Yuli Veterans Hospital

We aimed to determine the incidence of subcutaneous emphysema following laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy and to evaluate its associated factors and clinical impact. In this retrospective cohort study, we included consecutive patients who underwent laparoscopic TEP inguinal herniorrhaphy between 2020 and 2023. The primary outcome was any SE, assessed using palpation method and radiographic imaging. Secondary outcomes were severe SE, defined as the SE extending to the area of the nipple and above. We also evaluated key postoperative recovery indices, comparing patients with and without SE. Among the 829 included patients, 161 (19.4%) developed any SE, and 98 (11.8%) developed severe SE. Four independent risk factors were identified for any SE: lower body mass index [adjusted odds ratios (aORs): 0.84, 95% confidence interval (CI): 0.77–0.90], higher peak airway pressure (aOR: 4.98, 95% CI: 1.53–16.17, on base-2 logarithmic scale), higher peak partial pressure of end-tidal carbon dioxide (aOR: 250.18, 95% CI: 73.41–852.59, on base-2 logarithmic scale), and use of volume-controlled ventilation (pressure- vs. volume-controlled ventilation: aOR: 0.40, 95% CI: 0.22–0.75) (c-statistic = 0.790). The safe threshold for any SE was peak airway pressure < 25 cm H2O and peak partial pressure of end-tidal carbon dioxide < 45 mm Hg. Patients with SE showed a higher need for supplemental oxygen after surgery. Independent factors associated with SE following laparoscopic TEP herniorrhaphy were identified and may facilitate timely recognition and management. SE can be accompanied by transient respiratory changes but is generally self-limited.

BackgroundSchizophrenia is a severe mental illness that affects the cognitive, social, and daily functions of patients. Physical activity has been found to be important for maintaining these functions in patients with schizophrenia, but many lack the motivation to participate in physical activities.ObjectiveThis study aimed to explore the efficacy of active video games (AVGs) on the behavioral intention and cognitive function of patients with schizophrenia.MethodsIn this experimental study, 103 participants were recruited from 2 medical centers. All participants were randomly assigned to the experimental or control group, and 82 participants (n=41, 50% in the experimental group and n=41, 50% in the control group) completed all the processes of our protocol. The experimental group was provided with AVGs for 30 minutes twice per week for 6 weeks. The Mini Mental State Examination and a behavioral intention questionnaire were administered before and after playing the AVGs. Data were collected between April 2021 and January 2022. Generalized estimating equations and 2-tailed paired t tests were used for data analysis.ResultsThe experimental group showed significant improvements in behavioral intention to participate in AVGs compared with the control group at both T1 (β=4.88; P=.009) and T2 (β=4.24; P=.04). In addition, the experimental group experienced significant improvements in orientation (T2: β=0.66; P=.04) and language (T2: β=0.28; P=.03) among cognitive functions compared to the control group. In contrast, there was no significant change in these variables in the control group.ConclusionsPlaying AVGs can effectively enhance the behavioral intention of patients with schizophrenia to participate in physical activity and exercise and significantly improve their orientation and language. AVGs are inexpensive and easily operated tools for people with mental or physical disabilities.Trial RegistrationClinicalTrials.gov NCT05933356; https://clinicaltrials.gov/study/NCT05933356

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.

While multidomain interventions show promise for promoting healthy aging, their impact on brain structure remains unclear. This randomized controlled trial (ENHANCE) assessed the efficacy of a 12-month group-based multidomain intervention on brain structure and function in community-dwelling older adults, with particular attention to urban-rural disparities. The ENHANCE trial delivered twice-weekly group-based multidomain sessions (physical exercise, cognitive training and nutrition education) in urban and rural communities for 12 months, while the control group received quarterly telephone education. A total of 88 participants completed the trial (attendance rates > 60% across all sites), with 76 completing longitudinal MRI assessments (intervention: n = 35; control: n = 41). The intervention group (n = 44; 75.0% female) was significantly older than the control group (n = 44; 70.5% female) (75.0 ± 6.6 vs. 72.3 ± 5.0 years, p = 0.035) and had lower BMI (23.4 vs. 25.2 kg/m2, p = 0.016) at baseline. The primary outcomes were brain structures (voxel-based changes in brain grey matter volume [GMV]), while secondary outcomes were functional outcomes (physical performance, nutritional status, cognitive function, psychosocial assessments and cardiometabolic biomarkers). Using two-stage tensor-based morphometry analysis, the intervention group demonstrated significantly less GMV reduction in regions over the left inferior temporal lobe compared with controls over 12 months (p < 0.05). Using generalized estimating equation (GEE) model, the intervention group showed enhanced physical performance at 6 months (5-time chair rise test: -1.19 s; 95% CI, -2.24 to -0.13; p = 0.028) and improved cognitive function by 12 months (Montreal Cognitive Assessment: +1.32 points; 95% CI, 0.10-2.54; p = 0.034). Cardiometabolic improvements included increased HDL-C (+6.65 mg/dL, p < 0.001) and decreased triglycerides (-16.07 mg/dL, p = 0.025) at 12 months in GEE models. In subgroup analyses, rural participants showed preserved GMV in additional regions including the cerebellum (Crus I and II) and occipital cortex with greater cognitive improvements (MoCA: +3.06 points; 95% CI, 0.84-5.27; p = 0.007), while urban participants showed greater GMV reduction in the left temporal-occipital fusiform cortex but achieved superior physical performance gains (5-time chair rise test: -1.85 s; 95% CI, -3.07 to -0.64; p = 0.003). This study demonstrates that multidomain interventions can induce neuroplasticity in older adults, with differential effects on brain structure and function between urban and rural participants, emphasizing the need for tailored approaches that consider sociocultural factors to optimize healthy aging across diverse populations.

