童綜合醫學雜誌

Abstract Meconium aspiration syndrome (MAS), a critical cause of morbidity and mortality in term newborns, mostly results from antepartum or postpartum aspiration of meconium-stained amniotic fluid (MSAF). The severity of MAS can vary from self-resolving to serious complications, such as persistent pulmonary hypertension or mortality. Concepts regarding pathophysiology and management have undergone drastic changes over the last few decades. For example, in both vigorous and nonvigorous neonates with MSAF, routine endotracheal suctioning during resuscitation is not recommended. There is no proven therapy for MAS; therefore, management is primarily supportive. Respiratory support, surfactant, inhaled nitric oxide, corticosteroids, and bronchoalveolar lavage significantly improved the overall outcome of MAS. This review will provide an overview of the challenges in understanding the complicated pathophysiology of MAS and optimal therapies for treating MAS.

Abstract Leishmania is a parasitic protozoan belonging to the family Trypanosomatidae. Leishmaniasis, caused by infection with Leishmania parasites, can manifest in three primary forms: cutaneous, mucocutaneous, and visceral. Approximately 2 million individuals worldwide are affected by leishmaniasis, with an estimated 0.7–1 million new cases occurring annually and around 20,000–65,000 deaths reported annually. Current chemotherapy for leishmaniasis faces several challenges, including high costs, adverse effects, drug resistance, and disease relapse. Consequently, there is an urgent need for alternative treatments. Drug repurposing presents a promising strategy for discovering and developing new antileishmanial therapeutics. This review aims to explore and summarize recent advances in the identification of antileishmanial drugs, highlighting the successful repurposing of existing drugs for leishmaniasis and their transition from academic research to industrial application. These advancements are primarily based on integrated computational and experimental approaches, including in silico , in vitro , and in vivo screening, as well as biological and biochemical analyses to identify effective antileishmanial agents. Further studies are needed to elucidate the mechanisms of action of these new leads and to conduct preclinical and clinical evaluations of the identified drugs for potential antileishmanial therapy.

Diabetic nephropathy (DN) is one of the complications of diabetes. The presence of high serum glucose concentrations can cause an irreversible progression of renal dysfunction, including glomerulosclerosis, arteriolar hyalinosis, and tubulointerstitial fibrosis. Oxidative stress has been linked to the pathogenesis of DN. The major sources of reactive oxygen species (ROS) in kidney are induced by the polyl pathway, nicotinamide adenine dinucleotide phosphate (NADPH) oxidases, protein kinase C (PKC), and advanced glycation end products (AGEs). A huge increase in ROS can cause protein denaturation and cell death by changing protein sensors or intracellular signaling pathways. In addition to the traditional clinical strategies of controlling glucose and dietary protein, providing antihypertensive treatment, and reducing hyperlipidemia, there are several new approaches to the treatment of diabetic nephropathy that are based on decreasing ROS. Here we review recent research describing the relationship between oxidative stress and DN, and the application of antioxidants to the treatment of DN.

Abstract Oncolytic viruses (OVs) can selectively infect and lyse cancer cells while simultaneously activating the host immune system and making them a prospective class of anticancer immunotherapeutic agents. In particular, mammalian reovirus (MRV) and avian reovirus (ARV) have gained unique attention for their significant properties and clinical potentials. This review explores their mechanisms of action, immunological interactions, and clinical applications in OV therapy. Studies have shown that MRV exploits defective antiviral responses in cancer cells to induce apoptosis and autophagy, whereas ARV modulates mTORC1 and energy metabolism pathways to enhance viral replication. Both OVs elicit robust innate and adaptive immune responses, which are critical for long-term antitumor immunity. Combining OVs with chemotherapy and immunotherapy has shown synergistic effects, enhanced antitumor responses, and overcome treatment resistance. However, challenges around managing the host immune response and the efficient delivery of the virus remain unresolved. Ongoing and future clinical trials are pivotal in validating the therapeutic potential of these OVs and considering them as innovative approaches in the oncology landscape.

