Tri-Service General Hospital

Adolescent pregnancy is a global public health concern associated with increased risks of physical health, mental well-being, and social functioning; however, its potential to increase the long-term risk of major psychiatric disorder (MPD) remains underexplored. Between 1996 and 2013, a cohort of 29,974 girls with adolescent pregnancy without MPD before and 1:4 matched controls based on age, family income, residence location, and individual psychiatric comorbidity were enrolled. A Cox regression model was used, adjusted for potential confounders, to estimate the risk of schizophrenia, bipolar disorder, and major depressive disorder (MDD). After adjusting for confounding factors, adolescent pregnancy was associated with significantly increased risks of bipolar disorder (hazard ratio 1.44; 95% confidence interval 1.20-1.72) and MDD (1.88; 1.76-2.00), but not schizophrenia (0.94; 0.73-1.21), compared to the control group. These associations persisted after excluding the first 3 years of follow-up, with elevated risks of bipolar disorder (1.27; 1.05-1.54) and MDD (1.61; 1.50-1.72) among adolescents with pregnancy compared to controls. These results underscore the importance of implementing long-term mental health surveillance strategies for young mothers who experience adolescent pregnancy.

BackgroundThe outcome of patients undergoing endovascular thrombectomy (EVT) for large vessel occlusion in a comprehensive stroke center (CSC) is affected by the onset-to-treatment time. Whether the pathway to CSC arrival (direct vs. interhospital transfer) is thus associated with EVT outcomes among such patients is unknown.MethodsUsing the Taiwan Registry of Endovascular Thrombectomy for AIS registry, patients ≥20 years of age and receiving EVT for AIS within 24 h of onset between January 2019 and December 2022 were included. Patients were categorized according to CSC arrival pathway into direct arrival and transfer groups. The primary outcome was 3-month functional independence, defined as a modified Rankin Scale (mRS) of 0–2.ResultsOf the1830 patients included, 79% arrived at a CSC directly and 21% via transfer. More patients in the direct arrival than the transfer group achieved a 3-month mRS of 0–2. A significant interaction was found between onset-to-puncture (OTP) time and arrival pathway for achieving 3-month mRS 0–2 (pinteraction = 0.017). Arrival by transfer was associated with reduced odds of achieving mRS 0–2 when OTP time was < 6 h (aOR, 0.55), but with increased odds when OTP was ≥6 h (aOR, 1.95).ConclusionsDirect arrival was associated with improved outcomes if OTP < 6 h. Patients who arrive via transfer may still benefit substantially from EVT during the later treatment window. Further study is warranted to examine the predictors of favorable post-EVT outcomes within a 24-h window to facilitate timely treatment.

Patients with benign prostatic hyperplasia (BPH) have an increased risk of developing cardiovascular disease. Taking alpha-1 blockers is associated with an increased risk of major adverse cardiovascular events. Patients suffering from ischemic stroke (IS) may develop baroreflex and parasympathetic dysfunction-induced cerebral autoregulation impairment. The relationship between pharmacotherapy for BPH and the risk of recurrent IS remains unclear. The purpose of this study was to determine whether medications for BPH increase the risk of recurrent IS. This is a retrospective cohort study. Data from patients diagnosed with IS between 2000 and 2015 was collected from Taiwan National Health Insurance Database. Newly diagnosed IS patients were identified (International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM): 433-437). BPH patients with an ICD-9-CM of 600 were identified. The event observed was recurrent IS after the firstever IS. The factors associated with recurrent IS were assessed via Cox proportional hazards regression. Recurrent IS was associated with BPH with an adjusted hazard ratio (HR) of 1.505 and a 95% confidence interval (CI) of 1.112-1.829, p < 0.001), and a competing risk model showed an adjusted HR of 1.544 (95% CI: 1.128-1.896, p < 0.001). The adjusted HR for treatment with alpha-1 blockers was 1.581 (95% CI: 1.16-1.915, p < 0.001), and increased risk with adjusted HR for treatment with high doses of 5-alpha reductase inhibitors over a long period of time are also at risk of recurrent IS. These findings highlight the association between BPH incidence and the risk of recurrent IS. The pharmacotherapy for BPH in IS patients should take great care.

Endoscopic sleeve gastroplasty (ESG) and intragastric balloon (IGB) are established endoscopic bariatric therapies (EBTs) for obesity, but their comparative efficacy and safety remain uncertain. We conducted a systematic review and meta-analysis of comparative studies evaluating ESG versus IGB. The primary outcome was percentage of total body weight loss (%TBWL), assessed at the longest available follow-up and stratified timepoints (1, 3, 6, and 12 months). To explore temporal trends, we performed a meta-regression using follow-up duration as a continuous moderator. Secondary outcomes included a meta-regression based on baseline BMI differences and a pooled analysis of adverse events. Six comparative studies (n = 5330) were included. ESG was associated with significantly greater %TBWL than IGB (mean difference: 2.541; 95% CI 0.754 to 4.327; p = 0.005), with increasing benefit over time. Meta-regression confirmed a significant positive association between follow-up duration and treatment effect (p = 0.0006). A separate meta-regression revealed greater efficacy of ESG in patients with higher baseline BMI (p = 0.0001). Overall adverse event rates were comparable between the two groups (p = 0.20) ; however, IGB showed observed trends toward higher device intolerance and early removal rates in individual cohorts. Our findings suggest that ESG may offer a therapeutic advantage over IGB regarding weight loss efficacy, a trend that appears more pronounced in cohorts with higher obesity severity and across extended follow-up periods. ESG offers a comparable safety profile to IGB and may represent a more durable endoscopic bariatric option with potential advantages in procedural tolerability. Long-term trials are needed to validate its metabolic and clinical advantages beyond 12 months.