Background: Ficolin-3 (FCN3) is a well-known circulating pattern recognition molecule which plays a role in host immune responses to cancer via activation of the lectin complement pathway. Nevertheless, the clinical significance of FCN3 in patients with hepatocellular carcinoma (HCC) is unclear. Methods: Eighty-seven HCC patients who received hepatectomy at our hospital were included. Immunohistochemical staining was used to assess the FCN3 expression in both tumorous and non-tumorous tissues from the patients, who were classified into high and low expression groups. Differences in clinicopathological characteristics between the two groups were then analyzed. Results: Survival was significantly associated with FCN3 immunohistochemical score (p for trend = 0.048). Kaplan-Meier analysis revealed a higher overall survival rate in the patients with a high FCN3 expression than in those with a low FCN3 expression (p=0.031). A high FCN3 expression in tumor tissue was independently associated with better overall survival (p=0.042). However, multivariate analysis showed that FCN3 expression was not an independent risk factor for overall survival. Conclusion: Our findings suggest that FCN3 is significantly related to the prognosis of HCC. FCN3 may be a prognostic marker in patients with HCC.

The associations of mental stress with decayed teeth in children and periodontitis in old-aged adults have been described. However, the associations for young adults were not clear. This study aimed to examine the associations of decayed teeth and localized periodontitis with mental stress in young adults. This study included 334 military recruiters, aged 19–45 years in Taiwan. Mental stress was assessed by the brief symptom rating scale-5 (BSRS-5), including five domains: anxiety, depression, hostility, interpersonal sensitivity and insomnia (maximum score of 20). Those with symptomatic mental stress were defined as having BSRS-5 > 5 (n = 34). Multiple linear and logistic regression models were used to determine the associations of decayed tooth numbers and periodontitis with BSRS-5, with adjustments for age, sex, education level, physical activity, body weight category and smoking status. The BSRS-5 was positively correlated with decayed tooth numbers [β: 0.26 (95% confidence interval: 0.01–0.52)]. Those who had more than two decayed teeth [odds ratio: 3.59 (1.52–8.46)] had a higher risk of symptomatic mental stress. In contrast, the correlation between BSRS-5 and localized severer periodontitis was null. Our study recommended that decayed teeth instead of localized periodontitis, was a risk factor for mental stress in young adults.

Introduction: Two common variants of sortilin-related receptor 1 gene (SORL1), rs2298813 and rs1784933, have been associated with late-onset Alzheimer’s disease (AD) in the Han Chinese population in Taiwan. However, neuroimaging correlates of these two SORL1 variants remain unknown. We aimed to determine whether the two SORL1 polymorphisms were associated with any volumetric differences in brain regions in late-onset AD patients.Methods: We recruited 200 patients with late-onset AD from Taipei Veterans General Hospital. All patients received a structural magnetic resonance (MR) imaging brain scan and completed a battery of neurocognitive tests at enrollment. We followed up to assess changes in Mini-Mental State Examination (MMSE) scores in 155 patients (77.5%) at an interval of 2 years. Volumetric measures and cortical thickness of various brain regions were performed using FreeSurfer. Regression analysis controlled for apolipoprotein E status. Multiple comparisons were corrected for using the false discovery rate.Results: The homozygous major allele of rs2298813 was associated with larger volumes in the right putamen (p = 0.0442) and right pallidum (p = 0.0346). There was no link between the rs1784933 genotypes with any regional volume or thickness of the brain. In the rs2298813 homozygous major allele carriers, the right putaminal volume was associated with verbal fluency (p = 0.008), and both the right putaminal and pallidal volumes were predictive of clinical progression at follow-up (p = 0.020). In the minor allele carriers, neither of the nuclei was related to cognitive test performance or clinical progression.Conclusion: The major and minor alleles of rs2298813 had differential effects on the right lentiform nucleus volume and distinctively modulated the association between the regional volume and cognitive function in patients with AD.