In the article titled “Self-perceived health status, psychological resilience, and life satisfaction of healthcare workers after 2 years of COVID-19 pandemic”, published on pages S28-S34, Supplement Issue, Volume 18 of Tungs’ Medical Journal,[1] the name of the second author is written incorrectly as “In-Chi Hu” instead of “Ying-Chi Hu”. The “How to cite this article” section should be read correctly as: Chu YT, Hu YC, Ko CP, Chang YK, Ho CC. Self-perceived health status, psychological resilience, and life satisfaction of healthcare workers after 2 years of COVID-19 pandemic. In the “Author Contributions” section, the author’s name is incorrectly written as “I.-C. H.” instead of “Y.-C. H.” The author apologizes for the error and any confusion it may have caused.

Abstract As the prevalence of obesity increases globally, the incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) also increases in both developed and developing countries. However, the MASLD phenotype remains unclear, with many unknown reasons. Since Ludwig and others coined the term nonalcoholic fatty liver disease in 1980, with our in-depth understanding of this condition, we gradually realized that its definition is complicated, mainly because of metabolic dysfunction. The heterogeneity of fatty liver disease and the related factors vary between individuals. The clinical manifestations and course of MASLD may be affected by multiple factors, including age, sex, race, diet, genetics, intestinal microorganisms, and environment. This study mainly searched for articles published in databases such as Cochrane Library, PubMed (Medline), UpToDate, and Google Scholar, using keywords related to digestive disease, metabolic syndrome, fatty liver, diabetes mellitus, and obesity. Case–control studies, systematic review, meta-analyses, and randomized controlled trials were also searched to explore the epidemiology and prevention of obesity or MASLD and to propose risk factors for MASLD, considering that early prevention keeps an unhealthy condition from progressing to serious chronic diseases.

Abstract The term “myofascial pain” was first coined by American researcher Dr. Travell in 1952. Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial contraction. MPS has received much attention from physicians. With the available treatment options, patients should be encouraged to face their fear and actively cooperate in their treatment to promptly eliminate painful trigger points and treat MPS. Scientific and standardized exercise, excellent living habits, and early therapy are key to early recovery from MPS.

Gout is an inflammatory disease caused by the accumulation of monosodium urate crystals in joints, cartilage, synovial bursa, tendons, and soft tissues. Gout is highly associated with hyperuricemia. Gout is not a new disease, which was first documented nearly 5000 years ago. Tophi are solid nodules that develop in the joints of people with uncontrolled chronic gout. Recently, many studies have advocated that hyperuricemia and gout are associated with insulin resistance syndrome. Hyperuricemia is also an independent risk factor for cardiovascular diseases. Recently, the prevalence of gout has increased globally, imposing a great disease burden worldwide. Moreover, gout or hyperuricemia is associated with various comorbidities, including cardiovascular diseases, metabolic syndrome, chronic kidney disease, urolithiasis, diabetes mellitus, thyroid dysfunction, and psoriasis. Furthermore, research has shown a correlation between high uric acid levels and type 2 diabetes, high blood pressure, and fatty liver disease. High uric acid levels may lead to permanent bone, joint, and tissue damage, kidney disease, and heart disease.

