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Postherpetic neuralgia, a persistent pain condition often characterized by allodynia and hyperalgesia, is a deleterious consequence experienced by patients after an acute herpes zoster vesicular eruption has healed. The pain associated with postherpetic neuralgia can severely affect a patient's quality of life, quality of sleep, and ability to participate in activities of daily living. Currently, first-line treatments for this condition include the administration of medication therapies such as tricyclic antidepressants, pregabalin, gabapentin, and lidocaine patches, followed by the application of tramadol and capsaicin creams and patches as second- or third-line therapies. As not all patients respond to such conservative options, however, interventional therapies are valuable for those who continue to experience pain. This review focuses on interventional therapies that have been subjected to randomized controlled trials for the treatment of postherpetic neuralgia, including transcutaneous electrical nerve stimulation; local botulinum toxin A, cobalamin, and triamcinolone injection; intrathecal methylprednisolone and midazolam injection; stellate ganglion block; dorsal root ganglion destruction; and pulsed radiofrequency therapy. Systematic review. Hospital department in Taiwan. Search of PubMed database for all randomized controlled trials regarding postherpetic neuralgia that were published before the end of May 2017. The current evidence is insufficient for determining the single best interventional treatment. Considering invasiveness, price, and safety, the subcutaneous injection of botulinum toxin A or triamcinolone, transcutaneous electrical nerve stimulation, peripheral nerve stimulation, and stellate ganglion block are recommended first, followed by paravertebral block and pulsed radiofrequency. If severe pain persists, spinal cord stimulation could be considered. Given the destructiveness of dorsal root ganglion and adverse events of intrathecal methylprednisolone injection, these interventions should be carried out with great care and only following comprehensive discussion. Although few adverse effects were reported, these procedures are invasive, and a careful assessment of the risk-benefit ratio should be conducted prior to administration. With the exception of intrathecal methylprednisolone injection for postherpetic neuralgia, the evidence for most interventional procedures used to treat postherpetic neuralgia is Level 2, according to \"The Oxford Levels of Evidence 2\". Therefore, these modalities have received only grade B recommendations. Despite the lack of a high level of evidence, spinal cord stimulation and peripheral nerve stimulation are possibly useful for the treatment of postherpetic neuralgia. Interventional treatment, postherpetic neuralgia, botulinum toxin, steroid, stellate ganglion block, peripheral nerve stimulation, paravertebral block, radiofrequency, spinal cord stimulation.

Immediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of such patients are immediately admitted to the ICU due to no reliable criteria for admission. The surgical Apgar score (SAS) (0–10) can be used to predict postoperative complications, mortality rates, and ICU admission after high-risk intra-abdominal surgery. Our study was performed to determine the relationship between the SAS and postoperative ICU transfer after all surgeries. All patients undergoing operative anesthesia were retrospectively enrolled. Among 13,139 patients, 68.4% and < 9% of whom had a SASs of 7–10 and 0–4. Patients transferred to the ICU immediately after surgery was 7.8%. Age, sex, American Society of Anesthesiologists (ASA) class, emergency surgery, and the SAS were associated with ICU admission. The odds ratios for ICU admission in patients with SASs of 0–2, 3–4, and 5–6 were 5.2, 2.26, and 1.73, respectively (P < 0.001). In general, a higher ASA classification and a lower SAS were associated with higher rates of postoperative ICU admission after all surgeries. Although the SAS is calculated intraoperatively, it is a powerful tool for clinical decision-making regarding the immediate postoperative ICU transfer.

Background The impact of poor oral health on older adults’ quality of life is a public health problem. In this study, the mediating effects of dental status, occlusal condition, dysphagia, and masticatory performance on the association between xerostomia and oral health-related quality of life (OHRQoL) were assessed in the older adult population. Methods Stratified cluster sampling was used to recruit 1076 community-dwelling adults aged 65 years and older from Kaohsiung, Taiwan. Community care centers were randomly selected according to their geographic classifications (urban, rural, or mountainous areas). Assessments of dental status and occlusal condition were performed by dentists. Information on demographics, physical function, xerostomia, dysphagia and depression was collected through face-to-face interviews. Masticatory performance was evaluated using color-changeable chewing gum. OHRQoL was measured using the Geriatric Oral Health Assessment Index. Hierarchical regression models were used to assess the relationships between OHRQoL and physical function, dental status and oral function in older adults. Path analysis was used to estimate direct and indirect pathways between xerostomia and OHRQoL. Results Participants with xerostomia exhibited a 0.20 OHRQoL reduction ( p  < .001) compared with patients with no xerostomia, and the direct effect accounted for 83.3% of the total effect. Dysphagia and masticatory performance were found to exert significant mediating effects on the association between xerostomia and OHRQoL (βs = 0.20 and − 0.12, respectively; both p  < .001; βs = 0.06 and − 0.09, respectively; both p  < .05). Moreover, potential mediating effects of the number of functional teeth (βs = − 0.11 and − 0.43, respectively; both p  < .001) and occlusal condition (βs = 0.09 and 0.13, respectively; both p  < .05) on the relationship between xerostomia and masticatory performance were noted. Conclusions Dysphagia and masticatory performance may serve as pathways through which xerostomia affects quality of life. Early oral function intervention may be a valuable and actionable target for older adults to maintain quality of life. Our results further suggest that checkup and screening for oral dysfunction are essential to prevent or delay the onset of complications.