Background: In Taiwan, services provided by patients’ peers in the mental health care system are still lacking. Therefore, this study aimed to develop a community setting model by a training program for severe mental illness (SMI) patients’ peers that also have SMI in Taiwan. Method: This training program comprised of 13-h lectures, 15-h practice classes, and an eight-week internship. In 2018 and 2019, the trainees provided one-to-one services to service users with SMI during the internship at a halfway house. The satisfaction and outcomes among all participants were measured in this training course. Results: The total mean satisfaction score in the training course for trainees (10 items, n = 13) and internship services for service users (12 items, n = 29) were 4.7 ± 0.4 and 4.6 ± 0.5, respectively. Among the trainees, 11 demonstrated improved Brief Psychiatric Rating Scale-18 (BPRS-18), Chinese Health Questionnaire-12 (CHQ-12), and Global Assessment of Functioning (GAF) scores after the whole training course. Among the 29 service users, their scores in the BPRS-18 and CHQ-12 decreased, whereas their scores in the GAF increased significantly under the internship service. Conclusion: In this pilot study, the trainees and service users who received internship services felt satisfied. The service providers and users with SMI both showed better clinical outcomes.

Kidney disease patients may have concurrent chronic kidney disease-associated mineral bone disorder and hypertension. Cardiovascular disease (CVD) and neuropathy occur due to kidney failure-induced accumulation of uremic toxins in the body. Indoxyl sulfate (IS), a product of indole metabolism in the liver, is produced from tryptophan by the intestinal flora and is ultimately excreted through the kidneys. Hemodialysis helps renal failure patients eliminate many nephrotoxins, except for IS, which leads to a poor prognosis. Although the impacts of IS on cardiac and renal development have been well documented using mouse and rat models, other model organisms, such as zebrafish, have rarely been studied. The zebrafish genome shares at least 70% similarity with the human genome; therefore, zebrafish are ideal model organisms for studying vertebrate development, including renal development. In this study, we aimed to investigate the impact of IS on the development of zebrafish embryos, especially cardiac and renal development. At 24 h postfertilization (hpf), zebrafish were exposed to IS at concentrations ranging from 2.5 to 10 mM. IS reduced survival and the hatching rate, caused cardiac edema, increased mortality, and shortened the body length of zebrafish embryos. In addition, IS decreased heart rates and renal function. IS affected zebrafish development via the ROS and MAPK pathways, which subsequently led to inflammation in the embryos. The results suggest that IS interferes with cardiac and renal development in zebrafish embryos, providing new evidence about the toxicity of IS to aquatic organisms and new insights for the assessment of human health risks. Accordingly, we suggest that zebrafish studies can ideally complement mouse model studies to allow the simultaneous and comprehensive investigation of the physiological impacts of uremic endotheliotoxins, such as IS, on cardiac and renal development.

Schizophrenia is a chronic, devastating mental disorder with complex genetic components. Given the advancements in the molecular genetic research of schizophrenia in recent years, there is still a lack of genetic tests that can be used in clinical settings. Chromosomal microarray analysis (CMA) has been used as first-tier genetic testing for congenital abnormalities, developmental delay, and autism spectrum disorders. This study attempted to gain some experience in applying chromosomal microarray analysis as a first-tier genetic test for patients with schizophrenia. We consecutively enrolled patients with schizophrenia spectrum disorder from a clinical setting and conducted genome-wide copy number variation (CNV) analysis using a chromosomal microarray platform. We followed the 2020 “Technical Standards for the interpretation and reporting of constitutional copy-number variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics (ACMG) and the Clinical Genome Resource (ClinGen)” to interpret the clinical significance of CNVs detected from patients. We recruited a total of 60 patients (36 females and 24 males) into this study. We detected three pathogenic CNVs and one likely pathogenic CNV in four patients, respectively. The detection rate was 6.7% (4/60, 95% CI: 0.004–0.13), comparable with previous studies in the literature. Also, we detected thirteen CNVs classified as uncertain clinical significance in nine patients. Detecting these CNVs can help establish the molecular genetic diagnosis of schizophrenia patients and provide helpful information for genetic counseling and clinical management. Also, it can increase our understanding of the pathogenesis of schizophrenia. Hence, we suggest CMA is a valuable genetic tool and considered first-tier genetic testing for schizophrenia spectrum disorders in clinical settings.