The coefficient of variation (CV) of the time interval between two consecutive R-waves, also known as the RR interval (RRI), is calculated by dividing the standard deviation of RRI (SDNN) by the mean of RRI. CV of RRI is similar to heart rate variability in terms of individual normalization. The purpose of this study was to evaluate the validity of CV of RRI as an index of cardiovascular function and its correlation with age and stroke. CV of RRI, SDNN, and baroreflex sensitivity (BRS) were evaluated in 31 healthy controls and 25 patients who had suffered ischemic stroke. Resting electrocardiography and arterial blood pressure were recorded for 10 min, once in the supine position in all recruited subjects and once in the head-up tilt position in the controls. BRS was measured using the spontaneous sequence analysis method.In the healthy controls, CV of RRI, SDNN, and BRS recorded in both the supine (r = −0.526, −0.731, and −0.637, respectively; all p ＜ 0.01) and head-up tilt positions (r = −0.785, −0.697, and −0.703, respectively; all p ＜ 0.01) were negatively correlated with age. In contrast, no correlation was found between these indices and age in the stroke patients. Significant correlations were found among CV of RRI, SDNN, and BRS in both the healthy controls and stroke patients (all p ＜ 0.01). In conclusion, CV of RRI measured using simple medical devices may be a potentially useful indicator of cardiovascular function in both healthy individuals and stroke patients. Aging is associated with a decline in SDNN, BRS, and CV of RRI in healthy individuals.

Abstract Background: The da Vinci single-port (DVSP) surgical system was developed to address the ergonomic and technical limitations of single-incision laparoscopic surgery. Although widely adopted internationally, its multi-specialty application in Taiwan has not been systematically assessed. Objectives: To evaluate the feasibility, safety, and perioperative outcomes of implementing the DVSP platform across multiple surgical specialties in a single Taiwanese medical center. Methods: This prospective observational study included 48 patients undergoing the DVSP procedures at Tungs’ Taichung MetroHarbor Hospital from May to August 2025. The consecutive cases from urology, general surgery, otolaryngology, and gynecology (12 per specialty) were analyzed. The perioperative parameters included operative completion, incision length, draping time, docking time, console time, blood loss, complications, and length of stay. Furthermore, descriptive and comparative analyses were performed. Results: All 48 procedures were completed without intraoperative or postoperative complications. The urologic procedures showed the longest console times (~161 min), while the gynecologic and general surgery procedures showed the shortest operative times and hospital stays (a mean of 4–5 days). The otolaryngology procedures showed a good feasibility in confined anatomical regions, but with longer hospital stays (mean 13.8 days). The docking and draping times were consistent across specialties (5–6 min). Furthermore, the DVSP surgical system showed technical feasibility, safety, and versatility across all four disciplines. Conclusion: This study represents the first multi-specialty experience with the DVSP surgical system in Taiwan. The platform was proven safe and effective for diverse procedures in urology, general surgery, otolaryngology, and gynecology. Its advantages included improved cosmesis, reduced incision morbidity, and improved dexterity in narrow anatomical spaces. With appropriate training and policy support, the DVSP surgical system has the potential to facilitate minimally invasive surgery and serve as a cornerstone of surgical innovation in Taiwan.

Abstract Dementia affects over 50 million people worldwide and is projected to triple by 2050. Chronic inflammation and microbial dysbiosis, including periodontal disease, may contribute to neurodegenerative disease development. We reviewed eight population-based studies from Taiwan (matched-cohort, prospective, and retrospective designs) that examined periodontal exposures (tooth loss, chronic periodontitis, and gingivitis) in relation to dementia or cognitive impairment, with multivariable adjustment for confounders. Periodontal disease was consistently associated with increased dementia risk (unadjusted hazard risk [HR] up to 1.79; adjusted HR = 1.16, 95% confidence interval = 1.01–1.32). Tooth loss and absence of denture use also predicted cognitive decline. Among patients with periodontitis, protective factors included statins (HR = 0.78), metformin (HR = 0.53), and influenza vaccination (HR = 0.67). Comorbidities such as diabetes, mental disorders, and stroke further amplify dementia risk. These findings support periodontal disease as a modifiable risk factor for dementia. Integrating periodontal treatment, metabolic and immunomodulatory therapies, and prosthetic rehabilitation may help reduce dementia risk. Randomized trials with standardized oral assessments, biomarkers, and cognitive measures are needed to establish causality and guide preventive strategies.