Background Juvenile idiopathic arthritis (JIA) has been categorized into seven different categories according to the International League of Associations for Rheumatology (ILAR) criteria. Enthesitis-related arthritis (ERA) was found to represent the largest category in a Taiwanese cohort study. The aim in this study was to compare the clinical characteristics, treatments, and outcomes of ERA in a single tertiary center in Taiwan, as compared to those of other categories of JIA. Furthermore, we determined patients’ characteristics and risk factors that can help assess the outcomes in ERA. Methods A retrospective chart review of all patients with JIA referred to a pediatric rheumatology clinic in the National Taiwan University Hospital between 1993 and 2018 were identified according to ILAR criteria. Outcomes were assessed based on the Wallace criteria to categorize patients into active and non-active, including inactive, remission on medication, and remission off medication, groups. A subset of samples was further tested by DNA sequencing to identify HLA-B27 subtypes. Results One-hundred and eighty-three patients were included in the study, with a mean of 8 years’ follow-up. ERA was the single largest category of JIA (39.9%); psoriasis and undifferentiated JIA were both the least common type (0.5%). ERA was male predominant (86%), had a late age of onset (11.0 ± 3.2 years), and the majority of ERA patients was HLA-B27-positive (97%). Of 25 HLA-B27-positive ERA patients checked by HLA-B27 sequencing, 23 were B*27:04 and 2 were B*27:05. ERA patients were significantly less likely to achieve non-active status compared to patients with persistent oligoarthritis ( P  = 0.036). In terms of treatment response to TNF-α inhibitors in methotrexate-refractory ERA, 26 patients remained active and only 11 patients (30%) achieved a non-active status. Sacroiliitis was a risk factor contributing to poorer treatment response in ERA ( P  = 0.006). Conclusion ERA represented the most common category of JIA in Taiwan. Those ERA patients with sacroiliitis were likely to have persistent active disease and may require a more aggressive treatment strategy to improve their outcomes.

Background: Immunoglobulin G4-related disease (IgG4-RD) is a rare, chronic inflammatory condition characterized by fibrosis and tendency for multi-organ involvement. This study aims to analyze the clinical characteristics associated with multi-organ versus single-organ involvement in IgG4-RD, thereby enhancing clinicians’ understanding of the differences between these two patient groups and ultimately improving patient prognosis. Methods: We performed a retrospective analysis of clinical data from 82 patients diagnosed with IgG4-RD admitted to Yichang Central People’s Hospital between January 2019 and December 2024. Results: Among the 82 patients diagnosed with IgG4-RD, 47 patients (57.32%) exhibited involvement of multiple organs. The incidence of multi-organ involvement was significantly higher in male patients than female patients [63.49% vs. 36.84%, odds ratio (OR): 2.98, 95% confidence intervals (CI): 1.03–8.64, P<0.05]. The misdiagnosis rate in the multi-organ involvement group was significantly higher than that in the single-organ involvement group (29.79% vs. 8.57%, OR: 4.525, 95% CI: 1.19–17.26, P<0.05). In patients with involvement of the pancreas (72.50% vs. 42.86%, OR: 3.515, 95% CI: 1.39–8.86, P<0.05), or lymph nodes (83.72% vs. 28.21%, OR: 13.091, 95% CI: 4.50–38.11, P<0.05), the incidence of additional organ involvement was significantly higher than those with involvement of other organs. The eosinophil percentage [median difference (Hodges-Lehmann): 1.60%, 95% CI: 0.40–2.80, P<0.05], absolute eosinophil count [median difference (Hodges-Lehmann): 0.10×109/L , 95% CI: 0.30–0.16, P<0.05], serum immunoglobulin G (IgG) levels [median difference (Hodges-Lehmann): 4.10 g/L, 95% CI: 0.10–7.80, P<0.05], and erythrocyte sedimentation rate (ESR) [median difference (Hodges-Lehmann): 30.50 mm/h, 95% CI: 13.00–48.00, P<0.05] were significantly higher in the multi-organ involvement group compared to the single-organ involvement group. There was a positive correlation between the number of involved organs and ESR (r=0.404, 95% CI: 0.166–0.597, P=0.001), eosinophil percentage (r=0.287, 95% CI: 0.068–0.480, P=0.009), absolute eosinophil count (r=0.293, 95% CI: 0.075–0.485, P=0.007), serum IgG levels (r=0.370, 95% CI: 0.130–0.570, P=0.003), and serum IgG4 levels (r=0.370, 95% CI: 0.130–0.570, P=0.003). Conclusion: The clinical features associated with multi-organ involvement in IgG4-RD are characterized by significant diversity and complexity. Clinicians must enhance their understanding of the characteristics associated with multi-organ involvement to more effectively improve patient prognosis.

