Liu PT, Fu PA, Yao M
… +4 more, Ko BS, Hsiao LT, Liu CJ, Chen TY
J Formos Med Assoc
· 2026 Jul · PMID 42401521
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BACKGROUND: Purpose: High-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) is an established consolidation for primary central nervous system lymphoma (PCNSL). However, real-world data in Asi...BACKGROUND: Purpose: High-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) is an established consolidation for primary central nervous system lymphoma (PCNSL). However, real-world data in Asian populations remain limited. This study aimed to evaluate the clinical outcomes of PCNSL patients undergoing HDC/ASCT in Taiwan. METHODS: We retrospectively analyzed 65 PCNSL patients from the Taiwan Blood and Marrow Transplantation Registry (TBMTR) who received HDC/ASCT between 2012 and 2022. Patients were categorized into frontline (n = 47) and salvage (n = 18) groups. Survival outcomes and the impact of thiotepa-based conditioning regimens were assessed. RESULTS: The 2-year overall survival (OS) and relapse-free survival (RFS) rates were 67.4% and 56.5% for the frontline group, and 76.0% and 61.1% for the salvage group, respectively. Non-thiotepa-based regimens demonstrated comparable survival outcomes; the 2-year OS was 64.3% for thiotepa recipients versus 72.2% for non-thiotepa recipients (p = 0.64). Disease progression was the leading cause of mortality, while non-relapse mortality was infrequent. CONCLUSION: HDC/ASCT is an effective consolidation strategy improving OS and RFS for PCNSL in both frontline and salvage settings within the Taiwanese population. Non-thiotepa conditioning regimens demonstrated comparable efficacy to thiotepa-based conditioning in this cohort, supporting their feasibility as an institutional alternative in settings with limited thiotepa access.
Lin HC, Chen IH, Lin TC
… +3 more, Yen HK, Lin WH, Groot OQ
J Formos Med Assoc
· 2026 Jul · PMID 42399119
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BACKGROUND/PURPOSE: Sarculator is a prognostic nomogram for extremity soft-tissue sarcoma (eSTS), but its performance in East Asian populations has not been validated. This study externally validated the Sarculator for p...BACKGROUND/PURPOSE: Sarculator is a prognostic nomogram for extremity soft-tissue sarcoma (eSTS), but its performance in East Asian populations has not been validated. This study externally validated the Sarculator for predicting 5- and 10-year overall survival (OS) and distant metastasis (DM) in an Asian cohort. METHODS: We retrospectively included 122 adults (median age 56 years) who underwent curative-intent resection for primary eSTS at a tertiary center in Taiwan (2010-2019). 5-year OS and DM rates were 62% (76/122) and 23% (28/122), respectively; 10-year OS and DM were 26% (16/61) and 39% (24/61). Model performance was assessed by area under the curve (AUC), calibration, Brier score, and decision-curve analysis. RESULTS: At 5 years, the Sarculator showed good discrimination (AUC 0.71 for OS; 0.73 for DM) and fair calibration, though OS was slightly overestimated (slope 0.75; intercept -0.32). It offered higher net benefit than the "treat-all" strategy at thresholds >0.27 (OS) and >0.02 (DM). For 10-year predictions, discrimination was moderate (AUC 0.71 for OS; 0.66 for DM), but OS calibration was poor (slope 0.66; intercept -1.72). Brier scores favored the Sarculator over the null model for 5-year predictions (OS 0.20 vs 0.22; DM 0.15 vs 0.17) but not for 10-year outcomes (OS 0.33 vs 0.19; DM 0.23 vs 0.23). CONCLUSION: Sarculator provided clinically useful and reasonably calibrated 5-year OS and DM estimates for Taiwanese patients with primary eSTS, supporting short-term decision-making. Its 10-year predictions were over-optimistic, warranting recalibration and validation in larger East Asian cohorts.
Feng YJ, Wang XY, Zhou DM
… +10 more, Li HB, Zhuang DY, Ruan YJ, Ren JL, Jiang LY, Guo YY, Chiu I, Gao F, He Y, Mao SS
J Formos Med Assoc
· 2026 Apr · PMID 42394438
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BACKGROUND: Presymptomatic treatment for infants diagnosed with spinal muscular atrophy (SMA) through newborn screening (NBS) can dramatically improve the prognosis. This study aims to investigate the feasibility of the...BACKGROUND: Presymptomatic treatment for infants diagnosed with spinal muscular atrophy (SMA) through newborn screening (NBS) can dramatically improve the prognosis. This study aims to investigate the feasibility of the amplification refractory mutation system polymerase chain reaction-capillary electrophoresis (ARMS-PCR-CE) in SMA NBS. METHODS: This technology combines multiplex fluorescence and automated capillary electrophoresis, achieving high sensitivity and multiplex detection through the size differences of fluorescently amplified fragments. The copy numbers (CNs) of survival motor neuron 1 (SMN1) and SMN2 exons 7 and 8 can be simultaneously determined in a single tube using specific primers designed based on differential bases. Two endogenous control genes were simultaneously assayed within the single-tube reaction system, while concordance of total CNs between exons 7 and 8 was comparatively assessed to ensure experimental veracity. Heterozygous with SMN1 1-copy were screened for 19 minor variants, and long-range amplification and exon sequencing were conducted to identify compound heterozygous SMA newborns. RESULTS: Among 20,193 dried blood spots (DBS) from eastern China, we identified 2 cases of SMN1 homozygous deletions and 380 individuals with heterozygous deletion yielding a carrier frequency of 1 in 53. Three minor SMN1 variations were found in 7 cases with SMN1 1-copy. The average detection time per sample was approximately 2.5 h, with median diagnostic time points occurring on the 7th postnatal day for SMN1/SMN2 CNs and the 11th day for minor variants. CONCLUSIONS: ARMS-PCR-CE is a comprehensive, accurate and rapid method for SMA DBS screening for SMN1/SMN2 CNs variations and minor variants detection.