Abstract The multiple physiological factors can contribute to the acute illness known as delirium. Treatment is possible for this organic condition of the central nervous system, which can lead to transitory cognitive dysfunction. Clinically, patients with delirium may experience visual hallucinations and emotional agitation in addition to symptoms like disorientation, impaired consciousness, difficulty concentrating, and muddled thinking. Impaired cognitive function due to delirium can often be improved if it is identified and treated quickly. However, if left untreated, it may result in a gravely poor prognosis, including extended hospitalization and a higher mortality rate. The first step is to rule out internal and external factors, such as polypharmacy, sensory deprivation, and emotional distress, as these can contribute to delirium. Identifying and addressing the underlying problem is the main goal of treatment, as the prognosis for delirium is typically favorable when underlying physiological issues are promptly treated.

Abstract Background: Currently, Taiwan has entered a super-aged society. Therefore, the number of people suffering from dementia and the social burden are expected to increase. Moreover, effectively reducing the risk factors for dementia and preventing and detecting its occurrence at an early stage will become an important issue. Objectives: This study aimed to explore the factors related to dementia severity in patients. Methods: Data from 183 patients with dementia were obtained from the case management database in 2020 and analyzed using t test, analysis of variance, Pearson product–moment correlation analysis, and multiple regression analysis. Results: The average age of patients was 81.98 years, and most of them were female, 80–89 years old, illiterate, married, and well-off. The average number of comorbidities was 2.24. Most patients with dementia generally met the conditions for dementia in the comprehensive geriatric assessment and severity. Significant differences and correlations were observed between sex and some health habits, medical conditions, medication status, health problems, and comprehensive assessments (independence of activities of daily living, nutritional status, frailty, depression, and cognitive status) in severity (risk factors, borderline personality, memory performance, emotional symptoms, and psychiatric symptoms). Diabetes, hypertension, depressive condition, frailty, painkillers, and communication disorders each had a significant impact on severity. Conclusion: Many factors affect dementia. To prevent this disease, it is necessary to maintain good lifestyle habits, engage in more mentally challenging activities, engage in social interactions, and deal with health problems early.

Abstract Yoga, a form of mind–body training integrating physical postures, breathing techniques, and meditation, has garnered interest as a nonpharmacological intervention to preserve cognitive function in aging populations. This narrative review synthesizes findings from 19 empirical studies, including 2 integrative/systematic reviews, examining the effects of yogabased interventions on cognitive outcomes among older adults at risk for or experiencing cognitive decline, as well as among caregivers of persons with dementia. The included studies comprised predominantly randomized controlled trials (RCTs) evaluating diverse yoga modalities, including Hatha, Kundalini, and mindfulness-based yoga, over intervention periods ranging from 8 to 24 weeks. Across the analyzed trials, yoga consistently improved attention, processing speed, memory, and executive function compared with active or wait-list control interventions. Neuroimaging studies demonstrated enhanced hippocampal connectivity and attenuation of gray matter atrophy. The mechanisms by which yoga confers its benefits may include stress reduction, upregulation of neurotrophic factors, and improved cerebral perfusion. Despite promising results, heterogeneity in study designs, small sample sizes, and short follow-up durations limit the generalizability of our findings. Hence, future large-scale, standardized RCTs with longitudinal follow-up and biomarker assessments are warranted to confirm the role of yoga in mitigating cognitive decline.

Abstract Colchicine was initially an anti-inflammatory drug used to treat gout and cardiovascular diseases and alleviate acute pain by inhibiting the immune response. Despite being an old drug, it has found a new purpose because it was recently approved by the US Food and Drug Administration for treating cardiovascular diseases, along with other medications such as statins, even though in Taiwan, it is yet to be used for treating conditions such as myocardial infarction, atherosclerosis, and ischemic stroke. However, it does pose some side effects; therefore, for its use in acute gout attack or cardiovascular events, patients must always comply with the doctor’s instruction to achieve the optimal therapeutic outcome and minimize any unnecessary risks associated with medication safety.