The objective of this study was to evaluate the efficacy of the traditional Chinese herbal medicine formula, San-Zhong-Kui-Jian-Tang (SZKJT), on patients with head and neck cancer who underwent concurrent chemoradiotherapy (CCRT). We performed a single-center, open-label, prospective feasibility study from 2018 to 2020. A total of 27 head and neck cancer patients who received CCRT were recruited for the study. SZKJT was given to patients simultaneously with CCRT for 9 weeks. The primary endpoint was the feasibility and completion rate of CCRT, while the secondary endpoint was occurrence of adverse effects. The quality of life (QoL) and traditional Chinese medicine body constitutions were measured by the QLQ-C30 and the Body Constitution Questionnaire (BCQ), respectively. There were 6 dropouts from the study due to complications, while 21 participants completed the trial. Among those 21 participants, 16 completed the CCRT treatment course, yielding a completion rate of 76.2%. The side effects observed during the CCRT and SZKJT trial included dermatitis in 4.8% (Grade 0), 57.1% (Grade 1), and 38.1% (Grade 2), and oral mucositis in 62.0% (Grade 1), 19.0% (Grade 2), and 19.0% (Grade 3) of participants. A comparison of the pre- and post-treatment QLQ-C30 scores revealed that QoL was unaffected (P = .506). However, the BCQ results showed significant increases in the Yin-Xu, Yang-Xu, and stasis constitutions (P < .001). No serious adverse events were observed due to SZKJT. Preliminary results indicated that additional SZKJT with CCRT was feasible, while noting a high completion CCRT rate (76.2%) among the SZKJT-treated patients. Our study reveals that SZKJT can effectively reduce the severity of dermatitis and oral mucositis associated with CCRT. Larger randomized controlled trials are required to further assess the efficacy and safety of SZKJT. The trial registration number is NCT05590650 on ClinicalTrials.gov. https://clinicaltrials.gov/study/NCT05590650

Background. The effectiveness of definitive radiotherapy (RT) for patients with clinical stage IIIB or IIIC lung adenocarcinoma and epidermal growth factor receptor (EGFR) mutations who received first- or second-generation EGFR tyrosine kinase inhibitors (TKIs) is unclear. Methods. Taiwan Cancer Registry data were used in this retrospective cohort study to identify adult patients diagnosed with EGFR-mutated stage IIIB or IIIC lung adenocarcinoma between 2011 and 2020. Patients treated with first- or second-generation EGFR TKIs were classified into RT and non-RT groups. Propensity score (PS) weighting was applied to balance covariates between groups. The primary outcome was overall survival (OS), and the incidence of lung cancer mortality (ILCM) was considered as a supplementary outcome. Additional supplementary analyses were conducted to assess the robustness of the findings. Results. Among 270 eligible patients, 41 received RT and 229 did not. After a median follow-up of 46 months, PS-weighted analysis showed the PS-weighted hazard ratio of death for the RT group compared to the non-RT group was 0.94 (95% CI: 0.61–1.45, p=0.78). ILCM rates did not differ significantly between the two groups. Supplementary analyses yielded consistent results. Conclusion. The addition of definitive RT to first- or second-generation EGFR TKI treatment does not significantly improve OS of patients with EGFR-mutated stage IIIB or IIIC lung adenocarcinoma. NCT03521154NCT05167851.