<sec><title>BACKGROUND</title>Post-TB bronchiectasis is a recognised but under-investigated category of bronchiectasis. This study evaluated its clinical features and identified risk factors for acute exacerbations (AEs).</sec><sec><title>METHODS</title>This retrospective observational cohort study analysed data from the Taiwan Bronchiectasis Registry. Patients with bronchiectasis were included, and those with post-TB bronchiectasis were identified for subgroup analysis. We collected demographics, symptoms, lung function, microbiological data, and modified Reiff scores to assess risk factors for AEs.</sec><sec><title>RESULTS</title>A total of 1,444 patients were analysed, including 222 (15%) with post-TB bronchiectasis. Among them, 54 (24%) experienced at least one AE during the study period. Post-TB bronchiectasis patients had more frequent AEs, higher FACED and modified Reiff scores, lower body mass index (BMI) and forced expiratory volume in 1 s (FEV1), and more symptoms than non-post-TB cases. Post-TB bronchiectasis patients with AEs had higher FACED and Reiff scores, lower BMI and FEV1, and higher rates of positive sputum cultures for gram-negative bacilli (GNB). Multivariable analysis identified FEV1 ≤ 60% predicted (adjusted odds ratio [aOR]: 2.334, 95% CI: 1.192-4.572) and positive GNB cultures (aOR: 3.075, 95% CI: 1.362-6.942) as independent risk factors for AEs.</sec><sec><title>CONCLUSION</title>Post-TB bronchiectasis is associated with a higher risk of exacerbations. Reduced FEV1 and positive GNB cultures are independent risk factors for AEs.</sec>.

BACKGROUNDPortal vein thrombosis (PVT) is a rare condition and is often associated with cirrhosis, malignancy, or prothrombotic states. Currently, systemic anticoagulation is the standard to treat PVT. The role of alternative treatments are currently under investigation. In particular direct thrombolysis for the treatment of nonmalignant PVT is controversial due to the risk of bleeding. Here we have reported a case highlighting therapeutic considerations and outcomes of direct thrombolysis.CASE SUMMARYA 67-year-old male without a prior history of cirrhosis or malignancy presented with acute abdominal pain and peritonitis. Contrast-enhanced computed tomography revealed complete thrombosis of the portal vein with extension into the superior mesenteric vein. These findings were consistent with impending mesenteric ischemia. Despite systemic anticoagulation the patient’s symptoms progressed. Urgent catheter-directed thrombolysis via a transhepatic approach was initiated using continuous urokinase infusion. We observed substantial thrombus regression and resolution of ischemic symptoms, thereby avoiding surgical intervention. Subsequent hematologic evaluation revealed a JAK2 V617F mutation-associated polycythemia vera as the underlying prothrombotic disorder.CONCLUSIONEarly low-dose catheter-directed thrombolysis provided a safe and effective treatment for a patient with noncirrhotic, nonmalignant PVT associated with mesenteric ischemia, demonstrating the utility of an alternative treatment for PVT.

To determine whether baseline ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) radiomic markers of thoracic tumor burden and metabolic heterogeneity predict early progression and overall survival (OS) in patients with small cell lung cancer (SCLC) receiving first-line platinum-etoposide chemotherapy. We retrospectively analyzed 45 patients with SCLC who underwent baseline ¹⁸F-FDG PET/CT before chemotherapy. Radiomic features were extracted from thoracic tumor volumes, including metabolic tumor volume (MTV), total lesion glycolysis (TLG), standardized uptake value (SUV) histogram parameters, and gray-level co-occurrence matrix (GLCM) metrics. Univariable and multivariable Cox regression assessed associations with progression-free survival (PFS) and OS. Receiver operating characteristic (ROC) analysis, with area under the ROC curve (AUC), assessed discriminatory ability for early progression (PFS < 6 months) and short-term mortality (OS < 12 months). Higher log-transformed TLG (logTLG) was correlated with shorter PFS and OS in univariable analysis. In multivariable models, logTLG independently predicted PFS (hazard ratio [HR] 2.20, 95% confidence interval [CI] 1.12-4.30; p = 0.021) and OS (HR 2.54, 95% CI 1.24-5.20; p = 0.011). Age (HR 1.07 per year; 95% CI 1.02-1.12, p = 0.007) and stage IV vs. III (HR 2.46, 95% CI 1.06-5.71; p = 0.037) were additional OS predictors. GLCM texture features were not significant. ROC analysis showed MTV (AUC 0.88) and serum lactate dehydrogenase (LDH) (AUC 0.74) best predicted early progression, while age (AUC 0.79), stage (AUC 0.73), and SUV entropy (AUC 0.75) predicted short-term mortality. Kaplan-Meier curves confirmed poorer survival with high logTLG, advanced stage, and older age. Baseline thoracic PET/CT radiomics, particularly logTLG, independently predict survival in SCLC. MTV and LDH identify early progression, while age, stage, and SUV entropy predict short-term mortality, supporting integrated imaging-clinical risk stratification.