Abstract The estrogen receptor alpha (ERα) protein, which is encoded by the ESR1 gene, is a key molecular factor that defines breast cancer. ERα activity regulates a complex program of hormonal activation and survival. ERα hypersensitivity, whether due to increased expression, activation, or aberrant activation, has been recognized as a crucial factor in disease progression and therapeutic resistance. The biological properties of ERα support conventional treatments and endocrine therapy inhibition. Moreover, they are pivotal for developing next-generation endocrine therapy strategies, including selective degraders and full antagonists. This article reviews the key roles of ERα in breast cancer and underscores recent developments in treatment strategies and their relevance to cancer. The goal is to improve the practical application of ER-driven breast cancer treatment. To summarize the multifaceted role of the ESR1 gene in breast cancer research, a comprehensive nonsystematic literature review was conducted. PubMed/MEDLINE and Web of Science were the primary electronic databases used. The search was not restricted by time to ensure the inclusion of historical landmarks and recent findings. The core search strategy employed keyword combinations focusing on “ ESR1 ” and “breast cancer,” further refining with terms, including “therapy,” “clinical diagnosis,” and “drug development,” to cover the breadth of the topic. Selection criteria focused on English-language peer-reviewed original and review articles. Case reports, non-peer-reviewed sources, and studies irrelevant to the clinical or therapeutic role of the ESR1 gene in breast cancer were excluded after screening the titles and abstracts.

Abstract Background: Gestational diabetes mellitus (GDM) presents a significant health challenge impacting one in six expectant mothers worldwide. GDM can cause life-threatening complications for both mother and child. As GDM is preventable, recognizing its prevalence and risk factors as early as possible is crucial for averting complications. Objectives: This study aimed to estimate the prevalence of GDM and identify the factors associated with it in the Juan block of the Sonepat District, Haryana. Methods: This facility-based cross-sectional study was conducted in the Juan block, which serves as the rural field practice area for the Department of Community Medicine, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat District, Haryana, India, among pregnant women residing in the study area for at least 6 months. Presuming a 13.9% GDM prevalence, the sample size was calculated using the formula: n = ([ Z 2 × p × q ]/l 2 ). Subsequently, the sample size was determined to be 520 participants. Community Health Center Juan had six Primary Health Centers (PHCs), two of which were randomly selected using the lottery method. Of the participants, 50% (260) were taken from one PHC (called Juan), and the remaining 50% were obtained from PHC Mahra. Data were analyzed using R software. Results: A single test procedure (Diabetes in Pregnancy Study group in India criteria) revealed an 11.9% GDM prevalence rate. The mean age of the participants was 24.17 ± 3.48 years. Factors, including advanced maternal age, low socioeconomic status, multiparity, early childbirth, passive smoking, increased sun exposure, family history of diabetes, prior macrosomia, overweight status, and anemia, were strong independent predictors of GDM. Conclusion: This study revealed that the GDM prevalence was 11.9%.

Abstract Both diabetes mellitus and dementia are major chronic conditions prevalent in the aging population. The global demographic trend of aging is reinforcing this epidemiological correlation, with type 2 diabetes mellitus (T2DM) recognized as a major independent risk factor for Alzheimer’s disease (AD). Typically, the onset of T2DM precedes the manifestation of dementia. Molecular and neuroimaging studies consistently demonstrate that dysregulated glycemic control, encompassing both sustained hyperglycemia and recurrent hypoglycemic episodes, contributes substantially to subsequent cognitive decline. While cross-sectional clinical data robustly confirm this intricate relationship, long-term findings from longitudinal studies are often less conclusive, underscoring the intricate molecular biological interactions between the two conditions. The shared, multifactorial etiology is driven by common metabolic risk factors, including a sedentary lifestyle, overweight/obesity, dyslipidemia, and systemic insulin resistance (IR). Crucially, IR further accelerates AD pathogenesis by converging on shared pathways, specifically impaired insulin signaling, chronic cellular inflammation, and abnormal cerebral glucose metabolism. Consequently, effective prevention strategies against future dementia require proactive measures. These measures include regular and thorough health monitoring, early detection of abnormalities in blood glucose and lipid profiles, and prompt therapeutic interventions to optimize overall metabolic health.

