Taiwan Adventist Hospital

BackgroundVortioxetine, a newer serotonergic antidepressant, has been used to treat adult depressive patients. It has been reported to enhance cognitive functions in patients. While the precise mechanism of action remains unknown, it’ s believed to share similarities with selective serotonin reuptake inhibitors (SSRIs). Since previous studies have indicated that SSRIs could alter gut microbial composition, and considering the correlation between depressive severity and cognitive function with gut microbiota through the gut-brain axis, we aimed to explore the disparities in gut microbial composition and cognitive function among patients treated with vortioxetine, SSRIs, and those without antidepressant treatment.MethodsWe recruited 211 patients currently experiencing depressive symptoms from hospitals in northern Taiwan. We gather their demographic, dietary, and clinical characteristics through questionnaires and electrical medical records. The Continuous Performance Test AX version (CPT-AX) assessed patients' cognitive function. Fecal DNA was extracted from 271 patients and subjected to 16S rRNA V3V4 gene sequencing to obtain their gut microbial profiles. We categorized patients into three groups for microbial and taxa comparisons. Additionally, targeted taxa correlation networks and their associations with depressive symptom severity and cognitive function indices were computed.ResultsWhile no significant differences in microbial diversity were observed among the groups, patients undergoing vortioxetine or SSRI treatments exhibited a decreasing trend. Compared to patients without antidepressant treatment, the vortioxetine group displayed reduced levels of four genera ( Ruminococcus, Turicibacter, Enterorhabdus, Lachnospira), and increased levels of four others ( Eggerthella, Gemella, Gordonibacter, Eubacterium). We also detected three decreased (Ruminococcus, Clostridia_UCG-014, Adlercreutzia) and one increased (Gemella) genera when comparing the vortioxetine and SSRIs groups. Notably, Eggerthella displayed a negative correlation with depression severity (r=- 0.44, p=0.04). Patients with antidepressant treatment had altered bacterial correlation compared to those without treatment. Patients taking vortioxetine exhibited slightly improved cognitive function and a more pronounced correlation trend between targeted taxa and cognitive function indices.ConclusionDespite vortioxetine’ s partially distinct and still not fully understood mechanism in contrast to SSRIs, our study highlights its influence on gut microbial composition, particularly taxa associated with depression or SSRIs. These findings extend previous research, emphasizing the role of microbiota in the dynamics of SSRIs and novel non-SSRI medications. This underscores the crucial involvement of gut microbiota in antidepressant treatments. Given our study's preliminary and cross-sectional nature, further research is needed to deepen our understanding of more effective therapeutic interventions.

This paper proposes an Automatic Recognition and Inventory System, named ARIS, which utilizes YOLOv7 as a surgical instrument recognition Artificial Intelligence (AI) model and a management information platform to promptly identify surgical instruments placed on the tray and automatically inventory the types and quantities of surgical instruments. Experimental results demonstrate that ARIS can accurately identify various types of surgical instruments, thus effectively reducing nursing manpower and enhancing surgical safety.

Chronic kidney disease (CKD) imposes a significant global health and economic burden, impacting millions globally. Despite its high prevalence, public awareness and understanding of CKD remain limited, leading to delayed diagnosis and suboptimal management. Traditional patient education methods, such as 1-on-1 verbal instruction or printed brochures, are often insufficient, especially considering the shortage of nursing staff. Technology-assisted education presents a promising and standardized solution, emphasizing the need for innovative and scalable approaches to improve CKD-specific knowledge and health literacy. This study aimed to develop and evaluate the effectiveness of an innovative 12-unit virtual health coaching program delivered through interactive robots that is intended to enhance disease knowledge and health literacy among patients with CKD. A quasiexperimental design was used, and 60 participants were evenly assigned to experimental and comparison groups. However, due to attrition, 14 participants in the experimental group and 16 participants in the comparison group completed the study. The intervention involved a 12-unit program, with each unit lasting approximately 20 minutes to 30 minutes and delivered across 3 to 4 learning sessions, and participants completed 3 to 4 units per session. The program addressed key aspects of CKD-specific health literacy including functional, communicative, and critical literacy and CKD-specific knowledge including basic knowledge, prevention, lifestyle, dietary intake, and medication. Data were collected through validated pre and postintervention questionnaires. All 30 participants completed the program and subsequent evaluations, with outcome measures assessing changes in CKD-specific knowledge and health literacy. Postintervention analysis using generalized estimating equations, adjusted for age, revealed that the experimental group (n=14) had significantly greater improvements in health literacy (coefficient=2.51, Wald χ²1=5.89; P=.02) and disease knowledge (coefficient=1.66, Wald χ²1=11.75; P=.001) than the comparison group (n=16). Postintervention t tests revealed significant improvements in CKD-specific health literacy and disease knowledge (P<.001) between the experimental and comparison groups. Additional analyses identified significant group × time interactions, indicating improvements in communicative literacy (P=.01) and critical literacy (P=.02), while no significant changes were observed in functional literacy. Regarding disease knowledge, the experimental group demonstrated a significant improvement in medication (P<.001), whereas changes in basic knowledge, prevention, lifestyle, and dietary intake were not significant. This study demonstrated that interactive robot-assisted eHealth coaching effectively enhanced CKD-specific disease knowledge and health literacy. Despite the challenges posed by the COVID-19 pandemic, which constrained sample sizes, the findings indicate that this program is a promising patient education tool in clinical nephrology. Future research should involve larger sample sizes to enhance generalizability and examine additional factors influencing effectiveness.

