case complexity proxied by work relative value units. Procedural categories were defined by Accreditation Council for Graduate Medical Education case log guidelines for pediatric orthopaedics using current procedural terminology codes. The primary outcomes were RTED and hospital readmission within 7, 30, and 90 days of the index procedure. Univariable and multivariable logistic regression analyses were done to identify notable predictors for each outcome. In total, 3,044 pediatric patients were included. In multivariable analysis, patients with Medicaid insurance had a higher odd of RTED at 30 days (odds ratio [OR] 2.26, P = 0.007) and 90 days (OR 2.39, P < 0.001), and a higher odd of readmission at 90 days (OR 3.82, P = 0.002). Hispanic ethnicity was associated with 90-day RTED (OR 1.54, P = 0.023). Black or African American race was associated with 7-day (OR 9.24, P = 0.012) and 30-day (OR 4.00, P = 0.013) readmission. After controlling for demographic variables, operations for infection (OR 15.3, P = 0.002) and soft tissue reconstruction (OR 5.45, P = 0.046) were associated with 7-day RTED. Spine deformity surgery was associated with 30-day (OR 12.0, P = 0.006) and 90-day (OR 5.19, P = 0.031) readmission. Medicaid insurance status and the type of surgical procedure (infection, spine deformity, or soft tissue reconstruction) may represent high-risk populations for postoperative RTED and readmission. These findings underscore the need for enhanced postoperative patient support programs to mitigate adverse outcomes.

This study aimed to evaluate the different risks of developing cardiovascular disease and major microvascular complications between sodium-glucose cotransporter-2 inhibitors (SGLT2i) and non-SGLT2i users in patients with type 2 diabetes (T2D) who do not have existing macrovascular or microvascular diseases. This study employed a retrospective, population-based cohort study design. Data were obtained from Taiwan's National Health Insurance Research Database, covering the period from January 1, 2008, to December 31, 2021. Propensity score matching was used to identify 91,327 matched pairs of SGLT2 inhibitor and dipeptidyl peptidase-4 (DPP-4) inhibitor users, 91,673 pairs of SGLT2 inhibitor and sulfonylurea users, and 20,857 pairs of SGLT2 inhibitor and glucagon-like peptide-1 receptor agonist (GLP-1 RA) users. The study included 1,145,035 patients diagnosed with T2D from the NHIRD. Cox proportional hazard models were used to assess the risk of outcomes. SGLT2i users showed a lower risk of coronary artery disease (0.80 (0.73-0.87), 0.78 (0.72-0.85) and 0.74 (0.64-0.86)), heart failure (0.44 (0.38-0.49), 0.56 (0.50-0.62) and 0.66 (0.55-0.78)), cardiovascular death (0.47 (0.40-0.56), 0.47 (0.40-0.55) and 0.68 (0.53-0.87)), dialysis (0.03 (0.02-0.05), 0.13 (0.10-0.17) and 0.16 (0.11-0.23)), vision-threatening retinopathy (0.58 (0.51-0.67), 0.59 (0.51-0.67) and 0.78 (0.62-0.98)), amputation (0.29 (0.20-0.41), 0.28 (0.21-0.38) and 0.61 (0.46-0.89)) and all-cause mortality (0.42 (0.39-0.445), 0.39 (0.37-0.42) and 0.68 (0.61-0.76]))when compared to DPP-4 inhibitors, sulfonylureas, and GLP-1 RA users, respectively. This study showed that SGLT2i use was associated with a lower risk of incident cardiovascular diseases, major microvascular complications and mortality compared with the use of DPP-4 inhibitors, sulfonylureas and GLP-1 RA in patients with T2D, who did not have macrovascular and microvascular diseases.

BackgroundDiabetes mellitus increases the risk of developing tuberculosis (TB) and negatively affects TB treatment outcomes. Dipeptidyl peptidase-4 (DPP-4) inhibitors are used in glycemic control but can also modulate immune pathways involved in immune-mediated diseases. Considering the immunoregulatory effects of DPP-4 inhibitors, this emulated target trial compared the risk of pulmonary TB in users and non-users of DPP-4 inhibitors with type 2 diabetes mellitus (T2DM).MethodsWe identified 328,842 pairs of DPP-4 inhibitor users and non-users from Taiwan’s National Health Insurance Research Database from January 1, 2007, and December 31, 2019. Cox proportional hazard models were used to determine the risk of new-onset pulmonary TB between the study and control groups.ResultsThe follow-up duration was 5.06 years for DPP-4 inhibitor users and 4.05 years for non-users. The incidence rates of new-onset pulmonary TB were 1.93 and 2.18 cases per 1,000 person-years in DPP-4 inhibitor users and non-users, respectively. Compared with non-users, DPP-4 inhibitor users had a significantly lower risk of developing pulmonary TB, with an adjusted hazard ratio (aHR) of 0.85 (95% CI: 0.81–0.90). Kaplan–Meier analysis showed a significantly lower cumulative incidence of new-onset pulmonary TB among DPP-4 inhibitor users than non-users (log-rank test, p < 0.001).Furthermore, a longer cumulative duration of DPP-4 inhibitor use was associated with a lower risk of pulmonary TB.ConclusionsIn patients with T2DM, the use of DPP-4 inhibitors was associated with a significantly lower risk of developing pulmonary TB compared to non-use. Additionally, a longer cumulative duration of DPP-4 inhibitor may further reduce the TB risk.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04423-1.

The 2024 global cryptococcosis treatment guidelines suggests that fluconazole (FLC) combined with liposomal amphotericin B (AMB) and 5-flucytosine (5-FC) as the mainstay of treatment for systemic cryptococcosis. Although this 2024 guidelines also list recommend voriconazole (VRC), posaconazole (POS), and isavuconazole (ISA) as alternatives to FLC during the consolidation and maintenance phases, current data on distributions of minimum inhibitory concentrations (MICs) of global Cryptococcus isolates for antifungals-and studies evaluating the application of their pharmacokinetic (PK) profiles and pharmacodynamic (PD) indices in the treatment of systemic cryptococcosis-remain limited. To optimize antifungal dosing, integration of global MIC distributions for Cryptococcus isolates with PK/PD parameters for key antifungal agents is needed. This study analyzed the MIC distributions from the 2010-2023 antifungal Antimicrobial Testing Leadership and Surveillance database, and determined epidemiological cutoff values for major Cryptococcus species. The majority of invasive Cryptococcus isolates were classified as wild-type strains (>90%). We analyzed PK profiles (particularly central nervous system [CNS] penetration from the bloodstream), PD indices of antifungals (azoles and AMB) against yeasts. Based on 25 studies clearly describing PK-PD relationships, FLC and VRC were considered optimal choices because of superior CNS penetration. The optimal dose of FLC is 800-1,200mg/day, whereas dosages of VRC and ISA do not require adjustment. Nevertheless, therapeutic drug monitoring for VRC is warranted during its prescription due to significant variability in plasma concentrations influenced by multiple factors. POS is not suitable for induction therapy in systemic cryptococcosis. Additionally, ISA is preferred over POS for consolidation therapy for Cryptococcus meningitis/meningoencephalitis (MME) based on differences in their PK profiles. Furthermore, a single 10mg/kg dose of liposomal AMB-a cost-effective strategy-should be combined with 1,200mg/day FLC and 5-FC, or alternatively VRC, as an effective induction-phase regimen for treating Cryptococcus MME. Diverging from the 2024 guidelines, this study provides novel insights into the treatment of Cryptococcus MME based on MIC distributions and PK-PD indices for antifungal agents.

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.