Abstract Inflammation plays a critical role in the pathogenesis of Alzheimer’s disease (AD) and related dementias, highlighting the need for investigations into the neuroprotective potential of non-steroidal anti-inflammatory drugs (NSAIDs). This review synthesizes epidemiological evidence published between 2010 and 2025 to examine associations between long-term NSAID use and the risk of cognitive decline or dementia among adults aged 50 years and older. Ultimately, 40 studies, including 29 cohort investigations and 11 systematic reviews or meta-analyses, with a combined sample size exceeding 300,000 participants were analyzed. Notably, available evidence suggests that low-dose aspirin was consistently correlated with reduced AD incidence (relative risk reductions from 25% to over 70%) and slower cognitive deterioration. In contrast, findings for non-aspirin NSAIDs (ibuprofen, naproxen, cyclooxygenase-2 [COX-2] inhibitors) were heterogeneous. Key modifiers of NSAID efficacy included age at NSAID initiation (e.g., more pronounced benefits when started before age 65), cumulative dose, and cardiovascular comorbidities. Moreover, varying safety profiles had been noted, as evidenced by elevated bleeding risk with aspirin-carrying and increased gastrointestinal adverse events with selective COX-2 inhibitors. Despite promising observational results, randomized trials have failed to confirm the cognitive benefits of NSAIDs, underscoring the need for mechanistic research and well-designed interventional studies. We therefore advocate for stratified clinical trials that consider NSAID type, dosage, timing, and patient genotype to clarify its therapeutic utility.

Abstract Background: Breast cancer is the most commonly diagnosed cancer and the leading cause of tumor-related death in women. Although the role of the Dynamin 1-like ( DNM1L ) gene in mitochondrial dynamics is well established, its clinical relevance and molecular mechanisms in breast cancer remain unclear. Objectives: This study employed a multi-omics approach to investigate the prognostic significance of DNM1L , its underlying mechanisms, and potential therapeutic strategies. Methods: This was a retrospective, multi-omics bioinformatics study integrating genomic, transcriptomic, and pharmacogenomic datasets to investigate the role of DNM1L in breast cancer. RNA sequencing and clinical data from TCGA-BRCA were analyzed alongside pharmacogenomic profiles from the Q-omics platform. Genetic alterations were examined using cBioPortal, DriverDBv4, and TIMER2.0, while differential expression and prognostic significance were assessed with UALCAN, CAMOIP, KM Plotter, and Q-omics. Tumor microenvironment profiling was conducted using the Tumor-Immune System Interaction Database. Functional validation was performed through CRISPR-based loss-of-function screening in breast cancer cell lines to evaluate gene networks and drug sensitivity, with a focus on the therapeutic potential of combining DNM1L targeting with pazopanib treatment. Results: DNM1L gene alterations were not associated with mutation frequency; however, elevated DNM1L mRNA levels were linked to BRCA1 hypermethylation, a marker of poor prognosis. DNM1L expression positively correlated with copy number variation and was significantly higher in tumor tissues compared to normal tissues. High DNM1L expression was associated with reduced overall survival and an immunosuppressive tumor microenvironment. CRISPR-mediated in vitro screening confirmed the involvement of DNM1L in cell cycle regulation and revealed heightened sensitivity to pazopanib in DNM1L knockout models. Conclusion: DNM1L is a potential prognostic biomarker in breast cancer, with high expression linked to poor survival outcomes. Targeting DNM1L in combination with pazopanib may offer a promising precision medicine strategy.