Abstract Background Nephroureterectomy with bladder cuff excision is the standard treatment for high-risk upper urinary tract urothelial carcinoma (UTUC). Minimally invasive surgery is the most common procedure in our experience, however previous prospective studies have reported inferior oncological outcomes of laparoscopic nephroureterectomy for locally advanced UTUC. The aim of this study was to compare the outcomes of open, laparoscopic and robotic surgery. Methods We retrospectively reviewed 705 patients with locally advanced UTUC from multiple institutions throughout Taiwan. Perioperative outcomes and oncological outcomes were compared between the open, laparoscopic and robotic groups. Results The minimally invasive group had better overall and cancer-specific survival (CSS) rates. The 5-year CSS rates of the open, laparoscopic and robotic groups were 51%, 69%, and 77% respectively (p &lt; 0.001). The robotic group had similar outcomes to the laparoscopic group. More lymph node dissections were performed and more lymph nodes were harvested in the robotic group. Conclusions Laparoscopic or robotic surgery can lead to better perioperative and oncological results in patients with locally advanced UTUC.

BACKGROUNDIleostomies are commonly performed after colon and rectal surgeries. Laparoscopy-assisted ileostomy with adhesion lysis may have potential benefits over conventional open surgery.AIMTo compare the outcomes of laparoscopy-assisted and conventional ileostomies.METHODSData from 48 consecutive patients who underwent ileostomy at our institution between May 2021 and May 2022 were retrospectively analyzed. The groups comprised 26 and 22 patients who underwent laparoscopic ileostomy (laparoscopic group) and conventional ileostomy (conventional group), respectively, performed by a single surgeon. Patient demographics, operative characteristics, postoperative outcomes, and 30-d morbidities and mortality rates were analyzed.RESULTSThe two groups had comparable mean ages, sex distributions, American Society of Anesthesiologists scores, and body mass indices. However, the laparoscopic group showed similar operative time, better visualization for adhesion lysis, and lower visual analog scale scores than the conventional group.CONCLUSIONLaparoscopy-assisted ileostomy is a safe and efficient method that produces lower visual analog scale scores, better intraoperative visualization for effective adhesion lysis, and similar operative time compared with conventional ileostomy.

BackgroundPrevious observational studies have shown that people with dental scaling (DS) had decreased risk of stroke. However, limited information is available on the association between DS and poststroke outcomes. The present study aimed to evaluate the effects of regular DS on the complications and mortality after stroke.MethodsWe conducted a retrospective cohort study of 49,547 hospitalized stroke patients who received regular DS using 2010–2017 claims data of Taiwan’s National Health Insurance. Using a propensity-score matching procedure, we selected 49,547 women without DS for comparison. Multiple logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of poststroke complications and in-hospital mortality associated with regular DS.ResultsStroke patients with regular DS had significantly lower risks of poststroke pneumonia (OR 0.58, 95% CI 0.54–0.63), septicemia (OR 0.58, 95% CI 0.54–0.63), urinary tract infection (OR 0.68, 95% CI 0.66–0.71), intensive care (OR 0.81, 95% CI 0.78–0.84), and in-hospital mortality (OR 0.66, 95% CI 0.62–0.71) compared with non-DS stroke patients. Stroke patients with regular DS also had shorter hospital stays (p < 0.0001) and less medical expenditures (p < 0.0001) during stroke admission than the control group. Lower rates of poststroke adverse events in patients with regular DS were noted in both sexes, all age groups, and people with various types of stroke.ConclusionStroke patients with regular DS showed fewer complications and lower mortality compared with patients had no DS. These findings suggest the urgent need to promote regular DS for this susceptible population of stroke patients.