Background/Objectives: Within the range of spread-out Bragg peak (SOBP), LET (linear energy transfer) gradually increases from proton beam entrance point toward the beam exit direction. While it is expected that the change in LET would lead to correspondent change in RBE (relative biological effectiveness) on many human cell lines, the incomplete cell killing due to low LET can result in tumor recurrence. Hence, this study aimed to assess the RBE on different cancer cell lines along low-LET proton SOBP. Methods: The clonogenicity of A549 and Panc-1 cells after irradiation was evaluated for investigating cell radiosensitivity in response to different types of radiation. The isoeffect doses of 6-MV photon and low-LET proton beams that resulted in equivalent cell surviving fractions at proton dose of 2 or 4 Gy were compared. Results: Ratios of α/β of A549 and Panc-1 cells from photon irradiation are 51.69 and −0.7747, respectively; RBE (2 Gy proton SOBP) on A549 and Panc-1 cells are 0.7403 ± 0.3324 and 1.0986 ± 0.3984, respectively. In addition, the change in RBE with proton LET was in a cell-specific and dose-dependent manner (LET-RBE linear correlations: A549 cells [r = 0.4673, p = 0.2430] vs. Panc-1 cells at 4 Gy [r = 0.7085, p = 0.0492]; Panc-1 cells at 2 Gy [r = −0.4123, p = 0.3100] vs. 4 Gy [r = 0.7085, p = 0.0492]). Conclusions: Compared with A549 cells, Panc-1 cells present greater resistance to low-LET proton beams. In addition, currently employed generic RBE value at 1.1 for proton therapy neglected the variation in cell-/tumor-specific radiobiological responses toward different dose levels of proton beams.

To determine the efficacy and safety, in terms of maternal and neonatal outcomes, of adding intrathecal midazolam to spinal anesthesia for cesarean delivery in healthy pregnant women. A meta-analysis of randomized controlled trials was conducted. PubMed, Cochrane Library, Embase, and Web of Science were searched manually, and citation screening was completed on May 20, 2021. Most of the included data were collected in the operating room and postoperative recovery area. A total of 1382 healthy parturients undergoing cesarean delivery with single-shot spinal anesthesia were recruited in 19 eligible randomized controlled trials. Single intrathecal midazolam adjuvant was compared to a control, with the local anesthetic dose in spinal anesthesia identical between the intervention and control groups. The primary outcomes were time to first analgesic use, maternal adverse effects, and neonatal Apgar scores at 1 and 5 min. The secondary outcomes were the onset and duration of the sensory and motor blocks. Adjuvant intrathecal midazolam prolonged the time to the first analgesic (mean difference [MD]: 59.96 min, 95% confidence interval [CI]: [23.12, 96.79]) and decreased perioperative maternal nausea and/or vomiting (odds ratio [OR], 0.28; 95% CI: [0.17, 0.45]). However, more sedation events were observed with midazolam (OR, 3.93; 95% CI: [1.12, 13.78]). There was no significant difference in the neonatal Apgar scores at 1 or 5 min (MD: -0.29, 95% CI: [−0.61, 0.03]; MD: -0.00, 95% CI: [−0.11, 0.1], respectively). Intrathecal midazolam also shortened sensory and motor block onset by less than 1 min and prolonged sensory block duration but had no significant effect on motor block duration. Current evidence indicates that intrathecal midazolam, as an adjuvant to spinal anesthesia, provides modest analgesic and significant antiemetic effects at the cost of more sedation events in cesarean delivery patients. The neonatal Apgar score was not affected by intrathecal midazolam administration. However, more objective, sensitive, and long-term measurements of neonatal safety and maternal neurological effects should be performed in the future. •Intrathecal midazolam adjuvant provides modest analgesia in cesarean delivery.•Intrathecal midazolam adjuvant provides antiemetic effects in cesarean delivery.•Increased sedation events without respiratory depression were observed.•The neonatal Apgar score at 1 and 5 min were not affected.•Future studies are warranted to clarify neonatal safety and maternal neurotoxicity.

The connection between microbial infections and tumor formation is notably exemplified by Helicobacter pylori (H. pylori) and its association with gastric cancer (GC) and colorectal cancer (CRC). While early studies hinted at a link between H. pylori and colorectal neoplasms, comprehensive retrospective cohort studies were lacking. Recent research indicates that individuals treated for H. pylori infection experience a significant reduction in both CRC incidence and mortality, suggesting a potential role of this infection in malignancy development. Globally, H. pylori prevalence varies, with higher rates in developing countries (80–90%) compared to developed nations (20–50%). This infection is linked to chronic gastritis, peptic ulcers, and GC, highlighting the importance of understanding its epidemiology for public health interventions. H. pylori significantly increases the risk of non-cardia GC. Some meta-analyses have shown a 1.49-fold increased risk for colorectal adenomas and a 1.70-fold increase for CRC in infected individuals. Additionally, H. pylori eradication may lower the CRC risk, although the relationship is still being debated. Although eradication therapy shows promise in reducing GC incidence, concerns about antibiotic resistance pose treatment challenges. The role of H. pylori in colorectal tumors remains contentious, with some studies indicating an increased risk of colorectal adenoma, while others find minimal association. Future research should investigate the causal mechanisms between H. pylori infection and colorectal neoplasia, including factors like diabetes, to better understand its role in tumor formation and support widespread eradication efforts to prevent both gastric and colorectal cancers.