Wei HY, Lin CY, Lin YJ
… +4 more, Huang SC, Shih YL, Lin FT, Yang CH
J Formos Med Assoc
· 2026 Jun · PMID 42362430
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This study reviewed the use of COVID-19 antiviral agents in Taiwan (2022-2025), focusing on how policy changes influenced drug deployment, and explored trends in outpatient visits, hospitalizations, emergency department...This study reviewed the use of COVID-19 antiviral agents in Taiwan (2022-2025), focusing on how policy changes influenced drug deployment, and explored trends in outpatient visits, hospitalizations, emergency department visits, and mortality. Policy changes and usage patterns of Remdesivir, Molnupiravir, and Nirmatrelvir/Ritonavir, were tracked using the Stockpile Management Information System (SMIS). As policies shifted to focus on the treatment of mild-to-severe cases in high-risk groups, the percentages of both oral antivirals and Remdesivir use increased. Remdesivir use (among hospitalized patients and emergency departments visits) rose from 10% in 2022 to 20% during COVID resurgence in 2025. Among adults aged ≥65 years, the oral antiviral utilization percentage remained stable at 53-54% after March 2023 based on total healthcare visits, and reached 65-69% when using outpatient visits as the denominator. As vaccine coverage expanded and herd immunity increased through 2022-2024, Taiwan's population developed robust hybrid immunity, hospitalizations and deaths declined substantially in subsequent epidemic waves. This analysis of the utilization percentages of COVID-19 antiviral drugs may serve as a valuable reference for future drug procurement and resource allocation. Timely, and adaptive deployment of antiviral agents remains critical for mitigating public health and healthcare system burdens during large-scale epidemics.
Hsieh TH, Tsai LC, Chang CC
… +3 more, Weng TI, Hsu CH, Lu FL
J Formos Med Assoc
· 2026 Jun · PMID 42336745
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BACKGROUND: This autopsy-based study investigated causes and risk factors for mortality among children under six years of age in Taiwan, using forensic data from the Institute of Forensic Medicine, Ministry of Justice, b...BACKGROUND: This autopsy-based study investigated causes and risk factors for mortality among children under six years of age in Taiwan, using forensic data from the Institute of Forensic Medicine, Ministry of Justice, between 2020 and 2023. Autopsies can identify causes not captured in clinical records. METHODS: A total of 305 forensic autopsy cases of children under six years of age were retrospectively reviewed, excluding stillbirths. Demographics, causes and manners of death, and contextual factors (scene, season, and time) were analyzed. Odds ratios and chi-square tests were used to assess associations. RESULTS: The most common causes of death among the autopsied cases were respiratory diseases (35.1%), asphyxia (23.0%), and brain injuries (11.1%). Infants under one year comprised the majority of cases. Asphyxia occurred primarily in infants, with milk aspiration accounting for 64.3% of asphyxia-related deaths. Children aged 1-6 years showed higher proportions of asphyxia and trauma than other groups. Most deaths occurred at home. Seasonal trends were noted for respiratory diseases, sudden death, multiple trauma, and brain injuries, while temporal trends were observed for respiratory and asphyxia deaths. Homicides accounted for 8.2% of cases, with male predominance. CONCLUSION: Respiratory diseases, asphyxia, and brain injuries were the most common causes of death among autopsied children under six in Taiwan. The high proportion attributed to respiratory diseases and milk aspiration may indicate over-attribution based on pathology alone. These findings highlight the need for standardized diagnostic frameworks and integrated clinicopathological assessment. Public health strategies should prioritize caregiver education and prevention of avoidable deaths.
Su YS, Chen CA, Chang LH
… +4 more, Su HK, Sung CY, Lin YJ, Chen SL
J Formos Med Assoc
· 2026 Jun · PMID 42315472
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BACKGROUND: In contemporary dental practice, implants are the standard solution for edentulism. However, the wide variety of implant brands and the prevalence of peri-implantitis present significant diagnostic hurdles fo...BACKGROUND: In contemporary dental practice, implants are the standard solution for edentulism. However, the wide variety of implant brands and the prevalence of peri-implantitis present significant diagnostic hurdles for clinicians. This study evaluated an automated hybrid AI framework designed to simultaneously identify implant brands, determine clinical treatment stages, and classify peri-implant bone loss severity using periapical radiographs, aiming to address the efficiency limitations of existing single-function AI models. METHODS: A dataset comprising 708 periapical radiographs with 3i and Xive implants was utilized. We employed a YOLOv8 model to localize implants and exclude background noise precisely. Subsequently, a custom implant segmentation algorithm and an automated alveolar crest detection method based on two-stage clustering were applied. EfficientNet-B3 served as the backbone for a multi-task classification of 12 composite classes, integrating implant brand, exposure status, and bone loss status. RESULTS: The YOLOv8 model demonstrated exceptional performance with 99.39% precision and 98.63% sensitivity. In the complex 12-class classification, the system achieved an overall accuracy of 97.42%, with specific categories such as Xive/Prothesis/Diseased achieving 98.28%. Clinical feasibility tests revealed the framework significantly outperformed manual expert evaluation, drastically reducing average assessment time from 15.5 to 0.16 s while elevating diagnostic accuracy from 90.73% to 97.38%. CONCLUSION: The proposed hybrid AI framework successfully consolidates brand identification, staging, and bone loss assessment into a unified, efficient workflow. By offering superior accuracy and speed, it serves as a reliable second opinion to support clinical decision-making and improve diagnostic consistency in dentistry.